Contact lenses have been used successfully to treat aphakic patients for many years, but now intraocular lens implants (IOLs) are being used more frequently. In a recent survey of AAPOS and ASCRS members, over 50% of members were placing IOL's in children. The advantages of intraocular lenses are that they are "permanent", avoid the risk of keratitis and frequent loss of lenses that occurs in contact lens wearers, and may provide a faster time course toward visual rehabilitation. IOL's are also a good option in a patient in whom compliance with contact lenses or access to contact lenses may be limited. Currently, the main challenge in the placement of IOL's is determining the desired refractive outcome and predicting refractive changes over time.
In general, IOL's are infrequently used in children under 6-7 months of age due to high rates of surgical complications. Ongoing studies investigating the use of the lenses in the younger age group may change this with time. Many patients with congenital cataracts, therefore, are not ideal candidates for IOL's. Other situations in which IOL's may be contraindicated include patients with active or poorly controlled uveitis, megalocornea, microphthalmos, and weakened zonules.
Thorough informed consent regarding the risks and benefits of IOL's is necessary prior to implantation. Parents need to understand that the child's refractive error will change over time and prediction of ultimate adult refractive outcome is not certain. Glasses and bifocals are also used on a long term basis as the child's refractive error changes.