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Global Practice Patterns in the Management of Infantile Cataracts
Euna B Koo1, Deborah K VanderVeen, Scott R Lambert
1Department of Ophthalmology (E.B.K., S.R.L.), Stanford University School of Medicine, Stanford, CA; and Pediatric Ophthalmology (D.K.V.), Boston Children's Hospital, Harvard Medical School, Boston, MA.
Insights
Pediatric ophthalmologists largely adopt management strategies for infantile cataracts influenced by the Infant Aphakia Treatment Study. Most surgeons prefer early surgery and contact lens correction for infants under six months.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Clinical Practice
Background:
- Infantile cataracts require timely management to optimize visual development.
- The Infant Aphakia Treatment Study (IATS) provided critical data on cataract management.
- Assessing current practice patterns is essential to understand the impact of research findings.
Purpose of the Study:
- To evaluate current practice patterns in infantile cataract management.
- To determine the influence of the Infant Aphakia Treatment Study on pediatric ophthalmologists' approaches.
- To identify trends in surgical timing and optical correction methods.
Main Methods:
- An anonymous 17-question online survey was distributed to pediatric ophthalmologists.
- Survey links were disseminated via professional newsletters and listservs (July-August 2016).
- The survey targeted current practice patterns in infantile cataract surgery and optical correction.
Main Results:
- 125 pediatric ophthalmologists responded, with most practicing in university settings.
- Strong consensus exists for unilateral cataract surgery between 4-6 weeks and contact lens correction for infants ≤6 months.
- 73% of respondents reported the IATS changed their management of unilateral congenital cataracts.
Conclusions:
- Pediatric cataract surgeons generally operate on congenital cataracts between 4-6 weeks.
- Aphakic contact lenses are the preferred initial optical correction for infants <6 months.
- Surgeons show equal preference for intraocular and contact lenses in infants >6 months.
Objectives:
Surveys are an important tool to assess the impact of research on physicians' approach to patient care. This survey was conducted to assess current practice patterns in the management of infantile cataracts in light of the findings of the Infant Aphakia Treatment Study.
Methods:
Pediatric ophthalmologists were emailed a link to the survey using newsletters from American Association of Pediatric Ophthalmology and Strabismus, World Society of Pediatric Ophthalmology and Strabismus, and the Pediatric Listserv. The 17-question survey was anonymous and active during July to August 2016.
Results:
One hundred twenty-five respondents (North America, 65%; Asia, 12%; Europe, 9%; and other, 14%) reported operating on pediatric cataracts. Most practice in a university setting (55%). There was a strong consensus that unilateral cataract surgery should be performed between ages 4 to 6 weeks and aphakic contact lenses should be used to optically correct their eyes, particularly in children ≤6 months of age. For bilateral cataracts, there was a trend for surgeons to perform cataract surgery at an older age than unilateral cataract surgery. Surgeons who performed less than 5 versus greater than 20 pediatric cataract surgeries/year were more likely to use aphakic contact lenses in children undergoing cataract surgery more than 6 months of age (62% vs. 35%, P=0.04). Most respondents (73%) indicated that the Infant Aphakia Treatment Study had changed how they manage unilateral congenital cataracts.
Conclusion:
Most pediatric cataract surgeons perform congenital cataract surgery between ages 4 to 6 weeks and use aphakic contact lenses for initial optical correction in infants less than 6 months. Surgeons have equal preference for intraocular lenses and contact lenses in infants more than 6 months of age.
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