pediatric and teen cl care
Hybrid Lenses Can Ease Transition into GP Lens Wear
BY MARJORIE J. RAH, OD, PHD
Often when fitting medically necessary contact lenses on pediatric patients, a GP lens is indicated. Although children can adapt to GP lenses, it often presents a challenge for the family when trying to get everyone to school or work in the morning. A child who is uncomfortable with the feeling of a GP lens can be uncooperative with lens application.
In some cases, fitting a hybrid lens can help with initial comfort while providing the vision of a GP lens. In other situations, hybrid lenses can provide the vision of GPs when GPs are contraindicated. The following is a review of a few brief case reports of successful hybrid lens use in pediatric patients.
• A 4-year-old boy with a history of an open globe injury to the left eye presented for contact lens fitting. Following surgical repair of the eye, the child was aphakic and had a large central corneal scar in the left eye. A spectacle prescription of +13.00 −3.00 x 170 with an irregular retinoscopy reflex was determined under anesthesia. The patient was cooperative for measurement of keratometry readings of 40.50/38.50 @ 090 with distorted mires. A diagnostic GP lens was initially assessed, but the child was extremely uncomfortable.
The need to keep a lens on the eye was critical and the family was concerned that the child wouldn't wear the lens. A hybrid lens trial proved to solve the initial comfort issue. He successfully adapted to a hybrid lens design and is wearing the lens regularly. At the follow up six months following the injury, vision had improved to 20/125 in the eye from hand motion vision two days after surgical repair of the globe.
• A 12-year-old girl presented with a history of open globe in jury to the right eye with a resulting central corneal scar. K readings were 45.00/46.00 @ 070 with distorted mires. A spectacle refraction of +1.75 −4.50 x 030 resulted in best spectacle corrected visual acuity of 20/60.
Although a GP lens was indicated for best corrected visual acuity, the patient was concerned about wearing a GP lens during horseback riding due to the dusty environment. After discussing with the patient and parents, it was evident that horseback riding was a significant activity and the concern was valid. We fit the patient with a hybrid lens with a resulting visual acuity of 20/20.
• A 14-year-old boy who had Down's syndrome had high myopia and astigmatism in each eye. Spectacle refraction of −6.50 −3.50 x 55 OD and −12.50 −2.00 x 120 OS were obtained via retinoscopy. Although the parents can tell by behavior that his vision significantly improved with vision correction, he won't wear his glasses. He was fit with both soft and GP lenses and although his parents report that his vision is notably better with contact lenses, retention has been an issue. He was referred to the clinic for fitting of a hybrid lens to aid in lens retention. Due to poor patient cooperation, keratometry measurements were not available and lenses were trial fitted until a good fit was achieved with hybrid lenses.
An Easier Transition
The improved initial comfort of a hybrid lens allows for an easier transition into lenses for families while maintaining the improved vision of a GP lens. In addition, hybrid lenses provide good comfort and vision for children who require GPs for best vision but are contraindicated for comfortable GP wear.
Although it may not be the lens of first choice in routine care, hybrid lenses can be useful in challenging cases of medically necessary contact lenses. CLS
Dr. Rah is a staff optometrist at the Massachusetts Eye and Ear Infirmary Contact Lens Service where she specializes in medically necessary and other advanced contact lens designs.