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Scott McClatchey - Pediatric IOL Choice

Updated: Jun 14, 2022

I have no conflicts of interest.

The opinions expressed in this presentation are solely those of the author, and do not reflect the official policy or position of the Department of the Navy, the Department of the Defense, or the US Government.

I am an employee of the U.S. Government. This work was prepared as part of my official duties. Title 17, U.S.C. §105 provides that copyright protection under this title is not available for any work of the U.S. Government. Title 17, U.S.C., §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

1. For adults, the usual goal of IOL power choice is emmetropia. For children, the goals are two-fold: good vision and minimal refractive error in adult life. This requires management of both amblyopia and the ever-changing refractive error with age.

First, gather data: age, axial length, cornea curvature, refraction of the other eye, and amblyopia management considerations. For young children, biometry requires anesthesia, often precluding the most accurate methods; the initial postop refractions usually have a greater error from predicted than seen in adult cataract patients.

2. Myopic shift in pseudophakic children varies with age:

Analysis of long-term refractions of aphakic, pseudophakic and calculated “aphakic refractions” of normal eyes shows a myopic shift from infancy to adulthood of 10 diopters (D), due to the normal growth of the eye.

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