Patients Say the Darndest Things
pediatric and teen cl care
Don't Make Age the Only Criteria when Fitting Lenses
BY JEFFREY J. WALLINE, OD, PHD, & MARJORIE J. RAH, OD, PHD
Several investigations have shown that children as young as 7 can routinely care for lenses without serious risk of adverse problems, but many practitioners continue to use age as a primary determinant of children's abilities to wear lenses. Perhaps practitioners believe children don't benefit from lens wear as much as teens or that children require too much time to learn application and removal, concluding that parents and practices are both burdened by fitting children.
Study Takes a Closer Look
The Contact Lenses In Pediatrics Study (CLIP) compared chair time and benefits of lens wear between children (ages 8 to 12) and teens (ages 13 to 17). The study was conducted at The Ohio State University College of Optometry, the New England College of Optometry and the University of Houston College of Optometry. They fit 85 teens and 84 children with Acuvue Advance or Acuvue Advance for Astigmatism lenses (Vistakon) and examined them for three months.
Figure 1. Histogram of times required for application and removal training for children and teens.
Children and teens completed the Pediatric Refractive Error Profile to determine quality of life with spectacles and after three months of lens wear. There was no difference between children and teens in how much the scales increased. The greatest increase was in the activities and appearance scales for both.
The overall chair time, including fitting, application and removal training, and three follow-up visits was about 15 minutes greater for children than for teens. Most of the time difference was during application and removal training, for which children required 11 extra minutes, on average. The median difference was only five minutes, and the maximum time required to teach a child application and removal was 173 minutes compared to just 100 minutes for a teen.
The large difference in the mean time may result from the extremes of the distribution (Figure 1). This indicates that the difference is not as dramatic as we may believe, but some children may require significantly more time to train than teens.
Consider Other Indicators
Age should not be the primary determinant for lens wear. Few children between ages 8 and 11 can't apply or remove their own lenses, and the majority can safely wear lenses without direct parental involvement.
Observing a child's aperture size, hygiene, motivation, maturity and anxiety will help determine the likelihood of success. Use these indicators to make recommendations instead of a strict age criterion. You'll make patients much happier and likely expand your patient base as well as your satisfaction. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #148.
Dr. Walline is an assistant professor at The Ohio State University College of Optometry, where he conducts studies of pediatric contact lens wear. Dr. Rah is an assistant professor at the New England College of Optometry where she works primarily in the Cornea and Contact Lens Service in patient care, teaching and research.
Contact Lens Spectrum, Issue: March 2008