Prosthetic contact lenses (PCL) help improve the appearance of disfigured, either sighted or nonsighted eyes.1 PCLs primarily consist of 3 active zones namely central pupillary area, tinted iris area, and transparent edge or peripheral zone (Fig. 1).2
Common indications include aniridia, iris coloboma, ocular albinism, leukocoria, leukoma, diplopia, amblyopia, scarring, and other abnormalities or disfigurement.1–3
Type A is used to eliminate diplopia, for amblyopia therapy, and masking the leukocoria or white reflex. Type B lens is with translucent tinted iris with no black pupil. Type C is used to improve the visual function by reducing glare and photophobia. Type D helps conceal opacities in nonseeing eyes.2
This case series illustrates the unique utilization of soft PCLs, especially type B. Written consent was obtained from every patient.
A 37-year-old female with complain of haloes and glare during night driving reported to clinic post–femtosecond-assisted (Femto) laser in-situ keratomileusis (LASIK). Her unaided vision was 20/20, N6, in both eyes. Slitlamp revealed LASIK flap in situ with clear interface, pupil size under dim illumination was 7.00 mm in right and 6.50 mm in left eye. Brimonidine tartrate 0.1% induced a reduction in pupil size to 6.00 mm in right and 5.50 mm in left eye, but the glare issue reduced very marginally. As a second option, prosthetic type C lens was tried in both the eyes with 4.5 mm clear pupil but failed, as clear pupil was allowing enough light to cause disturbing glare. Thereafter, type B lens was tried as further reduction in pupil diameter was not possible. The patient reported significant reduction of glare with type B lens while maintaining vision (Supplemental Digital Content 1, showing both eyes prosthetic type B lenses, https://links.lww.com/APJO/A183).
A 35-year-old male underwent penetrating keratoplasty in right eye due to corneal opacities. Corrected vision was 20/400, N18, and 20/50, N6, in right and left eye, respectively. Slitlamp revealed corneal opacities and anterior capsular cataract in right and dense corneal scar involving half of the visual axis in left eye. Type C PCL with a 4.5-mm clear pupil showed poor cosmesis as the opacity was visible through clear pupil. Type D PCL showed better cosmesis but vision deteriorated due to central black pupil. Finally type B medium brown iris enhanced the cosmesis with maintained vision [Supplemental Digital Content 2, illustrating both eyes without any contact lens (A), appearance with type C lens (B), appearance with type D lens (C), and appearance with type B lens (D), https://links.lww.com/APJO/A184].
A 34-year-old male was complaining of gradually increasing white opacity in left eye due to diffuse stromal scar. Vision was 20/20, N6, in right and 20/50, N6, in left eye. With type C PCL vision was maintained but the opacity was visible through the central clear pupil. Type D showed improved cosmesis but vision deteriorated. Finally, a type B medium brown lens showed better cosmesis while maintaining the vision [Supplemental Digital Content 3, showing left eye without any contact lens (A), appearance with type D lens (B), and appearance with type B lens (C) https://links.lww.com/APJO/A185].
Although alternative options such as prosthetic shell, corneal tattooing4 are available, PCLs are considered as a preferable option to mask the disfigurement, reducing visual symptoms due to its availability, affordability, and wide-range of options.
Das and Mahadevan2 reported no use of type B lenses in their retrospective study. Kanemoto et al5 reported 21 eyes and Patricia et al6 reported 8 cases with type B lenses. All cases in present series were dispensed with brown-tinted type B lenses as Asians have brown iris colour.7
In conclusion, prosthetic type B lenses can be beneficial to mask the disfiguration along with stabilizing the vision by reducing the visual symptoms. Few unique cases require an extra effort, skills, and knowledge to fulfill the patient’s needs, and the final outcome can give immense satisfaction to both patient and practitioner. Practitioners should keep the benefits of prosthetic lenses in mind while managing such special cases.
The authors thank the entire Contact Lens Department for their continuous support.
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