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GP contacts better than spectacles in children with monocular aphakia
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Children who undergo surgery for monocular congenital cataract can benefit from the use of gas-permeable contact lenses, while spectacles are not the ideal correction, according to a study.
Forty-six patients with unilateral aphakia following cataract extraction at the Department of Ophthalmology in Xin Hua Hospital, Shanghai Jiao Tong University, China, were divided into three groups.
In groups 1 and 2, GP contact lenses were used to correct aphakia, but group 2 comprised patients with persistent fetal vasculature. In group 3, patients were corrected with spectacles.
The mean age of patients was 3 years, ranging between 1 and 11 years.
Visual acuity improved significantly with age in group 1, but not equally so in groups 2 and 3. Nystagmus also decreased significantly, with a remission rate of 58%, while no improvement was reported in groups 2 and 3. No infection or other ocular complication was observed.
“We believe that wearing gas-permeable contact lenses is an effective method that can improve the visual acuity of children with unilateral aphakia after cataract surgery,” the authors wrote.
The lenses have high oxygen permeability, ensure an adequate tear exchange and provide high image quality. They promote the development of binocular vision and fusion in children and affect the afferent information of the trigeminal nerve, reducing the intensity of nystagmus, they pointed out. Spectacles, on the other hand, cause an optical aberration and amplification effect, leading to disparity in the binocular image and difficulty with fusion. They are, therefore, “an unsatisfactory correction method,” the authors concluded. – by Michela Cimberle
Disclosure: The authors reported no relevant financial disclosures.
Perspective
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Clarke Newman, OD, FAAO
This study is important. Determining whether the monocular congenital cataract patient is better off with spectacles or contact lenses is valuable. This study showed a clear advantage of the GP lens over spectacles for these children. Because these children have significant problems with strabismus and nystagmus, showing a treatment modality that reduces both of these problems relative to other treatments after a year is very promising.
This study further reinforces the concept that the monocular congenital cataract patient is treated best with early surgery, proper correction and patching compliance.
The biggest weaknesses of this study are the relatively small sample sizes in each of the three groups, the retrospective nature of the study that limits how the groups were matched and the fact that the GP lens wear group was not compared to soft lenses. It would be interesting to see how the GP lens group without persistent fetal vasculature would stack up in a prospective manner against a matched group wearing the silicone elastomer lens.
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