In the Netherlands, approximately 15 babies are born each year with anophthalmia or microphthalmia. These children are referred by other ophthalmologists to the specialized MICA team in Amsterdam. Dr. Hartong explains: “Sometimes it’s difficult to distinguish between the two conditions, but with an ultrasound we can immediately see if there is still a small eye present in the early stages of development. The child usually cannot see anything with the affected eye. In 50% of cases, we find that the baby has other abnormalities as well. Fortunately, however, those abnormalities aren’t always as severe.”
When should treatment be administered?
“We distinguish between three groups of young patients. As a rule, we do not treat the group with a relatively large eye (75 percent or more of the size of the healthy eye). This is because we do not expect this group to have any noticeable facial asymmetry. If the slightly smaller eye is blind and looks less aesthetically pleasing, we may use an ocular prosthesis or contact lens to improve the eye’s appearance. Whether this is done depends on the wishes of the parents and the child (if older). For a baby with an eye size of less than 45 percent, it is important to start treatment as soon as possible. This is because a baby’s eye socket grows extremely quickly in the first few months of life. You want to take advantage of that during treatment. Then there’s also the middle group, whose eye size falls between 75 and 45 percent. It’s important to treat these children quickly as well, but the urgency is slightly lower. Here, we can take the time to develop a customized treatment plan with additional preparatory work.”
Conformers
Conformers are used in the treatment of anophthalmia and microphthalmia. Dyonne: “Our ocular prosthesis maker, Jelmer Remmers, uses a 3D printer to create a shell or small sphere (conformer) that mimics the growth of the other eye. He places it in the eye socket.” The conformer applies pressure and stretch beneath the eyelids. This causes the eye socket to grow. At first, a new conformer is inserted into the baby’s eye every few weeks. After about 10 months, the best possible symmetry is achieved, and Jelmer can custom-make the first ocular prosthesis. With this method, young children achieve an average symmetry of 94%. In rare cases, surgery is necessary. In such cases, we insert a small amount of buttock fat into the eye socket. This gives the eye socket a natural volume and makes it easier to fit an artificial eye. The advantage is that the buttock fat grows along with the child.”
Until around the age of three, children attend the MICA clinic regularly. In the years that follow, the doctors see the children about once a year or when there are problems. However, they do visit the ocularist more often, because they regularly need a larger ocular prosthesis. Visits to the MICA clinic usually stop around age 12.
Various healthcare providers
, RadiologistThe radiologist performs an ultrasound. He measures the length of the eye and the size of the eye sockets, and examines the inside of both eyes. For example, he examines the optic nerves, the lens, and the retina, and looks for any cloudiness in the eye.
Orthoptists These orthoptists perform tests to determine visual acuity, prescription strength, and the degree of strabismus.
, Pediatric Ophthalmologist The pediatric ophthalmologist assesses the development of the healthy eye and the affected eye.
Ocularist
The ocularist is the primary provider responsible for creating, fitting, and replacing ocular conformers and prostheses. Between office hours, the child visits the ocularist for any necessary adjustments.
, Orbital Specialist The orbital specialist and primary care provider reviews the examination results from her colleagues, assesses the eye and eyelids, and discusses the treatment plan with the parents.
Clinical Geneticist
All babies are referred to a clinical geneticist. On average, a genetic cause is found in 10% of children with unilateral MICA. In cases of bilateral MICA, that figure rises to 80–90%.
, PsychologistSome children have other conditions in addition to their MICA. They often need to be examined at the hospital by various doctors. As a result, some children develop a fear of the treatments. These children are referred to a psychologist. Parents, too, sometimes need mental health support. A referral can be arranged for them as well.
Visual Rehabilitation Center Depending on the situation, children may also be referred to a visual rehabilitation center (Koninklijke Visio or Bartiméus).
Box
Overheard during the consultation hourat
: During this consultation, Dr. Hartong sees 5-year-old Thijmen from Den Bosch. His parents are worried. Thijmen has a hard lump in his eye socket. Because of this, his ocular prosthesis no longer fits properly. Dr. Hartong is able to reassure the parents. It’s nothing serious. It’s a granuloma, an inflammation. Thijmen is prescribed eye drops to treat the inflammation. In addition, ocularist Jelmer polishes the ocular prosthesis and drills a small hole in it to allow fluid to drain more easily. Dr. Hartong also recommends trying not to remove the prosthetic eye every night. In some cases, this can cause the mucous membrane to become irritated more quickly. If the suggested measures are ineffective, the parents can contact Dr. Hartong again, as there are other options for treating the inflammation.
