GP Lenses and Young Patients in 2008, Part 1
BY EDWARD S. BENNETT, OD, MSED, ROBERT DAVIS, OD, S. BARRY EIDEN, OD, KIM LAYFIELD, OD, MICHAEL J. LIPSON, OD, & JULIE OTT DEKINDER, OD
Every good salesman knows that you don't pitch a specific product; you promote the benefits that customers will receive from the product. For young progressive myopes, benefits of GP lenses may include the ability to see the blackboard clearly, read books without eyestrain or play video games without squinting. Also, some studies have found that GPs can slow myopia progression in some young patients.
Overnight orthokeratology can allow the freedom of not wearing correction during the day. It represents a much underutilized modality in vision care practice today, and numerous studies have found that the majority of qualified children can adapt to overnight ortho-k.
Young GP Candidates
Young progressive myopes are excellent candidates for GPs. Beginning at age 8 (or younger for patients who are mature and motivated), these young people have demonstrated that they can adapt to and successfully wear GP lenses. In the Contact Lenses and Myopia Progression (CLAMP) study, 80 percent of young people fitted with GP lenses successfully adapted to them.
It's important that they have initially worn spectacles and are motivated to discontinue spectacle wear. If they're scared of eye drops or of anything touching their eyes, they may not be ready for contact lenses. If they cling to mom or seem disinterested in the examination process, they may not be mature or motivated enough to proceed.
Even young athletes who are tired of, and perhaps hindered by, wearing glasses or sports goggles can benefit from properly designed GP lenses. A large overall diameter (10mm to 11mm) with low edge clearance will minimize risk of decentration or dislodgement during sports activities.
If you're introducing overnight orthokeratology into your practice, it's important to have a corneal topographer and to begin with young people who are most likely to succeed (1.00D to 2.00D myopes). Pupils should be ≥6mm to minimize symptoms of glare.
Using topical anesthetic is important for the initial application. It should wear off before the patient leaves with the lenses to provide a realistic perception of the initial awareness. Jeff Walline, OD, PhD, recommends placing a drop of topical anesthetic into the lens bowl prior to application to avoid the need to apply eye drops, especially for children who don't like eye drops.
Communicate to young patients that they will experience some initial awareness because the eyelid interacts with the lens edge. This is much more realistic than telling them that they'll experience discomfort or, conversely, very little sensation.
The Adaptation Process
Lens loss is especially common during the adaptation period, so providing a spare pair is essential. It's beneficial if at least one parent is a contact lens wearer to assist the child with lens handling and care. However, emphasize to parents that they must be supportive (and not demonstrate any signs of frustration or impatience) and encourage their child to apply and remove the lenses. They must resist the temptation to save time and rush the process by applying and removing the lenses for their child. Children need to learn on their own, and the initial extra time necessary to become proficient will enhance the likelihood of long-term success. CLS
Dr. Bennett is an associate professor of optometry at the University of Missouri-St. Louis and is executive director of the GP Lens Institute.
Dr. Davis has an eyecare specialty practice outside Chicago.
Dr. Eiden is president of a private group practicein Illinois. He is also an assistant clinical professor at the University of Illinois at Chicago Medical Center.
Dr. Layfield is a cornea and contact lens resident at the University of Missouri-St. Louis.
Dr. Lipson is a clinical assistant professor with the University of Michigan's Kellogg Eye Center.
Dr. Dekinder is a clinical assistant professor at the University of Missouri-St. Louis.