Whether an aphakic child gets a lens depends on the centre, not the vision

Design

Long-term follow-up of a randomised clinical trial cohort (Infant Aphakia Treatment Study)

Population

51 children left aphakic to age 4.5 years after unilateral congenital cataract surgery

Primary outcome

Cumulative incidence of secondary intraocular lens implantation by age 10.5

Effect

43% implanted (95% CI 29–58%), most before age 6; rate independent of visual acuity

After unilateral congenital cataract surgery in infancy, some children are left aphakic and corrected with a contact lens, with a secondary intraocular lens considered later. This long-term follow-up of the Infant Aphakia Treatment Study looked at how often that lens is actually implanted.

By age 10.5, 43% of children left aphakic had received a secondary lens, most before age six. Strikingly, implantation did not track visual acuity — children with good and poor vision were implanted at similar rates — nor did it reduce contact-lens wear. What varied most was the study centre, pointing to practice patterns and family preference as the real drivers.

The point for counselling is honesty about equipoise: the decision to implant a secondary lens in these children is not currently guided by clear visual benefit, so it should be an explicit, preference-sensitive conversation rather than a default, and families deserve to know how much it varies by where they are treated.

• By age 10.5, 43% of children left aphakic after unilateral congenital cataract surgery had a secondary intraocular lens.
• Implantation rates were similar in children with good (≤20/40) and poor (≥20/200) vision.
• A secondary lens did not reduce contact-lens wear (94% vs 90% of waking hours).
• Rates varied substantially by centre — treat the decision as preference-sensitive, not a default.

Why it matters

It exposes a common paediatric decision as practice-driven rather than outcome-driven, which should change how it is discussed.

Don't overread it

This describes practice patterns and incidence, not whether a secondary lens improves or worsens long-term visual outcomes.

The statistics, in plain English

That implantation rates were similar across good and poor vision, yet varied by centre, is the key signal: if vision drove the decision you would expect it to track acuity, not geography. This points to practice variation rather than evidence.

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