Article Date: 9/1/2008

Putting ’em on the Path to Successful Lens Wear

Putting ’em on the Path to Successful Lens Wear

Learn how to spot the best candidates and hone your communication skills.

Most contact lens wearers remember the process of being fitted for contact lenses. So it's important to determine which kids are the best candidates up front and sharpen your communication skills to ensure they have a lifetime of successful contact lens wear.

Here's how to spot the best candidates and strategies to improve your daily interaction with kids and parents.

Best Candidates

Many kids age 8 and up make good candidates for contact lenses. Kristi Kading, O.D., F.A.A.O., who specializes in pediatric optometry at Totem Lake Vision Center in Kirkland, Wash., looks for these characteristics:

Healthy eyes. Most children have good anterior segment health. If the child has allergies or blepharitis, the doctor needs to treat the condition first before prescribing contact lenses.

Motivation. For success, children – not the parents – must be excited about getting contact lenses.

Active lifestyles. Kids participating in sports and other outdoor activities enjoy the freedom of wearing contact lenses. Parents have an added benefit as well: no more broken eyeglasses.

Higher prescriptions. Children with higher prescriptions usually have to wear eyeglasses during all waking hours. The eyeglasses eventually become part of their identity. Having the option to wear contact lenses, even part-time, can have lasting benefits.

Anisometropia. If the difference in prescription between a child's two eyes is significant enough, his brain will have difficulty merging two images. This doesn't occur with contact lenses. With contact lenses, the result is better binocular vision.

Good hygiene. Kids with dirty fingernails or poor general hygiene aren't good candidates for contact lenses.

"Age isn't the sole deciding factor," Dr. Kading says. "I've spoken with teens who don't want to be told what to do, and I've seen first graders follow my directions to the letter. I fit a 7-year-old competitive gymnast for daily disposables, and at her next follow-up visit, she was so grateful."

Choice Words

As a technician or member of the front desk staff, you often begin conversations with kids and parents about contact lenses. When parents make an appointment, ask if they're considering contact lenses for their child. If the parent seems baffled or dismisses the idea, calmly say that many children in the practice wear contact lenses, and they're quite happy with them.

To start an in-depth discussion with patients, Kelly T. Harris, F.C.L.S.A., N.C.L.E.-A.C., R.O., director of contact lenses at the University of Virginia department of ophthalmology in Charlottesville, asks kids these questions:

■ In what sports and activities do you participate?

■ Which type of contact lens would you like? "If they have no knowledge of contact lenses, I discuss the different types we have, their wear schedules and how to take care of them," Ms. Harris says.

■ How often do you plan to wear contact lenses? "This is a huge deciding factor," Ms. Harris explains. "If they'll only wear them occasionally or for sports, a daily lens is best. For everyday wear, I suggest a lens with a 2-week or monthly replacement schedule."

K. Heather Power, F.C.L.S.A., Contact Lens Certified Optician and owner of Contact Lens Services in Winnipeg, Manitoba, Canada, asks parents:

■ Do you have to nag your child to wash his hands, take a bath or brush his hair? "Kids whose parents must nag them about good hygiene aren't ready for contact lenses," Ms. Power says.

If good hygiene isn't an issue, Ms. Power asks children:

■ Why do you want to wear contact lenses?

■ Do you know that you need to follow certain rules when you wear contact lenses? "Kids need to understand that the consequences of poor contact lens care can be far more severe compared to not cleaning their eyeglasses," Ms. Power explains.

Ms. Power also asks children:

■ Do you understand that you'll need to continue wearing your eyeglasses for part of the day? And if you develop any problems, you may have to go back to your eyeglasses temporarily? "Kids need to understand that they're not throwing away their eyeglasses. They still have to wear them if they have an injury, pink eye and so on," Ms. Power says.

What should you avoid saying to young patients about contact lenses? "Never lie," advises Keith W. Harrison, A.B.O./N.C.L.E.(A.), F.C.L.S.A., optician and certified contact lens fitter at Harrison Optical Services, located at Toronto Western Hospital. "Don't say, ‘You won't feel anything.’ I tell kids that if they were always barefoot and they started wearing shoes, it would feel a little different, and so will wearing contact lenses. I want to keep things simple and realistic, so I can underpromise and over-deliver."

Of course, some parents like to focus the discussion on dollars and cents. Keep a reference sheet with all the fees and lens costs in the reception area. It should list the cost of the exam, fitting and 1 year of disposable contact lenses.

Fitting, I&R and Lens Care Discussions

Most practices involve the parents in the fitting, insertion and removal (I&R) training and contact lens care discussions. This enables the whole family to learn about contact lens care, but it also can create some confusion. (See for a primer on contact lens care.)

To begin, ask the parent to sit down nearby. Face the child (not the parent) and maintain eye contact. You want to make it clear that the child is the patient, not the parent. Direct all of your comments to the child – even if you're answering a parent's question.

Sometimes, a parent's presence puts pressure on you and the child or is counterproductive in some other way. Christopher Thaxton, N.C.L.E., A.B.O., a licensed optician at Physician's Eye Center in Aiken, S.C., believes the technician should feel free to request time alone with the child if needed.

"I tell parents, ‘It can be hard for kids to concentrate with so many eyes watching,’ or ‘I need some one-on-one time with Adam so I can ensure he masters the manual dexterity and proper technique to learn to wear contact lenses.’ "

6 Ways to Boost Patient Compliance
Employ these six strategies to ensure young contact lens wearers follow the rules:
  1. Suggest a lens with a care regimen that works best for them, such as daily disposables.
  2. Send home a contact lens care sheet so kids can easily refer to the instructions.
  3. Encourage parents to designate an area in their home for insertion and removal where kids can use a magnifying mirror.
  4. Be available for complimentary visits if kids need more I&R training.
  5. Direct parents and kids to Web sites that offer free information about contact lenses and how to care for them. Several companies like CooperVision have sites especially for patients (
  6. Quiz kids during progress visits. Dr. Kading brings kids back for a progress visit in about a week. She asks them questions such as:
  • How do you care for your contact lenses when you plan to swim?
  • How long do you wear your contact lenses during the day?
  • When do you throw them out?
  • What do you do if you realize you've forgotten to take your lenses out?
  • Do you wear your friends' contact lenses?
  • Can you put contact lenses in your mouth? Can you rinse them in water?
  • When should you carry your solution with you?

Making the Most of Opportunities

If having a parent in the room isn't a problem, use the time as an opportunity to tell the parent about possible contact lens options.

"If I have a parent who's wearing eyeglasses, I begin a discussion about contact lenses for him," says Christian P. Guier, O.D., of the Mayo Clinic in Jacksonville, Fla. "Often, I find that the parent believes he can't wear them because of astigmatism or bifocals. I tell him that almost anyone can wear contact lenses, just like his 10-year-old. Usually, he'll make an appointment, and he'll talk to other friends and family members, too."

Vickie S. Portis, N.C.L.C.-A.C., F.C.L.S.A., advanced certified CL technician at Vistar Eye Center in Roanoke, Va., finds that younger siblings sometimes envy older brothers or sisters who are getting contact lenses. "If a younger sibling is there, I plant the seed so the parent will consider having the younger child fitted as well," she says. "Once, a very bright 7-year-old showed great disappointment, because she had eyeglasses and her 10-year-old sister received contact lenses. We fitted the 7-year-old in contact lenses, and she turned out to be one of my best patients."

When it comes to contact lens candidates, that kind of motivation can make all the difference in long-term success – at any age. ■

Contact Lens Spectrum, Issue: September 2008