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Aphakia - Causes, Symptoms, Diagnosis, and Management

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The lack of a lens in the typical pupillary space is known as aphakia. Read the article below to learn more about aphakia.

Written by

Dr. A. Srividya

Medically reviewed by

Dr. Shikha Gupta

Published At July 26, 2022
Reviewed AtDecember 20, 2023

Introduction:

Aphakia is a condition in which the crystalline lens is either completely absent or positioned abnormally. Furthermore, the lens is either fully or partially dislocated from its normal pupillary area. Aphakia may occur on one or both sides. A condition known as unilateral aphakia occurs when the crystalline lens completely disappears in one eye; bilateral aphakia occurs when this occurs in both eyes.

What Are Eye Lens?

The biconvex, a transparent structure known as the eye lens is located behind the pupil, or central portion of the eye, and the iris, or colorful portion of the eye. The basic function of the eye lens is to focus light that enters the eye onto the retina. The ring of a fibrous ligament holds the lens in place.

What Causes Aphakia of the Eye?

Numerous factors are responsible for the development of aphakia. The factors contributing to the development of aphakia include,

  • Surgical removal of lenses for cataract correction results in surgical aphakia.

  • The aphakic lens may be congenitally present from birth.

  • Although it is rare, children with a history of trauma can experience lens matter absorption.

  • In rare cases, extrusion of the lens following trauma is seen.

  • Optical aphakia is caused by the lens dislocating into the vitreous body of the eye.

  • There are various conditions that go along with lens dislocation.

    • Dislocation of the Lens Associated With Many Genetic Disorders Includes:

    • Dislocated Lens Linked to Hereditary Disorders Includes:

    • Ocular Diseases Linked to Dislocation of the Lens Include:

      • Intraocular tumors.

      • Exfoliation syndrome of the lens.

      • Hypermature cataracts.

What Are the Optical Changes Brought About by Aphakia?

Aphakia of the lens primarily causes the following optical changes:

  • First, the changes in the aphakia vision. The eyes become highly farsighted. As a result, patients are not able to see nearby objects.

  • Secondly, there is a shift in the focal point of the eye. It shifts to the anterior surface of the cornea.

  • The actual size of the image after correction varies. For example, images formed by a spectacle-corrected lens have 25 percent magnification, while a contact lens-corrected eye forms images with six to eight percent magnification.

  • The vision of corrected aphakia is high.

  • The blurring of the vision is present.

  • Patients with one eye affected by aphakia start using the normal eye to view objects, which leads to amblyopia due to suppression in that eye, so the operated eye deviates.

What Are the Clinical Signs and Symptoms Associated With Aphakia?

Patients suffering from aphakia of the eye present with the following signs and symptoms:

  • The majority of patients suffer from farsightedness or aphakia hypermetropia.

  • The lens no longer has its accommodation capacity.

  • Both nearsightedness and farsightedness are impaired.

  • Looking through the damaged eyes, everything appears red (erythroplasia) or blue (cyanopsia) in color. The lack of a lens is the main cause of the colorful vision.

  • Because the lens does not provide support, the iris of the eye moves in tandem with movement (iridodonesis).

  • There is no picture generation from the lens; instead, images are formed from the retina.

  • The lumbus region of the eye contains scar tissue that delineates the boundary between the sclera and cornea.

  • The lack of a lens gives the pupil the appearance of being jet-black in color.

What Makes Aphakia and Pseudophakia Different From One Another?

Aphakia is the absence of a lens in the eye. An intraocular lens (IOL) implanted in one's eye is referred to as pseudophakia. This typically occurs during surgery when cataract-ridden lenses are removed. Lenses affected by cataracts become foggy or hazy.

How Is Aphakia Diagnosed in Patients?

The primary diagnostic criteria for aphakia are its clinical signs and symptoms. During the routine eye examination for adults and children, the treating physician looks at the patient's iris, cornea, and lens. The physical inspection is carried out using the slit-lamp approach, which involves flashing strong light and looking at the object under a microscope. In some circumstances, ultrasonography can identify aphakia in prenatal children.

What Are the Conditions That Mimic Aphakia?

Before forming a definitive diagnosis of aphakia, the following conditions are eliminated.

  • Glaucoma.

  • Accumulation of fibers in all the ocular tissues leads to the development of pseudoexfoliation syndrome.

  • There is a sudden onset unilateral headache and blurred vision characteristic of acute angle-closure glaucoma.

  • There is a rise in the intraocular pressure causing primary open-angle glaucoma.

How Is Aphakia of the Eye Managed?

The management of aphakia comprises both surgical and non-surgical management.

Non-Surgical Management of Aphakia:

Aphakia is managed through the medical optic theory by two forms of treatment -

  • Patients with aphakia are prescribed cylindrical spectacles with extra positive power. Cylindrical and extra positive power are advised to compensate for astigmatism (a frequent, curable abnormality in the eye's curvature that results in blurry vision at all distances) and presbyopia (a condition of the eyes where the capacity to focus quickly on nearby objects gradually fades). However, wearing spectacles is associated with a number of negative effects, including thicker glasses, colored vision, diminished binocular vision (the overlap of pictures created by both eyes), and image magnification.

  • Patients with aphakia have been prescribed specialized contact lenses, also known as aphakic lenses, which have been shown to be effective in treating aphakia. A better vision field, the elimination of optical aberration, and reduced image magnification for individuals with uniocular aphakia are only a few benefits of contact lenses over spectacles. The primary drawbacks of wearing lenses include foreign body reactions and the difficulty of wearing lenses, as reported by senior patients.

Surgical Management of Aphakia:

For these patients, the best course of action is to have an intraocular lens implanted once the defective lens is removed. This procedure requires less post-operative care and improves binocular vision quickly.

  • Refractive corneal surgeries involving corneal inlays and onlays are done, however not in clinical settings. Because onlays are easier to maintain and more patient-friendly, they are a better choice.

  • Hypermetropia laser-assisted in situ keratomileusis (LASIK) is also performed for these patients.

What Are the Complications of Aphakia?

The significant complications linked to aphakia include:

  1. Inflammation, along with other contributing factors, causes aphakic glaucoma.

  2. In addition, aphakia causes optical defects that make the patients intolerant to spectacles.

  3. Aphakia often leads to the development of retinal detachment.

  4. Aphakic bullous keratopathy formation owing to increased corneal edema after cataract surgery.

What Is the Prognosis of Patients Suffering From Aphakia?

The overall outlook for the aphakia of the eyes is good. However, the eye's visual acuity worsens due to the underlying pathology. However, the presence of myopia and ruptured posterior capsule worsens the prognosis of the disease.

How Can One Lower the Chance of Developing Aphakia?

Although aphakia cannot be prevented, there are steps one may take to preserve the ability to see. For example, one could:

  • Get eye checkups on a regular basis.

  • When working or engaging in rigorous exercise, wear safety glasses.

  • Put on some sunglasses.

  • Consume a diet rich in leafy green vegetables.

  • Give up smoking.

  • Continue being active.

Conclusion:

Aphakia of the eye can occur as a complication of ocular surgery or is associated with other hereditary and systemic diseases. Patients with aphakic eyes are primarily present with farsightedness. It is mainly treated with spectacles or contact lenses. Aphakic eyes have a favorable outlook after proper treatment.

Frequently Asked Questions

1.

What Is the Meaning of Aphakia?

Aphakia is a medical condition where lenses in one or both eyes are absent. It is mainly caused due to the surgical removal of lenses during cataract surgery.

2.

What Are the Signs and Symptoms of Aphakia?

Following are the signs and symptoms of aphakia;
- Blurred vision.
- Farsightedness or short-sightedness.
- Difficulty in seeing color brightness and color may appear faded.
- Eyes lose the ability to change the focus.

3.

Which Lens Is Used in Aphakia?

People with aphakia are provided with special contact lenses, which are highly powered. Certain types of aphakic lenses can be worn for many days without changing.

4.

What Is the Treatment of Aphakia?

The treatment of aphakia includes;
- Surgery: In surgery, the damaged lens is replaced with an intraocular lens (IOL).
- Contact lenses: Highly powered contact lenses are provided for aphakic patients.
- Glasses: Glasses are suggested in the case of bilateral aphakia.

5.

How Is Aphakia Diagnosed?

The doctor will use a slit lamp to examine the eyes during an eye examination. Slit lamps can help check the presence or absence of eye lenses.

6.

What Are the Problems With Aphakic Lenses?

Implantation of intraocular lenses in children with aphakia may cause major vision problems. So children with implanted intraocular lenses and children with high-powered lenses are advised to wear bifocal glasses to adjust the refraction, allowing them to have proper vision.

7.

What Are Aphakic Glasses?

Aphakic glasses are recommended only for people with bilateral aphakia. These glasses are thick and magnify images at a high level.

8.

What Is Aphakic Eye Pressure?

An increase in the intraocular pressure in the aphakic eye is called aphakic eye pressure or aphakic glaucoma. It occurs in children who have undergone congenital cataract surgery. However, aphakia alone is not the direct cause of increased intraocular pressure post-surgery.

9.

What Is Normal Eye Pressure?

The normal range of eye pressure is 12-22 mmHg. If it is greater than 22 mmHg, it is considered hypertensive. It occurs when there is a problem with fluid drainage in the eye.

10.

Can a Person With Aphakia See?

A person with aphakia has blurred vision, short sight, far sight, and problems viewing bright objects. Also, the colors may appear faded. Hence, they often struggle with vision problems.

11.

Is Aphakia a Disability?

Aphakia is a medical condition that occurs congenitally, after an injury, or following cataract surgery. Children and adults with aphakia often face vision difficulties.
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Dr. Shikha Gupta
Dr. Shikha Gupta

Ophthalmology (Eye Care)

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