CLM - Paediatric Contact Lens Fitting - Week 11 Flashcards
List four indications for paediatric contact lens fitting.
Infantile aphakia
High myopia (uni/bilateral)
Hyigh hyperopia (uni/bilateral)
Ocular trauma
What percentage of world childhood blindness does infantile cataract account for?
10%
What percentage of infantile cataract cases are bilateral? What percentage are idiopathic?
65%
?50% idiopathic
Is uni- or bilateral infantile cataract more common? Is it generally hereditary? What is it associated with?
Bilateral is more commonly hereditary or associated with systemic disorders
How does a denser cataract affect HVID in infantile cataract? what about K values?
Smaller HVID
Steeper K
What is unilateral infantile cataract often associated with? Give three examples.
Ocular anomalies
i.e. microphthalmia, aniridia, PHPV
What demographic of infants is infantile cataract associated with (2)?
Prematurity
Low birth weight
What is the most common cause of acquired infantile cataract? What is it more likely with?
Blunt or penetrating trauma
-more likely with penetrating
Is visual prognosis better or worse with uni- or bilateral infantile cataract? Explain why (2).
Better with bilateral cataracts
Amblyopia is inevitable with unilateral, common with bilateral
What is more critical with unilateral infantile cataract vs bilateral?
Age of treatment
What is the best treatment for amblyopia after infantile cataracts?
Patching
What is a treatment option for amblyopia following bilateral infantile cataract? Comment on effectiveness.
Refractive penalisation - no lens in the better eye
Doesnt always work
Is the incidence of strabismus higher in uni- or bilateral infantile cataract or the same?
More common in unilateral
What is generally considered once VA of the amblyopic eye is optimised (infantile cataract)?
Strabismus surgery
What is the treatment for infantile cataract? What does this increase the risk of and within what timeframe? What should be done immediately following treatment (2)? What is the best option? Comment the use of spectacles and IOLs for bilateral aphakia in infants.
Surgical removal ASAP -extraction <1/12 increases the risk of glaucoma Immediate visual rehabilitation after -refractive correction -any amblyopia therapy Contact lenses the best option Can do spectacles for bilateral aphakia -use of IOLs in infants controversial
List 9 aspects of patient examination for infantile cataracts.
Discussion with the parents Case history -prematurity, other problems Ocular alignment Hand-held slit-lamp Hand-held keratometry Retinoscopy HVID/lid anatomy EUA
List three types of contact lenses for infantile aphakia.
Rigid lenses
Soft lenses
silicone elastomer lenses
Between soft and rigid contact lenses, which causes less mechanical irritation for infants?
Soft
Between soft and rigid contact lenses, which is more forgiving in terms of fitting for infants?
Soft
Between soft and rigid contact lenses, which is more easily rubbed out by infants?
Soft
What is a potnetial problem with hydrogel soft contact lenses in infants?
Low Dk/t causing corneal hypoxia
What does soft contact lens dehydration create the need for?
May need even higher BVP
Is lens insertion on infants easy or hard with soft contact lenses?
Very difficult