We would like to comment on 2 recent articles: the editorial entitled “The Final Frontier: Pediatric Intraocular Lens Power,” by Hoffer and associates, and the article entitled “Accuracy of Intraocular Lens Power Calculation Formulae in Children Less than Two Years,” by Kekunnaya and associates, published recently in the Journal.
We read with interest both articles dealing with the issue of pediatric lens power calculations and pediatric cataract surgery. Although the treatment of the subject was quite thorough, one very important aspect of this problem, as well as some recent developments in intraocular lens (IOL) technology, were not discussed. No matter how accurate the preoperative or intraoperative biometry may be, it is almost a given that as a child matures, the refractive status of the eye will change, and it can change unpredictably. For an IOL to correct vision accurately at all time points, current IOL technology simply does not work.
A way to overcome these maturational changes lies in the use of adjustable lenses, such as the multicomponent IOL first described by Werblin during the 1999 Barraquer lecture. The multicomponent IOL (now manufactured by InfiniteVision Optics [Paris, France]) theoretically allows the surgeon to update the refractive status of the eye over time by surgically enhancing in the short or in the long term (minimally invasive procedure) one of the lens elements. So far, this concept has been tested in only a few adult human subjects. The exchange concept allowed a refractive surprise of 2 diopters to be reduced to 0.25 diopter residual refractive error. In theory, this methodology could address the ever-changing refractive needs of the pediatric cataract patient.