Adults and children both can receive permanently implanted lenses after cataract surgery, but a new study suggests that there may be better options for infants.
This study found that infants who had surgery to correct cataracts — a cloudiness in the lens of the eye — often required additional eye surgery after permanent lenses were implanted.
The researchers saw no significant difference in the clearness of vision between the infants wearing contacts and those with permanent lens implants.
This study was led by Scott Lambert, MD, professor of ophthalmology at Emory University in Atlanta.
The research team looked at 114 infants with a congenital cataract in one eye, which is a cloudiness in the lens of the eye. The children were recruited from 12 clinical centers and were between 1 and 6 months old at the time of surgery to correct their cataract.
The researchers randomly assigned about half the infants to receive an intraocular lens (IOL), which was considered standard treatment. The other half of the infants received either soft silicon or hard gas-permeable plastic contact lenses designed to fit small eyes.
The research team followed up when the children reached the age of 4.5 years by using a traveling examiner to assess their clearness of vision.
The children were evaluated with the HOTV test, which requires kids to read the letters H-O-T-V or match flash cards containing one of the letters to a response card in their hands.
The authors of the study found no significant differences in clearness of vision between the children with an IOL and those with contacts at 4.5 years of age.
The study showed that the group of children who received an IOL were more likely to have post-operative complications, including lens reproliferation, which happens when cells left behind after cataract surgery move to other areas of the eye and interfere with vision.
The data showed that by the age of 5, 40 percent of the IOL group had been diagnosed with lens reproliferation, compared with 4 percent of children in the contact lens group — a 10-fold greater risk.
This study also revealed that complications requiring additional surgery occurred in 72 percent of the IOL group and only 21 percent of the contact lens group.
The researchers noted that by age 5, nine children in the contact lens group had been diagnosed with an eye infection that required antibiotic drops, and one child broke a contact while wearing it. None of these cases had a permanent impact on the patients' vision.
In addition, three infants from the contact lens group eventually received an IOL due to the difficulty in maintaining day-to-day contact use in an infant.
"We think that for most infants with unilateral cataract, contact lenses are a better option than an IOL," Dr. Lambert said. "However, in some cases, the parents and their physician may decide that contact lens wear proves to be too challenging, and ultimately not in the child's best interests."
Dr. Lambert also noted, "When we began this study, the prevailing theory was that IOLs would be the better option for cataract in infants because they correct vision constantly, while contact lenses can be removed or dislodged from the eye. But our data suggest that if the family can manage it, contact lenses are the better option until the child gets older."
The authors of this study noted that failure to remove the cataract early in the child’s life can lead to permanent vision loss that can be avoided through surgery followed by either an IOL or contacts.
These authors wrote that their study was limited by an inability to know if each infants' eye condition existed or had worsened since birth.
This study was published March 6 in JAMA Ophthalmology.
This research was supported in part by the National Institutes of Health.
The authors reported no conflicts of interest.