Strabismus Prevalence Not Affected by Aphakia Management Strategy in Children

Little boy making eyes strabismus
Little boy making eyes strabismus
Researchers conduct a secondary analysis of the Infant Aphakia Treatment Study to determine strabismus rates 10 years after monocular cataract surgery.

Strabismus, especially exotropia, is common 10 years after infant monocular cataract surgery regardless of whether primary intraocular lenses (IOLs) or contact lenses were used for aphakia management, according to research published in the Journal of the American Association for Pediatric Ophthalmology and Strabismus.

Researchers conducted a secondary analysis of 109 participants from the Infant Aphakia Treatment Study (IATS; Identifier: NCT00212134) 10 years after they underwent unilateral cataract surgery as infants. All children underwent ocular alignment assessment and strabismus quantification. Visual acuity (VA) was compared between children with and without strabismus.

Overall, 88% of study participants had strabismus at 10.5 years of age. Exotropia was the most common form among participants (45%) and 48% of the children underwent strabismus surgery. Strabismus prevalence was almost identical in children treated with IOLs and contact lenses (82 vs 83%; P =.8). Children with microtropia (deviation of <10Δ; 35%) or orthophoria experienced more favorable VA outcomes compared with participants with strabismus (0.56 vs 1.30 logarithm of the minimum angle of resolution (logMAR); P =.0003). A total of 70% of patients with a VA of 20/40 (Snellen) had orthophoria or microphoria compared with 38% of children with a VA worse than 20/40 (P =.0003). 

Strabismus is common 10 years following unilateral infantile cataract surgery, irrespective of aphakic management,” the researchers said. “Better alignment was associated with better visual acuity in the affected eye. The delayed emergence of exotropia with longer follow-up should lead to caution in managing early esotropia with strabismus surgery in these children.”

Study limitations include a small sample size and a lack of randomization to contact lens or IOLs. 


Bothun ED, Shainberg MJ, Christiansen SP, et al. Long-term strabismus outcomes after unilateral cataract surgery in the Infant Aphakia Treatment Study. J AAPOS. Published online July 14, 2022. doi: 10.1016/j.jaapos.2022.05.003