pediatric and teen cl care
Corneal Reshaping in Kids: Fitting Tips
BY JEFFREY J. WALLINE, OD, PHD, & MARJORIE J. RAH, OD, PHD
Corneal reshaping contact lenses work for a variety of patients, but are ideal for children for several reasons. They allow children to see clearly without wearing lenses for daytime activities. Children also wear these lenses only at home, so contact lens loss may be less frequent. Most children have low refractive error and pliable corneas, so every-other-night lens wear is possible. While adapting to corneal reshaping, children can wear their old glasses because over-correction doesn't bother them as much as it bothers adults.
When fitting children, challenges may arise that you typically don't experience with adults. Here are a few tips to make the process easier and to improve chances of success.
Not all children will adapt to corneal reshaping lens wear. Based on two long-term studies, you can expect approximately 75 percent of children to continue to wear corneal reshaping lenses for at least two years. Most children who discontinue quit before the second follow-up visit, so you won't spend too much time with a given patient only to have him or her not be ultimately successful.
The two eyes are amazingly similar, so you can frequently dispense the same lens for each eye. If you use a dispensing set, use the same parameters for each eye, but flatten the base curve in the smallest amount possible for one eye. Patients won't notice the slight over-correction. You can order the lens with the appropriate base curve, but in the meantime you can dispense lenses and monitor the fit, and the child will enjoy wearing lenses right away.
Use anesthetic drops at the fitting and dispensing visits. This will allow you to get a better evaluation of the fluorescein pattern, and it lets the patient slowly feel the sensation of the lid rubbing over the edge of the lens. Edward Bennett, OD, MSEd, and colleagues also showed that using anesthetic at fitting and dispensing visits improves acceptance of GP lenses. Because most children do not like eye drops, just put the drop of anesthetic on the lens before application.
Ask the child to close his eyes if he complains of discomfort. He'll tell you that the lenses are more comfortable, so remind him that they will be in the eyes only during sleep when eyes are closed.
Limit the time teaching application and removal of lenses. The faster you apply the lens, the less anxiety for the child. If too much frustration builds up after 45 minutes of application and removal training, send the child home with eye touching exercises for one week, then have him return for more instruction. The more frustrated the child or you becomes, the less likely that training will be successful.
Don't make too many changes to lens parameters based on the one-day follow-up visit. This is typically the first night that the child has worn lenses, so he may rub the eyes and the lenses may move. If the lenses looked good at the dispensing visit and the topography is acceptable, wait until the next visit to make any parameter changes.
Be fun and friendly during the examination. Foolishness goes a long way when working with children. A business-like approach may befriend you to many adults, but children won't respond to that attitude. Be willing to go out on a limb, and you'll find that working with children can be more refreshing than a cup of coffee in the morning. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #166.
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. 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.