• IOLs in Infants and Long-Term Visual Outcomes

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

    Journal Highlights

    JAMA Ophthalmology, April 2020

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    Does implantation of an IOL enhance long-term visual outcomes for infants who undergo unilateral cataract sur­gery? Lambert et al. performed a ran­domized study to address this question. Their findings showed that roughly 10 years following surgery, best-corrected visual acuity (BCVA) was no better if an IOL had been used as opposed to leaving the eye aphakic and correcting it later with a contact lens.

    This multicenter randomized study included 114 infants with unilateral congenital cataract who had cataract surgery between 1 and 6 months of age, with or without primary implantation of an IOL. Visual outcomes were evalu­ated when the patients were 10.5 years of age. The primary outcome measure was BCVA according to the electronic testing protocol of the Early Treatment Diabetic Retinopathy Study.

    Among the final analysis set of 110 patients, BCVA was excellent (logMAR 0.30 [Snellen 20/40] or better) in 22% of IOL-treated eyes and 27% of aphakic eyes. However, BCVA was inadequate (logMAR 1.00 [Snellen 20/200] or worse) in 44% of both groups. Results were similar in shorter-term studies of the same patients, at ages 12 months and 4.5 years.

    The median BCVA for IOL-treated eyes was 0.89 (Snellen equivalent, 20/ 159; interquartile range [IQR], 0.38-1.38) and for aphakic eyes was 0.86 (Snellen equivalent, 20/145; IQR, 0.30-1.46). Although the difference between groups was small, the estimate was imprecise (99% confidence interval, –0.54-0.47 for difference in medians).

    Originally, the authors had hypothe­sized that BCVA would be better in the IOL group since those infants would have had at least partial correction at all times. Because they found no visual benefit, coupled with the fact that IOL-treated eyes are more likely to have visual axis opacity and require addi­tional surgery, the authors no longer recommend routine use of IOLs for infants who require cataract surgery.

    In summary, IOL implantation at the time of cataract surgery is neither beneficial nor detrimental to visual outcomes, the authors said. Based on the longitudinal consistency of results for these patients, the authors expect the visual outcomes to continue into adulthood, barring ocular injury or disease. The extent to which the findings may apply to less-experienced surgeons, or to patients whose families cannot afford contact lenses, should be factored into treatment decisions. (Also see related commentary by Michael X. Repka, MD, MBA, in the same issue.)

    The original article can be found here.