This review does not examine the treatment of damaged corneae through the use of scleral lenses or unilateral conditions, which cause a reduction in monocular visual acuity (for example, corneal opacities, ocular trauma) or adversely affect binocularity that may benefit from contact lens correction or penalisation (for example, high anisometropia inducing amblyopia or aniseikonia). The purpose of this review is to summarise the literature concerning the development of refractive errors in paediatric low vision populations and the use of contact lenses in the rehabilitation of ocular conditions that cause an irreversible, bilateral reduction in visual acuity, including the optical and therapeutic advantages, clinical challenges and practical considerations for contact lens practitioners. Contact lenses may also be used for non-refractive therapeutic purposes in low vision rehabilitation to reduce photosensitivity, minimise eye movements and enhance cosmesis and self-esteem. Compared to spectacle lenses of similar power, they offer a substantially wider field of view (for myopes) and field of fixation, improved optical quality (fewer inherent oblique aberrations), increased magnification (in high myopia) and a reduction in eye relief, when using low vision aids (telescopes and magnifiers can be held much closer to the eye, enlarging the useable field of view). ![]() ![]() Consequently, for a variety of reasons, for both paediatric and adult patients with low vision from an early age, contact lenses may be the preferred method of refractive correction. ![]() Numerous ocular conditions that impair vision from birth or shortly thereafter during childhood are frequently associated with significant spherical or astigmatic refractive errors due to altered emmetropisation. The contact lens correction of patients with congenital vision impairment can be challenging for both practitioner and patient but should be considered as a potential optical or therapeutic solution in modern low vision rehabilitation. In addition to the known optical benefits in comparison to spectacles for high levels of ametropia (an improved field of view for myopes and fewer inherent oblique aberrations), contact lenses may be of significant psycho-social benefit for patients with low vision, due to enhanced cosmesis and reduced conspicuity and potential related effects of improved self-esteem and peer acceptance. The historical and present use of therapeutic tinted contact lenses to reduce photosensitivity and nystagmus in achromatopsia, albinism and aniridia are also presented, including clinical considerations for the contact lens practitioner. The advantages and disadvantages of the use of contact lenses for increased magnification (telescopes and microscopes) or field expansion (reverse telescopes) are discussed, along with the benefits and practical considerations for the correction of pathological high myopia. This review examines the use of contact lenses as a refractive correction, low vision aid and therapeutic intervention in the rehabilitation of patients with bilateral, irreversible visual loss due to congenital ocular disease. The disruption of this feedback mechanism in children with congenital or early-onset visual impairment often results in the development of significant ametropia, including high levels of spherical refractive error, astigmatism and anisometropia. ![]() Ocular pathology that manifests at an early age has the potential to alter the vision-dependent emmetropisation mechanism, which co-ordinates ocular growth throughout childhood.
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