Majority of pseudophakic children show significant myopic shift in second decade

This retrospective study evaluated the refractive shift in pseudophakic eyes of children after their tenth birthday. I think this is an important clinical study in many eyes showing that significant myopic shift continued in children after 10 years of age; thishas important implications for the use of multifocal IOLs in preteens and teenagers and for IOL power selection.

The authors reviewed the charts of 114 subjects (114 eyes) with at least two refractions at a minimum of a one-year interval after each subject’s tenth birthday.

The mean shift in refraction per year was -0.30 D. There was a myopic shift in refraction in 86.8 percent of eyes, with 64 percent having up to a 0.50 D myopic shift per year. The mean refractive shift per year was -0.19 D in the operated eye and -0.22 D in the fellow eye (P = 0.67).

Age at the time of IOL implantation (before or after 10 years of age) did not influence the refractive shift in pseudophakic eyes of children after their tenth birthday. However, the refractive shift was significantly different between black patients and white patients (P = 0.006), which concurs with one other study, although the authors did not attempt to explain this.

They conclude that the data reported in this study could be used during discussions with patients and parents to set realistic expectations of the long-term need for spectacles. Eyes operated on at 10 years of age should have a residual refraction of mild hyperopia to minimize myopia at a later age. If aiming for emmetropia, parents should be informed about the possibility of low myopia at ocular maturity.