IOL survey

🔍 Help Shape the Global Picture of Paediatric IOL Implantation!

On 29th November 2024, the world marked 75 years since the first intraocular lens (IOL) was implanted following cataract surgery in a human patient, a landmark moment in the history of vision care.

WSPOS is launching a global survey on paediatric IOL implantation, with the goal of making it the largest of its kind, as part of our ongoing efforts to advance paediatric ophthalmology.

Your expertise can help shape clinical understanding, guide future discussions, and contribute to international research.

The survey is now open – don’t miss your chance to take part!

IOL survey

General Information

In which country or region do you primarily practise? *

How old are you? *

< 30

30-40

40-50

50-60

60-70

< 70

Are you: *

Male

Female

Non-binary

I’d prefer not to reveal this information

Are you an: *

Ophthalmologist

Optometrist

Orthoptist

Allied Healthcare Professional

Other

Please Specify *

If you are an ophthalmologist, do you have subspecialty training in paediatric ophthalmology or any other ophthalmic subspecialty?

Yes (If yes, please list out your specialty)

Please list out your specialty *

If you are an optometrist, are you paediatric trained? *

Yes

For how many years have you been practising in the field of eye care? *

I’m currently in medical school

I’m currently in training

0 - 5 years

6 - 10 years

11 - 20 years

21 - 30 years

Over 30 years

Not applicable

In what type of medical setting do you primarily work? *

Public hospital

Private hospital / clinic

Academic or research institution

NGO or charitable organisation

Retired or do not currently perform surgery

Other

Please Specify *

PRE-OP CONSIDERATIONS

What is your primary indication for paediatric IOL implantation? *

Myopia and astigmatism

Congenital or developmental cataracts, including traumatic lens damage

Secondary lens implantation

Glaucoma management

Retinal detachment

What according to you are the three key criteria in assessing suitability for paediatric IOL implantation? *

Parental preference

Axial length, corneal curvature, and compliance with postoperative care

Availability of advanced IOL technology

Lack of other ocular morbidity

Patients’ and parents’ ability to handle contact lenses

Contact lens availability & / cost

Aphakic glasses availability & / cost

. Please select the 3 options that you feel are most appropriate here.

What according to you is the most accurate method for biometry in paediatric patients? *

Handheld keratometry with USS axial length

Optical biometry when feasible, supported by manual methods as needed

Clinical estimation based on age

Ocular biometry for children who are compliant and for those who are not, handheld keratometry and USS axial length under sedation / anaesthesia.

According to you, how have recent advancements in IOL design benefited paediatric patients? *

Made surgeries faster and more affordable

Improved flexibility and biocompatibility for younger eyes

Eliminated the need for follow-up care

No significant advancements

. Please select the option that you feel is most appropriate here.

What according to you are the current barriers to IOL implantation in paediatric patients globally? *

Lack of surgical expertise

Limited access to anaesthesia and necessary ophthalmic equipment for young children

Lack of appropriate IOL designs for paediatric eyes

All of the above

At what age is an IOL implantation in Unilateral cases advisable in your opinion? *

Always

After 1 year of age

After 2 years of age

Other

Please Specify *

At what age is an IOL implantation in Bilateral cases advisable in your opinion? *

Always

After 1 year of age

After 2 years of age

Other

Please Specify *

How do you manage the impact of eye growth on IOL power selection in paediatric patients under the age of 2 years? *

Use adult formulae without adjustment

Select a lens power that accounts for anticipated myopic shift as the eye grows

Choose the highest available power

Leave the child aphakic and consider secondary IOL later

How do you manage the impact of eye growth on IOL power selection in paediatric patients over the age of 2 years but under the age of 8 years? *

Use adult formulae without adjustment

Select a lens power that accounts for anticipated myopic shift as the eye grows

Choose the highest available power

Leave the child aphakic and consider secondary IOL later

How do you manage the impact of eye growth on IOL power selection in paediatric patients over the age of 8 years? *

Use adult formulae without adjustment

Select a lens power that accounts for anticipated myopic shift as the eye grows

Choose the highest available power

Leave the child aphakic and consider secondary IOL later

How according to you does IOL implantation affect amblyopia management in children? *

It eliminates the need for amblyopia therapy

It may still require ongoing amblyopia management, including patching or vision therapy

It worsens amblyopia

It has no impact on amblyopia treatment

IOL

Do you recommend the use of Multifocal or Toric IOLs in paediatric patients? *

No, I do not recommend their use in children

Yes, but only in very specific cases, where benefits outweigh risks

Yes, I recommend them quite routinely

No, They are experimental and not yet widely available

What is your opinion on the use of non-diffractive extended depth of focus IOLs in children? *

Should not be used

Should be used only in children older than 10 years of age

I would want more evidence before I use them in children

They are a great way of tackling reading vision difficulties in children

What is your preferred IOL material / design in children below the age of 2 years? *

A single piece hydrophobic acrylic IOL

A three piece hydrophobic acrylic IOL

A single piece hydrophilic acrylic IOL

Hydrophobic Bag in the lens

What type of IOL do you implant in your patients?

1 piece foldable acrylic IOL

3 piece foldable acrylic IOL

1 piece PMMA IOL

Other

Please Specify *

What according to you is the consensus on the use of multifocal IOLs in paediatric patients under the age of 2 years? *

Widely accepted as a first-line option

Not recommended due to lack of evidence

Only used in specific cases with parental consent

Still under research and not yet a standard practice

What according to you is the consensus on the use of multifocal IOLs in paediatric patients under the age of 8 years ? *

Widely accepted as a first-line option

Not recommended due to lack of evidence

Only used in specific cases with parental consent

Still under research and not yet a standard practice

INTRA-OP CONSIDERATIONS

What according to you are the recommended surgical capsulotomy modifications for paediatric IOL implantation? *

Standard adult anterior capsulorhexis

Posterior capsulotomy with anterior vitrectomy

Posterior capsulorhexis

Two incision push pull rhexis (TIPP) for anterior , or posterior capsule or both

Laser-assisted anterior capsulotomy

What is your preferred type of anaesthesia for paediatric IOL implantation? *

General anaesthesia

Local anaesthesia

Topical anaesthesia

Sedation only

According to you, what is the ideal position for an IOL to be placed in the child’s eye? *

In the sulcus

In the capsular bag

In the capsular bag with posterior optic capture

In the sulcus with double optic capture

I prefer other ways of IOL stabilisation

Do you always remove the posterior capsule during paediatric IOL surgery? *

Yes, to prevent posterior capsular opacification

For any child under 5 years of age

No, it is unnecessary in most cases

Only in infants under 2 years old

Only in children under 8 years of age

How do you suture the corneal wound ? *

I use mono nylon 10/0

I suture with 10/0 vicryl

I do not suture

What intraocular substances / medications do you routinely use for your cases? *

Viscoelastics

Viscoelastics and Intraocular antibiotics

Viscoelastics and miotic substance

BSS only

POST-OP MANAGEMENT

What is your typical postoperative medication regimen for paediatric IOL implantation? *

Antibiotics only

Steroid drops and antibiotics

Oral Pain management medication only

Non-steroidal anti-inflammatories

I do not usually recommend any medication after a paediatric IOL implantation

Please select ALL the options that you feel are appropriate here.

What follow-up strategies are effective for ensuring optimal visual outcomes in children? *

Regular vision tests and amblyopia therapy as needed

Annual check-ups only

Use of adult follow-up protocols

Only address complications

When according to you is secondary IOL implantation appropriate in aphakic paediatric patients? *

I never leave the child aphakic

Only after the child is above one year old

Only for children over 5 years old

Only when contact lenses or aphakic glasses are not tolerated

When ocular biometry parameters reach near adult size (axial length, corneal diameter)

POST-OP COMPLICATIONS

What according to you is the most common postoperative complication in paediatric IOL implantation? *

Retinal detachment

Visual axis opacification

Secondary glaucoma

Astigmatism due to excessive corneal scarring

Endophthalmitis

How do you manage secondary glaucoma post IOL implantation in children? *

It rarely occurs, so no special measures are needed

Early detection and monitoring of intraocular pressure

Using glaucoma medications pre-emptively

Only through surgical intervention

What signs indicate IOL decentration or dislocation in children? *

Blurred vision or astigmatic refractive surprise

Redness and swelling

Pain and discomfort

No visible signs

In case of secondary posterior capsule opacification, how often do you perform YAG laser? *

Always

Yes, but only after 4 years of age

Never, I only perform primary posterior casulorhexis or capsulotomy

Yes, but only after 8 years of age

How do you look for glaucoma postoperatively in a young child ? *

Non-contact tonometry

Based on myopic shift of refraction

Examination under anaesthesia to check IOP

Rebound tonometry / non-contact tonometry

If you have any additional thoughts, comments, questions or concerns regarding Paediatric IOL implantation, please use this space to let us know

If you are human, leave this field blank.

Contact

IOL survey

🔍 Help Shape the Global Picture of Paediatric IOL Implantation!

General Information

PRE-OP CONSIDERATIONS

IOL

INTRA-OP CONSIDERATIONS

POST-OP MANAGEMENT

POST-OP COMPLICATIONS

Thank you, as always, for your ongoing support of WSPOS and for being part of our global community dedicated to advancing paediatric vision care.