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SynergEyes Duette is great for children involved in athletics due to the stable,
consistent vision provided by the lens, which is not affected by lens rotation.

You can be successful in prescribing contact lenses to pediatric patients with astigmatism.

It is five o’clock on a Friday, and the 12-year-old patient with astigmatism in front of you asks every OD’s favorite question: Can I wear contacts? This scenario used to send shudders down my spine, but now with contact lens technology ever improving, I am much more confident in a successful evaluation. The main issue is the obvious one: kids have small apertures, and toric lenses have larger diameters.

First, if the astigmatic child in your chair is also myopic, you should discuss myopia progression control with the patient and the parent. Treating with either toric multifocals or CRT (if the child is a candidate) can significantly prevent progression of nearsightedness and, more importantly, decrease retinal pathology later in life. The toric multifocal I reach for most often with pediatric patients is the custom SpecialEyes 54 Multifocal. The diameter can be customized to help with insertion and removal, and the custom optic zones can be adjusted for visual acuity.

If the parent declines myopia progression treatment or the child is a non-adapt to the multifocal lens, I always recommend daily disposables, with one exception, if the patient has oblique astigmatism. Dailies are my number one choice due to ease of compliance. The three toric dailies in my arsenal are 1-DAY ACUVUE MOIST Brand Contact Lenses for ASTIGMATISM from Johnson & Johnson Vision Care, Inc., DAILIES AquaComfort PLUS Toric from Alcon and CooperVision’s clariti 1 day toric. The clariti has become my lens of choice due to the durability and ease of handling, especially in a first-time contact lens patient.

When oblique cylinder causes a challenge due to the limited parameters of the dailies or the vision fluctuates too much in soft lenses, I reach for SynergEyes Duette. This hybrid lens is also an effective option for children involved in athletics due to the stable, consistent vision provided by the lens, which is not affected by lens rotation.

If cost is a factor or the patient’s parent declines all other options, I will reach for a two-week or monthly modality. My lens of choice in this category is the Extreme H20 54% Toric LC from X-Cel Specialty Contacts. It is the smallest diameter in this class and is approved for either two-week or monthly wear.

A couple of tricks we use to help in the process with first-time toric wearers are all related to the insertion and removal instruction session. If the patient seems to be having issues with the toric, we will start with a spherical lens and work back to the toric. The staff involved should be very patient, and an occasional pat on the back from the doctor helps as well.

Brooke S. Kaplan, OD, is in private practice in Mountain Brook, AL.


Alcon Laboratories, Inc.
800.451.3937 |

CooperVision, Inc.
800.341.2020 |

Johnson & Johnson Vision Care, Inc.
800.843.2020 |

SynergEyes, Inc.
877-733-2012 |

X-Cel Specialty Contacts  
800.241.9312 |


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