Pediatric and Teen CL Care
Tips for Pediatric Dispensing
By Christine W. Sindt, OD, FAAO
There are few things more gratifying than knowing you've made a difference that will last a lifetime. That is the joy of pediatric contact lenses. Even the best contact lens fit, however, will only be as successful as the dispensing.
Pediatric contact lens dispensing starts with a firm, yet kind, discussion about the contact lenses. Caregivers must “buy in” to the process or the lenses will be useless. Stress that a lens does not hurt the child, rather, the child may protest because of the physical restraints and touching of the face/lids. If the caregiver backs off when the child screams, he is likely to scream harder the next time. Conversely, if the caregiver perseveres, the child will protest progressively less.
Applying, Removing the Lens
There are many theories on pediatric lens application that vary by lens type and the age of the child. As a general rule, infants are fairly easy until the age of 6 months. Nine- to 15-month olds are probably the most difficult. This is when children learn that they have control of the environment, but before the age of reason. After 18 months, it gets progressively easier. Children this age may also be able to tell you if there is a problem with the lens.
Practices vary in theory on whether lenses should be removed daily. There are several reasons why we believe lenses should be removed daily:
• Children work better in a routine.
• Caregivers become more proficient at handling the lens.
• Children become more comfortable with lens application. Contact lenses will certainly come out at inconvenient times, and it's best if they can be re-applied without fuss.
• Lenses stay cleaner, which will lead to better comfort, fewer infections, and better optics.
• It's easier for caregivers to inspect the lens.
Caregivers should watch for lenses to decenter or pop out. Advise caregivers that they need a back up lens in case the original lens is lost.
Children have even been known to eat their lenses! If a lens is found in a diaper, tell care-givers that soft lenses should be discarded, while a GP contact lens can be cleaned and sterilized in the usual manner.
RSVP stands for redness, secretions, visual blurring (if a child can communicate this), and pain. Caregivers need to be aware of these symptoms and remove the lens immediately and notify the practitioner if they occur.
The wearing time should be approximately six to eight hours the first day, 10 hours the second day, and then all waking hours. Children may nap in lenses, but they should be removed at night.
Children may take over lens removal at ages 4 to 5 years, application at 6 to 8 years, and cleaning/care at 10 to 12 years. Of course, this depends on the maturity/dexterity of the child.
Caregiver compliance is necessary for follow-up appointments. During the evaluation, obtain a good lens history. Make every attempt to assess visual function, keeping in mind that caregiver impression is important. Perform a refraction and/or retinoscopy along with a check of the lens fit and evaluation of physiological tolerance.
You can also use this time to re-educate patients and caregivers in certain aspects of lens care or application/removal.
Financial assistance is another issue of discussion. Caregivers may have only minimal eye coverage, if any. Funding may be available through state agencies such as Medicaid, with a letter of medical necessity from you.
A Rewarding Experience
Lens care in children is time consuming and can be stressful, but also rewarding and wonderful. If the dispensing is done correctly, it sets parents and children up for years of positive vision. CLS
Dr. Sindt is a clinical associate professor of ophthalmology and director of the contact lens service at the University of Iowa Department of Ophthalmology and Visual Sciences. She is also the 2010-2011 Chair of the AOA Cornea and Contact Lens Council. She is a consultant or advisor to Alcon, Ciba Vision, and Vistakon and has received research funds from Alcon. You can reach her at firstname.lastname@example.org.