NAVIGATING THE WORLD OF CLs FOR CHILDREN

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Kids’ readiness for contact lenses can vary, but several factors can help point their practitioners and families in the right direction.

—
 Bausch + Lomb’s BioTrue ONEday
start and end the day with more
moisture.
 —
 Vistakon’s 1-DAY ACUVUE TruEye
contact lenses provide high Dk
along with excellent fit and comfort.
 —
 DAILIES TOTAL1® by Alcon approach
100% water content at the outermost
surface.
 —
 CooperVision’s Clariti 1 Day offers a high
Dk silicone hydrogel material in a daily
replacement modality.

 

When is a young child ready to enter the arena of contact lenses? This is a common dilemma practitioners confront when newer advancements in contact lenses emerge. Innovations in higher Dk materials, thinner edge designs, improved water content, and frequent disposable lens options allow practitioners to fit and dispense lenses to children as young as 8 with ease and without hesitation.

DECIDING FACTORS
By and large, a child’s maturity level and motivation, as well as the degree of parental involvement are all key to predicting the final success of contact lens wear and the amount of chair time required. A recent Contact Lenses in Pediatrics (CLIP) study showed that children ages 8 to 10 were just as successful as teenagers in contact lens wear and tolerated contacts lenses well. Additionally, the CLIP study determined that on average, 8 to 10 year olds require only 15 minutes of additional chair time for insertion and removal training. An additional 15 minutes may seem daunting; however, these patients and their family members are likely to return to your office for years to come.


Practitioners can usually gauge a patient’s motivation level based on their initial enthusiasm upon examination. Children may resist anything entering their eyes at this young age. On the other hand, the child may show some level of interest and a readiness to pursue contact lenses with the acknowledgment that contact lens upkeep is a big responsibility. Problems can arise when a parent coerces contact lenses without a child’s consent or interest. It seems imperative to ask children directly if they are ready to pursue contacts and to undertake the responsibility of handling and caring for them. Their answer will provide valuable insight on their readiness. If the parent is the primary driving force, the practitioner should refrain from moving forward.


A child’s maturity level can be ascertained simply by asking if she assumes the responsibility of chores at home, cleans her bedroom on her own, or brushes her teeth without being asked. Questions about cleanliness and self care help emphasize to the parent and child that high levels of maturity are needed for successful contact lens wear. In addition, educating children about contact lenses hygiene is essential. Poor hygiene and contact lens overwear can lead to eye infections and contact lens intolerance. A poster in the exam room displaying common contact lens complications can be an effective tool in educating a child on the need for compliance.


But parental involvement is the real key to successful wear and compliance. As much as it is preferred that the child be independent and able to handle and care for the lenses on his own, it can reassure the practitioner to know that someone at home can assist the child when difficulties arise. Involved parents will monitor proper wear and removal of contacts before bedtime and ensure proper follow-up visits.


A recent Contact Lens Assessment in Youth (CLAY) study showed that teenagers and young adults, especially those in college, showed an increase incidence of contact lenses-related infections compared to 8 to 10 year olds. The CLAY study demonstrated that when parental involvement was lacking, the incidence of infections rose.


LOGISTICS
Certain medical or visual disturbances are better corrected with contact lenses. Children with anisometropia benefit with reduced image disparity when wearing contact lenses versus glasses and can achieve better binocular vision and improved depth perception. Individuals with high minus or high plus prescriptions can avoid heavy frames and thick lenses that weigh down on their small bridge or small nose. Contact lenses, especially gas permeable lenses, can often provide better visual optics than eyeglasses for high astigmatism corrections.


Perceived improved appearance and self-esteem with contact lenses can affect a child’s interaction with the world. Building better self-esteem and self-confidence enables a child to perform better at school and improves interactions with peers. A child who once hid behind glasses may now feel more confident.


Daily disposable contacts are an easy solution for fitting children with contact lenses. These lenses offer the ease and comfort of contact lenses in a one-day use modality. By eliminating the hassle of cleaning and storing, daily disposable contacts are convenient and require less time. Daily disposable contacts are available in extended ranges of spherical and toric powers and are now available in high Dk materials.


Here are a few brands for patients (and their parents) to consider.
•DAILIES TOTAL1 by Alcon are the world’s first and only water gradient contact lenses that approach 100% water content at the outermost surface for comfort that lasts until the end of the day, according to the company.
•Clariti 1 Day by CooperVision offers a high Dk silicone hydrogel material in a daily replacement modality that provides excellent fit and comfort.
•1-DAY ACUVUE TruEye Brand contact lenses from Vistakon provide a silicone hydrogel material in a daily replacement modality offering high Dk along with excellent fit and comfort.
•Bausch + Lomb’s Biotrue ONEdayâ„¢ contact lenses start and end the day with more moisture, according to the company.

BENEFITS
With improved breathability and lens design, the onset of contact lens-related infections drops significantly with the added benefit of end-of-day comfort. Although children rarely face issues regarding dry eye, new silicone hydrogel lenses with increased water content reduce dryness associated with contact lens wear. One-day lenses eliminate deposits, debris, and allergens that may accumulate on extended wear contacts. Inserting a fresh contact for each day of wear lessens the worry of proper cleaning and the hassle of non-compliance. If a child rips or drops a contact lens, another one can be opened without a significant financial burden. For this reason, daily disposable lenses prove to be cost effective for families with children and can be purchased in three-month, six-month, or annual supplies.


Daily disposable contact lenses also offer a better profit margin than many monthly or two-week modalities. In addition to contacts, these young patients should be encouraged to purchase updated glasses as well on an annual basis. Contact lens sales, glasses sales, and a yearly fitting fee will undoubtedly prove to be a winning combination for the practitioner.


If a child is unsuccessful with proper insertion and removal, suggest that parents come back another day for a second try. An additional charge may be warranted for subsequent insertion and removal training visits. After all, your time is valuable. And if you have any young patients who don’t have success with this method, encourage them to try again the following year. OO

WHERE TO FIND IT:
Alcon Laboratories, Inc. •800-451-3937 •alcon.com
Bausch + Lomb •800-828-9030 •bausch.com
CooperVision, Inc. •800-341-2020 •coopervision.com
VISTAKON Division of Johnson & Johnson Vision Care, Inc.  800-843-2020 •ACUVUEProfessional.com

Anar Maurya specializes in fitting specialty contact lenses at Woodhams Eye Clinic in Atlanta, GA.

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