pediatric and teen cl care
Lens Selection, Follow up: Keys to Fitting Young Lens Wearers
BY MARJORIE J. RAH, OD, PHD, & JEFFREY J. WALLINE, OD, PHD
More children as young as 7 or 8 years old are being fitted with elective contact lenses. Several studies have demonstrated the safety and efficacy of fitting elective lenses on children in this age group. Even so, it is important to select an appropriate lens modality and to complete follow-up visits at appropriate intervals.
Daily Disposable Lenses
Many parents and practitioners prefer to use daily disposable lenses with younger children. Daily disposable lenses eliminate the need for daily lens cleaning and disinfection and they provide a clean lens on the eye each day they are worn. These lenses may even be cost effective for children who do not intend to wear lenses every day, but rather prefer to wear contact lenses solely for extracurricular activities.
Although daily replacement simplifies lens wear, practitioners still must address compliance. Instruct children to remember to remove lenses prior to bedtime. Recommending lens removal an hour before bedtime can help. This ensures that children are not too tired to remember to remove their lenses and do not just fall into bed still wearing them.
Also, it is important to educate patients and parents that the lenses are intended for daily replacement and that multiple use of a single lens is not recommended.
Other Modalities, Compliance
In some instances, daily disposable lenses are not an option because of price or prescription. In these cases, several two-week or monthly lenses are available. Because these children potentially have decades of lens wear in their future, providing the healthiest lens option is necessary.
In most cases, a silicone hydrogel lens is the first choice in this population to provide the highest possible oxygen permeability. With frequent replacement of lenses, the care regimen becomes more complex than with daily disposables, and patient education increases proportionately.
Educate patients and parents to replace lenses on the first and fifteenth of the month for two-week lenses and on the first of the month for monthly lenses. It is important to remind patients that stretching lenses beyond the prescribed wearing schedule is not recommended.
Thoroughly explain the prescribed care system to both patients and parents and review it at each subsequent visit. As with daily disposables, instruct patients to remove their lenses prior to bedtime. If children wait until they are too tired, compliance with lens care can suffer.
Children between 8 and 17 years old may still be in a period of rapidly progressing refractive error. For this reason, it is wise to recommend follow up at six-month intervals rather than yearly. It also may be practical for patients to order lenses in six-month quantities. However, if patients order lenses in annual supplies, be sure to explain that boxes can be returned in the event of a prescription change provided that they are unopened with no writing on them.
Another benefit of examining children at six-month intervals is that it provides an excellent opportunity for reviewing contact lens wearing time recommendations, replacement schedules, and proper use of care systems.
Children are becoming a significant addition to the contact lens-wearing patient population. Although they often require more follow up and careful consideration with regard to modality selection, the reward is the new life they bring to your practice. CLS
Dr. Rah is a staff optometrist at the Massachusetts Eye and Ear Infirmary Contact Lens Service where she specializes in medically necessary and other advanced contact lens designs. Dr. Walline is an assistant professor at The Ohio State University College of Optometry, where he conducts studies of pediatric contact lens wear. He is also a consultant or advisor and has received research funds from Paragon and Vistakon.