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NUR RABIHA MOHD NOOR
P 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 fit
Effect of image MINIFICATION &
MAGNIFICATION
LIMITED FOV (e.g. in lenticular lens)
1) APHAKIA 3) PSEUDOPHAKIC
2) IRREGULAR ASTIGMATISM
5) HIGH MYOPIA4) PROSTHETIC
OR THERAPEUTIC
 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
Causes:
Laceration of cornea
Infection to cornea
Must be treated to
prevent deprivational
amblyopia
Fit with RGP
Wearing IOL
o 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
WHY?
Cosmetic reason (to camouflage the good eye)
To enhance visual performance (e.g. to reduce
photophobia)
Indicated to:
 Albinism
 Aniridia
 Iris coloboma
 Achromatopsia
 Micropthalmos
WHY not prescribe spec?
- Reduce retinal image
- Peripheral distortion
- Reduce effective visual field
Advantage of px CL for high myope:
- Cosmesis
- Comfort
- Compliance of patient
ANTERIOR SEGMENT
- To check any staining
KERATOMETRY
REFRACTION
CL MOVEMENT
CL CENTRATION
CL FLOURESCEIN PATTERN
LENS SELECTION
There are 2 types of lens:
a) Soft lens
b) 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 astigmatism
o Insertion is difficult
o Dehydration of lens (baby - dry eye – due to less blinking
rate
o Frequent lens loss
Estimated SCL specifications based on age for aphakic:
Age
(month)
BOZR
(mm)
TD (mm) Power (D)
1 7.00 12.00 +35
2 7.20 12.50 +32
3 7.50 13.00 +30
6 7.80 13.50 +25
12 8.10 13.50 +20
Source: Nathan Efron; Contact Lens Practice
b) RGP
Advantages:
Available in wide range of parameters
Durable
Correct corneal astigmatism and irregular astigmatism
Insertion and removal easy because of rigidity
High oxygen permeability
Can be custom made
Disadvantages:
Not suitable for continous wear
Risk abrasion to cornea
Dislodgement
Initial discomfort
Parents more apprehensive
Paediatric management

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Paediatric management

  • 1. NUR RABIHA MOHD NOOR P 82496
  • 2. 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 fit Effect of image MINIFICATION & MAGNIFICATION LIMITED FOV (e.g. in lenticular lens)
  • 3. 1) APHAKIA 3) PSEUDOPHAKIC 2) IRREGULAR ASTIGMATISM 5) HIGH MYOPIA4) PROSTHETIC OR THERAPEUTIC
  • 4.  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
  • 5.  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
  • 6. Causes: Laceration of cornea Infection to cornea Must be treated to prevent deprivational amblyopia Fit with RGP
  • 7. Wearing IOL o 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
  • 8. WHY? Cosmetic reason (to camouflage the good eye) To enhance visual performance (e.g. to reduce photophobia) Indicated to:  Albinism  Aniridia  Iris coloboma  Achromatopsia  Micropthalmos
  • 9. WHY not prescribe spec? - Reduce retinal image - Peripheral distortion - Reduce effective visual field Advantage of px CL for high myope: - Cosmesis - Comfort - Compliance of patient
  • 10. ANTERIOR SEGMENT - To check any staining KERATOMETRY REFRACTION CL MOVEMENT CL CENTRATION CL FLOURESCEIN PATTERN
  • 11. LENS SELECTION There are 2 types of lens: a) Soft lens b) RGP
  • 12. a) Soft lens - Continuous / daily wear - High WC Advantage: • Custom made • Comfortable • Parents less apprehensive about inserting lens Disadvantages: o Do not correct corneal astigmatism o Insertion is difficult o Dehydration of lens (baby - dry eye – due to less blinking rate o Frequent lens loss
  • 13. Estimated SCL specifications based on age for aphakic: Age (month) BOZR (mm) TD (mm) Power (D) 1 7.00 12.00 +35 2 7.20 12.50 +32 3 7.50 13.00 +30 6 7.80 13.50 +25 12 8.10 13.50 +20 Source: Nathan Efron; Contact Lens Practice
  • 14. b) RGP Advantages: Available in wide range of parameters Durable Correct corneal astigmatism and irregular astigmatism Insertion and removal easy because of rigidity High oxygen permeability Can be custom made Disadvantages: Not suitable for continous wear Risk abrasion to cornea Dislodgement Initial discomfort Parents more apprehensive