Refractive Change at 5 Years in the Toddler Aphakia and Pseudophakia Study

Purpose: To report refractive change at 5 years of age in children with pseudophakic eyes operated on before 2 years of age. Design: Retrospective case series at 10 Infant Aphakia Treatment Study (IATS) sites. Participants: Children who underwent cataract surgery with primary intraocular lens (IOL) placement during the IATS enrollment years, including infants 1 to younger than 7 months of age with bilateral cataract and all children 7 to 24 months of age, regardless of laterality. Methods: Change in spherical equivalent refractive error (in diopters [D]) was calculated from 1 month after surgery to 5 years of age and was compared for patients with unilateral and bilateral (first eye only) cataract and for children 1 to < 7 months versus 7-24 months of age at surgery. Main Outcome Measures: Refractive change (D) from surgery to 5 years of age. Results: Ninety-six children were included: 50 children with unilateral cataract (surgery at age 7–24 months) and 46 children with bilateral cataract (n = 20 with surgery at age 1 to < 7 months; n = 26 with surgery at age 7–24 months). Median refractive change was significantly greater for eyes in the bilateral group undergoing surgery at age 1 to < 7 months (7.50 D; range, 2.5 to 15 D) versus age 7 to 24 months (1.94 D; range, –1.88 to 7.75 D; P < 0.001). For children 7-24 months of age at surgery, median change was similar between those with unilateral cataract (3.25 D; range, –1.75 to 13.5 D) versus bilateral cataract (1.94 D; range, -1.88 to 7.75 D; P = 0.053). By 5 years of age, no eyes in the 1 to < 7 month age group had less than 2.5 D myopic shift, but in the 7-24 month age group, 62% of patients with bilateral cataract and 38% of patients with unilateral cataract showed less than 2.5 D myopic shift. Conclusions: Greater magnitude and variability in refractive change was found in pseudophakic eyes undergoing surgery at 1 to < 7 months of age and for patients with unilateral cataract, which should be considered when choosing IOL power and initial postoperative target refraction for infants and toddlers. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.