contact lenses management in pediatrics
TRANSCRIPT
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Contact Lenses in Pediatrics
Ling Sook YeeP 82495
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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
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Cataract & Aphakia Congenital cataract : surgery as early as
possible Infantile cataract : surgery once
vision interferedUnilateral CataractCome with concomitant
strabismus
Associated with ocular anomalies
Higher risk of ambloypia
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Correction of Aphakia
Optical Correction
Glasses
Contact Lenses
Intraocular Lens
Epikeratophakia
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
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Post Operative CorrectionSpe
ctacles
•Narrow visual field to 30°•Retinal size disparity•Heavy and large frame
Co
ntac
t Lenses
•Best choice for post-operative aphakia•Allow changes for visual correction with IOL upon visual maturity•Good visual quality
Intraocular lens (IOL)
•Excellent visual quality•High risk of complications (eg: PCO)•Challenging in predicting future refractive shifts due to immature visual system •Induced corneal astigmatism
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Contact Lens Considerations Power changes
First 11 – 18 months: expected to decrease ~ 10D Need for supplementary spectacles? Wound healing Ocular medications Systemic condition Compliance
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Contact Lens in Pediatric Fitted immediately after cataract surgery
Available in a) Hydrogel lensb) Silicone elastomerc) 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
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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)
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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
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Water ContentWater Content
Low
Minimize hydration
Minimize lens deposits
Maximize durability
HighMaximize O2
transmissibility
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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
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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
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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
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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)
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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.