Contact Lens Correction of Aphakia in Children OTA

A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel: Scott R. Lambert, MD,¹ Raymond T. Kraker, MSPH,² Stacy L. Pineles, MD,³ Amy K. Hutchinson, MD,⁴ Lorri B. Wilson, MD,⁵ Jennifer A. Galvin, MD,⁶ Deborah K. VanderVeen, MD⁷ 

Ophthalmology, April 2018, Vol 125, 1452-1458 © 2018 by the American Academy of Ophthalmology. Click here for free access to the OTA.

Purpose: To review the published literature to assess the visual outcomes and adverse events associated with the 2 most commonly used contact lenses for treating aphakia in children: silicone elastomer (SE) and rigid gas permeable (RGP).

Methods: Literature searches were last conducted in January 2018 in the PubMed, Cochrane Library, and ClinicalTrials.gov databases with no date or language restrictions. These combined searches yielded 167 citations, 27 of which were reviewed in full text. Of these, 10 articles were deemed appropriate for inclusion in this assessment and subsequently assigned a level of evidence rating by the panel methodologist.

Results: The literature search identified 4 level II studies and 6 level III studies. There were insufficient data to compare visual outcomes for eyes treated using SE lenses versus RGP lenses. Silicone elastomer lenses have the advantage that they can be worn on an extended-wear basis, but they were associated with more adverse events than RGP lenses. These adverse events included microbial keratitis, corneal infiltrates, corneal edema, corneal scars, lenses adhering to the cornea, superficial punctate keratopathy, lid swelling, and conjunctival hyperemia. The lens replacement rate was approximately 50% higher for RGP lenses in the only study that directly compared SE and RGP lenses.

Conclusions: Limited evidence was found in the literature on this topic. Silicone elastomer and RGP contact lenses were found to be effective for treating aphakia in children. Silicone elastomer lenses are easier to fit and may be worn on an extended-wear basis. Rigid gas permeable lenses must be removed every night and require a more customized fit, but they are associated with fewer adverse events. The choice of which lens a practitioner prescribes should be based on the particular needs of each patient.

¹Department of Ophthalmology, Stanford University School of Medicine, Stanford, California
²Jaeb Center for Health Research, Tampa, Florida
³Jules Stein Eye Institute, Los Angeles, California
⁴Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
⁵Casey Eye Institute, Oregon Health & Science University, Portland, OregonDepartment of Ophthalmology, Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, College of Medicine, Cincinnati, Ohio
⁶Eye Surgery Associates, LLC, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
⁷Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts