Using contact lenses to correct aphakia in infants following cataract surgery may provide better results than IOL implementation, says a study published in the March 6 JAMA Ophthalmology.

The Infant Aphakia Treatment Study, a randomized clinical trial conducted at 12 different sites, compared IOLs to contact lenses in 114 infants with unilateral congenital cataracts.

The infants were between one and six months old when cataract surgery was performed. Through random assignment, half were given IOLs while the other half received contact lenses to treat aphakia following surgery. Each child was assessed in a follow-up visit approximately four years following surgery (age 4.5).

No significant differences in median visual acuity were found between the two groups, but the children who received IOLs experienced significantly more adverse events than those who were left aphakic. The study also found that more subjects in the IOL group received at least one additional intraocular surgical procedure than those in the contact lens group (contact lens, 21%; IOL, 72%; p<0.001).

The researchers concluded that IOL implantation should be reserved for infants when the cost and handling of contact lenses would prove to be such an insurmountable obstacle that the end result would be significant periods of uncorrected aphakia.

Lambert SR, et al. Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy: a randomized clinical trial of hotv optotype acuity at age 4.5 years and clinical findings at age 5 years. JAMA Ophthalmol. 2014 Mar 6. [Epub ahead of print]