BY:NOOR MUNIRAH BINTI AWANG ABU BAKAR

P82498

Paediatric Contact Lens Management

OUTLINES:

Indications for paediatric contact lenses fitting

Various contact lens option for paediatricFitting techniquesChallenges that are present with

paediatricCL as Myopia control

WHO is PAEDIATRIC?

Paediatrics : A branch of medical care that deals with infants, children and adolescents, from birth up to age of 18 (in US up to 21)

The word paediatric is derived from two Greek words (pais = child and iatros = healer), which means healer of children.

Classification by American Academy of Paediatrics:STAGE AGEBaby 0-12 months old

Toddler 1-3 years oldPre School 3-5 years

Grade-schooler 5-12 years oldTeen 12-18 years old

Young adult 18-21 years old

INDICATIONS

„Purpose of wearing CL: Refractive and Therapeutic

1.Aphakia (congenital cataract, genetic , rubella, Post-partum trauma, PHPV and micro-ophthalmia)

2.High Myopia „ 3.High hyperopia (Accomodative esotropia) „ 4. Irregular Astigmatism (trauma, HSV scarring )„ 5.Photophobia (aniridia, iris coloboma, albinism,

achromatopsia „)6.Amblyopia7.Anisometropia (refractive>2D)„8.Nystagmus (Often accompanied with high refractive

error „ )9.Myopia Control

INDICATION cont.

Aphakia Congenital cataracts occur in 1.7 of 10,000 births Surgeon do not insert IOL for children under 2-3 yo during

the lensectomy, due to fragile posterior capsule and the eye not yet stable, as keep growing.

Resultant aphakia best corrected with Contact Lens to restore vision

Anisometropia In case of aniseikonia, contact lenses reduce differences in

image size between eyes and improve peripheral vision.Amblyopia

An occluder or opaque contact lens as alternative to patching therapy

CL OPTIONS-Description

1. Soft/Hydrogel „ lensAdvantages Disadvantages

Comfort Stays in place

High cost Low Dk ( corneal edema ) Poor handling Not durable ( rippage ,

deposits) Infection risk in EW No UV protection avail Cannot mask irregularity

CL OPTIONS-Description

2. Prosthetic Lenses To improve appearance of disfigured eye : Aniridia,

Iris coloboma, injured cornea (ulcer or trauma) To block light reaching back of the eyes; for

photophobia to reduce glare & increase comfort: Albinism (less pigment)

To eliminate diplopia for certain eye conditions. Amlyopia therapy:

Pt wear two identical-appearing colored contact lens, GOOD eye wears lens with opaque pupil to block (occlude) light from entering the eye.

More effective than applying eye patch „HOW?: Custom painted to color match „

CL OPTIONS-Description

3. Silicone Elastomer/B&L Silsoft Silicone elastomer lens providing the high oxygen permeability  Silsoft by B&L:Option for paediatric aphakia-30 days continuous wear

lens Advantages:

High O2 permeability Comfort & stay in place Easy handling

Disadvantages: Poor lens wetting Hydrophobic

Rapid lipid deposition Limited parameters

Power range 3D step 3 Base Curves 1 diameter

High cost

Parameters Available rangeMaterial Elastofilcon

Water content 0.2%O2 permeability (Dk) 340

O2 transmission (Dk/t)

71

Base Curves 7.5, 7.7, 7.9mmDiameter S 11.30mm

Power +23.00D to +32.00D (3.00D steps)

Optical zone 7.0mmCentre thickness 0.51mm - 0.71mm

CL OPTIONS-Description

4. Rigid Gas Permeable (RGP) Preference: Menicon Z

Highest level of oxygen permeability

Advantages: Provide clearer vision than other methods. Allow improved tear flow and oxygen under the CL-high Dk Easy to handle (insertion & removal) Reduction in the progression of myopia Flexibility designs/parameters (customize curve, power, diameter. Safety profile: less bacterial and protein adherence Cost: less expensive

Disadvantages: Adaptation/ comfort Lens loss/ dislocation

Parameters DetailsMaterial Tisilfocon A with UV filter 

O2 permeability , Dk 163

FDA Approval 30 days continuous wear

CONTACT LENS FITTING

What age appropriate to fit contact lens? American Academy of Optometry in 2004 stated : “ by the age of eight, a child was able to handle contact lenses and assume

some degree of responsibility.” However, child's maturity and ability to handle contact lenses responsibly is

more important than age alone. Otherwise, optometrist should educate and guide parents on proper

handling of CL.Pre-fitting apparatus

Contact lens fitting sets Retinoscope and loose lenses Fluorescein strips and Wratton filter Keratometer (optional) Burton Lamp Contact lens solution, case & cleaners

CL FITTING PROCESS

CL FITTING PROCESS

CL FITTING PROCESS

CL FITTING-PARAMETERS

Average Power Needed for the Aphakic Eye 0-12 months : +29 D to +32 D 12-24 months : +20 D to +26 D > 2 Years : +12 D to +20 D

Corneal Curvature (Table 1)

CL FITTING- CONSIDERATION

Considerations Specific to the Infant maximum oxygen permeability expanded powers steeper base curves smaller overall diameters ease in handling and durability reproducible ability to use medication

CHALLENGE IN PAEDIATRIC CL MANAGEMENT

Infant & toddler eye anatomy Small palpebral fissure Steeper cornea than older patient Higher powers than the older pt (due to shorter axial length)

Parent time & motivation Time limitation Find difficulty on lens insertion and removal process, lens care

Unable to understand instruction (infants) Alternative: voice, touch & smell

Anxiety about the procedures (for toddlers) Resisting during procedures

CL as MYOPIA CONTROL

Orthokeratology (Ortho-K) Temporarily reverse myopia Specially designed GP worn during night sleep, and removed

in the morning .“Dual-Focus” soft contact lenses:

Latest finding: able to slow the progression of nearsightedness in children ages 11 to 14, compared with regular soft contact lenses.

Design: Concept: peripheral defocus in the retina might reduce the

lengthening of the eyeball during childhood that is associated with myopia progression.

Central optical zone : Fully corrects myopia

Peripheral zone: Lesser correction

REFERENCES

1. Scalafani, L. August, 4 2002. Kids and Contacts: Pediatric Aphakia Contact Lens Fitting: Review of Optometry.

2. Edmonds, C.A., October, 23 2003. Fitting Infants and Toddlers with Contact Lenses: Review of Optometry.

3. Stephenson, M. 2014. Prosthetic Contact Lenses. Allaboutvision.com

4. Walline, J.J. 2000. Fitting Kids with Rigid Gas Permeable Lenses. Contact Lens Spectrum.

5. Heiting,G. Are Contact Lenses a Good Choice for Kids?. Allaboutvision.com

6. Reeder, R.E.Kattouf, V. November ,1 2010.Succeeding with Kids and Contact Lenses: Optometric Management.

7. Saltarelli, D.P. 2013. Contact Lenses For Infant Aphakia: Tips For Successful Management.