The Management of Infant Aphakia

Transcription

1 The Management of Infant Aphakia Christina Twardowski O.D., FAAO Please silence all mobile devices and remove items from chairs so others can sit. Unauthorized recording of this session is prohibited.

2 Disclosure Statement: Nothing to disclose

3 Pediatric Cataracts Isolated or Associated Congenital or Acquired Inherited or Sporadic Unilateral or Bilateral Partial or Complete Stable or Progressive

4 Isolated vs Associated Systemic disease bilateral involvement Bilateral involvement systemic disease

5 Congenital vs Acquired Earlier onset = more amblyogenic Lens opacities that are visually significant before 2-3 months of age are most likely to be detrimental to vision 1 American Academy of Ophthalmology. Pediatric Ophthalmology and Strabismus. Basic and Clinical Science Course. San Francisco: AAO,

6 Unilateral vs Bilateral Unilateral Cataract Idiopathic Ocular Anomalies: Persistent fetal Vasculature, Retinal detachment Trauma Bilateral Cataracts Idiopathic Familial (Hereditary) Chromosomal Abnormality Craniofacial Syndromes Musculoskeletal Disorders Renal Syndromes Metabolic Diseases After Intrauterine Infection Iatrogenic

7 Removal of Cataract 1. When to perform the surgery? 2. When to implant an intraocular lens?

8 Timing of cataract extraction The younger the child the greater urgency to remove the cataract Unilateral cataract remove before 6 weeks of age 1 Bilateral cataracts remove before 8 weeks of age 1 American Academy of Ophthalmology. Pediatric Ophthalmology and Strabismus. Basic and Clinical Science Course. San Francisco: AAO,

9 IOL vs Contact Lens

10 IOL vs Contact Lens Visual Acuity Anisometropia Stereopsis Secondary Glaucoma

11 IOL vs Contact Lens Visual Acuity

12 IOL vs Contact Lens Visual Acuity Median visual acuity was 0.90 logmar (20/159) for both groups No visual benefit of implanting IOL at the time of cataract surgery

13 IOL vs Contact Lens - Anisometropia

14 IOL vs Contact Lenses - Anisometropia

15 IOL vs Contact Lens - Anisometropia

16 IOL vs Contact Lens - Stereopsis

17 IOL vs Contact Lens Glaucoma 18% developed glaucoma No difference in prevalence between the two groups

18 Examination of Aphakic Infants 1 week 4 weeks Monthly

19 REFRACTION 1 week Refraction Watch your lens position when performing retinoscopy Use the effective power equation to calculate contact lens power IOP Check Insert Contact Lens! " =! $ 1 '!$ Over Refraction Occlusion Treatment! " = ( )! " =

20 REFRACTION 1 week Refraction IOP Check Insert Contact Lens Over Refraction Watch your lens position when performing retinoscopy Use the effective power equation to calculate contact lens power Don t forget to overcorrect Occlusion Treatment

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22 IOP Check IOP CHECK 1 week Refraction IOP Check Insert Contact Lens Over Refraction Occlusion Treatment CCT tends to be increased in these patients

23 Insert Contact Lens 1 week Refraction IOP Check Insert Contact Lens Over Refraction Occlusion Treatment Base Curve Diameter Power Dk Silsoft Peds 7.5, 7.7, , , +26, +29, +32 Silsoft Adult 7.5, 7.7, 7.9, 8.1, , to +20 in 1D steps

24 Over Refraction 1 week Refraction IOP Check Insert Contact Lens Over Refraction Occlusion Treatment Over ret = minus

25 What about glasses?

26 Spectacles vs Contact Lenses Spectacles Contact Lenses PROS CONS PROS CONS Safest/simplest method of correction Less parental effort May be appreciated more in bilateral aphakic patient Cosmetic Appearance Cost greater compared lens with standard refractive power Easy Power Changes Cosmetic Appearance Easily displaced Expense of replacement Risk of microbial keratitis

27 Occlusion Treatment 1 week Start 1 week post op Refraction IOP Check Insert Contact Lens Begin with 6hrs/day This will be tapered with improved vision and age Over Refraction Occlusion Treatment Must patch throughout visual development period to maintain visual progress

28 Timeline of Follow Ups 1 week 4 weeks Monthly Refraction Over refraction Over Refraction IOP check IOP check IOP check Insert new lens Insert new lens Insert new lens Over Refraction Over Refraction Over Refraction Occlusion Treatment Occlusion Treatment Occlusion Treatment

29 Factors Affecting Visual Progress: Age of Cataract Onset Timing of Surgery Treatment of Amblyopia

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