Pediatric and Teen CL Care

Occlusion Contact Lenses for Amblyopia

BY MELANIE FROGOZO, OD, FAAO

Amblyopia is the most common cause of decreased vision in childhood, affecting up to 5% of the population (Carlton and Kaltenthaler, 2011). Treatments for amblyopia include occluding or penalizing the non-amblyopic eye. Inexpensive adhesive patches are typically used to treat amblyopia because they are easy to apply and remove. Nevertheless, some children refuse to wear adhesive patches or can form dermatitis to the adhesive itself. In such circumstances, occlusion contact lenses can be used as an alternative treatment. This article reviews the different types of occlusion contact lenses that are available for amblyopia treatment.

Prosthetic Lenses

Prosthetic soft lenses are typically used to mask disfigured eyes to provide a more normal appearance. These lenses can, however, be made opaque over the pupil to act as an occluding lens for amblyopia (Collins et al, 2008).

The hydrogel material in which custom opaque lenses are currently manufactured can be difficult to handle, especially when dealing with toddlers or young children. Consider ordering the lens in a high-plus power to create a thicker lens that will aid with application. A benefit to this approach is that if the tint starts to wear off, the child will still have a high-plus lens to penalize the vision.

Clear High-Plus Lenses

Clear high-plus-powered contact lenses can also optically penalize the sound eye. A benefit of using high-plus lenses is that they can be made in any material and parameters and are available in different designs. Often, children will learn how to rub out soft or small-diameter GP lenses. In such cases, a scleral lens can be used.

Consider occlusion therapy with high-plus lenses for unilateral aphakic children who are not compliant with a traditional adhesive patch treatment (Figure 1). Parents experienced with aphakic contact lenses usually welcome this option because they are already familiar with lens handling (Saltarelli and Motley, 2013). If the aphakic lens fits well on the non-amblyopic eye, the same design can be used for both eyes.

Figure 1. (A) Toddler wearing an adhesive patch over his phakic left eye to treat amblyopia since infancy. A corneal GP is worn habitually in his aphakic right eye. (B) He eventually refused the adhesive patch, so he was fitted into a high-plus corneal GP lens to penalize his vision.

Summary

For children who refuse or cannot wear an adhesive patch to treat amblyopia, prosthetic lenses with opaque pupils and high-plus lenses may be an alternative for optical occlusion/penalization of the sound eye. Occlusion lenses should be considered for amblyopic children who are not compliant with traditional therapies. CLS

For references, please visit www.clspectrum.com/references and click on document #245.

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. She also was a consultant to CooperVision. You can contact her at contactlensinstitutesa@gmail.com.