1. PEDIATRIC CONTACT
LENS MANAGEMENT
MOHD ZHARIF BIN MOHD NOR
P82505

2. LEARNING OUTCOME
•Provide technical knowledge to successfully fit
infants
•To provide required knowledge to train and fully
service the ongoing need of families of aphakic
infants

3. WHY FIT CONTACT LENS?
•Key reason – prevention of amblyopia
•Anisometropia – monocular aphakia
•Accommodative esotropia
•High refractive error
•Corneal distortion
•Aniridia or ocular albinism

4. PREPARATION
•Self-confidence
•Comprehensive history
•Family involvement
•Lens selection

5. FITTING PREOCEDURE (STEPS)
•Case history
•Examination of the anterior segment
•Corneal curvature and diameter
•Refraction
•Selection of initial diagnostic lens

6. CASE HISTORY
•Premature / full term
•Associated systemic abnormalities
•Previous fail efforts
•Problems with general anaesthesia

7. INITIAL DIAGNOSTIC LENS
•Understand usual parameters is essential
•Corneal curvature
•Corneal diameter
•Refractive error
•Not always possible to obtain accurate
measurement
•Often based on expected value for patient’s age

8. •At birth:
•Average corneal curvature – 48.50D (6.96mm) and
47.00D (7.18mm)
•Average corneal diameter – 10mm
•Refractive error at corneal plane of an aphakic
eye at age 1 month can be anywhere between
+19D and +38D (average +30.75D)
•2.5 times greater than average aphakic adult

9. •Rapid growth of the eye during the first 18
months
•Increase corneal radius of curvature
•Increase corneal diameter
•Reduction in hyperopia
•Frequent changes in the CL prescription

10. •Aphakic eye ≠ normal eye
•Corneal flattening has been observed faster rate in
the aphakic eye
•Congenital cataract occur frequently in
microphthalmic eye
•Reduction in hyperopia higher for an aphakic eye
•Aphakic eye have far more rapid growth in axial
length following cataract removal

11. FITTING ASSESSMENT
•Goal: Achieve a fit that is a little on the steep
side with adequate edge profile and movement
•RGP – evaluate fluorescein pattern
•Lens ejection or displacement is major issue
•SCL – Penlight evaluation.
•Central bubble indicate tight fit
•Stable movement and adequate edge profile for
good tear exchange

12. OVER-REFRACTION
•Aphakic infants unable to accommodate
•Interested in objects that are close to them
•Overcorrected by about +2.50D to +3.00D
•Reduced to +1.00D to +1.50D at 18-24 months
of age
•3-4 years of age give appropriate distance
correction with reading correction (bifocal/MF)
to be worn over the CL

13. CONCLUSION
•Fitting CL for infants and toddlers is an exciting,
challenging and highly rewarding
•Knowing the tools to use, how to use them
effectively and what to do when things do not
go as planned critical to successfully performing
this procedure

14. REFERENCES
• Chen YC, Hu AC, Rosenbaum A, Spooner S, Weissman BA.
Long-term results of early contact lens use in pediatric
unilateral aphakia. Eye Contact Lens 2010; 36:19-25
• Speedwell L. Paediatric contact lenses. In: Phillips AJ,
Speedwell L, eds. Contact Lenses, 5th ed. London:
Butterworth-Heinemann, 2006. p 508–513.