Pediatric and Teen CL Care
Valuable Lessons From a Case of a Young High Myope
By Mary Lou French, OD, MEd, FAAO
Little “Maggie” walked in at age 3 for a second opinion on her recent eye exam at a local children's hospital. Without any history of any observable vision issues, the mother was extremely concerned with the prescription given to her of –19.00 sph OD and OS. The pregnancy was uneventful, the labor and delivery were uneventful, all developmental milestones met—the only reason for Maggie's exam was that her older sister had been hospitalized for another medical issue and their mom decided to have Maggie checked, too.
This little sweetheart was, in fact, exactly that highly myopic. How she managed to function without anyone noticing her poor vision is a mystery to me as the family is lovely and very caring. She selected her first pair of glasses that day. Her visual acuities were difficult to determine, both due to her age and her correction. Amazingly, the ocular health and the appearance of her fundus gave no indication of the amount of myopia present.
A First Contact Lens Fit
Over the next year of follow-up visits, Maggie's visual acuity improved to a measurable 20/80 OD and OS. It was at this point that we began a conversation about contact lenses. Considering her age, her small eye size, and her amount of myopia, I realized the limitations of my office and proceeded to consult with Christine Sindt, OD, FAAO, at the University of Iowa. Fortunately for Maggie, her mom is a very determined parent. When presented with the option to drive to Iowa for an opinion on a contact lens fit, she pursued the appointment. Over the course of a summer they visited Dr. Sindt a total of five or six times. One of these visits involved an exam under anesthesia to determine the best prescription as well as to critically evaluate the health of the retinal tissue to determine a long-term prognosis. There was also an evaluation of genetic history. It appears that Maggie has a relative who is also highly myopic. The good news is that the poor vision exists in isolation and is not part of any condition.
A Few Setbacks
When Maggie wears the lenses, her BVA approaches 20/30. Unfortunately, the battle to get her to wear them is being lost. Bribery, threats, and reasoning have all failed. It seems that even the best GP lenses in this high of a prescription are still too uncomfortable for a 5-year-old. However, her mom is still determined to provide her daughter with the best vision correction possible.
This summer we have tried a soft lens. My excellent staff were unable to convince her to try the lenses in the office, so we let Maggie and her mom take them home. The next day we received a phone call reporting success, but it was short lived—and as of this writing I haven't seen her for a follow-up visit. I hope that with more time I will be able to report success for this young patient.
There are lessons to be learned, even with less than successful contact lens patients: 1. Admit when you need to refer to a better qualified clinician (thank you Dr. Sindt) and 2. Never give up on those really difficult cases when you know there is hope. CLS
Dr. French is a graduate of Illinois College of Optometry. After her doctorate, she completed post-doctoral programs in learning disabilities, early childhood development, and business management. She is a lecturer, author, and industry consultant specializing in children's vision. She is also a consultant or advisor to Vistakon. You can reach her at email@example.com.