Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy: A randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years

Scott R. Lambert, Michael J. Lynn, E. Eugenie Hartmann, Lindreth DuBois, Carolyn Drews-Botsch, Sharon F. Freedman, David A. Plager, Edward G. Buckley, M. Edward Wilson

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

IMPORTANCE: The efficacy and safety of primary intraocular lens (IOL) implantation during early infancy is unknown. OBJECTIVE: To compare the visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy. DESIGN, SETTING, AND PARTICIPANTS: The Infant Aphakia Treatment Study is a randomized clinical trial with 5 years of follow-up that involved 114 infants with unilateral congenital cataracts at 12 sites. A traveling examiner assessed visual acuity at age 4.5 years. INTERVENTIONS: Cataract surgery with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Treatment was determined through random assignment. MAIN OUTCOMES AND MEASURES: HOTV optotype visual acuity at 4.5 years of age. RESULTS: The median log MAR visual acuity was not significantly different between the treated eyes in the 2 treatment groups (both, 0.90 [20/159]; P = .54). About 50% of treated eyes in both groups had visual acuity less than or equal to 20/200. Significantly more patients in the IOL group had at least 1 adverse event after cataract surgery (contact lens, 56%; IOL, 81%; P = .02). The most common adverse events in the IOL group were lens reproliferation into the visual axis, pupillary membranes, and corectopia. Glaucoma/glaucoma suspect occurred in 35%of treated eyes in the contact lens group vs 28%of eyes in the IOL group (P = .55). Since the initial cataract surgery, significantly more patients in the IOL group have had at least 1 additional intraocular surgery (contact lens, 21%; IOL, 72%; P < .001). CONCLUSIONS AND RELEVANCE: There was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. When operating on an infant younger than 7 months of age with a unilateral cataract, we recommend leaving the eye aphakic and focusing the eye with a contact lens. Primary IOL implantation should be reserved for those infants where, in the opinion of the surgeon, the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected aphakia. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00212134.

Original languageEnglish (US)
Pages (from-to)676-682
Number of pages7
JournalJAMA Ophthalmology
Volume132
Issue number6
DOIs
StatePublished - Jun 2014

Fingerprint

Aphakia
Intraocular Lenses
Contact Lenses
Cataract
Randomized Controlled Trials
Intraocular Lens Implantation
Visual Acuity
Ocular Hypertension
Glaucoma
Lenses
Therapeutics
Outcome Assessment (Health Care)
Safety
Costs and Cost Analysis
Membranes

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy : A randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years. / Lambert, Scott R.; Lynn, Michael J.; Hartmann, E. Eugenie; DuBois, Lindreth; Drews-Botsch, Carolyn; Freedman, Sharon F.; Plager, David A.; Buckley, Edward G.; Wilson, M. Edward.

In: JAMA Ophthalmology, Vol. 132, No. 6, 06.2014, p. 676-682.

Research output: Contribution to journalArticle

Lambert, Scott R. ; Lynn, Michael J. ; Hartmann, E. Eugenie ; DuBois, Lindreth ; Drews-Botsch, Carolyn ; Freedman, Sharon F. ; Plager, David A. ; Buckley, Edward G. ; Wilson, M. Edward. / Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy : A randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years. In: JAMA Ophthalmology. 2014 ; Vol. 132, No. 6. pp. 676-682.
@article{6eb995bc3dc940cf9c411535c904fa42,
title = "Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy: A randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years",
abstract = "IMPORTANCE: The efficacy and safety of primary intraocular lens (IOL) implantation during early infancy is unknown. OBJECTIVE: To compare the visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy. DESIGN, SETTING, AND PARTICIPANTS: The Infant Aphakia Treatment Study is a randomized clinical trial with 5 years of follow-up that involved 114 infants with unilateral congenital cataracts at 12 sites. A traveling examiner assessed visual acuity at age 4.5 years. INTERVENTIONS: Cataract surgery with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Treatment was determined through random assignment. MAIN OUTCOMES AND MEASURES: HOTV optotype visual acuity at 4.5 years of age. RESULTS: The median log MAR visual acuity was not significantly different between the treated eyes in the 2 treatment groups (both, 0.90 [20/159]; P = .54). About 50{\%} of treated eyes in both groups had visual acuity less than or equal to 20/200. Significantly more patients in the IOL group had at least 1 adverse event after cataract surgery (contact lens, 56{\%}; IOL, 81{\%}; P = .02). The most common adverse events in the IOL group were lens reproliferation into the visual axis, pupillary membranes, and corectopia. Glaucoma/glaucoma suspect occurred in 35{\%}of treated eyes in the contact lens group vs 28{\%}of eyes in the IOL group (P = .55). Since the initial cataract surgery, significantly more patients in the IOL group have had at least 1 additional intraocular surgery (contact lens, 21{\%}; IOL, 72{\%}; P < .001). CONCLUSIONS AND RELEVANCE: There was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. When operating on an infant younger than 7 months of age with a unilateral cataract, we recommend leaving the eye aphakic and focusing the eye with a contact lens. Primary IOL implantation should be reserved for those infants where, in the opinion of the surgeon, the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected aphakia. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00212134.",
author = "Lambert, {Scott R.} and Lynn, {Michael J.} and Hartmann, {E. Eugenie} and Lindreth DuBois and Carolyn Drews-Botsch and Freedman, {Sharon F.} and Plager, {David A.} and Buckley, {Edward G.} and Wilson, {M. Edward}",
year = "2014",
month = "6",
doi = "10.1001/jamaophthalmol.2014.531",
language = "English (US)",
volume = "132",
pages = "676--682",
journal = "JAMA Ophthalmology",
issn = "2168-6165",
publisher = "American Medical Association",
number = "6",

}

TY - JOUR

T1 - Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy

T2 - A randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years

AU - Lambert, Scott R.

AU - Lynn, Michael J.

AU - Hartmann, E. Eugenie

AU - DuBois, Lindreth

AU - Drews-Botsch, Carolyn

AU - Freedman, Sharon F.

AU - Plager, David A.

AU - Buckley, Edward G.

AU - Wilson, M. Edward

PY - 2014/6

Y1 - 2014/6

N2 - IMPORTANCE: The efficacy and safety of primary intraocular lens (IOL) implantation during early infancy is unknown. OBJECTIVE: To compare the visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy. DESIGN, SETTING, AND PARTICIPANTS: The Infant Aphakia Treatment Study is a randomized clinical trial with 5 years of follow-up that involved 114 infants with unilateral congenital cataracts at 12 sites. A traveling examiner assessed visual acuity at age 4.5 years. INTERVENTIONS: Cataract surgery with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Treatment was determined through random assignment. MAIN OUTCOMES AND MEASURES: HOTV optotype visual acuity at 4.5 years of age. RESULTS: The median log MAR visual acuity was not significantly different between the treated eyes in the 2 treatment groups (both, 0.90 [20/159]; P = .54). About 50% of treated eyes in both groups had visual acuity less than or equal to 20/200. Significantly more patients in the IOL group had at least 1 adverse event after cataract surgery (contact lens, 56%; IOL, 81%; P = .02). The most common adverse events in the IOL group were lens reproliferation into the visual axis, pupillary membranes, and corectopia. Glaucoma/glaucoma suspect occurred in 35%of treated eyes in the contact lens group vs 28%of eyes in the IOL group (P = .55). Since the initial cataract surgery, significantly more patients in the IOL group have had at least 1 additional intraocular surgery (contact lens, 21%; IOL, 72%; P < .001). CONCLUSIONS AND RELEVANCE: There was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. When operating on an infant younger than 7 months of age with a unilateral cataract, we recommend leaving the eye aphakic and focusing the eye with a contact lens. Primary IOL implantation should be reserved for those infants where, in the opinion of the surgeon, the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected aphakia. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00212134.

AB - IMPORTANCE: The efficacy and safety of primary intraocular lens (IOL) implantation during early infancy is unknown. OBJECTIVE: To compare the visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy. DESIGN, SETTING, AND PARTICIPANTS: The Infant Aphakia Treatment Study is a randomized clinical trial with 5 years of follow-up that involved 114 infants with unilateral congenital cataracts at 12 sites. A traveling examiner assessed visual acuity at age 4.5 years. INTERVENTIONS: Cataract surgery with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Treatment was determined through random assignment. MAIN OUTCOMES AND MEASURES: HOTV optotype visual acuity at 4.5 years of age. RESULTS: The median log MAR visual acuity was not significantly different between the treated eyes in the 2 treatment groups (both, 0.90 [20/159]; P = .54). About 50% of treated eyes in both groups had visual acuity less than or equal to 20/200. Significantly more patients in the IOL group had at least 1 adverse event after cataract surgery (contact lens, 56%; IOL, 81%; P = .02). The most common adverse events in the IOL group were lens reproliferation into the visual axis, pupillary membranes, and corectopia. Glaucoma/glaucoma suspect occurred in 35%of treated eyes in the contact lens group vs 28%of eyes in the IOL group (P = .55). Since the initial cataract surgery, significantly more patients in the IOL group have had at least 1 additional intraocular surgery (contact lens, 21%; IOL, 72%; P < .001). CONCLUSIONS AND RELEVANCE: There was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. When operating on an infant younger than 7 months of age with a unilateral cataract, we recommend leaving the eye aphakic and focusing the eye with a contact lens. Primary IOL implantation should be reserved for those infants where, in the opinion of the surgeon, the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected aphakia. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00212134.

UR - http://www.scopus.com/inward/record.url?scp=84897983260&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84897983260&partnerID=8YFLogxK

U2 - 10.1001/jamaophthalmol.2014.531

DO - 10.1001/jamaophthalmol.2014.531

M3 - Article

C2 - 24604348

AN - SCOPUS:84897983260

VL - 132

SP - 676

EP - 682

JO - JAMA Ophthalmology

JF - JAMA Ophthalmology

SN - 2168-6165

IS - 6

ER -