Aphakia in childhood: 43% of children left aphakic still had a secondary lens by age 10

Design

Follow-up of a randomised trial arm with retrospective data collection at 10.5 years

Population

51 children randomised to aphakia after unilateral congenital cataract surgery, with vision better than light perception at 4.5 years

Primary outcome

Cumulative incidence of secondary intraocular lens implantation by 10.5 years

Effect

22 of 51 (43%, 95% CI 29% to 58%) implanted; wide variation by centre

The Infant Aphakia Treatment Study randomised infants with unilateral congenital cataract to an intraocular lens or to contact lens correction left aphakic. This follow-up looked at the children randomised to aphakia who had better than light perception vision at 4.5 years, with data collected at 10.5 years.

Of 51 children, 22 (43%, 95% CI 29% to 58%) received a secondary lens by 10.5 years, and 59% of those by age 6. Implantation occurred across the range of visual acuity, in 39% with 20/40 or better and 44% with 20/200 or worse. Children with a secondary lens did not wear contact lenses less (94% of waking hours against 90%). The proportion implanted varied substantially by centre.

The authors read practice patterns and family preference as important drivers. The data were collected retrospectively at 10.5 years and numbers are small. They describe what happened in a trial, not what should be done.

• More than half of children left aphakic stayed aphakic through primary school.
• Decision to implant later varied more by centre than by visual outcome.
• Discuss secondary implantation with families as a choice, with its uncertain benefit.
• Lens implantation did not reduce reported contact lens wear in this small group.

Why it matters

It shows that the decision to implant later is driven more by local habit than by clear visual criteria.

Don't overread it

Small follow-up of a trial arm with retrospective data collection; it describes practice, not best practice.

The statistics, in plain English

A 95% interval of 29% to 58% around the 43% shows how much 51 children leave open. Differences between centres in such small groups can be due to chance as well as practice.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.