Cost of Intraocular Lens versus Contact Lens Treatment after Unilateral Congenital Cataract Surgery: Retrospective Analysis at Age 1 Year

Abstract

Purpose To describe the differences in treatment costs for infants randomized to contact lens correction versus primary intraocular lens (IOL) implantation after unilateral cataract surgery in The Infant Aphakia Treatment Study. Design Retrospective cost analysis of a prospective, randomized clinical trial based on Georgia Medicaid data and the actual costs of supplies used. Participants The Infant Aphakia Treatment Study (IATS) is a randomized, multicenter (n=12) clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with unilateral congenital cataract. Intervention Infants underwent cataract surgery with or without placement of an IOL. Main Outcome Measures The mean cost of cataract surgery, and all additional surgeries, examinations, and supplies used up to 12 months of age. Results The mean cost of treatment for a unilateral congenital cataract with primary IOL implantation was $14,752 versus $10,726 with contact lens correction. The initial cataract surgery accounted for approximately 50% of the treatment costs for both groups. Contact lens costs accounted for 15% ($1,600/patient) in the aphakic group whereas glasses costs only represented 4% ($535/patient) in the IOL group. The increased costs in the IOL group were primarily due to the higher cost of cataract surgery in this group ($7,302 vs. $5,357) and the cost of additional operations. Conclusions For IATS patients up to 12 months of age, cataract surgery coupled with IOL implantation and spectacle correction was 37.5% (about $4000) more expensive than cataract surgery coupled with contact lens correction.

Complications in the First 5 Years Following Cataract Surgery in Infants With and Without Intraocular Lens Implantation in the Infant Aphakia Treatment Study

“…(2–7) Theoretical advantages of primary IOL implantation at the time of cataract surgery in infants include having a constant, albeit partial, optical correction during the early years of visual development, the ability to place the IOL within the capsular bag and the avoidance of contact lens use with the associated cost and effort required of the child’s caregivers. (8, 9) Advantages of leaving the baby aphakic and visually rehabilitating the eye with a contact lens include the ability to change the contact lens power as needed to keep up with the rapidly growing eye’s refractive needs, not subjecting the baby to the increased rate of complications and subsequent need for additional surgeries associated with IOL implantation and not requiring spectacle wear during the first few years of life. (10–18)…”

Comparison of Contact Lens and Intraocular Lens Correction of Monocular Aphakia During Infancy

“…9 However, significantly more intra- and postoperative adverse events and additional intraocular operations occurred in the IOL group. 7 Also, the mean cost of treatment was 38% higher in the IOL group 10 and parenting stress was higher among caregivers in the IOL group 3 months after cataract surgery. 11 This paper reports the visual acuity outcomes using the HOTV test at age 4.5 years and the clinical findings at age 5 years by treatment group.…”

“…7–9 Additional intraocular surgeries are often required to treat these adverse events which are associated with risks, costs and parental stress. 10,11 Furthermore, the rapid and somewhat unpredictable growth of infant eyes makes it difficult to select the ideal IOL power to implant. 12,13 Although it is generally agreed that cataract surgery during early infancy is associated with the best visual outcomes, 14–16 it remains undetermined whether primary IOL implantation is advisable in this age group.…”

“…We have previously reported the design of the clinical trial, baseline findings and clinical outcomes at age 12 months. 17–19 7,9,10,13,20–23 . Grating acuity was not significantly different between the two treatment groups.…”

Cost of Intraocular Lens versus Contact Lens Treatment after Unilateral Congenital Cataract Surgery in the Infant Aphakia Treatment Study at Age 5 Years

“…It was also noted that the average cost of supplies was three times higher in the CL group ($1600 per patient) versus the IOL group ($535 per patient). 4 …”