Congenital cataract is a major cause of visual impairment in children. Immediate treatment is necessary to avoid deprivation amblyopia (Moore, 1994; Wiesel and Hubel, 1963). Early surgical removal of congenital cataract, optical correction, and aggressive treatment of amblyopia provide the best visual outcome (Birch and Stager, 1988; Birch et al, 1993; Birch et al, 1998; Lundvall and Kugelberg, 2002; and others. Full list available at www.clspectrum.com/references .).

Contact lenses are a choice for optical correction in aphakia. In fact, aphakia from congenital cataract extraction is the most common indication for infantile contact lens fittings. Nonetheless, infants who undergo cataract extraction are at risk for glaucoma. Ocular hypertension from pediatric glaucoma (PG) can change the corneal contour, thus affecting contact lens fit (Lindsay and Chi, 2010). This article will review how PG may be detected through contact lens evaluation.

Cataract Surgery-Induced Pediatric Glaucoma

PG following cataract surgery in infants is well documented. It may occur as early as the postoperative period or as late as decades after surgery. PG or ocular hypertension was as high as 59% over a 10-year period following cataract extraction (Egbert et al, 2006). The risk of developing glaucoma is greater for those undergoing surgery at an earlier age (Rabiah, 2004; Watts et al, 2003; Vishwanath et al, 2004; Lundvall and Zetterström, 1999; and others).

Infants who have undergone cataract surgery should be monitored for increased intraocular pressure (IOP). Initially, children may be asymptomatic; however, elevated IOP is associated with corneal haze and epithelial edema that subsequently causes tearing, photophobia, and blepharospasm.

Additionally, buphthalmos can occur in PG. Vertical breaks in Descemet’s membrane also may be observed (Swamy et al, 2007). If it can be assessed, patients should be monitored for optic nerve cupping and changes in visual field (Lloyd et al, 2007).

How the Contact Lens Fit Can Signal PG

Corneal changes brought on by elevated IOP in PG can suddenly change the contact lens fit. Buphthalmos will cause an increase in diameter and flattening of the cornea. In corneal GP designs, this may manifest as a steeper fluorescein pattern (Figure 1) and/or the lens will persistently pop out of the child’s eye.

In both GP and soft lenses, a smaller area of coverage may be noticed due to the increased corneal diameter in buphthalmos. Additionally, a myopic shift in the contact lens prescription may be seen as a result of the corneal flattening (Lindsay and Chi, 2010).

Contact lenses are an excellent option for aphakic infants after congenital cataract extraction. Be suspicious for glaucoma and high IOPs if the contact lens parameters change unexpectedly. Glaucoma eventually develops in the majority of children who have undergone congenital cataract extraction; therefore, monitor such patients for its development. CLS

For references, please visit www.clspectrum.com/references and click on document #269.