In this edition of BJO, Shenoy et al write of their experience with secondary intraocular lenses (IOLs) placed in aphakic children: ‘Refractive outcomes and prediction error following secondary intraocular lens implantation in children: a decade long analysis’. The authors analysed records of 104 children less than 16 years of age, who underwent secondary IOL implantation for aphakia following congenital cataract surgery. The relationship between age at secondary IOL implantation, axial length, keratometry readings and the difference between final refraction and the predicted value (prediction error or PE) was investigated. Prediction error in the enclosed study was affected by the biometry method as well as the age of the patient at the time of secondary IOL placement. Age-based refraction targets are frequently used in paediatric cataract surgery. The current study reviews the possible sources of error in the final outcome. Additionally, it might be useful to look at some of the other present and future challenges related to the use of IOL in children.

Less than a decade after Sir Harold Ridley’s first IOLs were implanted in adults, Dr Edward Epstein, a South African, and Prof D Peter Choyce of the UK, successfully implanted these lenses in children.1 It would take another 20-some years before the Federal Drug Administration of the USA approved the IOL for use in adults, an approval that still does not extend to the use of IOL in children. Nevertheless, IOL implantation after cataract removal in children, especially over the age of two years, has become commonplace.

If one speaks only of prevalence, paediatric cataract pales in comparison with that of adults. However, if we take into consideration the burden of blindness in terms of years impacted, then each case of preventable paediatric blindness due to cataract weighs heavily on society. The major barrier to successful …