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Contacts effectively treat infantile unilateral aphakia
Gas permeable and silicone elastomer lenses are both recommended in managing infantile aphakia, but visual acuity data in the Eye & Contact Lens study fail to provide evidence as to which lens material is the best option.
Fifty-seven infants out of the 114 in the Infant Aphakia Treatment Study were randomized to contact lens wear and studied for 5 years. Keratometry was performed at enrollment, at about 1 year of age and again at 5 years.
The main inclusion criteria were a visually significant congenital cataract in one eye and an age of 28 days to less than 210 days at the time of cataract surgery.
A traveling examiner assessed visual acuity at approximately 1 year and 4.5 years of age.
Twenty-four treated eyes wore a silicone elastomer (SE) contact lens, Silsoft Super Plus (Bausch + Lomb), 11 wore a gas permeable contact lens, X-Cel Specialty Contacts (Valeant Pharmaceuticals), and 17 wore both lens types at various points of time.
Median age at cataract surgery was 1.8 months, 56% of infants were female and 86% were white.
Of the 52 who wore the contact lens successfully, 24 (46%) were treated with SE lenses only, 11 (21%) were treated with GP lenses only, and 12 (33%) used both lens types and/or soft contact lenses at various points.
Three patients were deemed contact lens failures, and in all cases the caregiver was unable to manage the application and removal of the contact lens.
At age 4.5 years, the objective logMAR visual acuity was +0.90, according to researchers. The SE subgroup median acuity was +0.70 logMAR. In the GP subgroup, median logMAR acuity was 2.03.
The researchers reported that 33% of patients wearing GP lenses achieved 20/40 or better vision compared with 20% wearing SE lenses.
The mean decrease in keratometric power of the treated eye between the ages of 1 year and 5 years was –0.14 D. The mean decrease in the mean keratometric power between 1 year and 5 years visits of the fellow eye was 0.06, according to the study. The mean keratometric astigmatism change between the ages of 1 year and 5 years was 0.40 D.
Researchers found that 66% of treated eyes had greater than 1.5 D of corneal astigmatism at 5 years of age.
Half (52%) of the treated eyes had no more than 2 D of corneal astigmatism, while the rest had more than 2 D at 5 years of age.
There were a total of 13 contact lenses-related adverse events. All but one were attributed to overnight wear with the SE lenses.
Researchers concluded that contact lenses provide a safe and effective treatment for infantile unilateral aphakia and are the recommended method of correction during the first 6 months of life, but they did not find a significant difference in visual acuity between the two lens subgroups. – by Abigail Sutton