Optical penalization with contact lenses for children with unilateral aphakia: an alternative to patching.

OBJECTIVES: To evaluate the efficacy of high-plus contact lenses as a form of optical penalization in children with unilateral aphakia. METHODS: An internal database review was used to identify 10 patients with unilateral aphakia after congenital cataract extraction who underwent treatment with a high-plus contact lens in their sound eye after a period of failure with traditional occlusive patching. The details surrounding the switch from patching to optical penalization with contact lens were recorded along with related changes in compliance and any demonstrable effect suggestive of an improvement in visual ability. RESULTS: After an average 15-month delay between the end of occlusive patching and the start of optical penalization with high-plus contact lenses, 6 of 10 patients achieved good compliance with high-plus contact lens therapy and most families were able to successfully administer the lenses according to the prescribed regimen. Three patients showed evidence of a fixation switch to the contact-lens-corrected aphakic eye during optical penalization of the sound eye. No safety issues were reported. CONCLUSION: Using a high-plus contact lens to optically penalize the sound eye of a unilaterally aphakic child seems to have the potential as an effective alternative to occlusive patching for those with compliance issues. A prospective study is warranted to assess long-term safety, and above all, efficacy in visual outcome.

Ophthalmic manifestations of mosaic Down syndrome.

PURPOSE: The cognitive and physical stigmata of mosaic Down syndrome (DS) are often considered to be less severe than complete trisomy-21 DS. In contrast to complete trisomy-21 DS, the ophthalmic manifestations in mosaic DS have rarely been reported. The aim of the present study is to report clinically significant ophthalmic abnormalities in a cohort of individuals with mosaic DS. METHODS: A prospective cross-sectional observational case series was designed to evaluate ophthalmic manifestations of mosaic DS. Individuals with mosaic DS were recruited and examined at the biennial meeting of the International Mosaic Down Syndrome Association. A medical, surgical, and ocular history was obtained. Each subject received a complete eye examination on site, including assessment of visual acuity, alignment, motility, sensory function, accommodation, anterior segment, fundus, and cycloplegic refraction. RESULTS: Seventeen individuals with mosaic DS (mean age, 9 years; range, 6 months to 32 years) underwent eye examinations. Clinically significant refractive errors were present in 41% of the subjects, accommodative insufficiency in 59%, strabismus in 35%, nystagmus in 6%, and cataract in 6%. Ten individuals completed optotype visual acuity testing. Mean LogMAR acuity of the better eye of each subject was 0.2 (20/32 equivalent). CONCLUSIONS: Clinically significant ophthalmic disorders are common among children and young adults with mosaic DS. Our findings support regular periodic eye examinations for these individuals.

Hyper oxygen-permeable rigid contact lenses as an alternative for the treatment of pediatric aphakia.

PURPOSE: To establish the safety and efficacy of a hyper oxygen-permeable rigid contact lens material, Menicon Z, for the fitting of aphakic infant eyes. METHODS: A prospective study was performed on 16 eyes of 10 newly aphakic infants. Aphakic fittings were performed postoperatively with the Dyna Z intralimbal design of lenses, made exclusively from Menicon Z material for this study. Examinations were performed at 1 day, 1 week, 1 month, 3 months, and 6 months, during which the lenses were used on a 1-week extended-wear basis. The following outcome measures were evaluated at each visit: Fit Characteristics, Ocular Integrity, Usability, and Contact Lens Integrity. RESULTS: When used for the treatment of pediatric aphakia, the Menicon Z material provided excellent Fit Characteristics, was not damaging to the ocular structures, was relatively easy to manipulate for caregivers, and maintained its integrity well throughout the course of the study. Because there were no observable increases in the rate of microbial infection during the course of the study, the hyper oxygen-permeable nature of the Menicon Z material seems to provide adequate corneal oxygenation for aphakic children when used on a 1-week extended-wear basis. CONCLUSIONS: The Menicon Z contact lens material provides a safe and effective alternative for the treatment of infants and children requiring aphakic correction. This hyper oxygen-permeable material offers sufficient corneal oxygenation at the lens powers and thicknesses demanded by newly aphakic eyes combined with a low risk for associated complications.