Several issues make IOL power selection for children much more complex than that for adults. The first challenge is obtaining accurate AL and corneal measurements, which is usually performed when the child is under general anesthesia. The second issue is that, because shorter AL causes greater IOL power errors, the small size of a child’s eye compounds power calculation errors, particularly if the child is very young. The third problem is selecting an appropriate target IOL power, one that will not only provide adequate visual acuity to prevent amblyopia but also allow adequate vision with the expected growth of the eye after the IOL implantation.
A possible solution to the third problem is to implant 2 (or more) IOLs simultaneously: one IOL with the predicted adult emmetropic power placed posteriorly and the other (or others) with the power that provides childhood emmetropia placed anterior to the first lens. When the patient reaches adulthood, the obsolete IOL(s) can be removed (sequentially). Alternatively, corneal refractive surgery may be used to treat myopia that develops in adulthood. Most recent studies have shown that the best modern formulas do not perform as accurately for children’s eyes as they do for adults’ eyes.
Hoffer KJ, Aramberri J, Haigis W, Norrby S, Olsen T, Shammas HJ; IOL Power Club Executive Committee. The final frontier: pediatric intraocular lens power. Am J Ophthalmol. 2012; 154(1):1–2.e1.
O’Hara MA. Pediatric intraocular lens power calculations. Curr Opin Ophthalmol. 2012;23(5): 388–393.
Excerpted from BCSC 2020-2021 series : Section 3 - Clinical Optics. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.