Counseling Teens and Their Parents About Contact Lenses
BY NEIL A. PENCE, O.D.
SEPT. 1997
We're prescribing contact lenses to more teen-agers and at an earlier age than ever before. And in this era of heightened consumerism, these younger teens and their parents are more likely to have questions and participate in health care decisions than previous generations. These factors present us with new challenges when counseling young patients and their parents about contact lenses.Today's teens are active, savvy consumers who want contact lenses. Here's how to zero in on their needs and their parents' concerns.
HOW YOUNG IS TOO YOUNG?
Parents often ask how old a child should be before you recommend contact lenses. This question can be genuinely exploratory, or it may suggest that whatever age you say, they expect it won't be their child's current age. This is your opportunity to explain that age is not a significant factor in contact lens success. Citing a case of the youngest person you've fit in contact lenses or telling them that young people adapt more quickly than adults will emphasize that age is not necessarily a limiting factor, but maturity may be.
Parents should know that some typical indicators of maturity, such as the ability to keep one's room clean, care for pets or take out the trash without frequent reminders, are not necessarily prerequisites to healthy contact lens wear. If they were, the number of successful teen-age contact lens wearers would not be nearly as high as it is.
Patients and parents need to understand the level of responsibility required to successfully wear contact lenses. The teen-age years may not be a time when people demonstrate high levels of responsibility, but teens must know that adhering to daily care procedures is essential.
An Indiana University study of teen-agers wearing contact lenses found that some participants liked their lenses a little too much, and were reluctant to wear eyeglasses even when there were apparent problems. Caution all young patients to not ignore symptoms, to remove their lenses if problems occur, and to report to their parents and practitioner when problems persist.
Some teens have the maturity and desire to wear contact lenses but may be quite apprehensive about placing something on their eyes. Assure them that this is a normal reaction that will fade. Instilling a topical anesthetic prior to lens insertion might benefit the very anxious RGP patient.
SELECTING THE APPROPRIATE MODALITY
All parents want to know if wearing contact lenses will jeopardize the health or vision of their child. They may ask which lenses are the safest or healthiest -- rigid gas permeable or soft contact lenses. Most will be satisfied by the answer that both are very safe, as witnessed by the millions of successful wearers of each type. You can inform the more inquisitive parent who presses for differences that more oxygen can probably be provided to the cornea through RGP materials and their smaller diameter lenses, but that for daily wear, soft lenses adequately meet the oxygen demands of the cornea.
Certain ocular conditions may affect contact lens wear, or influence the type of lens you choose. The presence of keratoconus, for example, makes RGPs a more likely choice. Congenital bilateral nystagmus might be slowed by contact lenses, possibly improving acuity by a line or two. Albino eyes may benefit from darker therapeutic tints in contact lenses. Soft lenses will often be the best choice for cases where the corneal and refractive astigmatism are significantly different.
Some teens will be interested in tinted lenses to enhance or change their eye color. Parents should know that these involve no added risks, and having one or more colors of tinted lenses can add a little fun to needing visual correction.
Don't overlook the potential for part-time contact lens wear for teen-agers. There are young people who are comfortable with spectacles, but may benefit from soft contact lenses for sports, which are comfortable quickly after each insertion and can usually be worn trouble-free for the length of the activity. When wear is sporadic, a disinfection regimen like Quick Care (CIBA Vision) may be advantageous because these patients often will not clean and disinfect their lenses the night before. With Quick Care, they can disinfect minutes before they need to wear the lenses and not worry about how long the solution has been in the case.
THE CONTROVERSY OVER MYOPIA CONTROL Perhaps the greatest source of disagreement among practitioners when counseling about contact lenses for young teen-agers is myopia control. Some practitioners actively advise rigid contact lenses over spectacles for young myopes in hopes of limiting their progression, and others feel no child should be prescribed contact lenses if the sole purpose is to control his myopia. The amount of the effect and how long it will last still appear to be in question. Reviewing the literature about reduction of myopia progression with rigid contact lenses can be confusing, and translating that into information to use to counsel parents can be even more difficult. Adding to the confusion is the fact that people have misquoted the data found in the literature. This has occurred repeatedly with the Houston study (Perrigin, Perrigin and Grosvenor, 1990), the most widely cited study in this field. Ted Grosvenor, O.D., Ph.D., one of the Houston study investigators, cautions that answers to parents' questions about myopia control must not be based simply on the averages from the studies. Dr. Grosvenor said that it is "impossible and unwise to make any promises about contact lenses controlling myopia progression," and he uses his daughter as an example. She was a -3.00D myope at age 10, when she was fit with PMMA lenses. She wore the lenses until age 18, at which point she was a -10.00D. It would be easy to find spectacle wearers who were also -3.00D at age 10 but who didn't become nearly as myopic by age 18. This does not mean the spectacles controlled myopia better, but rather is an example of the wide variability of changes among individual subjects, Dr. Grosvenor said. We surveyed a number of practicing optometrists in an attempt to learn what practitioners believe about the topic and what they tell parents. This was by no means a scientific study, but rather an effort to sample what practitioners believe based upon their clinical experiences. When asked if they mention myopia control with rigid lenses when counseling parents, nearly all replied they discuss it only if the parent brings up the subject. They generally tell patients and parents that the effect may be present, but it is a relatively small effect, and is just one of the many factors they consider when deciding the best option for each case. You can demonstrate this to the parent by placing your hand about 36 inches above the ground and saying "this is how nearsighted your son or daughter will probably become," then lowering your hand to 30 inches to demonstrate where the patient may end up if he or she were to wear rigid lenses. Explain that rigid contact lenses may have some effect but that their child will still need correction either way. The average percentage of young patients fitted with soft contact lenses in the practices surveyed was around 85 percent, which suggests that most practitioners don't consider myopia control a major factor. We also asked if the practitioners ever told parents that soft lenses might increase myopia, and all responded "no." One other thought raised by several practitioners concerning the effect of RGP lenses was the belief that the slightly better stability of refractive error when wearing RGPs might mean better visual acuity. A child wearing spectacles or soft lenses whose myopia is progressing might have to tolerate reduced clarity of vision for a longer time before his prescription is updated than if he were wearing RGPs. Some practitioners believe that this acuity stability may be an important benefit, and even if myopia progression is slowed only minimally, the patient will still benefit from wearing RGPs. Myopia control should not be used as justification to sell contact lenses, but the many other benefits of wearing contact lenses make doing so unnecessary. |
DIRECTING EXPECTATIONS AND GAINING CONSENT
Parents' experiences with contact lenses may affect how they view contact lenses for their children. A successful RGP wearer may favor RGPs for his child, and a parent who had a negative experience may be reluctant to consider contact lenses or certain types of lenses for his son or daughter.
For hesitant parents, emphasize that contact lenses are not simply a cosmetic option, but one that offers real benefits in terms of their child's visual function. For patients with high myopia, demonstrate the magnification advantage of contact lenses versus eyeglasses. For patients with strong hyperopic corrections, explain the ring scotoma and somewhat decreased mobility and general coordination that occurs with eyeglasses.
Find out about other contact lens wearers in the family. If other family members wear similar lenses, it may be wise to recommend similar care systems, but with distinctively different lens cases if possible.
It's not unusual for parents to have started wearing contact lenses in their late teens, at a time when most of their refractive changes were nearly complete. Therefore, they may reasonably assume that the lenses stopped further progression and may expect the same result for their children. Explain the differences in beginning wear at age 13 versus age 18.
When dealing with minors, remember that you need parental consent for any invasive procedure, treatment plan or contact lens fitting. Most legal consultants say a written consent is best, but witnessed verbal consents that are clearly documented in the record have been recognized by the courts as well. A consent is valid only after the parent has been educated and informed of all the visual correction options and of the risks and benefits of contact lenses.
Occasionally during a routine eye examination, an unaccompanied teen-ager may request a contact lens fitting. After at least providing verbal consent, the parent or legal guardian should be present at the contact lens dispensing, or he should stop by the office at some prior time to sign a consent form.
DISCUSSING FEES AND REPLACEMENT SCHEDULE
Any discussion about contact lenses must cover the costs of the various options. Tell patients and parents that the fees will differ among practices, but generally the professional service fee will be somewhat higher for rigid lenses as opposed to spherical soft lenses. Lens cost will depend upon the frequency of replacement, either planned or unexpected from loss or damage.
In general, the slightly higher initial costs of RGPs are offset when they last more than one year. But teens are more likely to lose RGP lenses, so there may not be much difference between the ultimate cost of rigid or soft lenses. Soft lenses are lost less often, but will be commonly torn, at least initially. Advise parents in advance that kids do lose and tear contact lenses.
In planned replacement, some of the cost of replacing lenses can be defrayed by wearing the next lenses on a slightly different schedule. It's best to replace lenses in the early stages of wear at reduced fees if possible, preventing the parents from becoming frustrated with the patient and perhaps ending what could have been successful wear.
It seems that many teens will need the replacement at some of the most inopportune times, such as before a big activity or competition, so having spare lenses on hand is important. The availability of extra lenses is an advantage of soft lens planned replacement, but you should also encourage spare lenses for RGP wearers.
COMMUNICATION PEARLS
Effective patient communication skills are particularly important in contact lens practice. In dealing with young patients and their parents, there are extra challenges.
While you need parental consent and parents are usually are paying the bill, it's important to include the teen-age patient in your discussions. Remember to avoid turning your back on the patient or talking about him as if he were not there.
Ideally, the patient and the parent should be seated so that you can talk to both of them without turning back and forth to different sides of the room. Try directing most of the discussion to the patient, then asking the parent if he has any further questions or concerns. This shows respect for the patient and prevents a more dominant parent from speaking or answering for the child.
THERE ARE BENEFITS FOR EVERYONE
There are many health benefits to contact lens wear among teens, not to mention the cosmetic, self-image and self-confidence benefits. Offering contact lenses to young teen-agers can prove a valuable service, resulting in happy young patients, satisfied parents and opportunities for you.
Today's teens represent the echo boom, the children of the baby boom generation. Their numbers are increasing, providing you with an eager supply of potential contact lens wearers. In addition, spectacle-wearing parents who are apprehensive about contact lenses are often convinced to give them a try when they see how easily their children adapt.
Both parents and teen-agers need to be well educated about the various options and the potential risks, and this requires documented informed consent. Teens must be cautioned against ignoring adverse symptoms, and they must understand that small problems can become serious if they do not comply. CLS
CHOOSING CONTACT LENSES FOR ATHLETES Clarity of vision is one area where everyone is looking for an edge. Simply stated -- see better, play better. The number one advantage of contact lenses over eyeglasses is that they offer a 15 percent wider field of view. With eyeglasses, an athlete's vision is limited by the size of the lens, so peripheral vision is reduced, leading to poor performance. There is also a psychological advantage. An athlete who wears contact lenses feels better knowing his opponent is unaware of his need for visual correction. Finally, eyeglasses break, are difficult to place helmets over, can be knocked off during play, decrease peripheral vision, fog up on the ice, become covered by dust and perspiration and are dangerous to other kids who may bump heads with the wearer. My 20 years of working with Michigan State University varsity athletes from 25 different sports has taught me that soft contact lenses are the best way to correct acuity problems for athletes. The initial comfort and ease of adaptation makes soft contact lenses ideal for athletes, and with the development of new custom designs, essentially everyone can be corrected with a soft contact lens. Because soft lenses have relatively large diameters, they drape over the cornea, making them very stable on the eye and enabling them to prevent debris from getting under the lens. Athletes are typically in dirty environments, and this promotes dirty lenses. Obviously, the last distraction an athlete wants is an eye irritation. By replacing the lenses either on a daily, weekly, or monthly schedule, clean lenses are always on the eye, preventing irritations and providing the sharpest vision. Some athletes wear rigid gas permeable lenses because they feel they provide superior vision. These patients should continue wearing the type of contact lens that gives them the most confidence. Unfortunately, few people give much thought to eye safety and protection before participating in a sport. The results of a 10-year retrospective eye injury study at MSU showed that wrestling had the highest incidence of eye injuries, followed by basketball, ice hockey and football. The majority of injuries were caused by a finger or object hitting the eye, and 80 percent occurred during practice. Most could have been prevented if the athlete had been wearing protective eyewear. Inform parents that the protection against blunt trauma to the eye from a ball, elbow or piece of equipment is greatest in polycarbonate protective eyewear. Certainly, protective eyewear is essential for all athletes -- whether they need to wear an optical correction or not. Tinted protective lenses may appeal to the outdoor tennis player, and face shields should be available for hockey and football helmets. Young athletes warrant even greater protective efforts, but be sure to discuss eye protection with every prospective contact lens wearer. -- Kenneth I. Marton, O.D. |
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