An interventional study of Contact lens correction of aphakia and Intraocular lens implantation in Congenital Cataract, sponsored by Stanford University. Completed at 13 sites in United States. Open to participants aged 28 Days to 210 Days. Per ClinicalTrials.gov, last updated 2024-07-24.
Sponsored by Stanford University · Not applicable, Interventional, and Treatment
The primary purpose is to determine whether infants with a unilateral congenital cataract are more likely to develop better vision following cataract extraction surgery if they undergo primary implantation of an intraocular lens or if they are treated primarily with a contact lens. In addition, the study will compare the occurrence of postoperative complications and the degree of parental stress between the two treatments.
Intraocular lenses are now a commonly accepted treatment for cataracts in older children and are used increasingly in younger children and infants. Intraocular lenses are superior to contact lenses in that they more closely replicate the optics of the crystalline lens, do not require daily ongoing care, and ensure at least a partial optical correction at all times. The simplicity and improved visual outcome of an intraocular lens correction may make caring for a child with a unilateral congenital cataract less stressful for parents. However, contact lenses remain the accepted treatment for children under 1 year of age due to concerns about the long-term safety of intraocular lenses and the potential for a large myopic shift developing in these eyes as they grow. Contact lenses provide excellent visual results in infants treated for bilateral congenital cataracts; however, two-thirds of infants treated with contact lenses for unilateral congenital cataracts remain legally blind in their aphakic eye. These poor visual outcomes are usually ascribed to competition from the sound eye and poor compliance with patching and contact lens wear regimens. Data from our pilot study and the literature suggest that superior visual results can be obtained if an intraocular lens is used to correct unilateral aphakia during infancy, but these eyes will experience more complications. Intraocular lenses will be increasingly implanted in infants regardless of whether or not we perform this trial. By performing this clinical trial, we can determine if the higher rate of complications with intraocular lenses is offset by improved visual outcome and decreased parenting stress.
The Infant Aphakia Treatment Study (IATS) is a multi-center randomized clinical trial comparing intraocular lens and contact lens correction for monocular aphakia. Infants will be enrolled over a 4 year period. Infants 28 to 210 days of age with a visually significant cataract in one eye are eligible. Cataract surgery will be performed in a standardized fashion by a surgeon who has been certified for the study. Surgery consists of a lensectomy, posterior capsulotomy, and anterior vitrectomy. Infants will be randomized at the time of surgery to one of two treatment groups. Infants randomized to the intraocular lens group will have an intraocular lens implanted into the capsular bag. Spectacles will subsequently be used to correct the residual refractive errors. Infants randomized to the contact lens group will be fitted with a contact lens immediately after surgery. Both groups will receive the same patching therapy and follow-up. All children will be examined by Investigators at fixed intervals using standard protocols with the major endpoint assessed at age 12 months by a Traveling Vision Examiner.
We are currently in a continuation of this project (beyond 5 years) in order to assess which of these patients have glaucoma or glaucoma suspect at age 10.5 years. Our goal is to understand which type of initial optical correction, an IOL or a CL, results in the best long-term visual outcome following unilateral congenital cataract surgery during infancy. Our central hypothesis is that primary IOL implantation will result in a better visual outcome. The rationale for this proposal is that final visual acuity cannot be determined by 5 years of age and the recommendation for early treatment can only be substantiated by adequate long-term assessment in this unique cohort. We chose a follow-up to age 10.5 years because it will provide a more accurate assessment of visual acuity and will allow us to diagnosis most cases of glaucoma.
69 studies on the registry are indexed under Aphakia; 6 are open to participants now.
This study's enrollment of 114 is above the median of 103 across 52 interventional studies indexed under Aphakia.
Browse Aphakia studies →Stanford University is the lead sponsor of 2,168 studies on the registry; 431 are open to participants now.
Of its 267 completed or terminated interventional studies of FDA-regulated products, 207 (78%) have results posted.
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You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Contact lens correction of aphakia INTERVENTION: use of an external contact lens (CL) to correct the large hyperopic refractive error produced by surgically extracting the natural cataractous lens. As the eye grows, the refractive error changes and the power of the CL can be changed accordingly.
Device: Contact lens correction of aphakia
Intraocular lens implantation INTERVENTION: At the time of surgery to remove the cataractous natural lens, an intraocular lens was implanted to correct the large hyperopic refractive error induced by the cataract surgery.
Device: Intraocular lens implantation
optical correction of infant surgical aphakia with Contact lens
Also known as: Silsoft aphakic contact lens, rigid gas permeable contact lens
optical correction of surgical aphakia with intraocular lens
Also known as: Alcon SA60AT, Alcon MA60AC
Visual Acuity
Visual acuity was measured by standard objective testing procedures at 12 months of age. Monocular grating acuity was assessed by the traveling examiner with the Teller Acuity Cards. This test uses cards with black-on-white lines of varying widths and a set distance apart in a square with fixed dimensions, so the thinner the lines, the more there will be on any given card (cycles/cm). The ability to see thinner lines indicates better vision. The cards with lines are presented simultaneously with a gray card and the child's visual attention is noted. It is presumed that the child will preferentially look at the card with the stripes as it is more interesting. When the lines are too thin and close together so as to be indistinguishable from the gray card, no preferential looking will be noted. The card with the thinnest lines that the child will look at is recorded as the best visual acuity in logMAR units.
Time frame: Phase 1 - Age 12 months
Visual Acuity - Subjective Assessment at Age 4.5 Years.
Visual acuity estimates were standardized by using the Electronic Visual Acuity Tester (EVAT) at each clinical site. The IATS patients were tested at 4.5 years of age allowing the use of the HOTV recognition acuity test. The Amblyopia Treatment Study protocol for presentation and determination of best corrected visual acuity was followed. Monocular visual acuity was evaluated using single letter optotypes with surround bars presented on the EVAT. The staircase procedure of the ATS projects was followed as this has documented success and reliability with this age group. In order to familiarize the subjects with the HOTV matching test, this test was introduced at the 4.0 year visit and the 4.25 year visit by experienced site personnel.
Time frame: Phase 2 - Age 4.5 Years
Visual Acuity - Subjective Assessment at Age 10 Years.
Visual acuity estimates were standardized by using the Electronic Visual Acuity Tester (EVAT) at each clinical site. The IATS patients were tested at 10.5 years of age allowing the use of the electronic early treatment diabetic retinopathy study (E-ETDRS) testing protocol. LogMAR typically ranges from -0.3 (20/10 vision on the Snellen chart) to 1 (20/200 vision).
Time frame: Phase 3 - Age 10.5 Years
Percent of Patients With 1 or More Intraoperative Complications at Cataract Surgery
Percent of Patients with 1 or More Intraoperative Complications at Cataract Surgery
Time frame: Cataract surgery immediately after enrollment
Percent of Patients With 1 or More Adverse Events
Time frame: Study enrollment to age 5 years
Parenting Stress
The PSI is a 120-item validated self-report measure of parenting stress. PSI is a continuous scale measuring stress with a range of 131 (low stress) to 320 (high stress); the average person's stress scores are between 188 and 252.
Time frame: Phase 1 - 3 months post surgery
Adherence to Occlusion Therapy
Parental report of the number of hours children wore an patch to occlude the fellow eye.
Time frame: Phase 1 - 12 months follow-up
Parenting Stress
The PSI is a 120-item validated self-report measure of parenting stress. PSI is a continuous scale measuring stress with a range of 131 (low stress) to 320 (high stress); the average person's stress scores are between 188 and 252
Time frame: Phase 1 - Age 12 Months
Recruitment 12/23/04 to 01/16/09 at 12 medical clinics.
| Milestone | Aphakic Contact Lens | Aphakic Intraocular Lens |
|---|---|---|
| Started | 57 | 57 |
| Complete first endpoint at 1 year | 57 | 57 |
| Completed | 57 | 57 |
| Not completed | 0 | 0 |
| Milestone | Aphakic Contact Lens | Aphakic Intraocular Lens |
|---|---|---|
| Started | 57 | 57 |
| Completed | 57 | 56 |
| Not completed | 0 | 1 |
| Milestone | Aphakic Contact Lens | Aphakic Intraocular Lens |
|---|---|---|
| Started | 57 | 56 |
| Completed | 55 | 55 |
| Not completed | 2 | 1 |
Visual acuity was measured by standard objective testing procedures at 12 months of age. Monocular grating acuity was assessed by the traveling examiner with the Teller Acuity Cards. This test uses cards with black-on-white lines of varying widths and a set distance apart in a square with fixed dimensions, so the thinner the lines, the more there will be on any given card (cycles/cm). The ability to see thinner lines indicates better vision. The cards with lines are presented simultaneously with a gray card and the child's visual attention is noted. It is presumed that the child will preferentially look at the card with the stripes as it is more interesting. When the lines are too thin and close together so as to be indistinguishable from the gray card, no preferential looking will be noted. The card with the thinnest lines that the child will look at is recorded as the best visual acuity in logMAR units.
| logMAR units | Aphakic Contact Lens | Aphakic Intraocular Lens |
|---|---|---|
| Visual Acuity | 0.80 (0.66 to 0.97) | 0.97 (0.80 to 1.10) |
Visual acuity estimates were standardized by using the Electronic Visual Acuity Tester (EVAT) at each clinical site. The IATS patients were tested at 4.5 years of age allowing the use of the HOTV recognition acuity test. The Amblyopia Treatment Study protocol for presentation and determination of best corrected visual acuity was followed. Monocular visual acuity was evaluated using single letter optotypes with surround bars presented on the EVAT. The staircase procedure of the ATS projects was followed as this has documented success and reliability with this age group. In order to familiarize the subjects with the HOTV matching test, this test was introduced at the 4.0 year visit and the 4.25 year visit by experienced site personnel.
| logMAR units | Aphakic Contact Lens | Aphakic Intraocular Lens |
|---|---|---|
| Visual Acuity - Subjective Assessment at Age 4.5 Years. | 0.90 (0.30 to 1.60) | 0.90 (0.40 to 1.73) |
Visual acuity estimates were standardized by using the Electronic Visual Acuity Tester (EVAT) at each clinical site. The IATS patients were tested at 10.5 years of age allowing the use of the electronic early treatment diabetic retinopathy study (E-ETDRS) testing protocol. LogMAR typically ranges from -0.3 (20/10 vision on the Snellen chart) to 1 (20/200 vision).
| logMAR units | Aphakic Contact Lens | Aphakic Intraocular Lens |
|---|---|---|
| Visual Acuity - Subjective Assessment at Age 10 Years. | 0.86 (0.30 to 1.46) | 0.89 (0.33 to 1.43) |
Percent of Patients with 1 or More Intraoperative Complications at Cataract Surgery
| percentage of patients | Aphakic Contact Lens | Aphakic Intraocular Lens |
|---|---|---|
| Percent of Patients With 1 or More Intraoperative Complications at Cataract Surgery | 11 (4 to 22) | 28 (17 to 42) |
| percentage of patients | Aphakic Contact Lens | Aphakic Intraocular Lens |
|---|---|---|
| Percent of Patients With 1 or More Adverse Events | 56 (42 to 69) | 81 (68 to 90) |
The PSI is a 120-item validated self-report measure of parenting stress. PSI is a continuous scale measuring stress with a range of 131 (low stress) to 320 (high stress); the average person's stress scores are between 188 and 252.
| units on a scale | Aphakic Contact Lens | Aphakic Intraocular Lens |
|---|---|---|
| Parenting Stress | 197.4 ± 35.7 | 231.1 ± 36.8 |
Parental report of the number of hours children wore an patch to occlude the fellow eye.
| Hours patched per day | Aphakic Contact Lens | Aphakic Intraocular Lens |
|---|---|---|
| Adherence to Occlusion Therapy | 3.92 ± 1.55 | 3.63 ± 1.68 |
The PSI is a 120-item validated self-report measure of parenting stress. PSI is a continuous scale measuring stress with a range of 131 (low stress) to 320 (high stress); the average person's stress scores are between 188 and 252
| units on a scale | Aphakic Contact Lens | Aphakic Intraocular Lens |
|---|---|---|
| Parenting Stress | 202.6 ± 34.4 | 208.3 ± 30.8 |
Collected over Ocular adverse events occurring the day after enrollment until the follow-up visit at 10.5 years of age are reported.. Non-serious events are listed at a 1% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Aphakic Contact Lens | 0/57 (0%) | 0/57 (0%) | 32/57 (56.1%) |
| Aphakic Intraocular Lens | 0/57 (0%) | 0/57 (0%) | 46/57 (80.7%) |
| Event | Aphakic Contact Lens | Aphakic Intraocular Lens |
|---|---|---|
| Lens reproliferation into visual axisEye disorders | 2/57 | 23/57 |
| Pupillary membraneEye disorders | 2/57 | 16/57 |
| CorectopiaEye disorders | 1/57 | 16/57 |
| GlaucomaEye disorders | 9/57 | 11/57 |
| Glaucoma suspectEye disorders | 11/57 | 5/57 |
| Contact lens related adverse eventEye disorders | 10/57 | 0/57 |
| Vitreous hemorrhageEye disorders | 2/57 | 5/57 |
| HyphemaEye disorders | 1/57 | 4/57 |
| Retinal hemorrhageEye disorders | 2/57 | 3/57 |
| Retained cortexEye disorders | 2/57 | 3/57 |
| Age, Continuous(months) | Aphakic Contact Lens | Aphakic Intraocular Lens | Total |
|---|---|---|---|
| mean/sd | 2.4 ± 1.6 | 2.5 ± 1.6 | 2.5 ± 1.6 |
| Age, Customized(participants) | Aphakic Contact Lens | Aphakic Intraocular Lens | Total |
|---|---|---|---|
| 28 - 48 days | 25 | 25 | 50 |
| 49 days - 3.0 months | 17 | 15 | 32 |
| 3.1 - 5.0 months | 9 | 10 | 19 |
| 5.1 - 6.8 months | 6 | 7 | 13 |
| Sex: Female, Male(Participants) | Aphakic Contact Lens | Aphakic Intraocular Lens | Total |
|---|---|---|---|
| Female | 32 | 28 | 60 |
| Male | 25 | 29 | 54 |
| Ethnicity (NIH/OMB)(Participants) | Aphakic Contact Lens | Aphakic Intraocular Lens | Total |
|---|---|---|---|
| Hispanic or Latino | 9 | 10 | 19 |
| Not Hispanic or Latino | 48 | 47 | 95 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Race (NIH/OMB)(Participants) | Aphakic Contact Lens | Aphakic Intraocular Lens | Total |
|---|---|---|---|
| American Indian or Alaska Native | 1 | 0 | 1 |
| Asian | 2 | 1 | 3 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 3 | 5 | 8 |
| White | 49 | 48 | 97 |
| More than one race | 0 | 3 | 3 |
| Unknown or Not Reported | 2 | 0 | 2 |
| Region of Enrollment(participants) | Aphakic Contact Lens | Aphakic Intraocular Lens | Total |
|---|---|---|---|
| United States | 57 | 57 | 114 |
| Private Insurance(participants) | Aphakic Contact Lens | Aphakic Intraocular Lens | Total |
|---|---|---|---|
| No | 20 | 24 | 44 |
| Yes | 37 | 33 | 70 |
| Qualified for Medicaid(participants) | Aphakic Contact Lens | Aphakic Intraocular Lens | Total |
|---|---|---|---|
| No | 40 | 35 | 75 |
| Yes | 17 | 22 | 39 |
11 further baseline measures are reported on the registry.
PDFs hosted by the registry, ClinicalTrials.gov.
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