Consider factors such as responsibility, the parents, and hygiene.
The number of children being fit with contact lenses has increased in the past few years at a considerable rate. That’s not surprising given the benefits. Children’s self-esteem can be improved, and they can participate in extracurricular activities without relying on glasses. In addition, you now have a patient who will return annually for an eye exam and contact lens evaluation, allowing you to ensure the patient’s eyes remain healthy and that the ever-changing vision is always corrected at its best.
However, as a practitioner, you need to be cautious when fitting children. There are several things to consider: Is the child responsible enough and mentally ready for contacts? How helpful will the parents be? Is the child’s skin condition healthy? Does the child have appropriate hygiene?
RESPONSIBILITY IS KEY
Before you fit a pediatric patient in contact lenses, you need to have an in-depth discussion with both the patient and the patient’s parents (or guardians). This conversation needs to include the importance of caring for and cleaning contact lenses, the importance of adhering to the wear schedule, and the severe consequences of misusing contact lenses.
Be sure to limit the wear of the contact lenses so that children do not become so dependent on them. Make sure they have a time that they can rest their eyes and use glasses. That will require them to keep an updated pair of glasses always on stand-by.
Include the patient’s family as much as possible. A well-informed adult can be a great asset. Make sure that the adults are trained on how to insert and remove the lenses and how to clean and care for the lenses. They can help keep the child on task and motivate the patient during the training process. During the training, a child can be very nervous, especially at the thought of touching the eyes, but a positive motivator can help the child be successful with the training process.
Hygiene can be a deal breaker. For example, a young male patient presented with –2.00D of myopia in each eye, an ideal prescription for contact lenses. When I entered the exam room, however, I saw that he had severe acne for which a dermatologist prescribed facial creams and an oral antibiotic. I had him return in three months to recheck his acne issues before fitting him with contact lenses. His dermatology treatment worked well, so I felt he was ready for contact lenses. You never want to fit patients, especially children, with contact lenses if there is a risk of bacterial infections, which can lead to corneal scarring and vision loss.
Acne is not the only issue to worry about. Patients need to have clean hands, faces and eyes, including eyelashes. Inform patients not to touch their eyes without clean hands. Sometimes that is difficult, especially after playing sports or doing some other school activities.
Blepharitis is especially common among children and teens. Blepharitis, which is caused by a skin condition, allergies, or bacterial infection, occurs when the tiny oil glands in the inner eyelid become inflamed. Treatment is simple—the patient cleanses the eyelids with lid scrubs or warm water and baby shampoo—but blepharitis is a recurring issue that requires daily treatment. In severe cases, an antibiotic ointment may be needed. These treatments will need to be done before fitting the patient with contact lenses.
Once the patient is ready to be fit, my go-to is a daily disposable lens. This gives the patient a clean, fresh contact lens every day, making it the safest way to ensure that patients care for their contact lenses. There is no worry because there is no cleaning process. Daily disposables also offer the option of using contact lenses more on a part-time basis rather than for extended periods.
I have several lenses that I prefer. For example, the DAILIES Total 1 from Alcon offers comfort and clear vision. The ACUVUE OASYS 1- DAY with HydraLuxe Technology from Johnson & Johnson Vision stays hydrated all day, making it ideal for individuals who have dry eyes or for kids who are out on the soccer field all day.
The toughest selling point on these lenses is the price. It’s hard to get parents to invest $500 to $800 for a one-year supply of contact lenses.
If the parents are unable to afford a one-day disposable, my next step is a two-week lens, such as ACUVUE OASYS 2-WEEK with HYDRACLEAR PLUS from J&J. These lenses provide comfort, and the price is more affordable. The only issue is making sure patients dispose of the lenses in two weeks. Many patients forget when they opened the pack and wear them for one month.
If that’s the case, you might need to consider a monthly disposable option, such as ACUVUE VITA from J&J, Biofinity from CooperVision, or Bausch and Lomb’s ULTRA contact lenses. They are all easy to handle and cost-effective. These brands have a toric version for patients who have astigmatism and a multifocal version for patients who have problems with accommodation.
OUTWEIGHING THE BAD
There can be many concerns with fitting kids with contact lenses, but given the positive outcomes I’ve seen, I believe that the good outweighs the bad. Caring for contact lenses will help teach them the importance of hygiene and the health of the eyes.
The key to success is having good communication skills with the patients and their families. Have a well-trained staff that can demonstrate how to handle contact lenses and care for them. Finally, make sure that your office keeps track of your patients. Get those recall cards ready.
Linda Hardy, LDO-GA, CPOT, COA, ABOC, NCLC, a licensed optician in Georgia, has been in the ophthalmic/optometric field since 1997 and is currently the office manager at Eyexam of Peachtree City in Peachtree City, GA.
WHERE TO FIND IT
800.451.3937 | Alcon.com
Bausch + Lomb
800.828.9030 | Bausch.com
800.341.2020 | CooperVision.com
Johnson & Johnson Vision
800.843.2020 | JJVision.com