Paediatric contact lenses

G RO U P N AM E : THE I N N OVATORS
G RO U P L EADE R : FA RA H N AHEE D
G RO U P M EM B ERS : I S HA A S L AM
M AL A I KA I N AYAT
A M B ER SA EE D
CONTENTS OF DISCUSSION:
 Introduction

 Materials of contact lenses

 Parameters of contact lenses

 Refractive applications

 Prosthetic applications

 Contact lens fitting

 Contact lens evaluation

 Contact lens Handling and care

 INTRODUCTION:
 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 Pediatrics:
STAGE AGE
Baby 0-12 months old
Toddler 1-3 years old
Pre School 3-5 years old
Grade-schooler 5-12 years old
Teen 12-18 years old
Young adult 18-21 years old
Successful contact lens wear:

1. being able to tolerate

2. Benefit from the use of device

 Paediatric contact lens materials:
 Key choice in peads:

1. Silicone hydrogel

2. Silicone elastomer

3. Rigid lenses
 1. Silicone hydrogel:
 Soft lenses

 Most frequently used in paediatric fitting

 High water content (preferably SiHy)

 Daily wear – reduce risk of infection

Advantages Disadvantages
Comfortable High cost
Stays in place Low Dk (corneal edema)
Not durable (rippage,deposits)
Infection risk in EW
No UV protection available
Cannot mask irregularity
Insertion can be difficult
2. Silicone Elastomer:
 Silicone rubber lenses
 Commonly used in babies & young children
 Can prevent lens loss or dry ocular surface
 Lens fit checked using fluorescein
 Silicone elastomer lens providing the high oxygen permeability
 Silsoft by Bausch + Lomb: Option for paediatric aphakia-30 days continuous
wear lens
Advantages Disadvantages
High permeability High cost
Easier
Easier to
to insert
insert Require
Require more
more chair
chair time
time
Less susceptible to damage Negative pressure effect
Less susceptible to damage Negative pressure effect
Comfort Surface coating can degenerate
Comfort Surface coating can degenerate
Stay in place Poor lens wetting
Stay
Easy in place
handling Poor lens wetting
Hydrophobic
Easy handling o Rapid lipid deposition
Hydrophobic
o Rapidparameters:
Limited lipid deposition
o Power range 3D step
Limited
o 3 Baseparameters:
Curves
o
o 1 diameter 3D step
Power range
o 3 Base Curves
o 1 diameter
Parameters of Silsoft By Bausch + Lomb:
Parameters Available range
Material Elastofilcon
Water content 0.2%
permeability (Dk) 340
transmission (Dk/t) 71
Base Curves 7.5, 7.7, 7.9mm
Diameter 11.30mm
Power +23.00D to +32.00D (3.00D
steps)
Optical zone 7.0mm
Centre thickness 0.51mm - 0.71mm
3. Rigid Gas Permeable (RGP) :
 Rigid lenses

 Preference: Menicon Z
 Highest level of oxygen permeability

Parameters Details
Material Tisilfocon A with UV filter
O2 permeability, Dk 163
FDA Approval 30 days continuous wear
Advantages Disadvantages
• Less expensive • Not for continuous wear
• Large range of materials & parameters • Risk of abrasion
• Can correct corneal astigmatism • Initial discomfort
• Durable • Ease of dislodgement
• Easy to insert & remove
• Provide clearer vision
• Less bacterial and protein adherence
• Reduction in the progression of myopia
• Flexibile parameters (customized base
curve, power & diameter)
• High Dk - allow improved tear flow and
oxygen under the CL
PARAMETERS OF PAEDIATRIC CONTACT LENSES:
ISHA ASLAM
 Refractive Applications:
1. Aphakia :

 Primary indication under 1 year of age is unilateral or bilateral cataract

extraction

 Development

 Vision interference

 Cataract extraction and optical correction

Optical Correction :
1. Spectacles :
It may theoretically be used ,especially in bilateral aphakia

 Problems:

Optical distortion , magnification , handling and unilateral aphakia develops aniseikonia .

2. IOL implantation and Epi-keratophakia:

 gives least distortion and magnification

 Principle advantage is that they require no parental effort.

Contin…
3. Contact lens:
 Advantages :

Optical correction can be changed ,simple assessment

 Disadvantages

Lens care, maintenance ,handling ,lens loss , breakage, obsolescence ,expensive ,difficulty in
obtaining custom made devices with optical power between +20 to +40 D.
Article Reference :
The visual outcomes for infants 18 months or younger with cataracts have
improved dramatically over the past couple of decades. Earlier detection of
infantile cataract and prompt surgical removal—with subsequent visual
rehabilitation with contact lenses—mean that these patients now have a much
better visual prognosis. Advances in contact lens technology have led to a
significantly higher success rate with contact lenses and this has been a major
factor in improving the visual outcomes for aphakic infants. This review outlines
the contact lens management of infantile cataract, including a detailed analysis
of the various contact lens options available and a discussion regarding the
important factors that can cause issues with contact lens wear and affect the
overall visual rehabilitation of the infant.
 Lindsay RG, Chi JT. Contact lens management of infantile aphakia. Clinical and
Experimental Optometry. 2010 Jan 1;93(1):3-14.
Types of lenses used :
 Rigid Contact Lens :
Advantages include available in extreme prescription, ease, less expense.
Disadvantages include lens breakage and loss .
 Flexible Silicon lenses:
Advantages are oxygenation ,less lens loss
Disadvantages include expense, not full correction, abrasions of cornea
 Hydrogel lenses:
More fragile ,unable to correct residual astigmatism.
 Extended wear lenses :
Acute red eye ,giant papillary conjunctivitis ,infectious keratitis
 Refractive Applications:
2. MYOPIA:
 Indicated in myopes greater than 10 D

 Contact lens will result in less image magnification and deceased peripheral
distortion.
 Spherical hydrogels
 Rigid lenses
 Orthokeratology
 Pirenzepine
 Refractive Applications:
3. Astigmatism :
 In extreme astigmatism ,irregular, as in trauma ,disease or surgery.
 In keratoconus
 Spherical Rigid contact lens
 Other contact lens
 Refractive Applications:
4. Aniseikonia:
 Use in one eye is advisable.

 It minimizes retinal image size difference .

 Reduces unwanted prismatic effect.
5. Accommodative Esotropia :
 Contact lens use to improve cosmesis, decreases the weight of optical
correction ,improves optics
 Plus power acceptance may be enhanced by using Contact lenses than
spectacles.
MALAIKA INAYAT
• Prosthetic applications
of contact lenses
MALAIKA INAYAT
 Prosthetic contact lenses:
There are four types of prosthetic contact lenses:

1. Black pupil lens:

 has a black central area

 Used for patching purposes, diplopia, iris hypertrophyand lens subluxation

Cont…
2. Clear edge with light brown tint lens:
 Tinted iris lens

 Used for cosmetic enhancement only

3. Clear pupil and clear edge with dark brown iris:

 Brown iris lens

 Used for photophobia, keyhole pupil, polycoria, micro cornea etc.

Cont…
4. Lens with black pupil and brown iris:

 Black pupil of 4mm diameter with dark brown iris

 Used for corneal disfiguration, corneal scarring, decentered pupil

 PROSTHETIC APPLICATIONS:
Prosthetic applications of contact lens in children include:

1. Amblyopia
2. Ocular disfigurements
3. Aniridia
4. Albinism
5. nystagmus
1. Amblyopia:
 Main purpose of prosthetic contact lens in amblyopic children is patching
therapy

 For ideal patching, the diameter of contact lens should be more than 10-11mm

 Tinted hydrogels are better than rigid lenses

 High plus and high minus contact lenses can also be used for patching
purposes in children

 Opaque/ black pupil prosthetic lenses are used in amblyopic children

2. Ocular disfigurements:
 Micro cornea, corneal scars, trauma, decentered pupil, congenital cataract
producing leukocoria etc.

 Rigid contact lens with clear pupil and clear edge are the best options for
ocular disfigurements
3. Albinism:
 Congenital disorder

 Severe photophobia

 Darkly tinted contact lenses or lenses with an opaque periphery with small
central zone are used
4. Aniridia:
 Needs contact lenses that reduce photophobia

 Opaque periphery contact lenses

 Darkly tinted lenses are used

5. Nystagmus:
 Oscillatory movements of the eyes

 Mostly seen in albinism

 Contact lens:
Corrects Refractive errors
Reduce spectacle and prism distortion
Case presentation (albinism, nystagmus):
 Patient age: 5 years

 Gender: female

 Chief complaint: decreased visual acuity, strabismus, light sensitivity

 Ocular examination:

Visual acuity: 6/36 (OU)

Cont…
 Slit lamp examination:
Adnexa: normal
Anterior segment: iris translucency
Posterior segment examination: bilateral fundus hypopigmentation,
foveal hypoplasia
Signs : photophobia, nystagmus, strabismus
Cont…
Treatment: patient was prescribed with soft cosmetic tinted iris contact lens
 Base curve:8.4mm
 Diameter: 13.8mm
 Power: Plano sphere power

Outcome:
 child tolerated well with the CL.
 Immediate improvement was reported by parents
 Visual acuity remained unchanged
AMBER SAEED
CONTACT LENS FITTING PROCESS:
1. HISTORY TAKING
• Pt chief complain, ocular & health history
• Family ocular & health history

2. OCULAR EXAMINATION
• VA & Refraction
• Corneal measurement: Handheld topo or Keratometry
3. CL TYPE & PARAMETER SELECTION
• Diameter: SCL: 2-3mm >HVID, RGP: 1-2mm <HVID
• Base curve: 1-2 D steeper than flatter K
• Power: According to expected age value

4. CONTACT LENS FITTING:

• Hold the pt’s upper lid with index finger &B pull down pt’s lower lid
with thumb
• Slide the lens under the upper lid and lower lid with the thumb of
other hand.

5. CL ASSESSMENT:
• Allow the lenses to settle for 20 mins. Observe with pentorch or
Burton lamp-Fluorescein.
• Avoid light fit and Optics should be within the pupil
6. FOLLOW UP:
• 1day: to evaluate fit, perform retinoscopy and stain the cornea
• 2-4 weeks: for lens removal, cleaning and disinfection & teach parents
• Advise parents to look for any redness, discharge and rubbing of eyes

7. LENS ORDER:
• Add 2D or 3D to final prescription to enhance near vision
• RGP: custom-made, variety of power
• Soft lens (silsoft): Power limitation- lens come in 3D increments,
prescribe more plus because the infant world is up close
 Contact lens Evaluation:
Fitting Evaluation Progress Evaluation

• Before the lens is dispensed • After lens dispensing and

• It permits the observation
of centration, movement,
physiological response and
estimation of residual
power.
wear
• It permits frequent
evaluations vital for
continued contact lens
success.
Fitting Evaluation:
1) In children above 7 years Of Age:
 Simply by slit lamp in a sitting posture
2) In children less than 7 years of Age :
Children are Usually restrained on pediatric bed and evaluated using:
i) Hand held biomicroscope
ii) Magnifying light
What if none of above is available ?
How estimation of residual power will be done ?
Hand held Bio microscope:
Magnifying Light:
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.
Contact lens Replacement schedule :
Contact lenses are designed for specific wearing times.
 Daily disposable wear - the contact lens is discarded after each removal

 Frequent/Planned Replacement - the contact lens is cleaned, rinsed and

disinfected each time it is removed from the eye and discarded after the
recommend wearing period .
It tells you when you need new lenses.
 Contact lens Handling and care:
For safe contact lens wear, lens care routine should be followed.
Parents should be guided as :

 Always wash, rinse, and dry hands before handling contact lenses.

 Always use fresh, unexpired lens care solutions.

 Use the recommended lens care system and carefully follow instructions on
solution labeling
Cont…
 Do not use saliva or anything other than the recommended solutions for
lubricating or rewetting your lenses. Do not put lenses in your mouth.

 Lenses prescribed in a frequent replacement program should be thrown away

after the expiration of the wearing period.

 Clean one lens first (always the same lens first to avoid mix-ups). Put that lens
into the correct chamber of the lens storage case. Then repeat the procedure for
the second lens.
Cont…
Never rinse your lenses in water from the tap. There are two reasons for this:

 Tap water contains many impurities that can contaminate or damage your lenses
and may lead to eye infection or injury.

 You might lose the lens down the drain.

After cleaning, and rinsing, disinfect lenses using the system recommended by your
eye care professional. Follow the instructions provided in the disinfection solution
labeling.
Cont…
To store lenses, disinfect and leave them in the closed/unopened case until
ready to wear. 
After removing your lenses from the lens case, empty and rinse the lens storage
case with solution(s) recommended by the lens case manufacturer; then allow
the lens case to air dry. When the case is used again, refill it with fresh storage
solution. Replace lens case at regular intervals.
Common Problems after Contact lens Insertion:
 Eye stinging, burning, itching, eye
pain,.
 Comfort less than when lens was first
put in, abnormal feeling of something in
the eye.
 Excessive watering, unusual eye
secretions, redness.
 Reduced sharpness of vision, blurred
vision, rainbows or halos around
objects, sensitivity to light.
Common contact lens Complications
What If you Notice any Issue ?
If you notice any issue with your contact lenses
Immediately remove your lenses and look :
If the discomfort or problem stops, then look closely at the lens. If the lens is in
any way damaged, do not put the lens back on your eye. Place the lens in the
storage case and contact your eye care professional.
If the lens has dirt, an eyelash, or other foreign body on it, or the problem stops
and the lens appears undamaged, you should thoroughly clean, rinse, and
disinfect the lenses; then reinsert them. After reinsertion, if the problem
continues, you should immediately remove the lenses and consult your eye care
professional.
Fun-fact:
Ask mothers to please don’t do this.
References:
Good Comments Expected

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