Contact lens for congenital aphakia and other eye conditions for infants and toddlers. The slide presentation encompasses indications for CL fitting in paediatric, contact lens options, fitting techniques, challenges and contact lens as myopia control.

1. BY:
NOOR MUNIRAH BINTI AWANG ABU BAKAR
P82498
Paediatric Contact Lens
Management

2. OUTLINES:
Indications for paediatric contact lenses fitting
Various contact lens option for paediatric
Fitting techniques
Challenges that are present with paediatric
CL as Myopia control

3. WHO is PAEDIATRIC?
Paediatrics : A branch of medical care that deals with
infants, children and adolescents, from birth up to age of 18
(in US up to 21)
The word paediatric is derived from two Greek words (pais =
child and iatros = healer), which means healer of children.
Classification by American Academy of Paediatrics:
STAGE AGE
Baby 0-12 months old
Toddler 1-3 years old
Pre School 3-5 years
Grade-schooler 5-12 years old
Teen 12-18 years old
Young adult 18-21 years old

4. INDICATIONS
„Purpose of wearing CL: Refractive and Therapeutic
1. Aphakia (congenital cataract, genetic , rubella, Post-partum
trauma, PHPV and micro-ophthalmia)
2. High Myopia „
3. High hyperopia (Accomodative esotropia) „
4. Irregular Astigmatism (trauma, HSV scarring )„
5. Photophobia (aniridia, iris coloboma, albinism,
achromatopsia „)
6. Amblyopia
7. Anisometropia (refractive>2D)„
8. Nystagmus (Often accompanied with high refractive error
„ )
9. Myopia Control

5. INDICATION cont.
Aphakia
 Congenital cataracts occur in 1.7 of 10,000 births
 Surgeon do not insert IOL for children under 2-3 yo during the
lensectomy, due to fragile posterior capsule and the eye not yet
stable, as keep growing.
 Resultant aphakia best corrected with Contact Lens to restore vision
Anisometropia
 In case of aniseikonia, contact lenses reduce differences in image
size between eyes and improve peripheral vision.
Amblyopia
 An occluder or opaque contact lens as alternative to patching
therapy

6. CL OPTIONS-Description
1. Soft/Hydrogel „ lens
Advantages Disadvantages
Comfort
Stays in place
 High cost
 Low Dk ( corneal edema )
 Poor handling
 Not durable ( rippage , deposits)
 Infection risk in EW
 No UV protection avail
 Cannot mask irregularity

7. CL OPTIONS-Description
2. Prosthetic Lenses
 To improve appearance of disfigured eye : Aniridia,
Iris coloboma, injured cornea (ulcer or trauma)
 To block light reaching back of the eyes; for photophobia to
reduce glare & increase comfort: Albinism (less pigment)
 To eliminate diplopia for certain eye conditions.
 Amlyopia therapy:
 Pt wear two identical-appearing colored contact lens, GOOD eye wears lens with
opaque pupil to block (occlude) light from entering the eye.
 More effective than applying eye patch
 „HOW?: Custom painted to color match „

8. CL OPTIONS-Description
3. Silicone Elastomer/B&L Silsoft
 Silicone elastomer lens providing the high oxygen permeability
 Silsoft by B&L:Option for paediatric aphakia-30 days continuous wear lens
 Advantages:
 High O2 permeability
 Comfort & stay in place
 Easy handling
 Disadvantages:
 Poor lens wetting
 Hydrophobic
 Rapid lipid deposition
 Limited parameters
 Power range 3D step
 3 Base Curves
 1 diameter
 High cost
Parameters Available range
Material Elastofilcon
Water content 0.2%
O2 permeability (Dk) 340
O2 transmission (Dk/t) 71
Base Curves 7.5, 7.7, 7.9mm
Diameter S 11.30mm
Power +23.00D to +32.00D (3.00D steps)
Optical zone 7.0mm
Centre thickness 0.51mm - 0.71mm

9. CL OPTIONS-Description
4. Rigid Gas Permeable (RGP)
 Preference: Menicon Z
 Highest level of oxygen
permeability
 Advantages:
 Provide clearer vision than other methods.
 Allow improved tear flow and oxygen under the CL-high Dk
 Easy to handle (insertion & removal)
 Reduction in the progression of myopia
 Flexibility designs/parameters (customize curve, power, diameter.
 Safety profile: less bacterial and protein adherence
 Cost: less expensive
 Disadvantages:
 Adaptation/ comfort
 Lens loss/ dislocation
Parameters Details
Material Tisilfocon A with UV filter
O2 permeability , Dk 163
FDA Approval 30 days continuous wear

10. CONTACT LENS FITTING
What age appropriate to fit contact lens?
 American Academy of Optometry in 2004 stated :
“ by the age of eight, a child was able to handle contact lenses and assume
some degree of responsibility.”
 However, child's maturity and ability to handle contact lenses responsibly is
more important than age alone.
 Otherwise, optometrist should educate and guide parents on proper
handling of CL.
Pre-fitting apparatus
 Contact lens fitting sets
 Retinoscope and loose lenses
 Fluorescein strips and Wratton filter
 Keratometer (optional)
 Burton Lamp
 Contact lens solution, case & cleaners

11. CL FITTING PROCESS

12. CL FITTING PROCESS

13. CL FITTING PROCESS

14. CL FITTING-PARAMETERS
Average Power Needed for the Aphakic Eye
 0-12 months : +29 D to +32 D
 12-24 months : +20 D to +26 D
 > 2 Years : +12 D to +20 D
Corneal Curvature (Table 1)

15. CL FITTING- CONSIDERATION
Considerations Specific to the Infant
 maximum oxygen permeability
 expanded powers
 steeper base curves
 smaller overall diameters
 ease in handling and durability
 reproducible
 ability to use medication

16. CHALLENGE IN PAEDIATRIC CL MANAGEMENT
Infant & toddler eye anatomy
 Small palpebral fissure
 Steeper cornea than older patient
 Higher powers than the older pt (due to shorter axial length)
Parent time & motivation
 Time limitation
 Find difficulty on lens insertion and removal process, lens care
Unable to understand instruction (infants)
 Alternative: voice, touch & smell
Anxiety about the procedures (for toddlers)
 Resisting during procedures

17. CL as MYOPIA CONTROL
Orthokeratology (Ortho-K)
 Temporarily reverse myopia
 Specially designed GP worn during night sleep, and removed in the
morning .
“Dual-Focus” soft contact lenses:
 Latest finding: able to slow the progression of nearsightedness in
children ages 11 to 14, compared with regular soft contact lenses.
 Design:
 Concept: peripheral defocus in the retina might reduce the lengthening of the
eyeball during childhood that is associated with myopia progression.
Central optical zone :
Fully corrects myopia
Peripheral zone:
Lesser correction

18. REFERENCES
1. Scalafani, L. August, 4 2002. Kids and Contacts: Pediatric Aphakia Contact Lens
Fitting: Review of Optometry.
2. Edmonds, C.A., October, 23 2003. Fitting Infants and Toddlers with Contact Lenses:
Review of Optometry.
3. Stephenson, M. 2014. Prosthetic Contact Lenses. Allaboutvision.com
4. Walline, J.J. 2000. Fitting Kids with Rigid Gas Permeable Lenses. Contact Lens
Spectrum.
5. Heiting,G. Are Contact Lenses a Good Choice for Kids?. Allaboutvision.com
6. Reeder, R.E.Kattouf, V. November ,1 2010.Succeeding with Kids and Contact Lenses:
Optometric Management.
7. Saltarelli, D.P. 2013. Contact Lenses For Infant Aphakia: Tips For Successful
Management.