The post-surgical management of the pediatric aphakic is important. Contact lens is the best optical device in the post-operative aphakia to provide good visual quality.

1. Contact Lenses in Pediatrics
Ling Sook Yee
P 82495

2. Why fit children with contact lenses?
 Aphakia
 Cataract, persistent hyperplastic primary vitreous
(PHPV), post-partum trauma
 Refractive error
 Anisometropia & amblyopia
 Binocular vision
 Appearance
 Myopia control

3. Cataract & Aphakia
 Congenital cataract : surgery as early as possible
 Infantile cataract : surgery once vision
interfered Unilateral
Cataract
Come with
concomitant
strabismus
Associated
with ocular
anomalies
Higher risk of
ambloypia
Bilateral
Cataract
Come with
nystagmus
Associated
with systemic
disorders

4. Correction of Aphakia
Optical
Correction
Glasse
s
Contact
Lenses
Intraocular
Lens
Epikeratophaki
a
 Modify refractive error from
cornea donor
 Rarely used due to complications
 May affect the function of
ciliary muscle
 Required when
patient not suitable
for IOL

5. Post Operative CorrectionSpectacles
• Narrow visual field
to 30°
• Retinal size
disparity
• Heavy and large
frame
ContactLenses
• Best choice for
post-operative
aphakia
• Allow changes for
visual correction
with IOL upon
visual maturity
• Good visual
quality
Intraocularlens(IOL)
• Excellent visual
quality
• High risk of
complications (eg:
PCO)
• Challenging in
predicting future
refractive shifts
due to immature
visual system
• Induced corneal
astigmatism

6. Contact Lens Considerations
 Power changes
 First 11 – 18 months: expected to decrease ~ 10D
 Need for supplementary spectacles?
 Wound healing
 Ocular medications
 Systemic condition
 Compliance

7. Contact Lens in Pediatric
 Fitted immediately after cataract surgery
 Available in
a) Hydrogel lens
b) Silicone elastomer
c) RGP
 Require near correction:
 Until age 2 : overcorrect by +3.00 D
 Age 2 – 3 : overcorrect by +1.00D to +1.50D
 After age 3 : bifocal with +3.00D add

8. Fitting CL in Pediatric
 79% success rate in congenital cataract
 Using contact lenses for a few years and having
lens implants later could work better. (National Eye
Institute)
 There was no difference in the vision between the
eyes treated with CL compared to IOL. But the IOL
group had more complications and required more
eye surgeries.
(Infant Aphakia Treatment
Study)

9. 1. Hydrogel Lens
Advantages Disadvantages
 Initial comfort  In high power, lens central thickness
, oxygen permeability , risk to
complications
 Can be custom-made  Prone to dehydration
 Stable position  Do not correct significant corneal
astigmatism
 Required skill for insertion due to
large diameter
• Diameter: 2mm larger than HVID

10. Water Content
Water
Content
Low
Minimize
hydration
Minimize
lens deposits
Maximize
durability
High
Maximize O2
transmissibility

11. 2. Silicone Elastomer
Advantages Disadvantages
 Comfort  Very expansive
 Easy handling  Heavy lipid deposits (hydrophobic)
 High dk  Limited power (highest +32.0D)
 Less loss rate  Large diameter
 No UV protection
• Example: B&L Silsoft
• Base curve: flattest K + 0.1mm

12. 3. RGP
 The best choice for elder children & small
palpebral fissure.
 Fitting:
 Diameter: 1-2mm smaller than cornea diameter
 Power : retinoscopy & correct for vertex distance
 Base Curve : slightly steeper
[flattest k – 0.1mm ]
 Movement : 1.0 – 1.5mm

13. RGP
Advantages Disadvantages
 Large range of parameters  Risk of abrasion
 Correct corneal astigmatism  Initial discomfort
 Durable  Requires skill in fitting/removal
 High oxygen permeability  Higher loss rate due to small
diameter

14. Challenges & Complications
 Lens frequently loss
 Too expansive
 Time consuming
 Difficulty in lens handling
 Non compliance
 Greater risk of infection
Failure of treatment is related to treatment of
amblyopia, and not related to the fitting and wearing of
contact lenses.
(Moore BD,
1993)

15. References
 Moore, BD. (1993) Pediatric aphakic contact lens
wear: rates of successful wear. J Pediatr Ophthalmol
Strabismus, 30(4):253-8.
 Szczotka, LB. Pediatric contact lenses. California
Optometric Association.
 Daniels K. (1999) Contact lenses. SLACK
Incorporated, 141-145.
 Extract from: http://web1.sph.emory.edu/IATS/. Infant
aphakia treatment study.
 Phillips AJ and Speedwell L. (2007). Contact lenses.
Butteworth Heinemann, 505-512.