Cataracts are a significant cause of visual impairment in children, and large, clinical, disease-specific registries can provide real-world estimates of visual outcomes and rates of adverse events in clinical practice.

Using such data, researchers recently found that amblyopia is a frequent post-cataract surgery finding. They also noted that visual acuity was typically less than normal and worse with unilateral cataract for children older than one. Visual axis obscuration management was the most common complication requiring surgical intervention.

This prospective, observational study evaluated 880 children younger than 13 years at the time of lensectomy in at least one eye with follow up within 15 months after surgery. Lens surgery was bilateral in 41.1% of children and unilateral in 58.9%, and 60.2% of the 1,132 eyes received an intraocular lens implant. The researchers observed amblyopia in 51.0% of study participants. In children aged three years or older, they found that mean visual acuity was 0.30 logMAR (about 20/40) in 153 bilateral pseudophakic eyes, 0.49 logMAR (about 20/63) in 141 unilateral pseudophakic eyes, 0.47 logMAR (about 20/63) in 21 bilateral aphakic eyes and 0.61 logMAR (about 20/80) in 17 unilateral aphakic eyes.

The researchers also discovered that mean visual acuity improved with older age at surgery by 0.2 logMAR line in eyes with bilateral pseudophakia and 0.3 logMAR line in eyes with unilateral pseudophakia. They made a new diagnosis of glaucoma or suspected glaucoma in 67 of 1,064 eyes that did not have glaucoma prior to lensectomy, 36 of 273 eyes with bilateral aphakia, five of 308 eyes with bilateral pseudophakia, 14 of 178 eyes with unilateral aphakia and 12 of 305 eyes with unilateral pseudophakia. They performed additional intraocular surgery, most commonly vitrectomy or membranectomy, to clear the visual axis in 17.0% of eyes.

Writing Committee for the Pediatric Eye Disease Investigator Group (PEDIG). Visual acuity and ophthalmic outcomes in the year after cataract surgery among children younger than 13 years. JAMA Ophthalmol. May 16, 2019. [Epub ahead of print].