Visual Outcomes With Use Of Contact Lenses Versus Glasses In Children With Bilateral Aphakia Secondary To Congenital Cataract

To compare long-term visual outcomes in infants with bilateral aphakia rehabilitated with either contact lenses or spectacles following congenital cataract surgery

This retrospective observational study was conducted across three centres of the L V Prasad Eye Institute, South India

Medical records of infants who underwent bilateral congenital cataract extraction without primary intraocular lens implantation between 2015 and 2021 were reviewed. Surgery consisted of lens aspiration with primary posterior capsulotomy and anterior vitrectomy. Children were rehabilitated postoperatively with either contact lenses or aphakic spectacles. Data collected included demographic characteristics, ocular biometry, refractive status, visual acuity (converted to logMAR), and presence of strabismus or nystagmus. Only children with a minimum of five years of follow-up were included. Visual outcomes were analysed using Welch’s t-test and mixed repeated-measures ANOVA.

Fifty-seven children met inclusion criteria (19 contact lens users, 38 spectacle users). Median age at surgery was 13 weeks in both groups. Visual acuity improved significantly over time in both groups (p < 0.001). There was no significant difference in final visual acuity between contact lens and spectacle users (p = 0.968), and no significant time × group interaction (p = 0.518). Postoperatively, the contact lens group showed a marked reduction in strabismus (78% preoperatively to 68% postoperatively) and improvement in nystagmus. In contrast, the spectacle group demonstrated an increase in both strabismus (60.5% preoperatively to 76.5% postoperatively) and nystagmus prevalence.

Long-term visual outcomes in infants with bilateral aphakia were comparable between contact lenses and spectacles. However, contact lens use was associated with more favourable postoperative ocular alignment and nystagmus profiles. These findings support contact lenses as a valuable option for visual rehabilitation in appropriately selected infants following congenital cataract surgery.