Refractive change at 5 years in the Toddler Aphakia and Pseudophakia Study (TAPS)

Deborah K VanderVeen; Edward Wilson; Jenny Y Wang; M Elias I Traboulsi; Sharon F Freedman; David A Plager; Kimberly G Yen; Natalie C Weil; Allison R Loh; David Morrison; Jill S Anderson; Scott R Lambert; Erick D Bothun; Toddler Aphakia and Pseudophakia Study

doi:10.1016/j.ophtha.2024.12.027

Refractive change at 5 years in the Toddler Aphakia and Pseudophakia Study (TAPS)

Ophthalmology. 2024 Dec 16:S0161-6420(24)00791-7. doi: 10.1016/j.ophtha.2024.12.027. Online ahead of print.

Affiliations

¹ Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
² Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina.
³ Department of Ophthalmology, Mayo Clinic, Rochester, MN.
⁴ Department of Pediatric Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
⁵ Departments of Ophthalmology and Pediatrics, Duke University Medical Center, Durham, NC.
⁶ Department of Ophthalmology, Indiana University, Indianapolis, Indiana.
⁷ Departments of Ophthalmology and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
⁸ Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
⁹ Department of Ophthalmology, Oregon Health and Science University, Portland, OR.
¹⁰ Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN.
¹¹ Department of Ophthalmology and Visual Neurosciences, Minneapolis, University of Minnesota, MN.
¹² Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia;; Departments of Ophthalmology and Pediatrics, Stanford University Medical Center, Palo Alto, CA.
¹³ Department of Ophthalmology, Mayo Clinic, Rochester, MN; Department of Ophthalmology and Visual Neurosciences, Minneapolis, University of Minnesota, MN;. Electronic address: [email protected].

PMID: 39694279
DOI: 10.1016/j.ophtha.2024.12.027

Abstract

Purpose: To report refractive change at age 5 years in pseudophakic eyes operated 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 placement during the IATS enrollment years, including infants 1 to <7 months of age with bilateral cataract and all children 7-24 months of age, regardless of laterality.

Methods: Change in spherical equivalent refractive error (diopters[D]) was calculated from 1-month postoperatively to 5 years of age and compared for unilateral and bilateral (first eye only) cases, and for 1 to <7 vs 7-24 months at surgery.

Main outcome measures: Refractive change (D) from surgery to age 5 years.

Results: 96 children were included: 50 unilateral (surgery 7-24 months of age); 46 bilateral (n=20, surgery at 1 to <7 months of age; n=26, at 7-24 months). Median refractive change was significantly greater for bilateral pseudophakic eyes operated at 1 to <7 months (7.50 D, range 2.5 to 15 D) vs. 7-24 months (1.94 D, range -1.88 to 7.75 D; P<0.001). For children aged 7-24 months at lensectomy, median change was similar between unilateral (3.25D, range -1.75 to 13.5 D) vs. bilateral cases (1.94D, range 1.88 to 7.75 D; P=0.053). By age 5 years, none of the pseudophakic eyes 1 to <7 months at surgery had <2.5D myopic shift, but 55% of bilateral and 25% of unilateral cases 7-24 months at surgery had < 2.5D myopic shift.

Conclusions: Greater magnitude and variability in refractive change was found in pseudophakic eyes operated at 1 to <7 months and for unilateral cases, which should be considered when choosing IOL power and initial post-operative target refraction for infants and toddlers.