International conference to address pediatric congenital cataract treatment in New York City

Emory UniversityMar 1 2011

An international conference addressing the treatment of children born with a cataract (congenital) will take place in New York City on Friday, March 11, 2011. The International Congenital Cataract Symposium will address how various countries, including less-developed counties, treat children needing cataract surgery. There are differences in treatments, and the meeting will bring together knowledge and data from around the world, perhaps lessening current health care disparities.

The event is coordinated by Atlanta's Emory Eye Center and other Emory University participants, who currently lead a national study, the Infant Aphakia Treatment Study (IATS). The important study is a multi-year, multi-clinic study to determine if an intraocular lens (IOL) or a contact lens is the best treatment for optical vision following removal of the cataract for these young children.

Conference directors include Scott R. Lambert, MD, R. Howard Professor of Ophthalmology and Pediatrics, Emory Eye Center; Edward Cotlier, MD, research scientist at New York State Institute for Basic Research in Developmental Disabilities; and David Taylor, FRCS, professor emeritus, University of London.

"Several of the pioneers in the treatment of congenital cataracts will be speaking at this symposium, including Creig Hoyt, MD, chairman emeritus at the University of California, San Francisco and David Taylor, FRCS, from London," says Dr. Lambert. "Pediatric ophthalmologists from Africa and India will be discussing how congenital cataracts are being managed in their countries. Exciting new developments in the treatment of congenital cataracts will also be discussed."

Speakers include Emory University IATS team members, ophthalmologists from this country, and researchers and doctors from Bangladesh, India, and Egypt. Emory Eye Center faculty presenting include Dr. Lambert (Pediatric Ophthalmology), Buddy Russell, COMT (Contact Lens); Allen Beck, MD (Glaucoma); and Emory researcher Carolyn Drews-Botsch, PhD.

Major topics to be discussed include:

• Visual Development & Amblyopia Correction
• The Infant Aphakia Treatment Study
• The Global Challenge of Congenital Cataracts
• Promising New Developments

In May 2010, the national study, led by Emory University researchers, showed that young children with a congenital condition causing a cataract in the eye can be treated successfully with either a contact lens or in intraocular lens (IOL) according to one-year outcomes.

The study was designed to determine which treatment for aphakia (absence of the eye's natural lens) is better for infants between the ages of four weeks to seven months, born with a cataract (congenital) in one eye. The study's findings were reported in the May 10, 2010, issue of the Archives of Ophthalmology.

IATS results at one-year outcomes show that there is not a difference in visual acuity in children, whether the child is fitted with a contact lens or given an IOL immediately following cataract removal.

However, there was nearly a three-fold higher rate of complications during surgery and five-fold higher rate of additional surgeries in the children treated with an IOL compared to the children treated with contact lenses.

The National Eye Institute, part of the National Institutes of Health, sponsors the study. It was based at Emory Eye Center, Emory University School of Medicine. The clinical trial was conducted at 12 centers throughout the country. The IATS Clinical Coordinating Center participants include Emory Eye Center's Dr. Lambert, the national study chair, and Lindreth DuBois, MEd, MMSc, CO, COMT, the national coordinator.

The Emory Data Coordinating Center, the group responsible for the statistical and data management activities of the study, was located at the Rollins School of Public Health of Emory University and was directed by Michael Lynn, MS. The Visual Acuity Testing Center directed by E. Eugenie Hartmann, PhD was located at the School of Optometry at the University of Alabama, Birmingham.

The purpose of the clinical trial was to determine if the higher rate of complications with intraocular lenses is offset by improved visual outcome and decreased parenting stress.

With the condition of aphakia-following removal of the cataract-there is no focusing mechanism, since the eye's natural lens has been removed. That missing lens must be replaced with another lens in order to be able to focus, and thus, to see. When the eye cannot focus, the eye can become amblyopic, or "lazy," and it will lose the ability to see at all over time. Replacing that lens is crucial to a child's vision.

In past decades, thick glasses followed a cataract extraction. Today, IOLs are commonplace. Since the 1970s, the standard of care following a baby cataract removal has been to focus a baby's eye with a contact lens and later, to implant an IOL when the child entered school. The study sought to determine if immediately implanting an IOL was a better choice for the child's visual acuity.

The authors say because contact lenses are a challenge with babies - they are hard to insert, they are often lost and there are a variety of other problems - IOLs for these babies may seem to be an answer, particularly in cases where there may be adherence issues or cost factors for numerous contact lenses. Quite simply, they are easier for parents.

IOLs have improved over recent years and focus the eye very much like the natural lens. Additionally, they provide at least partial correction at all time for the child, though there are more complications with IOLs.