Dr Child's Casebook: Out of Focus

How do I bring the world back into focus when it has lost all definition? We view life through a lens, a transparent structure that is integral to our interpretation of the world around us. It bends and focuses light rays on the retina, adjusting its power to produce a sharp image. It is critical to sight. If and when it is removed, what should replace it?

By Dr Anne Child & Victoria Hilton

Q: My 8-year-old child has Marfan syndrome. Her lenses are dislocated significantly and in a recent appointment we were told that now was the time for surgery.

The surgeon mentioned two options; lenses clipped on the iris, or removing the lens and for him then to use contact lenses.

This potentially transformational surgery is an exciting prospect and we were wondering what would be your advice as regards these two options?

Do you know any families who've had these different options that we could possibly get in contact with? Any advice gratefully received.

A: Your question is a good one that I put to our Advisory Panel. I sought two opinions given the importance of this matter.

Our first expert responded to say: “It depends if the lenses are completely dislocated out of the pupil area. If out of the way completely, contact lenses can be used to give good vision.

If the lenses are interfering with the visual access: usually subluxation rather than dislocation, then removal of the lenses surgically may be warranted.

A secondary artificial lens at this age is usually not recommended as the eye can still change.”

Our second expert agreed, saying “I would elect for contact lenses in the first instance. We can implant secondary scleral fixated lenses at a later date but would usually wait until her eyes are fully grown at the age of 10 or beyond.

I personally don't like the iris clip lenses but acknowledge that all the lenses have their potential downsides. This is why contact lenses if possible are the least worst option.”

We hope this helps you.