Physicians must analyze costs, benefits of IOLs for pediatric cataracts

PUNTA DEL ESTE, Uruguay — Because of the extensive preparation required, possible complications and necessary continued follow-up, physicians and patients' families must be aware of both costs and benefits of IOL implantation in pediatric cataract patients, according to a surgeon speaking here.

"When you talk about pediatric cataracts, the cataract extraction surgery is just the beginning of the story," said Marlene Vogel, MD, at Subspecialty Day of the Curso Regional Panamericano.

When deciding whether to proceed with surgery, parents and physicians must consider the cost-to-benefit ratio, she said. Parents must also understand what the procedure entails and be fully educated about the necessary follow-up care, which could be challenging. Refractive results after pediatric cataract surgery are not always satisfactory, and if the child is especially young, it may be a difficult, delicate procedure, Dr. Vogel said.

In addition, she said, there is always the potential for adverse effects, such as strabismus or glaucoma. Many children have to be sedated for exams, and that could be expensive, she added. In the end, Dr. Vogel said, all those efforts might result in less than useful vision.

According to Dr. Vogel, in many cases, a child with a unilateral cataract should not receive an IOL, but there is a consensus that most children with bilateral cataracts should undergo the procedure after 2 years of age due to the overall visual benefits.

If the decision is made not to operate due to the presence of strabismus, untreated retinopathy of prematurity, significant microphthalmos or other significant conditions, the best alternative may be to use contact lenses as long as the parent is able to handle such lenses safely.

"Children who have IOLs implanted do go through more surgeries as a result of complications, but IOLs have proven to result in better visual acuity," Dr. Vogel said.