Aphakia

What is aphakia?

Aphakia (pronounced “uh-FAY-kee-uh”) means that you’re missing the lens in your eye. The lens sits behind your pupil and iris, which is the colored part of your eye. Your iris is protected by the clear cornea and is surrounded by the sclera (the white part of your eye).

The lens focuses the light that comes into your eye and sends a focused image to the back of your eye. Without a lens to provide focus, things will look blurry.

If you’re missing the lenses in both eyes, you have bilateral aphakia. Bilateral means that something is happening on both sides.

If you’re missing the lens in one eye, you have unilateral aphakia, or aphakia on only one side. This is also called monocular aphakia.

What is the difference between aphakia and pseudophakia?

Aphakia refers to having no lens in your eye. Pseudophakia refers to having an intraocular lens (IOL) placed in your eye. This usually happens when lenses with cataracts are removed during surgery. Cataracts make your lenses cloudy or filmy.

Who does aphakia affect?

Aphakia can affect anyone, but it’s most common in people who have surgery to remove cataracts.

What are the signs and symptoms of aphakia?

Signs and symptoms of aphakia may include having:

• Blurred vision.
• Problems seeing things that are close and far away.
• Problems seeing the brightness of colors. Colors may seem to be faded. This isn’t the same thing as color blindness.
• An iris that jiggles. This is called iridodonesis.
• Problems adjusting to differences in how far away or close something is.

What causes aphakia?

Causes of aphakia include surgery, injury and congenital medical conditions.

Aphakia caused by surgery

Cataract surgery is the most common procedure that results in removing a lens from your eye. During surgical treatment, the surgeon removes the clouded lens and usually replaces it with an artificial lens. These intraocular lenses (IOLs) are used in most cataract surgeries. However, surgeons may decide not to implant lenses in some babies or children.

Aphakia caused by congenital medical conditions

Acongenital condition is a condition that’s present when you’re born. Babies can be born with congenital aphakia, or without lenses in one or both eyes. Congenital aphakia is rare. It can occur with other eye problems that are present at birth. It may happen if you’re infected with rubella during pregnancy.

There are two types of congenital aphakia: primary and secondary. In the primary type, the lens never develops at all. In the secondary type, the lens starts to develop but never fully does. You may have lens fragments but still have no lens.

Aphakia caused by injury

Eye injuries or wounds can result in the loss of a lens. This type of aphakia is also known as traumatic aphakia.

How is aphakia diagnosed?

Your ophthalmologist will be able to diagnose aphakia during a complete eye exam. During this examination, the provider will use a slit lamp (lamp and microscope) to examine your eyes. This’ll allow your provider to see if you have a lens in your eyes or not.

Some cases of aphakia are found during prenatal ultrasounds.

How is aphakia treated?

Aphakia treatments include:

• Surgery: This is the most usual treatment for aphakia. Your surgeon will replace your damaged lens with an IOL (intraocular lens).
• Contact lenses: Your provider may suggest that you or your baby wear special (aphakic) contact lenses.These lenses are very high-powered. Some types used for infants can be left in for multiple days at a time, but some need to be changed daily.
• Glasses: If you have bilateral aphakia (missing lenses in both eyes), your provider might suggest wearing glasses. However, these types of glasses might cause issues. The glasses might be heavy. The lenses might cause you to perceive straight lines as curving inward (this is called the pincushion effect). You might have problems with depth perception. You might have cosmetic objections. Because of these issues, your provider is more likely to suggest contact lenses.

Complications/side effects

Open-angle or angle-closure glaucoma is a possible complication of cataract removal and pediatric aphakia. This type of glaucoma is called aphakic glaucoma.

Children who have cataract surgery will need to wear bifocal glasses even if they have implanted lenses or aphakic contact lenses. This is to prevent amblyopia, commonly called “lazy eye.”

Changes in the eye sizes of growing children mean that any type of corrective lens will have to be adjusted often. This is also to prevent amblyopia.

Aphakia is associated with retinal tears and retinal detachment.

How can I reduce my risk of aphakia?

There’s no way to prevent aphakia, but you can do things to maintain your vision. For instance, you can:

• Get regular eye exams.
• Use protective glasses when working or participating in vigorous activity.
• Wear sunglasses.
• Eat a healthy diet that includes green leafy vegetables.
• Quit smoking.
• Stay active.

What can I expect if I have aphakia?

Aphakia can be treated. You may not see as well as someone who doesn’t have an eye condition, but you should be able to see reasonably well with treatment, which will include corrective lenses of some type.

If your baby has aphakia, your provider will discuss which treatment is best. For instance, using contact lenses may be safer for your very young child than having IOLs.

When should I see my healthcare provider?

You won’t know that you have aphakia until you have a diagnosis, but you’ll probably have symptoms that affect your vision. If you’re having problems seeing, or you think there’s a problem with your child’s vision, see your healthcare provider.

A note from Cleveland Clinic

Protecting your vision is important to you and to your healthcare provider. If you have aphakia because of injury or surgery, or if your child is born without a lens in their eye, work with your healthcare provider to determine the best treatment. It’s always important to make and keep regular appointments with your eye care provider.