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Refractive Change at 5 Years in the Toddler Aphakia and Pseudophakia Study
Deborah K VanderVeen1, M Edward Wilson2, Jenny Y Wang3
1Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Insights
Infants undergoing cataract surgery before 7 months of age experienced greater refractive changes. This highlights the need for careful intraocular lens selection in pediatric pseudophakic eyes.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Refractive Surgery
Background:
- Cataract surgery in infants requires careful consideration of refractive outcomes.
- Early intraocular lens (IOL) implantation is common in pediatric cataract cases.
Purpose of the Study:
- To analyze refractive error changes at age 5 in children who had cataract surgery before 2 years of age.
- To compare refractive outcomes based on age at surgery and cataract laterality.
Main Methods:
- Retrospective case series involving 96 children from the Infant Aphakia Treatment Study (IATS).
- Analysis of spherical equivalent refractive error from 1 month post-surgery to 5 years of age.
- Comparison of refractive change between unilateral and bilateral cataracts, and between early (<7 months) and late (7-24 months) surgery groups.
Main Results:
- Eyes operated on between 1 to <7 months showed significantly greater refractive change (7.50 D) compared to those operated on between 7-24 months (1.94 D).
- In the 7-24 month surgery group, refractive change was similar for unilateral (3.25 D) and bilateral (1.94 D) cataracts.
- By age 5, all eyes operated on <7 months had >2.5 D myopic shift, versus 62% (bilateral) and 38% (unilateral) in the 7-24 month group.
Conclusions:
- Early cataract surgery (1 to <7 months) is associated with greater magnitude and variability in refractive error.
- Unilateral cataract cases also showed significant refractive changes.
- These findings are crucial for IOL power selection and postoperative refractive targets in infants and toddlers.
Purpose:
To report refractive change at 5 years of age in children with pseudophakic eyes operated on before 2 years of age.
Design:
Retrospective case series at 10 Infant Aphakia Treatment Study (IATS) sites.
Participants:
Children who underwent cataract surgery with primary intraocular lens (IOL) placement during the IATS enrollment years, including infants 1 to younger than 7 months of age with bilateral cataract and all children 7 to 24 months of age, regardless of laterality.
Methods:
Change in spherical equivalent refractive error (in diopters [D]) was calculated from 1 month after surgery to 5 years of age and was compared for patients with unilateral and bilateral (first eye only) cataract and for children 1 to < 7 months versus 7-24 months of age at surgery.
Main Outcome Measures:
Refractive change (D) from surgery to 5 years of age.
Results:
Ninety-six children were included: 50 children with unilateral cataract (surgery at age 7-24 months) and 46 children with bilateral cataract (n = 20 with surgery at age 1 to < 7 months; n = 26 with surgery at age 7-24 months). Median refractive change was significantly greater for eyes in the bilateral group undergoing surgery at age 1 to < 7 months (7.50 D; range, 2.5 to 15 D) versus age 7 to 24 months (1.94 D; range, -1.88 to 7.75 D; P < 0.001). For children 7-24 months of age at surgery, median change was similar between those with unilateral cataract (3.25 D; range, -1.75 to 13.5 D) versus bilateral cataract (1.94 D; range, -1.88 to 7.75 D; P = 0.053). By 5 years of age, no eyes in the 1 to < 7 month age group had less than 2.5 D myopic shift, but in the 7-24 month age group, 62% of patients with bilateral cataract and 38% of patients with unilateral cataract showed less than 2.5 D myopic shift.
Conclusions:
Greater magnitude and variability in refractive change was found in pseudophakic eyes undergoing surgery at 1 to < 7 months of age and for patients with unilateral cataract, which should be considered when choosing IOL power and initial postoperative target refraction for infants and toddlers.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
