Corporate Banner
Satellite Banner
Technology
Networks
Scientific Communities
 
Become a Member | Sign in
Home>News>This Article
  News
Return

Contacts Better Than Permanent Lenses for Babies After Cataract Surgery

Published: Saturday, March 08, 2014
Last Updated: Saturday, March 08, 2014
Bookmark and Share
Permanent lenses lead to more repeat eye surgeries, NIH study finds.

For adults and children who undergo cataract surgery, implantation of an artificial lens is the standard of care. But a clinical trial suggests that for most infants, surgery followed by the use of contact lenses for several years - and an eventual lens implant - may be the better solution. The trial was funded in part by the National Eye Institute (NEI), a component of the National Institutes of Health.

A cataract is a clouding of the eye's 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 the trial found that the use of contact lenses is safer than, and just as effective as, an IOL for infants under seven months old. The most recent data from the trial were published in JAMA Ophthalmology.

"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," said Scott Lambert, M.D., the study's lead investigator and a professor of ophthalmology at Emory University in Atlanta.

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. The new study compared 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, Dr. Lambert said. "I've had patients wait until they were in college whereas others will have it done when they are 5 or 6 years old," he said.

Some prior research suggested that using an IOL to treat cataract during infancy can improve long - term visual outcomes, he said. 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.

On the other hand, the use of IOLs during infancy also 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 postoperative 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," said Donald Everett, M.A., who is NEI's director of collaborative clinical research.

The Infant Aphakia Treatment Study began in 2004 (aphakia refers to an eye without a lens). The study involved 12 clinical centers, and enrolled infants with a cataract in one eye. Parents visiting these clinics were informed about the study, and about the potential benefits and risks of cataract surgery with and without an IOL.

The study ultimately enrolled 114 infants who were between 1 to 6 months old at the time of surgery. By random assignment, about half of the infants received an IOL and the other half received contact lenses. The lenses were soft silicon or hard gas-permeable plastic, and designed to fit small eyes.

The children in the study are now toddlers, and the investigators have examined visual acuity and other outcomes over the long term in both treatment groups. Of note, visual acuity testing in studies like this one presents unique challenges. An adult visual acuity test involves that familiar eye chart with rows of progressively smaller letters, and isn't feasible for a child who hasn't learned the alphabet.

The 1-year-olds in the study were tested with Teller acuity cards, which are flash cards imprinted with finer and finer grating patterns - the idea being that a visible pattern will grab a baby's attention while a card that looks blank will not. At 4 1/2 years old, the children were evaluated with the HOTV test, which requires kids to read the letters H-O-T-V or match flash cards containing one of the letters to a response card in their hands.

There were no significant differences in visual acuity between the two groups at age 1, or at age 4 1/2. However, there were more post-surgical complications in the IOL group, which in turn led to more corrective surgeries. The most frequent complication was lens reproliferation-which is when lens cells left behind after cataract surgery migrate into the pupil and interfere with vision. By age 5, lens reproliferation was 10 times more common with IOLs, occurring in 23 (40 percent) of infants in that group, compared to two infants (4 percent) in the contact lens group. This complication and others led to the need for one or more additional eye surgeries among 41 (72 percent) of the infants in the IOL group, and 12 (21 percent) in the contact lens group.

By age 5, nine children in the contact lens group developed minor eye infections that cleared up with antibiotic drops, and in one child, a contact lens broke during wear. None of these issues had permanent effects on vision. Three infants in the contact lens group had IOLs implanted before age 5, because their families had difficulty with day-to-day contact lens changing and maintenance.

"We think that for most infants with unilateral cataract, contact lenses are a better option than an IOL," Dr. Lambert said. "However, in some cases, the parents and their physician may decide that contact lens wear proves to be too challenging, and ultimately not in the child's best interests."

Aside from potential discomfort for the child and anxiety for the parents, there may be less obvious challenges to wearing contact lenses in infancy. Congenital cataract is sometimes hereditary, which means that some parents may have vision problems of their own that would make it difficult to change their kids' contacts. Affordability could also be a challenge for some families. Although health insurance plans generally pay for an IOL, most plans do not pay for contact lenses.

Why not delay both the cataract removal and the IOL until later in childhood? In that scenario, the loss of visual experience in early life could cause some permanent vision loss later, Dr. Lambert said.


Further Information

Join For Free

Access to this exclusive content is for Technology Networks Premium members only.

Join Technology Networks Premium for free access to:

  • Exclusive articles
  • Presentations from international conferences
  • Over 3,300+ scientific posters on ePosters
  • More Than 4,900+ scientific videos on LabTube
  • 35 community eNewsletters


Sign In



Forgotten your details? Click Here
If you are not a member you can join here

*Please note: By logging into TechnologyNetworks.com you agree to accept the use of cookies. To find out more about the cookies we use and how to delete them, see our privacy policy.

Related Content

Oxygen Can Impair Cancer Immunotherapy
Researchers have identified a mechanism within the lungs where anticancer immune resposnse is inhibited.
Friday, August 26, 2016
Diagnosing Bacterial Infections in Blood Samples
Researchers have diagnosed a bacterial infection from a blood sample in infants.
Wednesday, August 24, 2016
Stem Cell Therapy Heals Injured Mouse Brain
A team of researchers has developed a therapeutic technique that dramatically increases the production of nerve cells in mice with stroke-induced brain damage.
Tuesday, August 23, 2016
New Inflammatory Disease Discovered
NIH researchers have discovered a rare and potentially deadly disease - otulipenia - the mostly affects children.
Tuesday, August 23, 2016
Agent Blocks Pain Without Morphine's Side Effects
Scientists have synthesised a molecule with specific pain-relief properties and has shown its efficacy in mice.
Friday, August 19, 2016
Exploring Ebola-Malaria Link
Data shows people infected with Ebola were more likely to survive if co-infected with malarial parasite.
Thursday, August 18, 2016
Public Support for National Study
Survey shows the majority of respondents support or show willingness for national precision medicine study.
Thursday, August 18, 2016
How Parkinson’s Disease Alters Brain Activity Over Time
The NIH study provides a new tool for testing experimental medications aimed at alleviating symptoms and slowing the rate at which the diseases damage the brain.
Tuesday, August 16, 2016
Schizophrenia, Autism Share Genetic Causes
Monkey brain developmental atlas pinpoints when, where genes activate.
Tuesday, August 16, 2016
Oral Immunotherapy Is Safe, Effective Treatment for Peanut-Allergic Preschoolers
Study demonstrates the potential of peanut OIT to suppress allergic immune responses to peanut.
Friday, August 12, 2016
How Breast Cancers Resist Chemotherapy
Researchers discovered an unexpected way that breast cancers cells with mutant BRCA1 or BRCA2 genes acquire drug resistance and evade chemotherapies.
Wednesday, August 10, 2016
Stem Cells Grown On Scaffold Mimic Hip Joint Cartilage
Adult fat-derived stem cells grown on a 3-D scaffold that mimicked a hip joint surface formed cartilage and maintained the correct shape.
Wednesday, August 10, 2016
Mutations Linked to Immunotherapy Resistance
Researchers uncover mutations in tumors of three patients with advanced melanoma that allowed the tumors to become resistant to the immune checkpoint inhibitor pembrolizumab (Keytruda®).
Tuesday, August 09, 2016
Using Animal Embryos Containing Human Cells
With recent advances in stem cell and gene editing technologies, an increasing number of researchers are interested in growing human tissues and organs in animals by introducing pluripotent human cells into early animal embryos.
Monday, August 08, 2016
Zika Vaccine Testing in Humans
The NAAID has initiated a clinical trail of a vaccine candidate for the prevention of the Zika virus infection.
Thursday, August 04, 2016
Scientific News
Shedding Light on HIV Vaccine Design
Broadly speaking - Mathematical modelling of host-pathogen coevolution sheds light on HIV vaccine design.
AACC 2016 Sees Clinical Chemistry Labs Drive Precision Medicine Offerings
Biomarker assays to enable precision medicine and risk assessment, mass spec-based tests designed for use in clinical labs large and small, and liquid biopsy technology captured the spotlight at the AACC annual meeting.
Automated Patch Clamping Trends
Learn more about current practices, preferences and metrics in ion channel drug screening using APC technology.
Lab-on-a-Stick: Miniaturised Clinical Testing For Fast Detection Of Antibiotic Resistance
A portable power-free test for the rapid detection of bacterial resistance to antibiotics has been developed by academics at Loughborough University and the University of Reading.
Genetic Ancestry of Cultivated Strawberry Unravelled
UNH scientists constructed a linkage map of the seven chromosomes of the diploid Fragaria iinumae, which allows them to fill in a piece of the genetic puzzle about the eight sets of chromosomes of the cultivated strawberry.
Progress In Vaccination Against Vespid Venom
Researchers at the Helmholtz Zentrum München and the Technical University Munich have presented a method which facilitates a personalised procedure for wasp allergy sufferers.
New Drug Target for Inflammatory Disorders
Penn study finds enigmatic molecules maintain equilibrium between fighting infection and inflammatory havoc.
Breast Cancer Cells Found To Switch Molecular Characteristics
Spontaneous interconversion between HER2-positive and HER2-negative states could contribute to progression, treatment resistance in breast cancer.
Mechanisms of Calcium Blockers
Researchers describe how the fundamental mode of action of two distinct chemical classes of calcium channel blockers differs.
Some Breast Cancer Patients With Low Genetic Risk Could Skip Chemotherapy
Genetic test can help predict survival and guide treatment options.
Scroll Up
Scroll Down
Skyscraper Banner

Skyscraper Banner
Go to LabTube
Go to eposters
 
Access to the latest scientific news
Exclusive articles
Upload and share your posters on ePosters
Latest presentations and webinars
View a library of 1,800+ scientific and medical posters
3,300+ scientific and medical posters
A library of 2,500+ scientific videos on LabTube
4,900+ scientific videos
Close
Premium CrownJOIN TECHNOLOGY NETWORKS PREMIUM FOR FREE!