A flexible approach to aphakia

Abstract

The task of fitting contact lenses for aphakia is considerably influenced by the technique and expertise employed in the extraction. Intra-capsular extractions are more commonly encountered than extracapsular, and where phako-emulsification is used the corneal incision is very small indeed. Hence, one would expect less corneal astigmatism where this technique is utilised. However, a capsulotomy may be necessary at a later date to provide a light passage through the thickened posterior capsule which can ensue. In unilateral aphakia spectacles cannot be employed as the retinal image size difference is of the order of 30%. Even in bilateral aphakia a spectacle correction provides a very distorted image and the resultant effect can be very disturbing. The theoretical ideal optical solution to aphakia is the intra-ocular lens. This is a controversial subject amongst surgeons and mention is made here merely for completeness. In contact lens correction of unilateral aphakia a small degree of aniseikonia remains, but this is within fusional limits, All contact lenses are suitable for the correction of aphakia (Table (i)) but as practitioners we must select the most appropriate type for each individual case. Fitting can be commenced as soon as one week following the extraction, provided the eye