Pediatric and Teen CL Care

Treatment Choices for Pediatric and Infantile Aphakia

BY MELANIE FROGOZO, OD, FAAO

Congenital cataract is a major cause of visual impairment in children, with a prevalence of 3 to 4.5 in 10,000 live births (Holmes et al, 2003). Without immediate treatment, visual prognosis is poor due to the effects of deprivation amblyopia (Holmes et al, 2003; Moore, 1994).

Early removal of congenital cataract (before 6 weeks of age for unilateral and 10 weeks of age for bilateral) and aggressive treatment for amblyopia provides the best visual outcome (Lloyd et al, 2007). Current options for vision correction after cataract removal are implantation of intraocular lenses (IOLs) or leaving the infants aphakic and correcting them optically with glasses or contact lenses.

Spectacles

High plus spectacles are heavy and awkward on the small faces of infants and children. Moreover, the optics decrease the visual field and cause prismatic effects, resulting in poor vision. Aphakic glasses are reserved for when parental cooperation with contact lenses is suboptimal (Baradaran-Rafil et al, 2014).

IOLs Versus Contact Lenses

The implantation of IOLs for treatment of aphakia is controversial in younger children and infants (Wilson, 1996). The infantile eye requires a smaller-diameter IOL that may lead to IOL luxation into the vitreous cavity during growth (Lundvall and Zetterstrom, 2006). Additionally, there is uncertainty in predicting the correct power of the IOL in rapidly growing eyes.

Contact lenses are a great choice for correction if aphakic because they are easily changed to accommodate fast-growing eyes of children. In 2014, the Infant Aphakia Treatment Study Group (IATS) showed that unilateral aphakes corrected with contact lenses have the same visual acuity as those corrected with an IOL.

Moreover, the study group also found a higher incidence of adverse events with intraocular surgeries in children implanted with IOLs versus those treated with contact lenses (Chen et al, 2010). Thus, contact lenses offer good quality of vision and have low complication rates in infants and should be considered the treatment of choice in aphakia.

GP lenses are a good treatment choice for pediatric aphakia (Figure 1). The rigid material is easier to handle because it does not fold over while applying or removing lenses. This is beneficial when it comes to the small eyes and tight lids of infants and children who are not always cooperative (Lindsay and Chi, 2010).

Figure 1. A 5-year-old bilateral aphakic girl successfully fit with GP corneal scleral lenses.

Other types of contact lenses that are available to fit pediatric aphakia include hydrogel, silicone hydrogel, and silicone elastomer lenses.

Summary

Prompt removal of infantile cataracts will offer the best chance of avoiding amblyopia. In infants, contact lenses are a great choice for optical correction after surgical removal of cataracts, and their resulting acuity has been shown to be the same as IOL implantation. CLS

For references, please visit www.clspectrum.com/references and click on document #239.

Dr. Frogozo specializes in adult and pediatric specialty contact lenses. She is the director of the Contact Lens Institute of San Antonio and the owner of Alamo Eye Care in San Antonio, Texas. You can contact her at contactlensinstitutesa@gmail.com.