Bifocal Lenses for an Aphakic Teen Myope
BY STEVEN H. EYLER, OD, FAAO
Our primary care practice has long embraced sports and pediatric vision care as an integral part of patient services. Enhancing performance through providing superior visual function is rewarding clinically, and essential to the peak performance of the athletes for whom we provide vision care. Our practice is increasingly fitting younger and younger patients, both athlete and non-athlete alike, in contact lenses. The following clinical case represents a non-traditional use of new contact lens modalities to meet the visual needs of an active youngster.
C.S. was first seen at age two-and-a-half upon referral from his pediatrician to rule out vision problems relating to his suspected tentative diagnosis of a learning disability or possible mental retardation. C.S. presented as an atypically lethargic toddler. Examination revealed an approximate refractive finding of 7.00D OU. Corrected visual acuity with animal cards was recorded as 20/70 OU. Atypical cortical lens changes were noted, with unstable macular fixation, bilaterally. Re-examinations occurring at six-month intervals over the next four years (including a thorough pediatric ophthalmologic consult) demonstrated a steady increase of myopia and development of bilateral nuclear lamellar cataracts. Best corrected visual acuity during this period was 20/30 OU. By age seven, his spectacle prescription was 14.00 0.50 x 175 OD, -13.00 0.50 x 180 respectively.
C.S.' development was steady, but during his eighth year, dropping visual acuity led to cataract (bilateral nuclear lamellar with riders into the cortical areas) extraction. We elected an aphakic procedure in 1993 because of the long-term perceived risks of IOLs in young patients. The resultant refraction was +5.50 1.50 x 40 OD, +6.00 1.25 x 150 OS, with a +2.50 add, with initial best corrected visual acuity of 20/40 and 20/40+ respectively. Within the year, as expected, C.S. had undergone bilateral YAG capsulotomy, when capsular haze developed rapidly over a six-month period.
By age 10, C.S.' corrected visual acuity slowly improved along with an expected myopic shift, recorded as +4.75 0.75 x 42 OD, +4.25 0.50 x 152 OS with a +2.25 add, with resultant corrected visual acuity of 20/30+ and 20/25+ respectively. C.S. was growing physically and maturing as a young person. He wore his fashionable wire frames with his polycarbonate lenses in a straight-top bifocal design very comfortably. By age 12, his spectacle prescription of +4.50 1.00 x 42 OD, +4.00 0.50 x 150 OS with +2.25 add was placed into a Varilux Comfort Lens high index design.
Sports and Girlfriend = Contact Lenses
When seen shortly after his fourteenth birthday, C.S. reported he was participating in sports and "sort of" had a girlfriend. These facts led to the anticipated question, "Dr. Eyler, can I wear contact lenses?"
Diagnostic Acuvue Bifocal lenses of +3.25/ +2.00 add OD, +3.50/ +2.00 add OS were placed on C.S. and determined to be acceptable. One week follow-up and monocular, distance/near over-refraction resulted in the final dispensed lenses of +3.00/ +2.00 add OD, +3.00/2.50 add OS, with resultant corrected visual acuity of 20/30 and 20/25, respectively at distance, 20/30 and 20/25+ at near. C.S. now sports a big smile with his new "glasses-free look," which is a hit both on the field and off.
C.S.' visual history has been amazing for a young man of 15. It is a credit to the contact lens industry that products continue to be developed that benefit an ever-increasing percentage of the patients we serve.
Dr. Eyler is president of a five-doctor practice in Charlotte, NC, and he currently serves on the National Board of Examiners in Optometry.