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Abstract

We appreciate the interest of Takkar et al in our publication. We previously published the changes in axial length in the treated and fellow eyes for both the contact lens and intraocular lens (IOL) treated groups.1Wilson M.E. Trivedi R.H. Weakley Jr., D.R. et al.Infant Aphakia Treatment Study GroupGlobe axial length growth at age 5 years in the Infant Aphakia Treatment Study.Ophthalmology. 2017; 124: 730-733Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar The difference in axial length growth between treated and fellow eyes was not significant and the change in axial length between treated eyes in the contact lens and IOL groups was similar at age 5 years (contact lens, 3.2 mm; IOL, 3.4 mm). Although animal studies have reported that the relative peripheral refraction affects the rate of axial growth, studies in humans have failed to find this association.2Walline J.J. Jones L.A. Sinnott L. et al.A randomized trial of the effect of soft contact lenses on myopia progression in children.Invest Ophthalmol Vis Sci. 2008; 49: 4702-4706Crossref PubMed Scopus (91) Google Scholar To the contrary, myopic shift has been reported to increase when myopic children switched from spectacles to contact lenses.3Marsh-Tootle W.L. Dong L.M. Hyman L. et al.Myopia progression in children wearing spectacles vs. switching to contact lenses.Optom Vis Sci. 2009; 86: 741-747Crossref PubMed Scopus (16) Google Scholar We have not been able to identify preoperative factors helpful in predicting the magnitude of the myopic shift in infantile eyes after unilateral cataract surgery and IOL implantation. This is another reason to defer implanting an IOL in an infant’s eye in addition to the higher adverse event rate associated with IOL implantation compared with aphakia.4Lambert S.R. Buckley E. Drews-Botsch C. et al.A randomized clinical trial comparing contact lens with intraocular lens correction of monocular aphakia during infancy: grating acuity and adverse events at age 1 year.Arch Ophthalmol. 2010; 128: 810-818Crossref PubMed Scopus (136) Google Scholar By deferring IOL implantation until the axial length of these eyes has stabilized, the risk of high anisometropia and an IOL exchange can potentially be mitagated.5Weakley D. Cotsonis G. Wilson M.E. et al.Anisometropia at age 5 years after unilateral intraocular lens implantation during infancy in the Infant Aphakia Treatment Study.Am J Ophthalmol. 2017; 180: 1-7Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar Re: Weakley et al.: Myopic shift 5 years after intraocular lens implantation in the infant aphakia treatment study (Ophthalmology. 2017;124:822-827)OphthalmologyVol. 125Issue 10PreviewIn the study by Weakley et al,1 the authors evaluated the myopic shift occurring after surgery in children with uniocular congenital cataract enrolled in the Infant Aphakia Treatment Study (IATS).1 The authors commented on eyes implanted with an intraocular lens (IOL), while excluding eyes that had been left aphakic and rehabilitated with contact lens only. Full-Text PDF