This slide presentation is about how to manage paediatrics patients with eye problem that cannot be corrected with glasses. For instance, in aphakic patients, aniridia, albinism and others. Take a look and get information regarding this topic.
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
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
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