Aphakia is the absence of the crystalline intraocular lens. Individuals may develop aphakia as a consequence of a rare genetic disorder, the development of a cataract at various stages of life, or the dislocation of the natural lens. The underlying etiologies of crystalline lens dislocation, or ectopia lentis, are broad. This dislocation can be secondary to trauma at any age or an outcome of an underlying systemic disease that leads to this malposition. Genetic mutations observed in Marfan syndrome, homocystinuria, or Weill-Marchesani can lead to a lens dislocation or complete subluxation.
A lensectomy, or the surgical removal of the crystalline lens, could be a necessary treatment or an unintentional complication intraoperatively. Congenital or infantile cataracts require lensectomy within the first 6 to 18 months of life. In pediatric and adult traumatic cataract cases, a lensectomy may be necessary first to allow complete healing before intraocular lens calculations can be obtained. The incidence of aphakia varies based on etiology.
Eyecare providers must consider short- and long-term optical strategies to address the symptoms like blurred vision, loss of accommodation, and faded colors that develop in aphakia. Visual correction is considered in each case and is contingent on the patient's age, the risk for anisometropic amblyopia, the condition's laterality, and the eye's visual potential.
Due to the optical effects of high-plus spectacle lenses, patients with aphakia may be offered contact lenses or intraocular lens implantation as a first-line intervention. Ultimately, each case is unique and treatment options must be individualized. This activity aims to highlight the use of glasses and other forms of optical correction in cases of aphakia.
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