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.

References

  • 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.
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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.

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