pediatric and teen cl care
To Numb or Not to Numb, That is the Question
BY CHRISTINE W. SINDT, OD, FAAO
If you ask any practitioner who fits pediatric contact lenses, you'll likely get a very strong opinion on the use of topical anesthetics during fitting. Recently I asked several such practitioners, and their opinion is split 50/50 on whether to numb or not to numb.
Taking a Long View
Personally, I do not use topical anesthetics while fitting pediatric patients. I will be the first to admit that I tailor my approach to fit the age and the individual child, yet as a general rule, I go without the drops.
Why do I take this approach when GP—and some say soft—lens fitting can initially be so uncomfortable? The simple truth is that I promise the child that I will never lie to him. For me, it's not about the one lens, but all the subsequent examinations. I try to set the child up with very realistic expectations for the fit, adaptation, and long-term comfort.
During the pre-fitting stage, I show the lens to the child. We wash our hands together (reinforcing hand hygiene), and I allow the child to handle the lens. Children are often amazed at how soft and “not scary” it is. Talking about the lens will give the child time to become used to the idea and to build confidence.
In my experience, the contact lens discomfort subsides very quickly in children. However, I want the child to know how the lens initially feels—that way the first foreign body experience won't be a surprise during dispensing or when the child starts to wear the lens at home. I would rather reassure the “comfort complaints” in the exam room and not to the parent over the phone. Occasionally, a child will say that he “will not wear” a lens based on the comfort issue. Quite frankly, I would rather know this at the first visit before any more time and money is spent.
Anesthetic drops burn upon instillation, and I subsequently find it difficult to apply the contact lens because of the child's fear that the lens will hurt, too. Not to mention that I need to instill fluorescein at every subsequent visit, and the child needs to trust me when I say that the fluorescein drop will not hurt.
While I may not lie to a child, I am not above bribery. Children are easily distracted, and the promise of the “toy box” will often make the wiggliest child sit still and the most uncomfortable lens a mere tickle. We have a box full of donated Beanie Babies, cars, and books, but oddly enough, the kids almost always pick the sheets of large cell bubble wrap.
A Different Opinion
Others disagree with me. Barry Eiden, OD, FAAO, chair of the American Optometric Association contact lens and cornea council, says that in his practice they almost always use proparacaine. He feels that topical anesthetics cause “less of an initial emotional trauma to young patients and as such allows them to accept GP lens wear—and even soft lens wear—with a very positive attitude. Creating a positive environment is what it is all about.”
Dr. Eiden also believes that topical anesthetics allow for “better assessment of physical fit of the lenses with less secondary adaptation epiphora.” He adds, “When multiple diagnostic lenses are needed, the patient is far more accepting in terms of the comfort response, again making the process more acceptable.”
So should you numb or not? It probably all comes down to what makes you more comfortable and confident. Children always know when they are in good hands. CLS
Dr. Sindt is a clinical associate professor of ophthalmology and director of the contact lens service at the University of Iowa Department of Ophthalmology and Visual Sciences. She is also the chair-elect of the AOA Contact Lens and Cornea Section. She is a consultant or advisor to Alcon, Ciba Vision, and Vistakon and has received research funds from Alcon.