Global Practice Patterns in the Management of Infantile Cataracts
Euna B. Koo, MD; Deborah K. VanderVeen, MD; Scott R. Lambert, MD
Stanford University School of Medicine
Palo Alto, CA
Introduction: The aim of this study was to survey current practice patterns in management of infantile cataracts globally.
Methods: Pediatric ophthalmologists were emailed a link to the survey via newsletters from AAPOS and WSPOS, and the Pediatric Listserv. The 17-question survey was anonymous and active during July-August 2016.
Results: 125 respondents (North America, 65%; Asia, 12%; Europe, 9%; other, 14%) reported operating on pediatric cataracts. Most practice in a university setting (55%). There was a strong consensus that both bilateral and unilateral cataract surgery should be performed between ages 4-6 weeks and aphakic contact lenses or spectacles should be used to optically correct these eyes, particularly in children </=6 months of age. Surgeons who perform 20 pediatric cataract surgeries/year were more likely to utilize aphakic contact lenses in children undergoing cataract surgery >6 months of age (62% vs. 35%, p=0.04). The preferred ages for secondary IOL implantation were 1-2 years (29%) and 3-4 years (17%), with no difference by region. Most respondents (73%) indicated that the Infant Aphakia Treatment Study (IATS) had changed how they manage unilateral congenital cataracts.
Discussion: The results of this study differ from a 2001 survey of AAPOS members, in which half of respondents were willing to implant an IOL in infants <7 months of age with unilateral cataract.
Conclusion: Current practice consensus in North America, Europe, and Asia is for congenital cataract surgery between ages 4-6 weeks, with initial correction using aphakic contact lenses or spectacles.
References: 1. Lambert SR, Lynn MJ, Hartmann EE, et al. 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. JAMA Ophthalmol. 2014;132(6):676-682.
2. Lambert SR, Lynn M, Drews-Botsch C, et al. Intraocular lens implantation during infancy: perceptions of parents and the American Association for Pediatric Ophthalmology and Strabismus members. J AAPOS. 2003;7(6):400-405.