It may seem impossible, trying to pry open a tiny eyelid with a contact lens balanced precariously on your forefinger. But scientists from the National Institutes of Health suggest the hassle may be worth it if your child has undergone cataract removal surgery.

When adults and children alike get cataracts removed, doctors routinely put an intraocular lens (IOL) in the place where the clouding once was. It serves as a mechanical replacement for the part of the eye responsible for bringing objects into focus. In adults the procedure is fairly standard, but in infants the eye is still growing, which means implanting a permanent device could eventually lead to complications. The contact lens, if kept in for a number of years, could be just as effective the team found, as jumping right into the IOL.

“Cataract surgery and the use of IOLs for infants have become more sophisticated and more widely practiced over time,” said Donald Everett, the NEI’s director of collaborative clinical research, in a statement. “In this study, the goal was to determine if the beneficial effects of IOLs outweigh their known complications.”

Researchers began their investigation in 2004. The trial involved 12 clinical centers and children with a cataract in one eye. Ultimately, 114 infants enrolled in the study. They received either a soft silicone or hard gas-permeable plastic lens, fit for a smaller eye, after they had had surgery at 1 to 6 months old. The team checked back in regularly to see how the subjects’ vision had faired since either gaining the IOL or using contacts.

While neither group showed greater proficiency than the other, the IOL group did face a far greater number of risks, the largest among them being lens reproliferation — an effect of the surgery in which the leftover cells in the lens migrate into the pupil, obscuring vision. In the IOL group, lens reproliferation was 10 times more common by age 5. This complication and others led to a need for reparative surgery in 72 percent of IOL subjects, compared to 21 percent of those given contacts.

Opting for the temporary fix isn’t all positive, according to Dr. Scott Lambert, study leader and professor of ophthalmology at Emory University. Even with the added effort of putting in and taking out a finicky child’s contacts (or putting them in incorrectly), parents with poor vision themselves may already be at a disadvantage when it comes to putting in another person’s contacts. And practically speaking, most health insurance plans cover IOL, but most do not cover contact lenses.  

“We think that for most infants with unilateral cataract, contact lenses are a better option than an IOL,” Lambert said. “However, in some cases, the parents and their physician may decide that contact lens wear proves to be too challenging, and ultimately not in the child’s best interests.”

For the some 1,200 to 1,600 infants diagnosed with congenital cataracts each year, in the end the appropriate treatment method may come down to personal preference. It may be that the costs of paying for cataracts out-of-pocket necessitate IOL, which insurance covers. Or both parents may have poor vision or unsteady hands. Or perhaps they want to exercise more control if they fear their baby will grow out of the IOL. Ultimately, either treatment is better than the alternative: unchecked vision loss in infancy that could lead to a lifetime of darkness.

 

Source: The Infant Aphakia Treatment Study Group. 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 Ophthalmology. 2014.