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PubMed This is a summary of 17 peer-reviewed journal articles Updated
Ophthalmology

Growing Up with MAC: Vision and Quality of Life

At a Glance

Living with microphthalmia, anophthalmia, or coloboma (MAC) requires a focus on vision rehabilitation and eye protection. Wearing shatterproof polycarbonate lenses full-time is essential to protect remaining vision, while early intervention and ocular prosthetics help patients thrive.

As a patient navigates life with MAC, the focus of care shifts from immediate medical stabilization to vision rehabilitation and long-term well-being. Growing up and living with MAC means adapting to a world that may look a little different, but with the right tools, individuals with MAC can thrive socially, academically, and professionally.

Protecting the Eye

For individuals with unilateral MAC (only one eye affected) or bilateral MAC with residual vision, the single most important rule is protecting the remaining functional vision. Any injury to an eye that provides your primary source of sight could be life-altering.

  • Polycarbonate Lenses: Medical guidelines strongly recommend that anyone with limited vision or only one functional eye wear glasses made of polycarbonate [1]. This material is virtually unbreakable and acts as a shield against everyday accidents, sports injuries, or falls [2][3].
  • Full-Time Wear: These glasses should be worn during all waking hours, not just for vision correction, but as “armor” for the eye [4].

Early Intervention and Low Vision Support

Children with MAC, especially those with bilateral (both eyes) involvement, benefit immensely from Early Intervention (EI) services to help them reach developmental milestones using their remaining vision [5]. Adults and older adolescents benefit from low-vision rehabilitation specialists.

  • Teacher of the Visually Impaired (TVI): A TVI can help adapt environments with high-contrast materials and specialized lighting to encourage maximum use of functional vision [5].
  • Orientation and Mobility (O&M): O&M specialists teach safe navigation of physical spaces, which is especially important for those facing challenges with depth perception or limited peripheral (side) vision [5].

School, Confidence, and Social Integration

Functional vision in MAC can impact quality of life, similar to other chronic health conditions [6]. For those with Anophthalmia or severe Microphthalmia, modern custom ocular prosthetics are more realistic and comfortable than ever, thanks to advancements like 3D printing and digital imaging [7][8].

  • Confidence and Self-Esteem: A well-fitted prosthetic eye helps maintain facial symmetry, which can significantly boost confidence and social integration [9][10].
  • Psychosocial Support: Adapting to visual differences or facial asymmetry can occasionally cause anxiety or social stress [11]. Routine check-ins with a counselor can help navigate questions from peers and foster a positive self-image [6].

Long-Term Care Milestones

The journey with MAC involves several ongoing milestones based on the specific condition:

For Coloboma & Mild Microphthalmia (Vision Retaining):

  • Patching Therapy: For young children, doctors may prescribe patching the “stronger” eye to force the brain to use the eye with the coloboma, preventing amblyopia (lazy eye) [12].
  • Frequent Refraction: Updating prescriptions for glasses to ensure the eye is focusing as clearly as possible.
  • Retinal Exams: Annual or semi-annual dilated exams to monitor for retinal tears or detachments.

For Anophthalmia & Severe Microphthalmia (Prosthetics):

  • Growth Spurts: Frequent visits to the ocularist to resize or replace the prosthetic eye during childhood. Children outgrow their prosthetics just like they outgrow shoes [13][14].
  • Adolescence: Transitioning to taking over the daily care of the prosthetic independently and making mature decisions about sports-specific eye protection [15][16].

By providing a multidisciplinary approach—including eye doctors, ocularists, and educators—patients with MAC are given the best foundation for resilience and independence [5][17].

Common questions in this guide

Why is it important to wear polycarbonate lenses with MAC?
If you have limited vision or only one functional eye due to MAC, protecting your remaining sight is crucial. Polycarbonate lenses act as a shatterproof shield against everyday accidents and sports injuries and should be worn during all waking hours.
How do ocular prosthetics help children with anophthalmia or severe microphthalmia?
Custom ocular prosthetics maintain facial symmetry, which is important for proper facial development. They also look highly realistic and help significantly boost a child's confidence, social integration, and self-esteem as they grow.
Will my child outgrow their prosthetic eye?
Yes, children outgrow their prosthetic eyes just like they outgrow their clothes and shoes. Frequent visits to an ocularist are required during childhood to resize or replace the prosthetic as your child experiences growth spurts.
How do specialists help children with MAC maximize their remaining vision?
A Teacher of the Visually Impaired (TVI) can adapt environments with high-contrast materials and specialized lighting. Additionally, Orientation and Mobility specialists teach safe navigation, which is vital for children dealing with depth perception challenges.
What is patching therapy used for in mild microphthalmia or coloboma?
Patching therapy involves covering the stronger eye to force the brain to use the eye affected by the coloboma or microphthalmia. This helps prevent the development of amblyopia, commonly known as lazy eye, in young children.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What is the vision potential of the affected eye, and how will we monitor the healthy eye for secondary issues?
  2. 2.Can you provide a formal prescription for 24/7 polycarbonate protective lenses to ensure remaining vision is shielded?
  3. 3.When should we begin working with a Teacher of the Visually Impaired (TVI) or an Orientation and Mobility (O&M) specialist?
  4. 4.What are the specific signs of eye strain or visual fatigue I should watch for?
  5. 5.Can you recommend a counselor or psychologist who specializes in adapting to facial differences or vision loss?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (17)
  1. 1

    Quantifying the efficacy of protective eyewear in pediatric soccer-induced retinal injury.

    Suh A, Lam M, Shokrollahi Y, et al.

    Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 2023; (27(3)):131.e1-131.e6 doi:10.1016/j.jaapos.2023.02.009.

    PMID: 37187408
  2. 2

    Analysis on sports and recreation activity-related eye injuries presenting to the Emergency Department.

    Moon S, Ryoo HW, Ahn JY, et al.

    International journal of ophthalmology 2016; (9(10)):1499-1505 doi:10.18240/ijo.2016.10.22.

    PMID: 27803871
  3. 3

    Epidemiology and risk factors for sports- and recreation-related eye injury: a multicenter prospective observational study.

    Lee DE, Ryoo HW, Moon S, et al.

    International journal of ophthalmology 2021; (14(1)):133-140 doi:10.18240/ijo.2021.01.19.

    PMID: 33469495
  4. 4

    Floorball Injuries Presenting to a Swiss Adult Emergency Department: A Retrospective Study (2013-2019).

    Radtke S, Trepp GL, Müller M, et al.

    International journal of environmental research and public health 2021; (18(12)) doi:10.3390/ijerph18126208.

    PMID: 34201228
  5. 5

    Real-world clinical and molecular management of 50 prospective patients with microphthalmia, anophthalmia and/or ocular coloboma.

    Harding P, Gore S, Malka S, et al.

    The British journal of ophthalmology 2023; (107(12)):1925-1935 doi:10.1136/bjo-2022-321991.

    PMID: 36192130
  6. 6

    Functional vision and quality of life in children with microphthalmia/anophthalmia/coloboma-a cross-sectional study.

    Dahlmann-Noor A, Tailor V, Abou-Rayyah Y, et al.

    Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 2018; (22(4)):281-285.e1 doi:10.1016/j.jaapos.2018.01.015.

    PMID: 29730053
  7. 7

    Eye Mapping: Innovative Technique for Precise Iris Positioning in Prosthetic Eye.

    Zilpilwar NR, Nimonkar SV, Chitlange P, et al.

    The journal of contemporary dental practice 2024; (25(7)):711-714 doi:10.5005/jp-journals-10024-3715.

    PMID: 39533944
  8. 8

    An alternative technique by using digital photography and UV printing for fabricating a custom made ocular prosthesis.

    Kocacikli M

    The International journal of artificial organs 2023; (46(3)):135-140 doi:10.1177/03913988231151447.

    PMID: 36705296
  9. 9

    Reviving Vision: A Case Report of Prosthetic Eye Restoration.

    Minase DA, Sathe S, Borle A, et al.

    Cureus 2024; (16(4)):e58811 doi:10.7759/cureus.58811.

    PMID: 38784308
  10. 10

    Fabrication of Custom Eye Prosthesis for a 5-year-old with an Eviscerated Eye: A Case Report.

    Netalkar PP, Grover R, Shetty R, et al.

    International journal of clinical pediatric dentistry 2025; (18(3)):305-307 doi:10.5005/jp-journals-10005-3079.

    PMID: 40415739
  11. 11

    Anxiety and depression in patients wearing prosthetic eyes.

    Heindl LM, Trester M, Guo Y, et al.

    Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie 2021; (259(2)):495-503 doi:10.1007/s00417-020-04908-0.

    PMID: 32870372
  12. 12

    Fibrin-glue-assisted retinopexy for coloboma-associated retinal detachment.

    Jain KS, Upadhyaya A, Raval VR

    Indian journal of ophthalmology 2024; (72(12)):1840 doi:10.4103/IJO.IJO_972_24.

    PMID: 39620692
  13. 13

    Rehabilitation of pediatric retinoblastoma patients with ocular prostheses and their subsequent modifications: A 15-year retrospective study.

    Legg LR, Ahmed ZU, Solano AK, et al.

    Journal of prosthodontics : official journal of the American College of Prosthodontists 2024; (33(1)):12-17 doi:10.1111/jopr.13681.

    PMID: 36951218
  14. 14

    Expander Eye Prosthesis Assisting Ocular Rehabilitation in Child with Eye Loss.

    Dos Santos DM, Andreotti AM, Iyda BG, et al.

    Journal of clinical and diagnostic research : JCDR 2017; (11(8)):ZD06-ZD08 doi:10.7860/JCDR/2017/26859.10511.

    PMID: 28969293
  15. 15

    A Systematic Review on the Effectiveness of Eyewear in Reducing the Incidence and Severity of Eye Injuries in Racket Sports.

    Mazarelo JFD, Winter SL, Fong DTP

    The Physician and sportsmedicine 2024; (52(2)):115-124 doi:10.1080/00913847.2023.2196934.

    PMID: 37070274
  16. 16

    Hazards of Malaysia's Favorite Sport: A Case Series of Badminton-Related Ocular Injuries at a Single Tertiary Center.

    Mat Nawi FN, Bastion MC

    Cureus 2026; (18(1)):e101594 doi:10.7759/cureus.101594.

    PMID: 41700279
  17. 17

    [Anophthalmia and microphthalmia requires multidisciplinary care. Many of the children also have other medical problems].

    Jugård Y, Odersjö M, Topa A, et al.

    Lakartidningen 2015; (112()).

    PMID: 26173131

This page provides educational information about living with MAC and vision rehabilitation. It does not replace professional medical advice. Always consult your ophthalmologist or eye care specialist regarding specific eye protection and treatment plans.

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