Pediatric and Teen CL Care
Fitting Corneal GP Lenses for Children
BY MELANIE FROGOZO, OD, FAAO
Gas permeable lenses offer sharp optics and are a great option especially in highly astigmatic children. In such cases, educate both the patients and the parents about the visual benefits of GP lenses. Although this lens type offers improved optical quality over spectacles and soft lenses, there is the perception that it is difficult to adapt to GP lenses. Nonetheless, 80% of children become accustomed to corneal GP lenses, which is the same adaptation rate as adults (Walline et al, 2014; Polse et al, 1999). Additionally, with the availability of scleral GP lenses and improved designs of newer corneal lenses, initial lens awareness is no longer as much of a concern.
Tips for Lens Fitting
The first step is to explain to patients that the small size of a corneal GP lens is easy to place on the eye. Staff members can demonstrate lens application on their own eye to ease children’s anxiety (Figure 1).
Figure 1. To ease any nervousness, show young patients that applying corneal GP lenses to the eye is simple.
Next, make sure to tell patients that when the lens is placed on the eye, they will be aware of its movement and will feel it on their lids each time they blink. Assure them that this sensation will decrease with time. Consider instilling anesthetic to decrease this initial awareness; however, make sure the anesthetic is allowed to dissipate so that patients gradually become accustomed to the realistic sensation of lens wear.
After placing the lens on the eye, encourage patients to look down until you are ready to assess the fit. This will decrease lid interaction and make the lens more comfortable for patients until you are ready to view the lens.
Finally, assess the lens-to-cornea relationship. An ideal fit would be an alignment fluorescein pattern and will look the same as in an adult (Figure 2).
Figure 2. Corneal GP lenses for children should fit the same as in an adult.
To increase lens comfort, use an ultrathin design and ensure that a lenticular is placed on the edge (i.e., a plus lenticular for high-minus-powered lenses and a minus lenticular on high-plus and low-minus lenses). Instead of diagnostic fitting, consider having your contact lens lab empirically design the initial lenses. This will not only reduce chair time, but children may perceive better comfort and be more motivated to adapt to lens wear because they have good initial vision.
GP contact lenses are a great vision correction option for children, especially those who have high astigmatism. In such patients, GP optics offers sharper and more stable vision in comparison to spectacles and soft lenses.
Educating patients and parents about the benefits of GP lenses, and setting the right expectations during the fitting process, is key to the success of corneal GP lenses in children. CLS
For references, please visit www.clspectrum.com/references and click on document #249.
Dr. Frogozo specializes in adult and pediatric specialty contact lenses. She is the director of the Contact Lens Institute of San Antonio and the owner of Alamo Eye Care in San Antonio, Texas. She also is a consultant to CooperVision. You can contact her at email@example.com.