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Scott R Lambert, Lindreth DuBois, E Eugenie Hartmann, George Cotsonis, Carolyn Drews-Botsch; Spectacle adherence in the Infant Aphakia Treatment Study: A secondary analysis of a randomized clinical trial. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5195. doi: https://doi.org/.
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Wearing spectacles after unilateral congenital cataract surgery is important to focus the treated eye, which often has reduced vision, and to protect both eyes. We evaluated spectacle use in a randomized clinical trial to learn more about how often spectacles are prescribed and to assess spectacle adherence in young children with unilateral aphakia.
This analysis used data from the Infant Aphakia Treatment Study (IATS) that randomized 1 to 6 month old infants with a unilateral congenital cataract to optical correction with an intraocular lens (IOL) or contact lens after cataract surgery. The IATS protocol mandated that spectacles be prescribed for all children in the IOL group one month after cataract surgery and for both groups at age 2 years for near correction. Spectacles were provided at no charge to patients. A total of 114 children were enrolled between 2004 and 2009. Visual acuity was assessed by a traveling examiner at age 4.5 years. Follow-up examinations were performed at specified intervals to age 5 years. Spectacles adherence was assessed by retrospective telephone interviews every 3 months and annual prospective diaries. The telephone interview at age 5 years and the diary completed at age 49 months were used to evaluate spectacle adherence. One patient was lost to follow-up.
At the 5 year visit, 98 of 113 (87%) of the participants were known to have been prescribed spectacles. All 56 patients in the IOL group and 47 of 57 (81%) patients in the contact lens group were prescribed spectacles. Among patients with 20/200 or worse vision in their treated eye, 6 of 55 (11%) had not been prescribed spectacles compared to 9 of 57 (16%) with better than 20/200 vision (p=0.45). Sixteen of 55 (29%) patients with 20/200 or worse vision reported no spectacle use whereas only 10 of 55 (17%) patients with better than 20/200 vision reported no spectacle use (Figure 1).
About 20% of children with unilateral aphakia were not prescribed spectacles even though it was mandated by the IATS protocol. Parents reported no spectacle use in nearly 30% of children with 20/200 or worse vision at age 5 years. Spectacle wear should be strongly encouraged in children after unilateral congenital cataract surgery particularly when vision is reduced in the treated eye.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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