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Implanted lens or contact lens after unilateral congenital cataract surgery?

NEW YORK (Reuters Health) – In infants having surgery for a unilateral congenital cataract, the short-term costs are lower with contact lenses instead of an implanted intraocular lens and glasses, a new study shows.

But Dr. Edmund R. Becker, a researcher on the study, told Reuters Health by email that while costs “are certainly influential, selecting the approach that has the best outcome is much more important to society and the individual patient especially in a study like ours related to the lifetime eyesight of an infant.”

“However,” he added, “like many medical conditions where there are alternative methods of treatment, it’s not apparent which approach will work best without many years of follow-up study.”

Dr. Becker of the Emory School of Public Health in Atlanta, Georgia and colleagues conducted a retrospective cost analysis using data on participants in the randomized IATS trial.

The original trial involved 114 infants who had cataract surgery and received either an intraocular lens or contact lenses. There was no significant difference in the visual outcomes at one year, and no indication that one treatment had a clear advantage over the other.

Given that equivalence, say the investigators, it’s “important that resource use considerations also be evaluated.”

To do so, the team examined the mean cost of cataract surgery, additional surgeries, examinations, and supplies used, and reported their findings online October 8 in Ophthalmology.

The mean cost in the first year was $10,726 in the contact lens arm and $14,752 in the intraocular implant arm. The implant, therefore, was 37.5% more expensive.

But the difference was a “negligible” 9% greater in implant patients who required no additional surgeries.

The greatest cost differences were in fact due to the increased number of membranectomies required in the implant vs the contact lens patients (34 vs 6). The next largest difference was due to the average cost of contact lenses ($1600) compared to glasses ($535).

A complicating factor is that many insurance companies cover implanted lenses but not the contact lenses. That, the authors say, means that “although societal costs of intraocular lens implantation may have been higher, the costs to a patient’s family may be lower with…implantation if contact lens costs are not covered by their medical insurance.”

They also note that while there was no difference in efficacy at 12 months between the methods, longer follow-up may reveal a difference. In addition, ongoing costs as the children grow may alter the expenses associated with a particular approach.

The team intends to follow these children until they’re five years old, “to determine the long-term direct and indirect costs of each treatment.”

Commenting on the use of contact lenses, coauthor Dr. Scott R. Lambert, also of Emory University, told Reuters Health by email, “Most parents become quite proficient at inserting and removing the contact lenses. However, there is an occasional child that doesn’t tolerate contact lenses. Some parents choose to not use the contact lenses because of the logistical problems involved with keeping the contact lenses in their child’s eye.”

Dr. Lambert, chairman of the Infant Aphakia Treatment Study, added, “Working parents have expressed to me the difficulty of having a day care center manage their child’s contact lens. Some parents have told me that this is the reason they chose to have an intraocular lens implanted in their child’s eye. Day care centers are generally more willing to manage glasses than contact lenses.”

SOURCE: http://bit.ly/WHdH6Q

Ophthalmology 2012.