Our most recent newsletter – which has just been posted on our website – features a summary of a paper that was published earlier this year in the Journal of the American Medical Association (JAMA) Ophthalmology. The paper showed there was no significant difference between the visual acuity of children who underwent primary intraocular lens (IOL) implantation and those who were fitted with contact lenses. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. Based on these findings, the authors recommended that for infants with unilateral cataract the best option was generally to leave the eye aphakic and use a contact lens – rather than an IOL – for vision correction.
While IOLs are now the preferred option for correcting aphakia in adults – and also generally for older children – their use in babies and infants is still controversial. IOLs have been implanted in babies as young as 8 days and they obviously have the advantage of providing a constant correction to an aphakic eye with optics similar to those of the normal human lens. This permanent (pseuodphakic) correction then obviates the need for the parents to perform contact lens insertion and removal on their child, thus making their life a little bit easier.
Unfortunately, there are many disadvantages associated with the use of IOLs in infantile eyes. The infantile eye requires a smaller diameter IOL which can lead to problems as the eye grows and there is also a greater risk of ocular complications (as confirmed by the paper). In addition, the subsequent myopic shift that occurs in a normal eye due to axial elongation as the eye grows means that the pseudophakic infantile eye will eventually become highly myopic.