Management of Contact Lenses and Visual Development in Pediatric Aphakia

Abstract

Congenital cataract is among the main causes of treatable vision loss in childhood. The first weeks and months of life are a critical time for the development of vision. Therefore, early cataract surgery and effective multifaceted treatment of the resulting aphakia in the early stages of life are of great value for the management of vision development. Among the treatment models, contact lenses (CL) have an important place in infancy and early childhood up to the age of 2 years. Although good visual gains were not considered very likely, especially in unilateral aphakia, important steps have been taken in the treatment of pediatric aphakia thanks to the surgical techniques developed over time and the increasing experience with optical correction systems, especially CLs. This review examines current developments in the types of CL used in pediatric aphakia, their application features, comparison with other optical systems, the features of amblyopia treatment in the presence of CL, and the results obtained with family compliance to CL wear and occlusion therapy in the light of existing studies.

Keywords: Congenital cataract; contact lens; pediatric aphakia; persistent fetal vasculature; visual rehabilitation.

Figure 1

Optimum gas permeable rigid contact lens fitting; the lens is centered, with no slipping or tight adhesion

Figure 2

Piggyback contact lens fitting in a 7-year-old patient with aphakia due to trauma. A scar caused by a penetrating corneal wound passes through the center of the pupil

Figure 3

Optimum Silsoft contact lens fitting in a 4-year-old child with unilateral aphakia

Figure 4

The lenticular design of the Silsoft contact lens with a thick 7-mm thick optic zone in the center and a thin periphery provides easy insertion and comfortable wear

Figure 5

Surface irregularity and deposits on a Silsoft contact lens

Figure 6

Emergence of the hydrophobic structure and blurring of a Silsoft contact lens due to deterioration of surface coating

Figure 7

Fitting of a daily silicone hydrogen contact lens in a 4-year-old child with unilateral aphakia

Figure 8

A 10-year-old child with unilateral aphakia fit with an 18-D, daily use hydrogel contact lens (Omafilcon A, water content: 62%, Dk/t: 42 @ -3.00 D) replaced every 15 days

Figure 9

Central keratitis in a 5-year-old unilateral aphakic child caused by the mechanical effect of a flat-fitting silicone elastomer contact lens