Significant anisometropia common after unilateral IOL implantation during infancy

Using data from the Infant Aphakia Treatment Study (IATS), investigators assessed the prevalence of anisometropia among children who were randomized to IOL implantation as infants.

Study design

Presence of anisometropia was calculated in 51 patients aged 5 years who had received a lens implant between 28 to 210 days of age during the IATS study. 

Outcomes

Significant anisometropia was found in most pseudophakic eyes at age 5 years. Median anisometropia was −3.50 D (range −19.63 to +2.75 D). The median refractive error was −2.25 D and +1.50 D in treated and fellow eyes, respectively.

Patients who developed glaucoma by the 5-year visit showed higher mean anisometropia (-8.25 D vs. -2.75 D, P=0.005).

Limitations

This study is limited by its small sample size, which hinders subgroup analysis. Some patients were excluded due to IOL exchange prior to age 5, which could have skewed the results.

Conclusions

This is a vital study demonstrating a large degree of anisometropia among children at 5 years of age that were made pseudophakic as infants due to unilateral cataract.

Anisometropia can interfere with the development of stereopsis in these patients, who are already at a higher risk of poor depth perception due to unilateral pseudophakia. Anisometropia also represents an additional amblyogenic factor, and may contribute to refractive asymmetry and aniseikonia. Variability in eye growth and myopic shift continue to make refractive outcomes challenging for IOL implantation during infancy.