The association between myopic shift and visual acuity outcome in pediatric aphakia

Purpose: The advent of intraocular lens implantation after pediatric cataract surgery necessitates an increased understanding of refractive development. The significant Variation in rate and amount of refractive change among eyes, both aphakic and pseudophakic, is well recognized, although the causes of such variation remain unclear. The purpose of this study was to determine if a correlation exists between the rate of refractive growth (RRG) and visual acuity outcome in pediatric aphakia. Methods: Multicenter, retrospective observational case series. One hundred and twenty-five eyes of 85 patients with cataract surgery before 1 year of age and a minimum of 3 years of follow-up were analyzed. RRG was calculated for each eye using the logarithmic model of ocular growth and compared with final logMAR acuity using linear regression. Results: The correlation of RRG with final logMAR acuity was statistically significant (r(2) = 0.10; P < .01), ie, 10% of variance in RRG is related to acuity outcome. The correlation was higher in unilaterally aphakic patients (n = 44; r(2) = 0.19; p < .01) than in bilaterally aphakic patients (n = 81; r(2) = 0.08; P < .01). Eyes with visual acuity of 20/60 or better had a significantly lower RRG than those with poorer acuity (4.1 v 5.4 diopters (D); P < .01). Conclusions. RRG in aphakia is correlated with visual acuity outcome. Eyes with poorer acuity have a greater RRG.