Pediatric and Teen CL Care
Continuing Education for Young Patients and Their Parents
BY MARY LOU FRENCH, OD, MED, FAAO
Just as there are three things in real estate—location, location, location—there are three things in fitting young children with contact lenses—educate the patient, educate the parent, re-educate the patient and the parent. Most patients understand the importance of wearing and replacement schedules, but fewer understand the importance of lens care solution. In the words of this patient’s mom, “I read the bottle and the ingredients were the same.”
Kayla is the youngest girl in a family of four children. The older two sisters have successfully worn contact lenses for a few years, but Kayla’s refractive error was not simple myopia easily corrected with a spherical two-week replacement lens, nor was her binocular vision in the normal range.
She began wearing a vision correction for hyperopia with astigmatism at the age of 3. However, her cooperation at that age was minimal. Mom and Dad did the best they could with a headstrong yet charming young girl. Although there was an exophoria present, her convergence skills more than compensated for this muscle imbalance.
After two years of a stable visual system she began kindergarten, and the exophoria decompensated into an intermittent and moderate angle OD exotropia. Office therapy was initiated, but sadly, the family dynamics shifted and the parents divorced. Vision therapy had to be discontinued. At the next annual exam, the OD exotropia became a larger angle of strabismus, and a referral for a consultation on a surgical correction became the operative treatment plan.
Fortunately, I have an excellent relationship with an outstanding pediatric ophthalmologist. And the other good news, both parents agreed with the recommended treatment plan for their daughter. The doctor performed the surgery with outstanding results.
Taking on Contact Lenses
When Kayla came in for her annual exam six months ago, the topic of contact lenses came up. Mom wanted her to wear contact lenses like her sisters, and also because Kayla didn’t always wear her glasses, especially when participating in sports. I was reluctant to begin the process of a contact lens diagnostic fitting with Kayla’s history of noncompliance with glasses wear, continued binocular vision concerns, and family issues. Nonetheless, with the older sisters wearing lenses successfully and compliant with their lens care, we forged ahead.
The diagnostic visit went well, but the multiple instruction sessions were challenging. Kayla was impatient and had the expectation that everything would resolve immediately. To her credit, she did it all and began to wear her lenses successfully.
I schedule a six-month evaluation for all my new contact lens patients prior to ordering more lenses. When I saw Kayla at this visit, her lenses were filmy and coated. During the course of questioning the care regimen, it became evident that Mom, not being a lens wearer herself, had been buying what was on sale.
To my surprise, Kayla knew the exact care solution that we recommended at the time of the instruction, but she had been unable to convince her mom that it was the care solution she should be using. So, Mom and I had a little heart-to-heart about generic care solutions. The patient in this case was not the one who needed the education, it was the parent.
That is why I enjoy fitting contact lenses on young children, they listen! CLS
Dr. French is a graduate of Illinois College of Optometry. After her doctorate, she completed post-doctoral programs in learning disabilities, early childhood development, and business management. She is a lecturer, author, and industry consultant specializing in children’s vision. She is also a consultant or advisor to Vistakon. You can reach her at email@example.com.