Year : 1983 | Volume
: 31 | Issue : 7 | Page : 934--936
Extended wear soft v/s semisort v/s hard contact lenses in uniocular aphakia
DP Sharma, Majnu Patni, SK Bardar
Upgraded Deptt of Ophthalmology, S.M.S. Medical College & Hospital, Jaipur, India
D P Sharma
Upgraded Deptt of Ophthalmology, S.M.S. Medical College & Hospital, Jaipur
|How to cite this article:|
Sharma D P, Patni M, Bardar S K. Extended wear soft v/s semisort v/s hard contact lenses in uniocular aphakia.Indian J Ophthalmol 1983;31:934-936
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Sharma D P, Patni M, Bardar S K. Extended wear soft v/s semisort v/s hard contact lenses in uniocular aphakia. Indian J Ophthalmol [serial online] 1983 [cited 2021 Jun 16 ];31:934-936
Available from: https://www.ijo.in/text.asp?1983/31/7/934/29710
The unaided vision in aphakic eye is too poor and the spectacle lenses fail to correct uniocular aphakia, because of aniseikonia amounting to about 33 percent, which give rise to intolerable diplopia. Contact lenses reduce this aniseikonia to about 7 to 10 percent and thus provide the patient with binocular vision. The invent of semisoft (Polycon and C.A.B.) lenses and extended wear soft (PolyHEMA) lenses have given new hopes for the uniocular aphakics. So far no extensive comparative study of these lenses has been done in the available literature. Therefore, it was thought of interest to have a study of hard, soft and semisoft contact lenses in'uniocular aphakia.
MATERIAL AND METHODS
250 cases of uniocular aphakia were selected from the upgraded department of Ophthalmology, S.M.S. Hospital, Jaipur. This series included 30 cases of congenital cataract, 40 cases of Juvenile cataract, 60 cases of traumatic cataract, 20 cases of complicated cataract and 100 cases of senile cataract. The youngest patient was of 3 years and the eldest was of 65 years. Out of the 250 cases, 175 were males and rest were females. Sauflon T-70% lenses were fitted in 100 cases, hard (PMMA) corneal in 100 cases and semisoft lenses were fitted in 50 cases. The hard lenses were permitted to wear for 18 hrs., semisoft lenses from 18 hrs to a week and Sauflon T-70% lenses for I to 3 months.
1. Visual improvement: The visual improvement was best recorded with hard lenses, Polycon lenses stood second. Cases having astigmatism of 3 or more were unsuitable for soft lenses, so they were fitted with semisoft or hard lenses. In cases of Sauflon T-70% further improvement in vision was achieved by overspectacle correction.
Simultaneous perception was achieved in 85% cases and stereopsis in 55% cases. 2) Diplopia: Out of the total 250 cases, 200 cases had no diplopia, while 28 cases had tolerable diplopia initially, which settled within a month or two, 22 cases having squint from 15° to 25° (of old duration) required a squint correction and then there was no diplopia on contact lens fitting. Diplopia was comparatively more common in young children and with Polycon and hard lenses as they provide better visual improvement. 3) Fields: With contact lenses 200 uncomplicated aphakics got almost the normal field of vision, while the remaining 50 cases of corneal opacity and scarring had restricted field, depending on the ,sub degree and site of corneal opacity. Better visual fields were recorded in cases fitted with soft contact lenses as compared to the series of semisoft and hard lenses.
4) Tolerance: Extended wear soft lenses had excellent tolerance. Semisoft (Polycon) lenses had good tolerance, while hard contact lenses were comparatively less tolerated due to lid sensation, oily smear on the lens surface and overwear syndroms. Hard lenses had poor tolerance specially in children and elderly aphakics.
With contact lenses majority of the inevitable discomforts with an aphakic glass were avoided. We got greater success with male patients as compared to female aphakics. This is because male finds that with spectacles employment is impaired and his life activities become restricted, while the female has no such driving motivation.
Fitting of contact lenses in infants and young children have prooved a major advance in Ophthalmology. Surprisingly the children had successful fitting with Sauflon-T 70% lenses. Younger patients below 8 years of age, where binocular reflexes are unstable, develop suppression and squint easily. These changes are more likely when the optical defects are left uncorrected for longer period. Therefore we advise to fit soft lenses in such cases as soon as possible after cataract operation.
The aphakic glasses used by the patients give restricted visual field from 38 to 42 degree. Oroptic, and the patient is completely blind apart 42 degrees. While, when the patient puts contact lenses, he obtains almost full visual field and can rotate his eyes and move both fixation and visual fields laterally at will to orient in space. Better visual fields were achieved with soft lenses and Polycon lenses as compared to hard lenses as the soft and semi-soft lenses over the full cornea, while the hard lenses are normally 1.5 mm to 2 mm smaller than the cornea, and are moving on cornea.
Simultaneous perception had good prospect of regaining binocular vision with contact lenses. Cases of monocular congenital cataract carried poorest visual results and they were often associated with squint and suppression of binocular vision. However, it is justified to try to improve binocular vision with a contact lens.
Some patients were not well motivated about wearing contact lenses. Some were highly apprehensive to put some thing in their eyes. In addition elderly patients were poor co-ordinated and their lids had loose tone which make insertion and removal of hard lenses difficult. Such cases well accepted the extended wear Sauflon lenses.
The common complications recorded with the hard lenses were, lid sensation, oily smear on lens surface and overwear syndrome. In cases of extended wear soft lenses the commonest complication was mucous, mineral and protein deposits on the lens and mild conjunctivitis at times. In such cases, the lenses were removed, cleaned and disinfected and wherever needed the lenses were replaced.
250 cases of uniocular aphakia were fitted with hard (100 cases) soft-sauflon-T 70% (100 cases) and semi-foft (50 cases) lenses. The visual improvement was best recorded with hard lenses, Polycon lenses stood second. In cases of sauflon T-70% lenses further improvement in vision was achieved by over spectacle correction.