Contact Lens Case Reports

Using a Tinted Lens to Manage Photophobia from Albinism

BY PATRICK J. CAROLINE, FAAO, & MARK P. ANDRÉ, FAAO

Albinism is a congenital anomaly characterized by the absence of pigment in the skin, hair, iris, retina, and choroid. The iris and fundus are pale in color because of the absence of melanocytes, and the eye transilluminates markedly. There can be poor visual acuity, photophobia, and nystagmus, depending on the type of albinism.

Types of Albinism

As you likely remember from your days in school, there are two main types of hereditary albinism: oculocutaneous albinism and ocular albinism. Patients who have complete oculocutaneous albinism are deficient in the enzyme tyrosinase and are incapable of synthesizing melanin. They have blond hair, pale skin, and often present with photophobia, pendular nystagmus, and visual acuities of 20/200 or less. The ocular features include a blue iris that completely transilluminates and a fundus lacking pigment without any foveal landmarks.

Figure 1. Patient’s external iris images.

Patients who have incomplete oculocutaneous albinism can synthesize variable amounts of melanin. These individuals vary in complexion from very fair to normal. The iris color may be blue or dark brown with variable degrees of iris transillumination. The degree of fundus pigmentation is also variable. However, irrespective of the fundus changes, visual acuity is usually impaired due to lack of differentiation of the fovea.

Figure 2. The BioSport Sun Tac tint on our patient.

Ocular albinism is confined to the eyes and, being X-linked, affects males only.

A Case of Incomplete Oculocutaneous Albinism

This month’s case report involves a 45-year-old female with a history of incomplete oculocutaneous albinism and nystagmus. Her best-corrected visual acuities were 20/70 in both eyes. Transillumination defects were observed in both eyes, with scattered peripheral areas of depigmentation on the iris. Her retinas were pale with non-distinct optic disc margins and macula. There were no peripheral retinal defects.

The patient’s primary symptom was photophobia. To address this, we tested a number of tinted diagnostic spectacle lenses. The color that the patient preferred was a gray/green tint. For maximum efficacy of the tint and for cosmetic concerns, we suggested that the tint be incorporated into soft contact lenses.

We ordered BioSport Sun Tac tinted lenses from Orion Vision Group. Upon dispensing the lenses to the patient, she reported an immediate improvement in her symptoms of photophobia. Indoor visual acuities with these lenses remained 20/70 in both eyes.

This case illustrates how the simple act of placing tint into a soft lens can significantly improve the quality of life for patients who have photophobia. CLS

Patrick Caroline is an associate professor of optometry at Pacific University. He is also a consultant to Contamac. Mark André is an associate professor of optometry at Pacific University. He is also a consultant to CooperVision.