Major article
Intraocular lens implantation during infancy: perceptions of parents and the American Association for Pediatric Ophthalmology and Strabismus members☆

https://doi.org/10.1016/j.jaapos.2003.08.004Get rights and content

Abstract

Background

To determine whether a randomized clinical trial, the Infant Aphakia Treatment Study, comparing intraocular lens (IOL) implantation with contact lens (CL) correction for infants with a unilateral congenital cataract (UCC), is feasible by (1) ascertaining whether American Association for Pediatric Ophthalmology and Strabismus (AAPOS) members have equipoise regarding these two treatments and (2) evaluating the willingness of parents to agree to randomization.

Methods

All AAPOS members were surveyed in August 1997 and again in June 2001 regarding their use of CLs and IOL implants to correct infants vision after unilateral cataract surgery. In addition, a pilot study was begun in March 2002 to evaluate the safety of IOL implantation during infancy and the willingness of parents to randomize their children with a UCC to either IOL implantation or CL correction.

Results

In 1997, 89% of the 260 respondents reported that in the previous year they had treated at least one infant with a UCC, but only 4% had implanted an IOL in an infant <7 months old. Silsoft (Bausch & Lomb, Rochester, NY) CL correction was the preferred treatment choice for 84% of the respondents. In 2001, 21% of the 279 respondents had implanted an IOL in an infant. On a scale from 1 to 10 with 1 strongly favoring an IOL implant and 10 strongly favoring a CL, the median score was 7.5. Sixty-one percent of the respondents indicated that they would be willing to randomize children with a UCC to one of these two treatments. The main concerns about IOL implantation were poor predictability of power changes, postoperative complications, inflammation, and technical difficulty of surgery. The main concerns about CL correction were poor compliance, high lens loss rate, high cost, and keratitis. In our pilot study, 30 infants <7 months of age were evaluated at nine clinical centers for a visually significant UCC. Of 24 infants eligible for randomization, the parents of 17 (71%) agreed to randomization.

Conclusions

Although most AAPOS members still favor CL correction after cataract surgery for a UCC, five times as many had implanted an IOL in an infant in 2001 compared with the number in 1997. Parents were almost equally divided in their preference for IOL implant versus CL correction. Given the relative equipoise of AAPOS members regarding these treatments and the willingness of more than two thirds of parents to agree to randomization, it seems likely that a randomized clinical trial comparing these two treatments could indeed be conducted.

Section snippets

AAPOS surveys

In August 1997 and June 2001, we mailed a one-page survey to all members of AAPOS in the United States and Canada (n = 650) to ascertain their perceptions regarding the use of IOL implants and CLs to correct aphakia in infants and their willingness to participate in a randomized clinical trial comparing these two treatments.

Randomization pilot study

In March 2002, we initiated a pilot study to determine the willingness of parents to randomize their child with a unilateral congenital cataract (UCC) to treatment with a CL

AAPOS surveys

A total of 260 (40%) of the 1997 and 269 (41%) of the 2001 surveys were returned. In the 1997 survey, most of the respondents (89%) reported treating at least 1 infant with a UCC during the previous year (Table 1). Six (3%) reported treating ≥11 infants with a UCC and 24 (10%) reported treating 6 to 11 infants with a UCC during the past year. In all, the respondents indicated that they treated at least 383 infants with a UCC during the previous year. More than one half (53%) of the respondents

Discussion

The perception of pediatric ophthalmologists regarding the implantation of IOLs in children has changed radically during the past two decades. Early reports of IOL implantation during childhood emphasized the high complication rate associated with their use.8, 9, 10, 11, 12, 13 As a result, some investigators recommended that IOLs be implanted only in older children with unilateral traumatic cataracts or in children who could not tolerate CLs.8, 9, 14 Results of many of these early case series

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    ☆

    Supported in part by the Emory Egleston Children's Research Center, Atlanta, GA; the Knights Templar Eye Foundation, Chicago, IL; Research to Prevent Blindness, Inc, New York, NY; and National Institutes of Health Core Grant No. P30 EY06360, Bethesda, MD.

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    Copyright © 2003 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.