SKIP THE TEENAGE ANGST OF COMPLIANCE

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Adolescents are no worse than adults with compliance, but you can still remind them of its importance.

In October, the headlines were filled with warnings and horror stories about teenagers wearing illegally sold costume contact lenses, resulting in eye infections that probably looked spookier than the wearer’s original intent. Okay, but isn’t this a careless mistake some teens make just to be the coolest—and creepiest—at a once-a-year costume party?

Not entirely. In 2016, an estimated 3.6 million adolescents ages 12 to 17 (14.5%) wore contact lenses, but 85%—more than six out of seven—reported engaging in at least one behavior that puts them at risk for a contact lens-related eye infection, according to a report from the Centers for Disease Control and Prevention. The most frequently reported risk behaviors in adolescents were not visiting an eye doctor at least annually, sleeping or napping in lenses, and swimming in lenses.

Still, it’s not necessary to stop from fitting teens. For example, Brook Messer, OD, FAAO, of Minneapolis, regularly prescribes contact lenses for children and teens, yet doesn’t see high levels of noncompliance. “Most of the time, they just need a reminder of how to take care of their lenses,” she said.

SAME AS ADULTS
The idea of 85% of teenage contact lens wearers putting themselves at risk of an infection sounds frightening, but it’s actually comparable to adults. Specifically, 81% of young adults and 88% of older adults also reported risky behaviors, according to the CDC. The most frequent: Replacing lenses at intervals longer than those prescribed, replacing lens storage cases at intervals longer than those recommended, swimming in lenses, and sleeping or napping in lenses.

By contrast, the CDC said, adolescents were significantly less likely to report replacing lenses at intervals longer than prescribed and replacing lens storage cases at intervals longer than recommended. Adolescents and adults mostly reported purchasing contact lenses through their ECP, but adults were actually more likely than adolescents to purchase lenses over the internet.

Also, the CDC found, 14.6% of young adults and 11.4% of older adults reported experiencing a red or painful eye that required an office visit compared to 4.2% of adolescents.

Additional research bears this out. Mark A. Bullimore, MCOptom, PhD, FAAO, of University of Houston College of Optometry, conducted a literature review of nine studies representing 1,800 patient years of wear in 7- to 19-year-olds. Analysis of the data, published in Optometry and Vision Sciences in June, found a low rate of corneal infiltrative events: 136 events per 10,000 years. One large retrospective study included suggested that the rate of these events was lower in younger children: 97 per 10,000 years in 8- to 12-year-old children, compared to 335 per 10,000 years in teens aged 13 to 17 years. Microbial keratitis was uncommon, with no cases reported in the prospective studies. And, in one retrospective study he included, there were no cases of microbial keratitis in younger children and 15 cases per 10,000 years in teenagers—similar to that reported in adults.

THE MESSAGE
Still, you might want to tailor your message to teens. For example, Messer said, teenagers may need reminders, such as to wash their hands before handling their lenses, not to wear lenses overnight and to follow the care regimen.

“For kids, it’s more about educating them about what can go wrong and reinforcing to them that if something does go wrong, it could impact their ability to wear contact lenses in the future,” Messer said. “So I think it’s just finding something that resonates with them, whether it’s a picture of an eye infection or telling them that someday they won’t be able to wear contacts. That sort of sticks with them.”

In some instances, the problem isn’t lack of education but simply forgetting to replace the lenses on schedule. “So we try to come up with solutions, like a reminder in their phone or something like that to get them to replace the lenses more often,” she said.

In the fall, Messer reminds patients about the dangers of ordering costume contact lenses from unlicensed vendors and without professional care. “Sometimes we’ll have a little counter display [that says]‘Ask us about Halloween lenses,’ or on our social media pages there will be little blurbs about safely wearing costume lenses,” she said.

THE CARE REGIMEN
Messer often finds that teenage patients are less willing to digitally rub their lenses as part of the cleaning regimen. So, she typically switches 15- to 16-year-olds from multipurpose to hydrogen peroxide care systems and educates them on proper use.

“Once they hit 15 to 16 years old,” she said, “they’re responsible enough to understand how to use a peroxide-based system. … So switching them into something like CLEAR CARE [Cleaning and Disinfecting System] that isn’t quite as dependent on a rubbing regimen with their lenses helps me know that their eyes are staying safe.” (For more on hydrogen peroxide care systems and a list of specific systems, see “Why Hydrogen Peroxide Is My First Choice,” October 2017.)

Don’t forget about the contact lens case. When Messer sees an adolescent contact lens patient sporting a red eye, the cause is often an unclean lens case, Messer said. She usually suggests to them that they replace the case every time they get a new box of solution. Or, they might try boiling the case or running it through the dishwasher to kill germs.

THE DISPOSABLE ROUTE
Be aware, however, that some teens “tend to be less compliant, listen to instruction less diligently, and sometimes hygiene can be an issue,” said Mary Lou French, OD, MEd, FAAO, of Orland Park, IL. “Females overuse makeup, and males tend to forget to bathe.”

The answer to compliance is often daily disposable lenses. “Parents may balk at the cost, which is a different conversation but emphasizing the hygiene issue is what usually works the best,” she said.

One-day lenses eliminate deposits, debris, and allergens that may accumulate on extended wear contacts. And, inserting a fresh contact for each day of wear lessens
the worry of proper cleaning and the hassle of non-compliance.

“I have found from experience that daily disposable contact lenses provide the most success in compliance,” said Anar Maurya, OD, of Atlanta. “Convenience and ease of care with daily disposables is optimal for the young age group. Without the hassle of daily cleaning and storing, parents and practitioner can be put at ease that the youngster will handle the contact lenses well without increased risk of infections.”

Another advantage: 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,” Maurya said. (For a listing of daily disposable lenses, see “AT A GLANCE: Daily Disposables,” October 2017.)

EACH VISIT
Messer reminds teenage patients at each visit the importance of being responsible. She asks them how they clean their lenses and has them bring their case in at each visit for inspection.

“Those are things that I ask them to do when they’re in the exam room, and sometimes it just takes reminding because they’re motivated and they need to do other things, too,” she said. “You just need to remind them how to best care for their lenses. For teens, I think it’s just treating them like adults and approaching them in a way, assuming that they have responsibilities and that they can take responsibility over their lenses—and speaking to them in that way, and trying to connect with them so they’ll actually listen.”

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