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College students who are headed away to campus present a unique circumstance for eye care providers. Taking up temporary residence away from home, these young people usually do not have relationships with local health professionals, and they often rely on school-based health clinics. Unfortunately, many such clinics are not well-versed in eye care.
Eye care providers should take the time to give specific advice to these patients who will have a high likelihood of needing eye care while at school but a lack of access to care. Patients in our practices who need particular attention include those in three specific categories:
• Those who wear contact lenses;
• Those who are in a myopia control treatment program; and
• Those who have a history of binocular or accommodative dysfunction.
Leaving home means less oversight from parents or guardians. As students leave for college, their daily routines are going to change, and this includes sleep patterns. It is imperative that we remind patients about proper contact lens hygiene and warn them about the risks of noncompliance with contact lens care.
For patients using reusable lenses, it would be wise to have a conversation about refitting them into single-use lenses, which have a lower risk of complications.1 The single-use contact lens market has grown substantially over the past few years, and it is much easier to find lenses for a variety of refractive needs, especially for patients who need toric lenses for astigmatism correction.
Some patients will still want to continue in their reusable lenses. For them, it is advisable to “prescribe” their contact lens solutions, so to speak, and not just recommend them. You should also “prescribe” a replacement schedule for their contact lens cases.
For all of our patients—not only the college students—we should remind them periodically to discontinue contact lens wear and seek treatment if they see any signs of inflammation or infection. I use the well-known mantra, “When in doubt, leave them out.” I suggest that patients order an updated spectacle prescription for use as backup.
In our practice, myopia control programs include orthokeratology, soft lens multifocal programs, and atropine treatments. For patients in these treatment programs, it is important to set expectations while they are away. It is a good idea to set up follow-up visits in advance when they anticipate being home on break.
It is also helpful to locate a colleague in the area of the student’s college or university who is comfortable with myopia management. A good place to start your search is on the “Find An Ortho-K Doctor” page of the American Academy of Orthokeratology and Myopia Control.2
BINOCULAR AND ACCOMMODATIVE DYSFUNCTIONS
Patients with a history of binocular or accommodative dysfunction may experience an increase in symptoms due to increased visual demands (studying, attending lectures, participating in all-night Risk games) at college. It is prudent to measure their accommodation and vergence and, if there are abnormalities, to consider prescribing appropriate lenses.
At the least, you should warn the patient of the possibility of symptoms increasing. Possible symptoms include headaches, eyestrain, and transient near or distance blur, among others. If symptoms do occur while they are away, tell these patients that they should look for an eye care provider who is well-versed in binocular vision and vision therapy. A good place to start is the locate-a-doctor tool on the College of Optometrists in Vision Development website.3
KEEPING IN TOUCH
For all college-age students, it is a good idea to let them know to monitor for increasing distance blur, as we know there is a correlation between higher education levels and increasing myopia.4
College students have different communication preferences, and you should provide options beyond a phone number for them to stay in touch while they are away. These should include connecting via email, through your website, and through your Facebook and other social media pages.
Our millennial patients seem to appreciate having various options for communication—although we have not quite figured out Snapchat yet. Nevertheless, we remind our college-age students that we are here for them if they need us, and we encourage them to reach out if they have any concerns about their vision.
1. Sorbara L, Zimmerman AB, Mitchell GL, et al. Multicenter testing of a risk assessment survey for soft contact lens wearers with adverse events: a contact lens assessment in youth study [published online ahead of print October 13, 2016]. Eye Contact Lens.
2. Find An Ortho-K Doctor. AAOMC. www.orthokacademy.com/find-an-ortho-k-doctor2. Accessed July 14, 2017.
3. Locate a Doctor. College of Optometrists in Vision Development. www.covd.org. Accessed July 14, 2017.
4. Mirshahi A, Ponto KA, Hoehn R, et al. Myopia and level of education: results from the Gutenberg Health Study. Ophthalmology. 2014;121(10):2047-2052. KEEPING IN TOUCH
Daniel Press, OD, FCOVD
• director, pediatric eye care, binocular vision, and vision therapy services, North Suburban Vision Consultants, Park Ridge, Ill.
• financial disclosure: none relevant