The management of monocular cataracts in infants is one of the most difficult challenges for pediatric ophthalmologists. The first step is to surgically remove the cataract leaving the child with aphakia. Aphakia is the condition where there is no focusing mechanism in the eye since the natural lens has been removed. The missing lens must be replaced with another lens in order to be able to focus, and thus, to see. When the eye cannot focus, the eye can become amblyopic, or “lazy,” and it will lose the ability to see over time. Replacing that lens is crucial to the child’s vision. In the past, thick glasses were used after the cataract extraction. Today, the use of contact lenses or intraocular lenses (IOLs) is common practice. Using contact lenses is a challenge with babies because the lenses are hard to insert. In addition, parents often experience tremendous stress when attempting to insert contact lens into the eye of their infant child. The use of IOLs is becoming more common, but there may be associated complications. It is important to determine which of these two methods is best for managing infants born with monocular cataracts.
An NEI-supported clinical trial showed that there is not a difference in visual acuity in children, whether the child is fitted with a contact lens or given an intraocular lens (IOL) immediately following cataract removal at 1 year of age. However, there was nearly a three-fold higher rate of complications during surgery and five-fold higher rate of additional surgeries in the children treated with an IOL compared to the children treated with contact lenses. The children were followed for 1 year after surgery. Longer-term follow-up of these children is planned to evaluate visual outcomes at 5 years of age.
Public Impact Statement/Significance:
These results are aligned with the need to improve the quality of life of children. It is important to treat monocular cataract in these infants in order to preserve useful vision. Determining how to best manage infants with this condition is essential.
U.S. National Institutes of Health, National Eye Institute (The Infant Aphakia Treatment Study (IATS), U10EY013272)
Infant Aphakia Treatment Study Group. Arch Ophthalmol. 2010;128(7):810-818. Published online May 10, 2010 (doi:10.1001/archophthalmol.2010.101).Pubmed
Last Reviewed: May 2010