• Infant Aphakia Contact Lens Wear and Cataract Surgery

    Written By: Lynda Seminara
    Selected By: Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, March 2018

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    Although contact lenses have been used for decades to correct vision in children after cataract surgery, prospective data on adherence to lens wear are limited. In a secondary analysis of the Infant Aphakia Treatment Study, Cromelin et al. documented adherence to contact lens use and examined its association with visual outcomes. Overall, the ad­herence level was high, and consistent lens use resulted in improved visual acuity (VA).

    In the authors’ study, 57 children (32 girls, 25 boys) received follow-up through 5 years of age. As infants, they had undergone unilateral cata­ract extraction and had been assigned randomly to receive a contact lens to correct aphakia. (The other study arm received intraocular lens implantation.) The contact lens was provided at no cost, and 2 lenses were dispensed for each prescription fill so that a spare would be available if needed.

    Adherence to prescribed lens wear was assessed from 48-hour–recall tele­phone interviews with caregivers, which were administered every 3 months, starting 3 months after surgery and continuing until the child was 5 years old. A traveling examiner tested visual acuity when the children were 4.5 years of age. Adherence estimates were calcu­lated from the mean percentage of wak­ing hours of lens use reported during at least 2 interviews for each year of life.

    Overall, 872 interviews were com­pleted. The proportion of children who wore their lens for nearly all waking hours was 95% in the first year of life, 93% in years 2 through 4, and 89% in the fifth year. Subanalysis by several factors resulted in similar findings.

    Linear regression showed that, in general, the children who wore their lens for more waking hours had better VA at 4.5 years of age, even when accounting for adherence to patching. Overall, the results demonstrate that good adherence to contact lens wear is possible for young children following cataract surgery. The fact that the lenses were provided at no cost may have con­tributed to the high rates of adherence.

    The original article can be found here.