P A E D I A T R I C

MANAGEMENT

NUR RABIHA MOHD NOORP 82496

Why not prescribe spectacles?

Drawbacks:

Spectacles is HEAVY (due to high power; e.g. in aphakia & high myope)

Limitation in available power (Lenticular lens power provided until +26D)

Difficulty to achieve good frame fitEffect of image MINIFICATION &

MAGNIFICATIONLIMITED FOV (e.g. in lenticular lens)PERIPHERAL DISTORTIONPRISMATIC EFFECT

INDICATIONS

1) APHAKIA 3) PSEUDOPHAKIC2) IRREGULAR ASTIGMATISM

5) HIGH MYOPIA4) PROSTHETIC OR THERAPEUTIC

A P H A K I A WHY?

- Congenital cataract (usually unilateral)- Subluxated lens- Traumatic cataract

In unilateral cataract, CL is very useful to overcome anisometropia

- thus, improve visual quality or performance- Improve binocular vision

Prescription power:- Infant only aware of near object- When grow up, become aware to distant object- Power given during infant: ADD +2D or +3D- However, at 18-24 m.o » reduce power

Before start preschool (3-4 years old), give bifocals to see near clearly

IRREGULAR ASTIGMATISM

Causes:Laceration of corneaInfection to cornea

Must be treated to prevent deprivational amblyopia

Fit with RGP

PSEUDOPHAKIC

Wearing IOLo As early as 2 weeks of age

Undercorrect of 6-10D Power will be compensated as they

grow up (myopic shift) Reduce power as they grow up

until reach emmet state

PROSTHETIC / THERAPEUTIC

WHY?Cosmetic reason (to camouflage the good eye)To enhance visual performance (e.g. to reduce

photophobia)

Indicated to:AlbinismAniridia Iris colobomaAchromatopsiaMicropthalmos

HIGH MYOPIAWHY not prescribe spec?- Reduce retinal image- Peripheral distortion- Reduce effective visual field

Advantage of px CL for high myope:- Cosmesis- Comfort- Compliance of patient

EXAMINATIONS

ANTERIOR SEGMENT- To check any staining

KERATOMETRY

REFRACTION

CL MOVEMENTCL CENTRATIONCL FLOURESCEIN PATTERN

LENS SELECTION

There are 2 types of lens:a)Soft lensb)RGP

a)Soft lens

- Continuous / daily wear- High WC

Advantage:• Custom made• Comfortable• Parents less apprehensive about inserting lens

Disadvantages:o Do not correct corneal astigmatismo Insertion is difficulto Dehydration of lens (baby - dry eye – due to less

blinking rateo Frequent lens loss

Estimated SCL specifications based on age for aphakic:

Age (month)

BOZR (mm)

TD (mm)

Power (D)

1 7.00 12.00 +352 7.20 12.50 +323 7.50 13.00 +306 7.80 13.50 +2512 8.10 13.50 +20

Source: Nathan Efron; Contact Lens Practice

b) RGP

Advantages:Available in wide range of parametersDurableCorrect corneal astigmatism and irregular

astigmatismInsertion and removal easy because of rigidityHigh oxygen permeabilityCan be custom made

Disadvantages:Not suitable for continous wearRisk abrasion to corneaDislodgement Initial discomfortParents more apprehensive

THANK YOU