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Author Spotlight: Advancements in Refractive Surgical Correction for Presbyopia and Exploring Postoperative Visual Acuity
Published on: September 20, 2024
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.
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.
