MIOLs IN KIDS

More long-term studies are needed to conclusively demonstrate the potential benefits and drawbacks of implanting multifocal IOLs in paediatric eyes, according to a recent French study.

“There are still a lot of unanswered questions surrounding this issue and we definitely need more longitudinal studies that can guide our choice of implant for paediatric cataract patients,” Clement Paya MD told delegates attending the annual meeting of the French Implant and Refractive Surgery Association (SAFIR).
With evolving IOL technology and designs, more surgeons are willing to contemplate multifocal IOLs as a potential alternative to monofocal pseudophakia in selected paediatric cataract patients, said Dr Paya, Ophthalmology Department, Bordeaux University Hospital, Bordeaux, France. 
Assuming that indications are rigorously respected, multifocal IOLs in children can offer independence from glasses, limit amblyopia, assist binocular vision and improve quality of life without any significant complications. 

Caution Urged
Despite these potential benefits, many paediatric ophthalmologists urge caution in the use of multifocal lenses, fearing that the loss of intermediate vision and loss of contrast sensitivity associated with their use may exacerbate amblyopia in young patients.
Dr Paya presented data from a comparative retrospective study carried out at the University Hospital of Bordeaux from January 2000 to October 2012. Inclusion criteria were paediatric cataract patients aged between three and 15 years, with primary IOL implantation in the bag and a follow-up of at least two years.  
Patients younger than three and older than 15 were excluded from the study, as were secondary implantations, glaucoma patients and also those with other causes of visual loss besides cataract.
Patients were divided into two groups: group one was comprised of 19 eyes of 13 children who received a multifocal IOL, and group two included 50 eyes of 41 children who received a monofocal IOL. Bilateral cataracts were present in six children for the multifocal group and nine children in the monofocal group. 
The mean postoperative spherical equivalent was -0.17 D in group one and -0.26 D in group two. The visual acuity outcomes were broadly equivalent for both groups of patients, said Dr Paya. 
Almost 84 per cent of children younger than eight years of age attained 8/10 visual acuity or better in the multifocal group compared to 69 per cent in the monofocal group, although this was not statistically significant. There was also no significant difference in the scores obtained for patients older than eight years in both groups.

More Research needed
Looking at the published literature, Dr Paya said that while good results have been obtained using multifocal IOLs in children, much more research was needed to better understand issues such as axial growth, which has been shown to continue throughout the second decade of life, refractive shift and patient variability. 
“While our study indicates that multifocal implants are safe, we still do not know enough about issues such as refractive shift and ocular growth. While we may try to target emmetropia at adult age, there is important variability from one child to another, with spectacle independence at adult age very difficult to predict,” he said.

Clement Paya: clementpaya@hotmail.com