NEW YORK (Reuters Health) - For children with a congenital cataract, replacing the intraocular lens in infancy leads to more adverse events and a greater number of surgeries than using a contact initially and implanting a permanent lens later, according to a new randomized trial.
"Certainly (intraocular lenses) are being implanted in younger and younger children after cataract surgery," said study author Dr. Scott Lambert, of Emory Eye Center in Atlanta, GA, in an email. "Our study helps surgeons to better understand the consequences of doing this."
The study, by the Infant Aphakia Treatment Study Group, was published online March 6 in JAMA Ophthalmology.
It included 114 infants age 6 months or less who underwent cataract surgery with or without receipt of an intraocular implant. Babies who didn't receive the implants were managed with contact lenses initially and then corrective surgery later.
All but one were available for follow-up after an average follow-up of 4.8 years.
There was no difference in the visual acuity of the two groups, but infants who had the intraocular implant as their initial therapy were more likely to have eye problems like lens reproliferation into the visual axis, pupillary membranes and corectopia.
This group was also more likely to require additional eye surgeries.
Dr. Rupal Trivedi, of the Saint Louis University School of Medicine in St. Louis, Missouri, said in an email that the similar visual outcomes in the two groups could be viewed as surprising.
"The rationale for the use of intraocular lenses was that they provide continuous optical correction and thus may lead to better visual outcome," she said.
Dr. Trivedi was not involved with this study analysis, however she was a part of the Infant Aphakia Treatment Study, from which the data was drawn.
One important difference for patients' parents, Dr. Lambert said, is that most of the costs of implanting an intraocular lens during cataract surgery are covered by health insurance, whereas contact lenses are not covered and are often out-of-pocket expenses for the parents.
"I do believe, in light of the findings of our study, that insurance companies should pay for the cost of contact lenses for children after cataract surgery," Dr. Lambert said. "It would save the insurance companies money and would be in the best interests of these children."
JAMA Ophthalmol 2014.
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