Visual Acuity Development After the Implantation of Unilateral Intraocular Lenses in Infants and Young Children

Birch, Eileen E.; Cheng, Christina S.; Stager, David R.; Felius, Joost

doi:10.1016/j.jaapos.2005.07.008

Cited by 53 publications

(31 citation statements)

References 16 publications

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“…Our results are consistent with Birch and coworkers 6 who reported no significant difference in visual acuity at age 4 years between eyes left aphakic and treated with contact lenses (n=5) and eyes after primary IOL implantation (n=4) following unilateral congenital cataract surgery. However, the mean logMAR visual acuity was better in the operated eyes in their series at age 4 years (both groups, 0.44 (20/55)) than the operated eyes in the IATS.…”

Section: Discussionsupporting

confidence: 93%

“…There are a number of possible reasons why visual acuities may have been worse in the IATS at age 4.5 years than these two other studies. First, the Birch 6 and Autrata 26 studies only analyzed the visual outcomes for patients who had good to excellent patching compliance, while we analyzed the visual outcomes for all patients. Second, the length of follow-up was variable in the Autrata study 26 whereas all of the patients in the IATS underwent visual acuity testing between ages 4.5 to 4.9 years.…”

Section: Discussionmentioning

confidence: 99%

“…3–5 In addition to their convenience, IOL implantation during childhood may be associated with better visual outcomes. 6 However, when IOLs are implanted during early infancy, these potential advantages are offset by a higher incidence of intraoperative and postoperative adverse events. 7–9 Additional intraocular surgeries are often required to treat these adverse events which are associated with risks, costs and parental stress.…”

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confidence: 99%

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Comparison of Contact Lens and Intraocular Lens Correction of Monocular Aphakia During Infancy

et al. 2014

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The Infant Aphakia Treatment Study Group IMPORTANCE The efficacy and safety of primary intraocular lens (IOL) implantation during early infancy is unknown.OBJECTIVE To compare the visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy. DESIGN, SETTING, AND PARTICIPANTSThe Infant Aphakia Treatment Study is a randomized clinical trial with 5 years of follow-up that involved 114 infants with unilateral congenital cataracts at 12 sites. A traveling examiner assessed visual acuity at age 4.5 years.INTERVENTIONS Cataract surgery with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Treatment was determined through random assignment.MAIN OUTCOMES AND MEASURES HOTV optotype visual acuity at 4.5 years of age. RESULTSThe median logMAR visual acuity was not significantly different between the treated eyes in the 2 treatment groups (both, 0.90 [20/159]; P = .54). About 50% of treated eyes in both groups had visual acuity less than or equal to 20/200. Significantly more patients in the IOL group had at least 1 adverse event after cataract surgery (contact lens, 56%; IOL, 81%; P = .02). The most common adverse events in the IOL group were lens reproliferation into the visual axis, pupillary membranes, and corectopia. Glaucoma/glaucoma suspect occurred in 35% of treated eyes in the contact lens group vs 28% of eyes in the IOL group (P = .55). Since the initial cataract surgery, significantly more patients in the IOL group have had at least 1 additional intraocular surgery (contact lens, 21%; IOL, 72%; P < .001). CONCLUSIONS AND RELEVANCEThere was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. When operating on an infant younger than 7 months of age with a unilateral cataract, we recommend leaving the eye aphakic and focusing the eye with a contact lens. Primary IOL implantation should be reserved for those infants where, in the opinion of the surgeon, the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected aphakia. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00212134

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Comparison of Contact Lens and Intraocular Lens Correction of Monocular Aphakia During Infancy

et al. 2014

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“…These numbers are equivalent to the median logMAR visual acuity we report in the untreated eyes of both treatment groups (0.66 logMAR). Birch and coworkers 19 have shown that the grating visual acuity of children steadily improves between the ages of 12 months and 4 years. In their study, the mean logMAR visual acuity of pseudophakic eyes improved from 0.76 at age 12 months to 0.45 at age 4 years and the logMAR visual acuity of aphakic eyes improved from 0.63 at age 1 year to 0.44 at age 4 years.…”

Section: Discussionmentioning

confidence: 97%

A Randomized Clinical Trial Comparing Contact Lens With Intraocular Lens Correction of Monocular Aphakia During Infancy

Lambert¹,

Eg²,

Drews‐Botsch³

et al. 2010

Arch Ophthalmol

149

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Objective-To compare the visual outcomes and adverse events of contact lens to primary intraocular lens (IOL) correction of monocular aphakia during infancy.Methods-In a randomized, multicenter (12 sites) clinical trial, 114 infants with a unilateral congenital cataract were assigned to undergo cataract surgery between 1 to 6 months of age either with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Grating visual acuity was tested at 1 year of age by a masked traveling examiner Main Outcome Measures-Grating visual acuity at 1 year of age.Results-The median logMAR visual acuity was not significantly different between the treated eyes in the two groups (CL = 0.80, IOL = 0.97, p =.20). More patients in the IOL group underwent one or more additional intraocular surgeries than patients in the CL group (63% vs 12%; p <. 0001). Most of these additional surgeries were performed to clear lens reproliferation and pupillary membranes from the visual axis.Conclusions-There was no statistically significant difference in grating visual acuity at age 1 year between the IOL and CL groups; however, additional intraocular surgeries were performed more frequently in the IOL group.Application to Clinical Practice-Until longer term follow-up data are available, caution should be exercised when performing IOL implantation in children 6 months of age or younger given the higher incidence of adverse events and the absence of an improved short-term visual outcome compared to contact lens use.

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“…This definition is consistent with definitions used in other clinical trials. 10, 11 We defined excellent patching as reportedly achieving at least 90% of prescribed patching.…”

Section: Methodsmentioning

confidence: 99%

Predictors of adherence to occlusion therapy 3 months after cataract extraction in the Infant Aphakia Treatment Study

Drews‐Botsch¹,

Hartmann²,

Celano³

2012

Journal of American Association for Pediatric Ophthalmology and

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Background Little information is available on factors that predict adherence to patching in infants. We evaluated data from the Infant Aphakia Treatment Study (IATS), a randomized clinical trial of treatment for infants with unilateral congenital cataracts, to investigate factors associated with successful adherence to patching protocols. Subjects and Methods In the IATS, patching was prescribed 1 hour daily per month of age until 8 months of age and 50% of waking hours thereafter. A centrally located staff member inquired about adherence to patching in a phone interview with the primary caregiver. Analyses used χ2 tests of independence and logistic regression to identify predictors of reported adherence and of achieving adherence rates of at least 75% (“good”) and 90% (“excellent”). Results A total of 104 caregivers provided data on patching 3 months after surgery, at which time 60% reported patching at least 75% of the prescribed time. Reported adherence was not associated with the type of treatment (P = 0.73) but was better in children with private insurance (P = 0.01) and for children with mothers reporting lower levels of parenting stress (P = 0.03). Conclusions Most caregivers reported being able to adhere to prescribed patching shortly after extraction of a unilateral congenital cataract. The type of correction (IOL vs contact lens) was not associated with the amount of patching achieved, whereas family socioeconomic status and maternal stress appeared to play a role.

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Visual Acuity Development After the Implantation of Unilateral Intraocular Lenses in Infants and Young Children

Cited by 53 publications

References 16 publications

Comparison of Contact Lens and Intraocular Lens Correction of Monocular Aphakia During Infancy

Comparison of Contact Lens and Intraocular Lens Correction of Monocular Aphakia During Infancy

A Randomized Clinical Trial Comparing Contact Lens With Intraocular Lens Correction of Monocular Aphakia During Infancy

Predictors of adherence to occlusion therapy 3 months after cataract extraction in the Infant Aphakia Treatment Study

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