PURPOSE:To evaluate change in astigmatism after postoperative healing was completed through 5 years following pediatric lensectomy with primary IOL implantation DESIGN: Post hoc analysis of a prospective cohort study PARTICIPANTS: Children <13 years of age who had early postoperative (60 days to 1.5 years postoperatively) and 5-year refraction data (4-6 years postoperatively). MAIN OUTCOME MEASURE:Change in astigmatism. METHODS:Change in astigmatism was calculated in 2 ways: (1) using clinical notation for astigmatism without regard to axis change and (2) using cylinder conversion to power vectors (J0, J45) to include the impact of axis changes. With conversion back to clinical notation, we calculated the change in the astigmatic component of the refraction between the early postoperative exam and 5 years. RESULTS:Among 213 children, mean (SD) age was 5.4 (3.2) years; among 266 study eyes, 153 (58%) were from bilateral cases. Mean clinical astigmatism was + 1.24 D (95% confidence interval [CI] 1.11-1.38 D) at early postoperative exams and + 1.61 D (95% CI: 1.47-1.75 D) at 5 years (mean change: +0.37 D, 95% CI: 0.26 to 0.48 D). Using power vector conversions, the mean change in astigmatism was 1.06 D (95% CI: 0.95-1.18 D). The proportions of children with astigmatism > 0.50 D postoperatively (N = 185) who had a change ≥ 1.00 D and ≥ 2.00 D were 47% (95% CI: 40%-55%) and 16% (95% CI: 11%-22%), respectively. Change in astigmatism was not associated with age at lensectomy (0.00 D per 1 year older, 95% CI: -0.04 to 0.04, p = .92) when analyzed with power vector conversions. CONCLUSIONS:When disregarding axis change, there was less than 0.50D increase in clinically determined astigmatism 5 years after cataract surgery. However, analysis of astigmatism change using power vectors with conversion back to clinical notation (accounting for change in magnitude and axis), about 1 in 6 eyes had a change of 2.00 D or more in the astigmatic component of their refraction. This suggests that toric IOLs may not be appropriate for pediatric cataract surgery.

PURPOSE:To describe strabismus surgery reoperation rates and risk factors for children and adults in the United States. DESIGN:Retrospective cohort analysis of health care data. PARTICIPANTS:A total of 79 424 597 patients in the IRIS® Registry (Intelligent Research in Sight). METHODS:Description of strabismus, strabismus surgery, and reoperations from 2013 to 2022. Multivariable models of factors associated with a reoperation within 1 year were developed. MAIN OUTCOME MEASURE:Reoperation rates at 1, 3, and 5 years were calculated for strabismus surgeries performed from 2013 to 2017. RESULTS:A total of 1 951 001 patients (2.46%) had strabismus (2.68% among male patients and 2.29% among female patients, difference = 0.39%, 95% confidence interval [CI], 0.38-0.40; P < 0.001). Diagnoses included esotropia (17.8%), exotropia (21.8%), hypertropia (13.5%), and paralytic strabismus (16.1%). At least 1 surgery was performed in 125 984 patients; 79% of reported codes were for horizontal surgery; 58% of cases were performed in patients aged less than 20 years. Reoperation rates were 5.61% (95% CI, 5.43-5.81), 8.53% (8.30-8.76), and 10.13% (9.88-10.38) within 1, 3, and 5 years, respectively. At each time point, reoperation rates were lowest for children 6 to 19 years of age. In multivariable models, the odds ratio (OR) for a strabismus reoperation within 1 year was lower in non-Hispanic Black or African American patients (0.82, 95% CI, 0.73-0.92) compared with non-Hispanic White patients. The risk for reoperation did not differ between White patients and patients of other races and ethnicities. When compared with Medicare Part B, ORs for a reoperation were lower for patients with commercial insurance (0.72, 95% CI, 0.64-0.80) and Medicaid (0.82, 95% CI, 0.72-0.94). The ORs of a reoperation when compared with the Northeastern United States were significantly lower in the Midwest (0.75), South (0.88), and the West (0.73). DISCUSSION:Strabismus is uncommonly reported in clinical practice. The odds of undergoing a reoperation after statistical adjustment differed significantly by race and ethnicity, insurance, and region of the United States. Reasons for these differences deserve future inquiry. Reoperation rates generally increased with duration of follow-up for all age groups, suggesting there is an ongoing need for strabismus care for patients of all ages. CONCLUSIONS:These findings may serve as benchmarks for surgical training, measuring physician performance, patient counseling, and development of risk adjustment tools. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found after the references.

We report demographics and post-lensectomy outcomes in 30 children (39 eyes) with Down syndrome and cataract. Mean age at first lensectomy was 3.0 years (range, 0.04-12.9); 16 of 30 patients (53%) had lensectomy before 12 months of age. The 5-year cumulative incidence of glaucoma-related adverse events was 38% (95% CI, 0%-69%); of retinal detachment, 3% (95% CI, 0%-9%). The median myopic shift in children with refractive data at 5 years was -10.00 D (IQR, -12.50 to -8.38 D) in 11 aphakic eyes and -1.50 D (IQR, -3.00 D to -0.25 D) in 7 pseudophakic eyes. The period prevalence (combining cases at baseline with those developing the condition during follow up) of strabismus by 5 years was 81% (95% CI, 40%-94%), and of nystagmus, 68% (95% CI, 41%-83%). In 11 children able to perform optotype testing, 2 of 12 study eyes (17% [95% CI, 3%-56%]) had visual acuity of 20/60 or better at 5 years.

SIGNIFICANCE:School-based vision programs can improve children's access to vision care in underserved areas. Little is known about the need for eyeglasses among students not wearing them compared with the need for prescription updates. A greater understanding of prescription trends will help identify gaps in care and inform resource allocation. PURPOSE:We aim to describe the baseline eyeglasses-wearing status and the need for new and updated eyeglasses prescriptions for students participating in a large school-based vision program. METHODS:This cross-sectional analysis examined retrospective data from the 2016-2022 operations of the Helen Keller Intl's United States Vision Program. Included students were pre-kindergarten to grade 12 and had received a school-based eye examination after a failed vision screening. Data extracted included student demographics, self-reported eyeglasses-wearing status, lensometer measurement, refractive error, and eyeglasses prescription. Multivariate logistic regression models were implemented to understand the factors associated with eyeglasses prescription and prescription change, defined as at least 0.50 D spherical equivalent change or 0.75 D cylindrical change between lensometer measurement and final prescription. RESULTS:Of the 97,069 students included in the analysis, 27.3% of students were self-reported current wearers of eyeglasses, 30.5% were inactive wearers of eyeglasses, and 42.2% were nonwearers. Overall, 72,784 (75%) students were prescribed eyeglasses. Among them, 48,600/72,784 (67%) were not current wearers. On multivariate logistic regression, students were more likely to be prescribed eyeglasses if they were in higher grade levels (grades 11 to 12 compared with grades 1 to 2, odds ratio: 2.39, 95% confidence interval: 2.17 to 2.64) and were current wearers (odds ratio: 8.82, 95% confidence interval: 8.24 to 9.43). Among current wearers, students with at least 6 D myopia and at least 3 D astigmatism had the greatest likelihood of spherical equivalent and cylindrical prescription change, respectively. CONCLUSIONS:Within a large sample of students enrolled in a school-based vision program, more than half reported having eyeglasses. However, two in three students who needed eyeglasses were not wearing them. The need for eyeglasses was notable across all age groups, especially among higher grade levels and those with more severe refractive error. Most students who failed a vision screening while wearing eyeglasses needed an eyeglasses prescription update.

Purpose Treatment of myopia has been informed by more than 3 decades of clinical trials and other observations. However, controversies regarding myopia control remain, such as when to stop treatment and what is the long-term efficacy of treatment. This perspective aims to describe clinically relevant and current controversies regarding myopia treatment. Design Perspective. Methods We reviewed clinical trial data and other studies regarding myopia control therapies. Results Controversies in myopia treatment are related to the efficacy of low dose atropine eyedrops and new lens design spectacles to substantially reduce progression of myopia. In addition to efficacy, safety of therapies including soft contact lenses, orthokeratology and low-level red light remains a concern. The therapeutic role of outdoor time in reducing myopia progression also requires further investigation. More research is necessary to confirm treatment effectiveness, duration of required treatment, tapering schedules and when to begin and stop treatment. Conclusions Myopia management is evolving and maintaining competency in the multiple approaches poses a challenge. Key challenges include identifying high-risk children who would benefit most from treatment, limited evidence supporting the effectiveness of myopia progression control treatments in certain populations, and concerns regarding availability and cost of treatment, which may create socioeconomic barriers to access. The limitations of current methods to slow or stop myopia progression highlight the need for continuing rigorous investigation of new and improved strategies to reduce the burden of myopia.

BACKGROUND:School-based vision programs (SBVPs) can increase children's access to eye care services, yet some children have needs beyond the scope of SBVPs and require referral to community providers. We describe the referral practices of a large United States SBVP. METHODS:A retrospective, cross-sectional analysis was conducted using data from pre-Kindergarten through grade 12 students (5-22 years of age) who underwent an SBVP eye examination after a failed vision screening. Data on student demographics, refractive error, and school-level indicators of socioeconomic disadvantage were extracted. The proportion of students referred to community eye care was assessed. Mixed-effects logistic regression models were implemented to understand associations between referral status and student-or school-level characteristics. RESULTS:Of 97,107 students, 72,814 (75.0%) received eyeglasses and 13,884 (14.3%) were referred to community providers. Referrals were more common among younger students and those with greater school-level indicators of socioeconomic disadvantage. Compared with students with emmetropia, students with high hyperopia (OR = 7.21; 95% CI, 5.77-9.01) and high myopia (OR =3.70; 95% CI, 3.36-4.05) were more likely to be referred. Frequent referral reasons included refractive error (42.1%), amblyopia suspect (26.6%), and uncorrectable vision (26.1%). Nonreferred students were more likely to receive eyeglasses prescriptions (85.9% vs 9.4%). CONCLUSIONS:SBVPs can address most uncorrected refractive error within the school setting, but a substantial proportion of students need further evaluation. Young students and those with high refractive error are more likely to require referral. SBVPs may benefit from developing resources and community networks to support students' referral completion.

PURPOSE:To evaluate 5-year visual acuity (VA) outcomes by age at surgery and laterality among infants left aphakic at initial lensectomy. DESIGN:Prospective Pediatric Eye Disease Investigator Group cataract registry. PARTICIPANTS:A total of 149 infants (203 eyes; 123 with bilateral surgery) underwent surgery before 12 months of age (median, 1.8; range, 0.6-11.6 months) for nontraumatic cataract without preexisting glaucoma or anterior/posterior segment anomalies who were left aphakic. METHODS:Records were reviewed annually for 5 years after surgery. Children were grouped by age at first surgery (<2 months, 2 to <6 months, and 6 to <12 months). Analyses accounted for nonindependence of eye pairs. MAIN OUTCOME MEASURES:Mean VA and proportion of eyes with VA better than 20/200. RESULTS:Eighty-nine (60%) infants were female, 114 infants (77%) were White, 17 infants (11%) were Black, and 21 infants (14%) were Hispanic or Latino. In unilateral cases (N = 80), surgery before 2 months of age was associated with better mean VA at 5 years than with surgery between 2 and <6 months of age (0.79 vs 1.13 logarithm of the minimum angle of resolution [logMAR], difference = 0.34 [95% CI, 0.08-0.59], P = 0.01). In bilateral cases (N = 123), age at surgery was not associated with 5-year VA outcomes (P = 0.18). A larger proportion of bilaterally operated eyes had VA better than 20/200 compared with undergoing unilateral surgery before 2 months (87% vs 61%; difference = 26% [95% CI, 8%-43%]; P = 0.004) and 2 to <6 months of age (95% vs 23%; difference = 72% [95% CI, 55%-90%]; P < 0.001). CONCLUSIONS:For bilateral surgery in the first year of life, 5-year VA did not differ by age at surgery. However, for unilateral cataract, 5-year VA was better with surgery before 2 months of age compared with 2 to <6 months. These observations may inform surgical decision-making when treating a cataract in the first 2 months of life. Given the increased risk for glaucoma with early cataract surgery, the surgeon may choose a modest delay in the timing of surgery, accepting a decrease in the VA outcome for unilateral cases. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found after the references.

PURPOSE:To describe refractive error findings and associated factors in students who received school-based eye exams following vision screenings. METHODS:Cross-sectional study of pre-kindergarten through 12th grade students who failed vision screening and underwent a school-based eye exam in the Northeast region of the United States during 2016-2022. Non-cycloplegic autorefraction and visual acuity measurements were used to categorize refractive error by type and severity. Main outcomes included any refractive error (at least -0.50D myopia, +0.50 hyperopia, 1.00D astigmatism, or 1.00D anisometropia), clinically significant refractive error (CSRE; more severe refractive error with decreased vision), and refractive amblyopia risk (RAR). Multivariable mixed-effects logistic regression was used to determine student- and school-level characteristics associated with refractive error outcomes. RESULTS:Of 103,159 included students who failed screening, 95,875 (92.9%) were analyzed. Overall prevalence of any refractive error was 94.2%, with 81.7% having CSRE. Pre-kindergarten & kindergarten students had the highest prevalence of CSRE (85.7%), which dropped to 77.0% by 3rd and 4th grade before rising with each higher grade level thereafter. Prevalence of RAR was 60.9% overall and highest in pre-kindergarten and kindergarten students (73.8%). Myopia was the most prevalent refractive error, followed by astigmatism, anisometropia, then hyperopia. The odds of hyperopia, astigmatism, and anisometropia decreased with higher grade level. CONCLUSION:Over 80% of students who failed vision screening at a large school-based vision program had CSRE, and over 60% had RAR. Pre-kindergarten and kindergarten students had an especially high prevalence of RAR. Refractive error remained common in every grade level.

Minimally invasive glaucoma surgery (MIGS) refers to a group of procedures generally characterized by an ab interno approach, minimal trauma to ocular tissue, moderate efficacy, an excellent safety profile, and rapid recovery. The number of MIGS procedures continues to increase, and their use has become widespread among glaucoma and cataract specialists.Standardization of the methodology and reporting of clinical endpoints in MIGS investigations enhances interpretation and comparison across different studies. The assessment of surgical interventions should not only consider statistical significance, but also whether the outcome is meaningful to patients. Minimal clinically important difference (MCID) is defined as the smallest change in a treatment outcome that is considered beneficial for an individual patient and prompts a change in their clinical management, and expert consensus is an accepted approach to determine the MCID. The American Academy of Ophthalmology’s GlaucomaPreferred Practice Pattern Panel is an expert panel that develops guidelines identifying characteristics and components of quality eye care. The panel recommends that the cumulative probability of surgical success at 2 years with Kaplan-Meier survival analysis be used as the primary efficacy endpoint in MIGS studies. The panel suggests that surgical success for standalone MIGS be defined as intraocular pressure (IOP) ≤ 21 mmHg and reduced ≥ 20% from baseline without an increase in glaucoma medications, additional laser or incisional glaucoma surgery, loss of light perception vision, or hypotony. The proposed MCID for the cumulative probability of success of standalone MIGS at 2 years is 50%. The panel recommends that surgical success for MIGS combined with cataract extraction with intraocular lens implantation (CE-IOL) be defined as a decrease in glaucoma medical therapy ≥ 1 medication from baseline without an increase in IOP, or IOP ≤ 21 mmHg and reduced ≥ 20% from baseline without an increase in glaucoma medications, additional laser or incisional glaucoma surgery, loss of light perception vision, or hypotony. The suggested MCID for the cumulative probability of success for CE-IOL/MIGS at 2 years is 65%.

This Viewpoint discusses common myths about myopia and educational strategies for bringing clinical practice better in line with evidence.

PURPOSE:School-based vision programs (SBVPs) deliver care to students at school, addressing disparities in access to pediatric vision care. We aimed to evaluate the associations between SBVP outcomes and school-level characteristics. DESIGN:Retrospective cross-sectional data analysis. PARTICIPANTS:Public schools with at least 50 SBVP-enrolled students 5 to 22 years old with complete demographic data. Schools with less than 60% of total grade levels served by the SBVP were excluded, creating a sample of 410 schools. METHODS:Vision screening and eye examination data were extracted from 2016-2022 Helen Keller International's United States Vision Program dataset. Individual student data were aggregated to characterize each school's SBVP outcomes and were analyzed with schools' publicly available socioeconomic and demographic data (student body race and ethnicity composition, proportion of students qualifying for free and reduced-price meals [FARM], and proportion of English language learners). Fractional regression models were used to understand associations between SBVP outcomes and school characteristics. MAIN OUTCOME MEASURES:SBVP outcomes were rates of vision screening failure, prescriptions for eyeglasses, and community eye care referral among each school's SBVP-enrolled students. RESULTS:We evaluated 151 elementary schools (36.8%), 155 middle schools (37.8%), and 104 high schools (25.4%), with a median proportion of students qualifying for FARM of 87.4% and a plurality of Hispanic students in 61.0% of schools. Median rates of vision screening failure, eyeglasses prescription, and referral were 38.4%, 25.2%, and 5.4%, respectively. High schools were associated with increased screening failure and eyeglasses prescription rates and a decrease in referral rate compared with elementary schools. In multivariable analysis, each 10% increase in proportion of students qualifying for FARM was associated with a 2.6% (95% confidence interval [CI]: 1.54%-3.65%), 1.8% (95% CI, 0.87%-2.74%), and 0.86% (95% CI, 0.36%-1.36%) increase in screening failure, prescriptions for eyeglasses, and referral rates, respectively. CONCLUSIONS:Significant vision care demand exists among public schools, especially those with students from lower socioeconomic backgrounds. School-based vision programs are important in improving pediatric vision care access. Our findings demonstrated opportunities to allocate personnel and equipment resources according to schools' anticipated needs, thus maximizing SBVPs' impact. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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Background Ectopia lentis is the dislocation of the natural crystalline lens and usually presents in the setting of trauma or other systemic diseases. Herein, we describe a case of an otherwise healthy four-year-old boy with isolated ectopia lentis whose partial lens dislocation was captured on a smartphone by the patient's father several days prior.Case presentation A four-year-old boy with no past medical, developmental, or trauma history presented with bilateral partial anterior lens dislocation with pupillary block. Initial ophthalmic evaluation two months prior was notable for uncorrected visual acuity at 20/100 OD, 20/250 OS, bilateral iridodenesis, and partially dislocated lenses inferonasally OD and inferiorly OS on slit lamp. Genetic testing found no abnormalities. Ten months later, the patient developed sudden onset of left eye pain. A dislocated lens and temporarily dilated left pupil were captured on a smartphone by the patient's father. He was evaluated 3 days later after a second episode and found to have hand motion vision OS, a fixed 8 mm left pupil with the crystalline lens subluxed into the pupil space and accompanying intraocular pressure OS of 40 mmHg. The lens was surgically removed with a limited anterior vitrectomy. Four and a half years after surgery, visual acuity was 20/125 OS with aphakic correction. The right eye eventually underwent prophylactic lensectomy and was 20/30 in aphakic correction.Conclusions This report presents a unique presentation of isolated ectopia lentis with anterior lens dislocation and pupillary block and illustrates the role of smartphone photography in assisting in the triage of eye emergencies.

PURPOSE:This study aimed to identify baseline factors associated with greater myopia progression and axial elongation in children with myopia. METHODS:This study performed a post hoc analysis of data from a 30-month randomized trial of atropine 0.01% versus placebo in children 5 to <13 years old with baseline spherical equivalent refractive error (SER) of -1.00 to -6.00 D, astigmatism of ≤1.50 D, and anisometropia of <1.00 D SER. Data from atropine 0.01% and placebo groups were pooled given outcomes were similar. Baseline factors of age, SER, axial length, race, sex, parental myopia, and iris color were evaluated for association with changes in SER and with changes in axial length at 30 months (24 months on treatment and then 6 months off) using backward model selection. RESULTS:Among 187 randomized participants, 175 (94%) completed 30 months of follow-up. The mean change in SER was greater among younger children (-0.19 D per 1 year younger; 95% confidence interval [CI], -0.25 to -0.14 D; p<0.001) and children with higher myopia (-0.14 D per 1 D more myopia at baseline; 95% CI, -0.23 to -0.05 D; p=0.002). The mean change in axial length was also greater among younger children (0.13 mm per 1 year younger; 95% CI, 0.10 to 0.15 mm; p<0.001) and children with higher baseline myopia (0.04 mm per 1 D more myopia; 95% CI, 0.002 to 0.08; p=0.04). CONCLUSIONS:Younger children with higher myopia had greater myopic progression and axial elongation over 30 months than older children with lower myopia. Developing effective treatments to slow the faster myopic progression in younger children should be a target of further research.

PURPOSE:To report the cumulative incidence of complications and to describe refractive error and visual acuity (VA) outcomes in children undergoing secondary intraocular lens (IOL) implantation after previous surgery for nontraumatic cataract. DESIGN:Pediatric cataract registry. PARTICIPANTS:Eighty children (108 eyes: 60 bilateral, 48 unilateral) undergoing lensectomy at younger than 13 years of age. METHODS:Annual data collection from medical record review through 5 years after lensectomy. MAIN OUTCOME MEASURES:Cumulative incidence of newly emergent complications after secondary IOL implantation; refractive error and VA by 5 years after lensectomy. RESULTS:Median follow-up after secondary IOL implantation was 2.7 years (interquartile range [IQR], 0.8-3.3 years; range, 0.6-5.0 years) for bilateral and 2.1 years (range, 0.5-6.4 years) for unilateral cases. A common complication after secondary IOL implantation was a glaucoma-related adverse event (GRAE; glaucoma or glaucoma suspect); the cumulative incidence was 17% (95% confidence interval [CI], 3%-29%) in bilateral cases and 12% (95% CI, 0%-23%) in unilateral cases. The cumulative incidence of surgery for visual axis opacification was 2% (95% CI, 0%-7%) for bilateral cases and 4% (95% CI, 0%-10%) for unilateral cases. The median prediction error within 90 days of implantation was 0.88 diopter (D; IQR, -0.50 to +3.00 D) less hyperopic than intended among 21 eyes for bilateral cases and 1.50 D (IQR, -0.25 to +2.38 D) less among 19 unilateral cases. The median spherical equivalent refractive error at 5 years (at a median of 5.1 years of age) in eyes receiving a secondary IOL was +0.50 D (IQR, -2.38 to +2.94 D) for 48 bilateral cases and +0.06 D (IQR, -2.25 to +0.75 D) for 22 unilateral cases. Median monocular VA at 5 years was 20/63 (IQR, 20/50-20/100) for bilateral cases (n = 42) and 20/400 (IQR, 20/160-20/800) for unilateral cases (n = 33). CONCLUSIONS:Eyes with secondary IOL implantation have a risk of developing new GRAEs. Five years after lensectomy (approximately 2.5 years after secondary IOL implantation), the average refractive error was less hyperopic than desired given the anticipated further myopic shift before refraction stabilizes. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Importance:Glaucoma can develop following cataract removal in children.Objective:To assess the cumulative incidence of glaucoma-related adverse events (defined as glaucoma or glaucoma suspect) and factors associated with risk of these adverse events in the first 5 years after lensectomy prior to 13 years of age.Design, Setting, and Participants:This cohort study used longitudinal registry data collected at enrollment and annually for 5 years from 45 institutional and 16 community sites. Participants were children aged 12 years or younger with at least 1 office visit after lensectomy from June 2012 to July 2015. Data were analyzed from February through December 2022.Exposures:Usual clinical care after lensectomy.Main Outcomes and Measures:The main outcomes were cumulative incidence of glaucoma-related adverse events and baseline factors associated with risk of these adverse events.Results:The study included 810 children (1049 eyes); 443 eyes of 321 children (55% female; mean [SD] age, 0.89 [1.97] years) were aphakic after lensectomy, and 606 eyes of 489 children (53% male; mean [SD] age, 5.65 [3.32] years) were pseudophakic. The 5-year cumulative incidence of glaucoma-related adverse events was 29% (95% CI, 25%-34%) in 443 eyes with aphakia and 7% (95% CI, 5%-9%) in 606 eyes with pseudophakia; 7% (95% CI, 5%-10%) of aphakic eyes and 3% (95% CI, 2%-5%) of pseudophakic eyes were diagnosed as glaucoma suspect. Among aphakic eyes, a higher risk for glaucoma-related adverse events was associated with 4 of 8 factors, including age less than 3 months (vs ≥3 months: adjusted hazard ratio [aHR], 2.88; 99% CI, 1.57-5.23), abnormal anterior segment (vs normal: aHR, 2.88; 99% CI, 1.56-5.30), intraoperative complications at time of lensectomy (vs none; aHR, 2.25; 99% CI, 1.04-4.87), and bilaterality (vs unilaterality: aHR, 1.88; 99% CI, 1.02-3.48). Neither of the 2 factors evaluated for pseudophakic eyes, laterality and anterior vitrectomy, were associated with risk of glaucoma-related adverse events.Conclusions and Relevance:In this cohort study, glaucoma-related adverse events were common after cataract surgery in children; age less than 3 months at surgery was associated with elevated risk of the adverse events in aphakic eyes. Children with pseudophakia, who were older at surgery, less frequently developed a glaucoma-related adverse event within 5 years of lensectomy. The findings suggest that ongoing monitoring for the development of glaucoma is needed after lensectomy at any age.