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Contact lenses in paediatric aphakia in the Netherlands; A multicentre retrospective chart study
K H Elving1, A J W Haasnoot2, E A E Ghyczy3
1Visser Contact Lens Practice, Department of Ophthalmology UMC Utrecht and Amsterdam UMC, Nijmegen, The Netherlands.
Insights
Soft contact lenses (CLs) effectively treat pediatric aphakia with low complication rates. However, CL loss, particularly in the first year, necessitates careful management and caregiver education.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Contact Lens Technology
Background:
- Pediatric aphakia, often resulting from congenital or secondary cataracts, requires effective refractive correction.
- Contact lenses (CLs) are a primary modality for managing aphakia in children, offering visual rehabilitation.
Purpose of the Study:
- To evaluate the types, parameters, loss rates, and complications associated with soft CL wear in pediatric aphakia over a decade.
- To assess the long-term outcomes and challenges of CL management in young aphakic patients.
Main Methods:
- A retrospective multicenter chart review of aphakic children under 9 years old treated between 2008 and 2018.
- Exclusion criteria included traumatic aphakia and corneal scarring; data collected encompassed CL type, parameters, wear time, reasons for replacement/discontinuation, visual acuity, and complications.
Main Results:
- Ninety-one children (132 eyes) were fitted with soft CLs, predominantly silicone elastomer (86%).
- Median CL power decreased significantly from +29 D to +20 D over 3 years (P < 0.001).
- High rates of CL replacement (1083 total) were noted, with 46% of first-year replacements due to CL loss; complications occurred in 9% and discontinuation in 8%.
Conclusions:
- Soft CLs provide a successful treatment for pediatric aphakia with generally low complication and discontinuation rates.
- Frequent CL replacement due to loss, especially within the first year, presents a significant challenge for caregivers and healthcare systems.
- Attentive patient care and clear communication are crucial for optimizing CL wear and minimizing issues in the initial year.
Purpose:
The main aim of this study was to evaluate the type, parameters, loss and complications of contact lenses (CLs) in the treatment of paediatric aphakia over a 10-year period.
Methods:
This retrospective multicentre chart review included the files of aphakic CL wearers under the age of 9 years old that were treated between 2008 and 2018. Patients with traumatic aphakia and scarring of the cornea were excluded. The following data were collected; demographic data, cataract type (congenital or secondary), CL type, parameters and wearing time, reason for replacement and discontinuation of the CLs, visual acuity (VA), prophylactic use of antibiotics (ABs), and complications.
Results:
Ninety-one aphakic children (132 eyes) were fitted with soft CLs. The median age of cataract extraction was 10.50 weeks (interquartile range (IQR) 7,15) in the congenital cataract group and 112 weeks (IQR 41,285) in the secondary cataract group. At the initial fitting a silicone elastomer CL was fitted in 86 % and a silicone hydrogel CL in 12 %, the remaining 2 % were mixed CL types. The median CL power at baseline was + 29 D (IQR 25,32) and after 3 years of wear the median power had shifted significantly to + 20 D (IQR 17,26), P < 0.001. A total of 1083 extra CL replacements were needed of which 414 in the first year of wear. Of these 414 replacements almost half (46 %;n = 191) were due to loss of the CL. Complications developed in 8 (9 %) cases and 7 (8 %) patients discontinued CL wear.
Conclusion:
This paper confirms that paediatric aphakia can be successfully treated with soft CLs with low rates of complications and discontinuation encountered. Unscheduled CL replacements due to loss are a concern, especially in the first year, and are straining for both the care giver and medical system. Attentive care and clear information is advised during the first year of CL wear.
