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Monofocal IOLs provide good distance and near visual acuities of about 20/40 or better for pediatric patients when the targeted vision is within 1 D of emmetropia.
"Premium IOLs are used basically to provide spectacle independence and restore accommodation, and they are appealing for use in older children," said Dr. Nihalani-Gangwani, a fellow at Children's Hospital Boston, Harvard Medical School, Boston. "Some of the major concerns in this patient group are IOL power calculation and refractive instability."
She and co-author Deborah K. VanderVeen, MD, addressed the question about whether multifocal IOLs are needed to achieve good distance and near vision in pediatric cases, considering that so many young children have monofocal IOLs and still have good distance and near visual acuity.
However, no reports had been published on the uncorrected distance and near visual acuity in the pediatric population, according to Dr. Nihalani-Gangwani. Therefore, they undertook a retrospective chart review to determine the uncorrected distance and near visual acuity levels in children with in-the-bag monofocal IOLs.
All children were older than 5 years and had been targeted for emmetropia within 1 D. The main outcome measures were the uncorrected distance and near visual acuities. The patients were divided into two groups. Group 1 had distance and near visual acuities of better than 20/40, and group 2 had distance and near visual acuities of 20/40 or worse.
The study included 41 eyes of 25 children, with mean age of 11.2 + 3.6 years.
Roughly 50% of the pseudophakic pediatric eyes and 75% of children with bilateral pseudophakia had an uncorrected distance and near visual acuity that exceeded 20/40, she said. The mean keratometry was steeper in group 1, and the mean cylinder was lower in group 1 compared with group 2 (–1.3 D versus –2.2 D, respectively). The mean spherical equivalent was almost plano in group 1.
Interestingly, she said, there was no significant difference in the mean cylinder postoperatively.