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Most eye care practitioners prescribe contact lenses on a regular basis and are comfortable fitting a range of types including soft lenses, rigid gas permeable lenses, hybrid designs, and even large-diameter lenses for the correction of refractive error. Not all practitioners, however, consider fitting contact lenses for pediatric patients.
Fitting contact lenses on pediatric patients can be rewarding, not only for the patient but for the doctor as well. In my practice, I have fit patients as young as 5 years of age with contact lenses. Many parents are unaware that fitting their children with contacts at a young age is even an option. I am usually the one initiating a conversation on this topic with patients and parents. I do tread lightly; however, many times I speak with the parents first before bringing up the topic of contacts with young patients.
CHOOSING THE RIGHT PATIENT
In fitting young patients with contacts lenses, there are many things to consider. I have found motivation to be one of the biggest factors. If the child is motivated to wear contacts, he or she is more likely to do what is required during the contact lens fitting process, including the training and education.
Other qualities that should be assessed in children before contact lenses are suggested include maturity, hygiene (both lid and overall body hygiene), lid aperture size, anxiety level, and participation in athletic or extracurricular pursuits. Another important thing to take into account is the level of parental support for the child hoping to be fit in contacts. If the parents are not on board with the entire fitting process, it can be difficult on both the prescribing doctor and the child.
If I feel that a child is slightly apprehensive with regard to the comfort of contact lenses, I demonstrate by inserting lenses myself to ease the anxiety. Once the child experiences the comfort of contacts and the quality of vision that they can provide, he or she is usually on board with the fitting process immediately. Getting there is just a matter of reassuring patients’ fears. This approach has worked well for me for many years.
One of the main reasons I start a conversation about contacts is if I learn that a child engages in athletic and extracurricular activities. I see a large number of kids in my family practice for whom sports such as baseball, soccer, swimming, running, basketball, and football are very popular. From my own personal experience growing up, playing the catcher position in baseball with helmet and mask, I know that the transition from glasses to contacts was literally a game changer for me.
Many children tell me that they go without their spectacles when they play because the glasses will fog, will not fit under their helmets, get too sweaty, or simply fall off. Contact lenses can solve all of these issues while also increasing peripheral vision, potentially enhancing the child’s performance.
When this situation comes up, I have a conversation with both patient and parents. I point out that they put in all this time practicing, they buy expensive equipment, they go to sports camps, all with the aim of improving performance. But if the child cannot see optimally, they are doing themselves a disservice.
The ACHIEVE study assessed how contact lenses affected the quality of life in children and teens.1 First, the participants filled out a Pediatric Refractive Error Profile (PREP) survey while wearing glasses. The PREP is a pediatric quality-of-life survey meant for use in youths affected only by refractive error. Then the participants were fitted with silicone hydrogel contact lenses, and another PREP score was obtained. The study found that not only did the children who started wearing contacts for sports feel more athletically competent, but also their self-perception of their physical appearance and social acceptance improved as well.2
CHOOSING THE RIGHT CONTACT LENS
Today there are more contact lens options than ever before. With the availability of new lens materials, modalities, and increased parameters, most pediatric patients can be fit into contact lenses. As a strong believer in the advantages of 1-day lenses for all patients—especially for kids—they are my go-to option when performing a new pediatric fit.
The major contact lens manufacturers—Alcon, Bausch + Lomb, CooperVision, and Vistakon—have all introduced 1-day lenses to meet the increasing demand for this convenient modality. Daily disposable hydrogel lenses have been around for several years now, but recently 1-day contacts are becoming available in silicone hydrogel materials. Daily disposable lenses made of silicone hydrogel materials include 1-Day Acuvue TruEye (Vistakon), Dailies Total 1 (Alcon), MyDay, and Clariti (both CooperVision). Expanded 1-day toric parameters are available mainly in hydrogel materials, with the exception of the Clariti 1 day toric (CooperVision). With all of these options available, we are prescribing in a world in which children can be fit into contact lenses safely, comfortably and with exceptional vision.
When I have the conversation with parents about daily disposable options, I always talk about the benefits of 1-day lenses, including improved compliance, health, comfort, and convenience, and the elimination of the need to regularly purchase solutions and cases.
If the 1-day route is not an option or not financially feasible, then I make sure to properly educate the parents and patient on care and compliance with 2-week or monthly contact lenses. When new young contact lens wearers were tested on care and compliance, younger children (ages 8-12 years) were comparable to teens (ages 13-17 years) at baseline (93.5% vs 93.6% correct answers). When tested again 3 months later, however, children showed a statistically significant decline in correct answers compared with teens (87.8% vs 91.9% correct).3 This illustrates the importance of properly educating and reeducating our younger contact lens patients on proper care and compliance.
When the conversation of sleeping with contacts comes up, I strongly advise against overnight or extended wear, and I discuss the complications that can arise. I make it clear to the patient and parents that, even though certain lenses are labeled for overnight wear, this is not an option for my pediatric patients. Lens removal must be made a part of the bedtime routine, just like brushing teeth.
FITTING THE PEDIATRIC PATIENT
If you are considering fitting contact lenses in your young patients, do not be discouraged by the potential for increased chair time. In the overall time for fitting a child or teen patient in soft contacts, children do not require that much extra chair time on the doctor’s end, according to the CLIP study.3 The biggest difference in time in that study was in the insertion and removal (I/R) portion; children took an average of 15 minutes longer than teens to learn the I/R process. However, this would not affect the doctor’s chair time and productivity, it would only mean extra time for the staff members who perform this instruction.
When our staff members perform I/R training sessions, we limit the time to 45 to 60 minutes. Any more than that and the child, parents and/or staff can become frustrated. Or, worse, the child can be turned off from wanting contacts.
If children are unsuccessful after the first I/R training session, we send them home with homework. The children are asked to work on keeping their eye open while using their pointer finger (the finger used to hold the contact lens) to touch the white of their eye five times gently. Doing this repeatedly increases the likelihood of a successful I/R at the next training session.
A steadfast rule in my practice is, if the child cannot take out the lenses on his or her own, then he or she is not allowed to leave the office with the lenses.
After the initial fitting process, both the ACHIEVE and CLAMP studies showed high success rates (91% and 93%, respectively) for children in soft contact lenses.1,4 Success was defined as wearing soft contact lenses for 3 years or more.
When you look at your spectacle wearing pediatric patients, try viewing them as potential contact lens wearers. Have the conversation early and often, and your young patients and their parents (and possibly their teammates) will appreciate it. And remember that by fitting children with contacts you can differentiate your practice from others around you. n
1. Walline JJ, Jones LA, Chitkara M, et al. The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) study design and baseline data. Optom Vis Sci. 2006;83(1):37-45.
2. Walline JJ, Gaume A, Jones LA, et al. Benefits of contact lens wear for children and teens. Eye Contact Lens. 2007;33(6 Pt 1):317-321.
3. Walline JJ, Jones LA, Rah MJ, et al; CLIP Study Group. Contact Lenses in Pediatrics (CLIP) Study: chair time and ocular health. Optom Vis Sci. 2007;84(9):896-902.
4. Walline JJ, Mutti DO, Jones LA, et al. The Contact Lens And Myopia Progression (CLAMP) study: design and baseline data. Optom Vis Sci. 2001;78(4):223-233.
Steve Rosinski, OD
• Private practice at Crozet Eye Care in Charlottesville, Virginia
• firstname.lastname@example.org; (434) 823-4441
• Financial disclosure: none acknowledged