Surveys of North American Pediatric Ophthalmologists

In August 1997, the North American members of the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) were surveyed to determine the number of infants they had treated with a unilateral cataract, the frequency of IOL implantation in infants with a unilateral cataract, and the youngest age of a child when they had implanted an IOL [24]. Most respondents (89%) reported treating at least one infant with a unilateral cataract during the previous year. However,relatively few report

Table 6.2. Pros and cons of intraocular lens vs contact lens correction of unilateral infantile aphakia

Intraocular lenses

Contact lenses

Arguments for:

1. Closely approximates the optics of the crystalline lens

2. Full-time partial optical correction is guaranteed

3. Limited human data show better visual outcome than CL correction

1. Power can easily be changed as the eye grows

2. Secondary IOL can be implanted when the child is older when the refractive error of the eye is stable

Arguments against:

1. Their long-term safety in a growing eye has not been established

2. The surgery required to implant an IOL is technically more difficult

3. An overcorrection with spectacles or CLs is needed initially or after the eye if fully grown

4. Limited human data show higher complication rate

1. Two-thirds or more of patients with this treatment have visual outcome <20/80

2. Poor CL adherence may reduce patching adherence

3. CLs are frequently lost and there may be a delay in their replacement

4. Ongoing maintenance takes time each day and can be stressful for patients and parents

ed treating many cases (e.g., more than two-thirds reported treating fewer than three cases per year). Only 3.5% of pediatric ophthalmologists had ever implanted an IOL in a child less than 6 months of age. More than one-half (52 %) of the respondents expressed a willingness to participate in a clinical trial comparing IOLs and CLs as a means of optically correcting aphakia in infants following unilateral cataract surgery.

In June 2001, the membership of AAPOS was again surveyed to ascertain (a) their relative preference for CL vs IOLs to optically correct infants with unilateral aphakia, (b) their concerns regarding the implantation of an IOL or the use of a CL during infancy, (c) their usage of an IOL to optically correct the last three infants they had treated with cataract surgery, and (d) their willingness to randomize an infant with a unilateral cataract to a clinical trial comparing treatment with an IOL vs a CL. On a scale of 1 to 10 with 1 strongly favoring an IOL and 10 strongly favoring a CL, the median score was 7.5, suggesting that CLs are still the preferred treatment for most pediatric ophthalmologists in North America. Their major concerns with IOL implantation were poor predictability of power changes, surgical complications, inflammation, and the technical difficulty of surgery. The main concerns with CL correction were poor compliance, the high loss rate, high cost, and keratitis. Twenty percent of the respondents had implanted in an infant <6 months of age; a sixfold increase since our 1997 survey. The percentage of the respondents who indicated that they would be willing to randomize an infant with a unilateral cataract to treatment with a CL vs an IOL has increased from 52 % in 1997 to 61 % in 2001.

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