Aphakia: Symptoms, Causes & Treatment

Aphakia is a condition in which there is no lens within the eye. The lens is the clear, ovular-shaped structure located behind the colored part of the eye (the iris) and the pupil. The lens plays a role in focusing light on the retina. 

What Aphakic Means

If you are aphakic, you will experience an impaired ability to focus, and your vision will be blurry without correction. You may also experience farsightedness, colors may appear faded, and you may have difficulty focusing on objects as they change in depth within your visual field. 

If aphakia is not detected early, you may have permanent vision impairment. 

While aphakia is manageable via surgery and/or corrective eyewear, it is critical that you get regular comprehensive eye examinations in order to detect any visual abnormalities and to determine their causes. A baby should have a comprehensive eye examination within their first six months of life in order to detect aphakia and any other pathology affecting the eye and its functioning. 

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Types of Aphakia

There are two types of genetic aphakia.

• Primary congenital aphakia: This type of aphakia occurs when a baby is born without lenses due to a developmental issue during pregnancy or a genetic condition. 
• Secondary congenital aphakia: This type of aphakia occurs when a baby has a lens, but it becomes detached or absorbed prior to being born. 

Non-genetic aphakia can also occur. It is usually a result of trauma to the eye from injury or surgery. 

Symptoms

Symptoms of aphakia can include the following:

• Changes in color perception and the appearance of faded colors
• An impaired ability to change focus as objects become closer or further away in the visual field
• Farsightedness and difficulty focusing at close distances

Causes of Aphakia

These are the most common causes of aphakia:

• Congenital defect: This occurs when a baby is born without lenses, or the lenses become detached or mutated during pregnancy. 
• Injury: Sudden and forceful impact to the eye can result in the lens becoming damaged or lost. 
• Cataracts surgery: A clouding of the eye’s lens associated with a cataract is intentionally removed and replaced with an artificial one via surgery. In some cases, babies or children may not have an intraocular lens (IOL) placed temporarily, and they may be without a lens for a period of time.

Diagnosis

Aphakia is diagnosed by an ophthalmologist using a slit lamp that includes a bright light and microscope, which allows for detection as part of a comprehensive examination of the eye. In cases of congenital aphakia, this condition may be detected using ultrasound. 

Treatment of Aphakia

There are three main treatment or management options for aphakia.

1. Surgical intervention: This is the most common treatment for the condition, and it is available for newborns and adults. An artificial lens is surgically implanted and can correct deficits in vision caused by aphakia. 
2. Corrective eyewear: Specialized lenses are available to augment vision caused by aphakia. This form of treatment is most efficient when both eyes lack lenses.
3. Contact lenses: As with glasses, contacts assist with vision when lenses are not present and can be used in cases when babies are too young for artificial lens implantation. These can be worn for up to one month without replacement. 

Long-Term Outlook

If not detected and managed early, aphakia can be irreversible and result in amblyopia, in which the eye and brain lose their connection and the eye does not develop properly. This is more commonly referred to as lazy eye. 

If detected early, the outlook for aphakia is generally very good. However, the visual acuity of the eye and the prognosis depends on the underlying pathology causing aphakia. In cases in which myopia and ruptured posterior capsules are present, the prognosis worsens. 

Aphakia FAQs

What can you see without a lens in your eye?

If you have aphakia in one or both eyes, you will likely experience difficulty focusing at both close and far distances, an inability to change focus as objects move closer and farther away within your visual field, and colors may appear to be faded. 

What is aphakic and pseudophakic?

Aphakic refers to the lack of a lens in the eye. Pseudophakic refers to the presence of a false lens, and this occurs when an artificial lens is implanted surgically in order to correct aphakia.

References

1. Aphakia. (2023). ScienceDirect.

2. What Is Aphakia? (December 2021). American Academy of Ophthalmology. 

3. Considerations in the Management of Aphakia. (April 2015). Indian Journal of Ophthalmology.