By Dr. A.L.W. Groot, ophthalmologist
Microphthalmia or anophthalmia are rare, congenital conditions in which an eye is too small or is even completely absent. These children often also have smaller eyelids, reduced facial volume on one side of the face, and a smaller eye socket. In many cases, the affected eye has impaired vision or is blind.
If it becomes clear that the child will not regain vision in the affected eye, treatment can focus on appearance. The goal in that case is to be able to wear an ocular prosthesis (an artificial eye) that ensures facial symmetry.
Until now, little was known about how different these conditions can be, and there were no clear guidelines for treatment. There was also no reliable way to measure whether a treatment had been effective.
New Method
In this study, we proposed a new method for determining the severity of eye damage. We did this by measuring the length of the eye using an ultrasound and comparing it to the other, healthy eye. This allowed us to classify the condition into three groups:
- Severe: 0–45% of normal height
- Moderate: 45–75%
- Mild: 75–100%
Children in the mild group usually do not need treatment, but we do monitor them, as the eye may not develop properly. If the affected eye is smaller than 10.5 mm, we recommend starting treatment within the first few months after birth. This is because these children are at greater risk of facial asymmetry.
We also proposed a simple way to determine whether a treatment is successful: by measuring the width of the palpebral fissure (the horizontal slit between the eyelids). It should be at least 80% of the width of the healthy eye. You can easily measure this with a ruler during a consultation.
3D-printed conformers
We also investigated whether 3D-printed devices (conformers) are a good alternative to traditional, handmade versions. This new method appears to work well: children end up with a well-shaped eye socket and can wear a properly fitting ocular prosthesis, often without the need for surgery.
About Annabel
In October 2015, Annabel began her residency in ophthalmology at Amsterdam UMC, and starting in June 2018, she combined this residency with her doctoral research under the supervision of Dr. Dyonne Hartong. Toward the end of her residency, she specialized in orbital and oculoplastic surgery, as well as strabismus. In November 2020, Annabel joined Radboudumc in Nijmegen as an ophthalmologist, specializing in neuro-ophthalmology and strabismus. She also completed a fellowship in strabismus at Leiden University Medical Center.
The dissertation defense took place on January 10, 2025, at the University of Amsterdam. The co-advisor was Dr. D.T. Hartong, and the advisors were Prof. Dr. A.C. Moll and Prof. Dr. P. Saeed.
