A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel: Scott R. Lambert, MD,1 Vinay K. Aakalu, MD, MPH,2 Amy K. Hutchinson, MD,3 Stacy L. Pineles, MD,4 Jennifer A. Galvin, MD,5 Gena Heidary, MD, PhD,6 Deborah K. VanderVeen, MD7
Ophthalmology, Vol. 126, Issue 4, p1454–1461, © 2019 by the American Academy of Ophthalmology. Click here for free access to the OTA.
Purpose: To compare the visual outcomes and adverse events associated with optical correction using an intraocular lens (IOL), contact lenses, or spectacles after cataract surgery in children 2 years of age or younger.
Methods: Literature searches were conducted in PubMed, the Cochrane Library, and the databases of clinical trials in February 2019, without date or language restrictions. The search resulted in 194 potentially relevant citations, and 34 were selected for full-text review. Fourteen studies were determined to be relevant to the assessment criteria and were selected for inclusion in this assessment. The panel methodologist then assigned a level of evidence rating to these studies.
Results: Intraocular lenses were associated with visual outcomes similar to outcomes for contact lenses or spectacles for children who had both bilateral and unilateral cataracts. Intraocular lenses were also associated with an increased risk of visual axis opacities. All treatments were associated with a similar incidence of glaucoma. Although ocular growth was similar for all treatments, infants younger than 6 months who underwent IOL implantation had large myopic shifts that often resulted in high myopia or severe anisometropia later in childhood. Corneal endothelial cell counts were lower in eyes that underwent IOL implantation. The incidence of strabismus was similar with all treatments.
Conclusions: Intraocular lens implantation is not recommended for children 6 months of age or younger because there is a higher incidence of visual axis opacities with this treatment compared with aphakia. The best available evidence suggests that IOL implantation can be done safely with acceptable side effects in children older than 6 months of age. However, the unpredictability of ocular growth means that these children will often have large refractive errors later in childhood that may necessitate an IOL exchange or wearing spectacles or contact lenses with a large refractive correction. In addition, the training and experience of the surgeon as well as ocular and systemic comorbidities should be taken into consideration when deciding whether IOL implantation would be appropriate.
1 Department of Ophthalmology, Stanford University School of Medicine, Stanford, California
2 Illinois Eye and Ear Infirmary, University of Illinois College of Medicine at Chicago, Chicago, Illinois
3 Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
4 Jules Stein Eye Institute, Los Angeles, California
5 Eye Physicians and Surgeons PC, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
6 Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
7 Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts