Intraocular lens (IOL) implants in infants undergoing unilateral congenital cataract surgery don’t seem to impact visual acuity, for better or worse, by the time the child is about 10, a study in JAMA Ophthalmology reports.           

Although IOLs are often implanted in such children, little is known about whether they or aphakic contact lens correction results in better long-term visual outcomes after unilateral cataract surgery during infancy, the researchers noted.

The multicenter randomized clinical trial enrolled 114 infants between the ages of one and six months with unilateral congenital cataracts who underwent cataract surgery with or without primary IOL implants.

Best-corrected visual acuity was measured at age 10.5 years for 110 of the original 114 patients (96%) enrolled as infants (58 girls and 52 boys).

Overall, 25% had good acuity in the treated eye (logMAR 0.30 or better): 12 in the IOL group (22%) and 15 in the aphakia group (27%). Additionally, 50 children (44%) had visual acuity of logMAR 1.00 or worse: 25 (44%) in the IOL group and 25 (44%) in the aphakia group.

The median logMAR acuity in the treated eye was similar in children with IOLs and those who remained aphakic. Although the overall difference in median visual acuity between the two groups was small, the estimate was imprecise, the study noted.

As in previous phases of the study, visual acuity outcomes were highly variable, with only 27 children (25%) achieving excellent visual acuity in their treated eye and 50 children (44%) having poor vision in the treated eye, the researchers noted in their paper on the study. “Implanting an IOL at the time of cataract extraction was neither beneficial nor detrimental to the visual outcome,” they concluded.

Lambert SR, Cotsonis G, DuBois L, et al. Long-term effect of intraocular lens vs. contact lens correction on visual acuity after cataract surgery during infancy: A randomized clinical trial. JAMA Ophthalmol. February 20, 2020. [Epub ahead of print].