Pediatric and Teen CL Care
Improving More Than Vision With a Contact Lens Fitting
By Mary Lou French, OD, MEd, FAAO
Do you ever consider the positive impact you can have on young patients, not only to help them see well but also to improve their self-esteem? Many factors contribute to the development of a child's self worth, including physical appearance, athletic competence, social acceptance and self-perception. The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) study assessed the effects of eyeglasses and contact lenses on self-perception of children with myopia ages 8 to 11 years (Walline et al, 2006). According to data from the 3-year, multisite study, compared with spectacles, contact lenses improve children's vision-related quality of life, especially in the areas of appearance and athletics (Walline et al, 2009).
Limited Spectacle Choices
“Allison” was 3 years old when she came in for her first eye examination. Left eye esotropia created by a significant amount of hyperopia with astigmatism was a fairly straightforward diagnosis. Her right eye was just as hyperopic but without astigmatism. Fortunately, this is the best scenario. Eyeglasses with the full hyperopic prescription yielded orthophoria at far and near. At this age, we were able to fit her with the best frame. It is difficult to find frames that fit children with small bridges and fairly significant prescriptions. Polycarbonate lenses are lightweight, but there is still a heft to them at her prescription, +9.50 sph OD, +9.00 –2.00 x 090 OS.
I have cared for Allison since then, and this year she turned 10 years old. The last few frame choices for her have been less-than-optimal plastic frames that ride down her nose, no matter how they are adjusted. So, this otherwise attractive little girl has eyeglasses that detract from her beauty. We have had conversations about contact lenses for the last few years—her mom wears them, and she is an advocate—so, we decided to try them.
Goal of Long-term Success
I must admit I had some reservations about the potential difficulties of fitting a contact lens for this amount of hyperopia. Although I do recommend contact lenses for patients as young as 8 years old, I have found that children who are 10 and older generally do better with the more difficult fits. At that age, if more than one lens is needed for the diagnostic evaluation, the patient has the cognitive skills to understand, whereas younger patients do not. As always, my overall fitting philosophy with Allison was to look toward her future. I wanted the experience to be positive so that she will be able to wear contact lenses for many years.
The intended contact lenses were not what I carry in my office as trials, so I ordered several trial lenses. The second pair we tried were acceptable, and my staff taught Allison about lens care, application and removal. Because her mom wears contact lenses, too, I was confident sending her home with the lenses.
From Trials to Smiles
Allison has done very well with her lenses. She was smiling from ear to ear at the diagnostic visit, and she was still smiling at the 1-week progress evaluation. Ironically, the only problem is that now everyone raves about how cute she is to the point where she is asking her mom if she was so unattractive in her eyeglasses, but I think the improvement in her self-confidence will win out. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #194.
Dr. French is a graduate of Illinois College of Optometry. After her doctorate, she completed postdoctoral 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 firstname.lastname@example.org.