I perform multifocal intraocular lens implantation in selective children 6 year or older for pediatric cataract as major part of the growth of the globe is already achieved. I prefer bilateral multifocal intraocular lens implantation. In unilateral cases congenital or developmental more chances of amblyopia so multifocal IOL is best avoided.

I would generally recommend against using multifocal IOLs in children under age 15-16 years at this time for two reasons: 1) in the potentially amblyopia age group- say under 6-8 years- the loss of image sharpness and contrast sensitivity at all focal lengths may, at least theoretically, have negative effects on vision development. In addition, retinoscopic refraction or confirmation of refraction is extremely difficult in the presence of an IOL which will reduce over refraction accuracy and may also lead to some amblyopia. But even in older children, since the lenses work optimally only if the final distance refraction is within a very narrow range of emmetropia, since the changes in final refraction caused by growth of the eye during puberty prevent predicting the final refraction, even within 1D, until very late, the benefits of the lens in terms of spectacle independence in children can easily be negated by refractive changes during the early teen years. Thus leaving all the disadvantages of the lenses without the advantages.

@ dr Del Monte.

Thank you for your answer. I would like to ask you: is your recommendation different in mono or bilateral congenital cataract?

In unilateral cataract in children it is best to implant monofocal IOL as chances of development of amblyopia remains high where as bilateral cataract we implant multifocal IOLs selectively.