Pediatric and Teen CL Care

Albinism and Children: One Fitter's Experience and Tips

By Christine W. Sindt, OD, FAAO

Albinism refers to a group of inherited disorders characterized by a lack of pigmentation in the eyes, skin, or hair. The two main categories are ocular albinism, which affects only the eyes, and oculocutaneous albinism, which affects the hair and skin as well as the eyes. Characteristic ocular features of albinism include iris transillumination defects, nystagmus, macular hypoplasia, and high refractive astigmatism.

Most patients who have albinism have reduced visual acuity. The degree of visual compromise is worse in patients who have severe macular hypoplasia; therefore, vision is typically worse in patients who have oculocutaneous albinism. Nystagmus, amblyopia, and uncorrected refractive error also contribute to low vision. Some patients may also experience photodysphoria because of the scattering of light within the eye where it is not properly absorbed by melanin (Kruijt, 2011).

Children who have albinism can benefit from contact lens wear for all of these reasons.

High Astigmatism Is Common

In my experience, children who have albinism typically have 3.00D or greater of refractive astigmatism. Uncorrected astigmatism may lead to meridional amblyopia and reduced acuity potential later in life. Full refractive error correction may slow the nystagmus, so provide full correction at the earliest age possible.

Addressing Photodysphoria

Although some patients experience photodysphoria, it may be difficult to determine which children would benefit from lens tints. I have found that small children who have albinism will rarely wear sunglasses, but this doesn't mean they won't benefit from a contact lens tint. I prefer to start young children with an annulus tint/iris ring (12mm, 20-minute brown tint with 5mm clear pupil, Figure 1), while I give older children the option of a solid tint (12mm, solid 20-minute brown) or an iris ring. If a child chooses a solid tint, I recommend trying different densities of tints in sunglasses, both indoors and out, before ordering the final tint.

Figure 1. Child with oculocutaneous albinism wearing an iris ring soft toric contact lens.

Because children who have albinism generally have high cylinder, the tint is typically put on a toric contact lens. Be aware that the ballasting and weight of a toric lens may lead to inferior lens decentration. Older children and adults wearing iris ring lenses may notice the tint edge, but children who have started wearing these lenses at a young age rarely, if ever, complain about this. The size of the clear pupil can be adjusted in a custom-tinted lens, but this adjustment may be more difficult in stock designs.

Life-Changing Effects

In my years of practice, I have seen many children who have albinism gain two or more lines of visual acuity with contact lenses compared with their best-corrected spectacle acuity. Contact lenses will treat their refractive error, reduce photodysphoria, and minimize nystagmus, leading to better vision development and improved vision as an adult. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #195.