Contact lenses are better long term than implanted lenses for babies who have had cataract surgery. Above, an infant wears a rigid gas permeable contact lens in the right eye. A patch covers the normal left eye to strengthen vision in the right eye. (Credit: Buddy Russell)

After cataract surgery, contact lenses best for babies

For most infants who have had cataract surgery, the use of contact lenses for several years—and an eventual lens implant—may be a better solution than the current standard of care, the intraocular lens implant, new research shows.

A cataract is a clouding of the eye’s natural lens and can be removed through a safe, quick surgical procedure. After cataract removal, most adults and children receive a permanent artificial lens, called an intraocular lens (IOL).

This is an option for infants, too, but a new trial shows that the use of contact lenses is safer than, and just as effective as, an IOL for infants under 7 months old.

“When we began this study, the prevailing theory was that IOLs would be the better option for cataract in infants because they correct vision constantly, while contact lenses can be removed or dislodged from the eye.

“But our data suggest that if the family can manage it, contact lenses are the better option until the child gets older,” says Scott Lambert, professor of ophthalmology at Emory University.

“The IATS is a landmark study in the refractive management of infants with cataracts,” says Timothy W. Olsen, chairman of the department of ophthalmology.

“Attempting to estimate the life-long lens implant power and also place an adult lens in a growing infant’s eye is challenging. Families and physicians may now comfortably choose to use contact lenses and wait until children are older when the eye is more mature. The strong evidence, generated by the dedicated investigators in the IATS, helps provide a solid basis for this choice.”

Best time for treatment

Although cataracts are often tied to aging, it’s estimated that 1,200–1,600 infants are diagnosed with congenital cataracts (present from birth) each year in the United States. The condition can affect both eyes, but it often affects just one, which is called unilateral cataract.

Published in JAMA Ophthalmology, the new study compares the use of IOLs versus the use of contact lenses during infancy for treating congenital, unilateral cataract.

In the United States, most children with cataract will eventually receive an IOL, but the timing varies, Lambert says. “I’ve had patients wait until they were in college, whereas others will have it done when they are 5 or 6 years old.”

Still, some prior research suggested that using an IOL to treat cataract during infancy can improve long-term visual outcomes. IOLs can also spare babies—and their parents—the discomfort of daily contact lens changes, and reduce the risk of introducing germs into the eye.

But the use of IOLs during infancy has some drawbacks. Surgeons have difficulty judging the right focusing power of the artificial lens for an infant, because it’s a time of rapid eye growth. Also, while IOL implants are typically safe and complication-free for adults, they are more likely to cause post-operative problems for infants.

“Cataract surgery and the use of IOLs for infants have become more sophisticated and more widely practiced over time. In this study, the goal was to determine if the beneficial effects of IOLs outweigh their known complications,” says Donald Everett, director of collaborative clinical research at the National Eye Institute.

Source: Emory University

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