contact lens case reports

Contact Lenses for Pediatric Aphakia

BY PATRICK CAROLINE, FAAO, & MARK P. ANDRE, FCLSA
MARCH 1998

Infants and young children often require contact lenses to satisfy a variety of therapeutic and refractive needs, such as in cases of unilateral or bilateral aphakia, high myopia or hyperopia, and post-trauma and occlusive therapy. Specialized contact lens designs are used because the infant eye is anatomically different from the adult eye, including diameter size and cornea steepness. Infants' visual systems are in a constant state of development, so early and uninterrupted correction of refractive errors is critical.

Case Study

Patient A.E., a newborn who was diagnosed with a unilateral cataract OS, underwent an uncomplicated lensectomy at the age of 12 days. Due to the dramatic growth of the infant eye from birth to approximately age six, intraocular lenses are frequently contraindicated (Table 1). So with compliant parents, contact lenses are often the treatment of choice, especially during the early years of life.

There are presently three contact lens modalities for the correction of pediatric aphakia -- RGP lenses, soft lenses and silicone lenses -- and each type has its advantages and disadvantages. A.E.'s mother had comfortably worn soft contact lenses for eight years, so we decided to fit him with a custom pediatric soft lens. We chose the Flexlens Pediatric Aphakia design, which is available in a wide range of parameters to accommodate the dynamic infant eye (Table 2). The standard design has a base curve of 7.50mm and a diameter of 12.50mm. At the one-week postop visit, we examined A.E. under anesthesia (Fig 1). The contact lens exam included: retinoscopy (+20.00D sph.), keratometry (50.12@180/ 50.50@90), axial length measurement (17.23mm) and overrefraction (+2.00D with diagnostic lenses: 7.50mm, +25.00D, 12.00mm). An additional +3.00D is often added to focus the eye for near. Final lens order was 7.50mm, +30.00D, 12.00mm.

Infants and young children can successfully wear contact lenses. The fitting techniques are not difficult, but frequent monitoring is important to assess ocular health, visual acuity and to make adjustments in the lens fit and power as the child grows.

Patrick Caroline is an assistant professor of ophthalmology at Oregon Health Sciences University and an assistant professor of optometry at Pacific University. Mark Andre is a fellow of the Contact Lens Society of America & director of Contact Lens Services at the Oregon Health Sciences University.