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Study finds phakic IOLs can benefit children with neuro-behavioral disorders
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SEATTLE — Phakic IOL implantation can be an effective option for improving visual function in children with high myopia and neuro-behavioral disorders who also have difficulties wearing glasses, according to a study presented here.
Gi Yoon Huang, MD, and colleagues studied 20 eyes of 12 ametropic children aged 4 to 17 years who were implanted with an iris-enclaved Verisyse phakic IOL (Advanced Medical Optics). All children had ametropia beyond the range that can be corrected by excimer laser refractive surgery, said Dr. Huang, who presented the study results at the American Association for Pediatric Ophthalmology and Strabismus meeting.
Dr. Huang described the noncompliant children as having "visual autism," including signs of "fearfulness, withdrawal and disinterest." These children tend to refuse spectacle correction, or they tend to look either around the edges or over the top of the lenses, she said.
The study included children with myopia over 10 D and an anterior chamber deeper than 3.2 mm. Surgeons implanted the phakic IOLs via clear corneal incisions, with two paracenteses made at 10:30 o'clock and 1:30 o'clock. They positioned each Verisyse lens over the pupil and then rotated it to position the haptics at the 3 o'clock and 9 o'clock positions.
At 11 months mean follow-up, 17 of the 20 eyes were corrected to within ±1 D of target refraction, which ranged from 0 D to 1 D. The remaining three eyes were corrected to within ±2 D of target refraction.
Dr. Huang and colleagues found that surgery improved children's mean uncorrected visual acuity from 20/3550 preoperatively to 20/53 postop. Investigators also validated children's visual function using a survey, which incorporated time trade-off and standard-gamble criteria.
Commenting on the study, Evelyn A. Paysse, MD, said she found the results interesting and the study well done.
However, she said she wished the study had included data on amblyopia improvement and questioned why only uncorrected visual acuity results were reported.
Dr. Paysse also noted that she feels that a threshold of –10 D is a bit low to qualify patients for phakic IOL implantation "when such good results are obtained from excimer procedures."
Yet, overall, Dr. Paysse thanked the researchers for their "bravery in going into a new frontier" and said she is interested in seeing long-term results.