GP Lenses and Young Patients in 2008, Part 2
BY EDWARD S. BENNETT, OD, MSED, ROBERT DAVIS, OD, S. BARRY EIDEN, OD, KIM LAYFIELD, OD, MICHAEL J. LIPSON, OD, & JULIE OTT DEKINDER, OD
Our February column discussed which young patients are good candidates for GP lenses as well as fitting tips and how to get young patients through the GP adaptation process. In this second part, we'll discuss GP lens care and compliance as well as some benefits of overnight orthokeratology for young patients.
Optimizing Patient Compliance
A one-bottle care system makes lens care much simpler and prevents problems such as inadvertently applying the lens with the cleaning solution or failing to completely rinse the cleaning solution from the lens. Regardless of the system, GP lenses must be cleaned upon removal.
For overnight ortho-k patients, instilling a viscous lubricant into the lens bowl prior to application may assist in lens centration and initial comfort. Likewise, using a less viscous drop upon awakening will rinse away debris and make lens removal easier. Patients should not remove lenses immediately upon awakening because the lenses typically adhere during sleep. This adherence effect usually ends soon after awakening as the patient blinks and uses a rewetting drop.
Instruct all patients to discard their lens case at minimum every three months. Consider providing several cases to encourage their regular disposal.
Benefits of Ortho-k
The greatest lifestyle benefit for young overnight ortho-k patients is that they can function normally with good unaided vision during all daily activities. Many of these young people feel more confident as a result of not having to worry about their glasses falling off, breaking or fogging up.
Dr. Lipson has found that such patients tend to become involved in activities they may not have ventured into before. He says, "I have one 9-year-old patient who has started swimming and gone from a beginner to a state competitor in one year. Another 5.00D myope refused to wear glasses because he felt self-conscious about his looks. He now wears overnight ortho-k lenses and has become involved in many activities and shown a steady improvement in his grades."
It's evident that one of the more common motivating factors is sports. Dr. Layfield saw one 9-year-old 2.00D myope who had been wearing a spectacle correction for one-to-two years. He refused to wear his glasses full-time. At their baseline Stabilizing Myopia by Accelerating Reshaping Technique (SMART) study examination, both dad and patient reported that the patient typically wore his glasses to school but not as much as when he was at home, outside or playing sports. Overnight ortho-k is giving him good unaided vision and freedom from his glasses during sports.
Andrew Paik, an optometry student working for Dr. Davis, commented on a 12-year-old 2.00D myope whom he assumed would be fit into a soft lens. Dr. Davis recommended overnight ortho-k. Paik says, "It was almost a paradigm shift for me, as my concept of the ideal ortho-k patient transformed from the typical 25-year-old young professional looking for a more affordable and less risky option to refractive surgery to the 12-year-old with probable myopic progression.
"Based on this experience, a young, myopic, motivated first-time lens wearer would be an ideal candidate for ortho-k because of the benefits of making the patient happy (by prescribing contact lenses) with the possibility of stabilizing their myopic progression and allowing the parents to supervise and support their child's lens wear at home." CLS
Dr. Bennett is an associate professor of optometry at the University of Missouri-St. Louis.
Dr. Davis has an eyecare specialty practice outside Chicago.
Dr. Eiden is president of a private group practice in Illinois.
Dr. Layfield is a cornea and contact lens resident at the University of Missouri-St. Louis.
Dr. Lipson is a clinical assistant professor with the University of Michigan's Kellogg Eye Center.
Dr. Dekinder is a clinical assistant professor at the University of Missouri-St. Louis.