Peter's Anomaly

Review of Peter's Anomaly - Scleral Lenses Improve Vision

by Victoria Galbreth

4th Year Optometry Student, Pennsylvania College of Optometry at Salus University

Peters Anomaly is a congenital disorder of anterior ocular structure resulting from the failure of the lens placode to detach from surface epithelium properly between four and seven weeks gestation (1, 2). This disruption in development causes malformation of other structures including the cornea, iris, and anterior chamber angle structures (2). A centrally located leukoma of the cornea forms in the layers of posterior stroma, descemets membrane, and endothelium due to damage caused by the poorly developed and detached lens placode (1). Because this step is crucial in triggering development of other ocular structures, the iris may develop poorly or not at all. When poorly developed, iris strands may extend from the collarette to attach posteriorly to the corneal luekoma (1). Occasionally, the iris fails to develop at the root. Failure of the iris to properly develop influences development of the anterior chamber structures, which places the infant at high risk for congenital glaucoma. Peters anomaly May be associated with systemic malformations including but not limited to dysplasia and short stature (2).

Global Vision Rehabilitation Center (GVRC) has helped two patients, siblings, with Peters Anomaly see better than before through the use of specialty contact lenses. In 2014, a 46 year old African American female with Peters Anomaly presented to GVRC to explore the use of contact lenses to improve her vision. Entering acuities were counting fingers at three feet (CF @ 3ft) in the right eye, and 20/800 in the left eye. Cover tests showed a low frequency, low amplitude, right beating nystagmus indicative of poor development of ocular structures. Slit lamp examination revealed hazy, neovascularized, scarred corneas in both eyes obscuring poorly developed iris and lens structures. Patient has cataracts in both eyes. Patient was fit with GVR Scleral lenses at initial appointment with intention to wear over a black soft contact lens with a clear pupil. Pupil sizes of 5mm, 6mm, 8mm, and 9mm were tried in the soft contacts, with the 8mm pupil providing the most comfortable vision for the patient. A number of adjustments were made to the GVR Scleral lenses prior to finding the best fit for the patient and reaching visual potential. Ultimately, this patient achieved 20/250 vision with each eye individually and both together with lights on, and one line improvement to 20/200 with lights off. Minor adjustments to current lenses will continue to be made as patient returns for follow up visits. Because of her success, the previous patient referred her brother, also born with Peters Anomaly, to GVRC for contact lenses. Without correction, his visual acuity was finger counting at 10 centimeters. By wearing GVR Scleral lenses and black soft contacts with clear pupils (8 mm), the patient was able to achieve 20/400 vision using both eyes together.


  • JW Change et al. 2012 Long term clinical outcome of Peters Anomaly. Eye (26): 1237-1242.
  • Gerstenblith, A. T., & Rabinowitz, M. P., (Eds.). (2012). The 2 Eye Manual: Office and Emergency
  • Room Diagnosis and Treatment of Eye Disease (6th edition). Philadelphia, PA: Lippincott Williams & Wilkins.

Peter's Anamoly

This eye has an extremely rare congenital condition known as Peters’ Anomaly. The symptoms include a very dry, irregular neovascularized cornea. In addition, the cornea is extremely cloudy and there is no iris (no pupil). The visual acuity in this eye is less than 20/1000.

To maximize this patient’s vision, we ordered a soft lens that was opaque (black) with a clear 5 mm pupil. Over this soft lens we placed a GVR gas permeable scleral lens. With this soft-scleral lens combination, this eye can now see 20/200 which is a dramatic improvement over the vision had before visiting our office. The patient is able to wear this lens combination all day with excellent comfort. See below.

The Wavefront Scleral Lens

The corneal irregularities created by refractive surgeries, such as LASIK and RK, are responsible for ghosting, halos, starbursting, and loss of contrast sensitivity. These "higher order aberrations" may exist on both the anterior and posterior. With aberrometry, the defects of the entire optical system can now be corrected by a scleral lens.

The Wavefront Scleral Lens

Autologous Serum for Dry Eyes

Dry eye conditions are among the most challenging conditions faced by refractive surgery patients. With autologous serum, blood is spun down to plasma, forming an eye drop that helps rehabilitate the cornea.

Learn More about Autologous Serum

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See Dr. Boshnick and Dr. Morris Waxler (former FDA chief research scientist on refractive surgery) talk about bad LASIK

Optimum Infinite Gas Permeable Material

I am happy to announce that our Global Vision Rehabilitation Center will be designing and fitting all of our “high need” patients with the Optimum Infinite gas permeable contact lens material. The Optimum Infinite material is the most oxygen permeable material ever to be approved by the FDA. In addition, this newly FDA approved material includes a UV lens blocker. Now for the first time, with certain patients, wearing a scleral lens made with the Infinite material under extended wear conditions can be considered.

SMAP 3D Scleral Lens Design

NEW: Powerpoint presentation on SMAP 3D

Last year we introduced an exciting piece of technology that has allowed us to custom design a scleral lens much more accurately. It is the SMAP 3D, which is a computer attached to a dedicated camera that allows us to obtain a 3 dimensional image of the entire front surface of the eye, including the cornea and the surrounding white portion of the eye (the sclera). Up until now there has not been any technology that would allow us to measure the ocular curvatures outside the cornea. The SMAP allows us to do this. Read More

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EyePrint Pro

EyePrintPro technology creates a scleral lens based on a mold of the cornea. The molding is accurate to 1 or 2 microns and fits perfectly because it exactly mirrors the irregularities of the individual corneal surface. The technology is well suited for post-Lasik, Keratoconus, RK, eye injury, and corneal transplant patients. Read More in this PDF about EyePrintPro Scleral Lens Technology

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