A Lesson in Teens and RGP Contact Lenses

By Richard W. Baker, O.D.
OCTOBER 1999

There is much to learn from fitting teens with RGPs. This article reveals some of the pearls that come with RGP experience.

Katie and Melissa are identical twins born in 1980. They were referred to me by their father, a pediatrician who specializes in neonatal care, as they were entering their second semester of the fifth grade. Both were doing quite well in their classes and after-school activities.

Their general and ocular health was unremarkable. Katie's previous spectacle correction from 1990 was: OD -2.67 sphere, 20/25, OS -1.25 -0.37 x 52, 20/25 and Melissa's was: OD -0.75 -0.75 x 92, 20/25, OS -1.25 -0.37 x 80, 20/20.

Katie's spectacle correction in 1991, 1 year prior to her contact lens fitting, was: OD -3.00 -0.25 x 90, 20/20, OS -3.00 sphere, 20/20. Melissa's 1991 correction was: OD -1.25 -0.50 x 85, 20/20+, OS -1.50 -0.25 x 75, 20/20+.

During the consultation following their eye exams, there was some discussion about contact lenses. We agreed that a contact lens evaluation and possible fitting would be considered at their next annual eye exam when they would be approaching their twelfth birthdays.

At this time, both the twins and their parents exhibited a great deal of enthusiasm about contact lenses during the case history.

There was also a great deal of concern about the possibility of the continued increase in their myopic refractive errors. (It's interesting to note that their mother has no distance refractive error and their father has a very low amount of myopia.)

Why Fit RGPs on Teenage Patients?

After a thorough discussion of the advantages of both rigid and soft contact lenses, the patients and their parents were very enthusiastic about the advantages of RGPs: crisp visual acuity, low risk of complications, possibility of slower progression of myopia and durability.

Always treat teen patients as responsible, young adults. I feel that this approach encourages patients to take a responsible role in their contact lens fitting and follow-up care, and they usually demonstrate a great deal of enthusiasm and willingness to achieve success.

Findings

Katie -- Katie's ocular and general health were unremarkable. There were no problems with allergies or any other pre-existing condition that might contraindicate contact lens wear. Her subjective refraction was: OD: -3.75 sphere, 20/20, OS: -3.75 sphere, 20/20 and keratometry was: OD 45.25/45.50 @ 89, OS: 45.00/45.37 @ 90. Slit lamp evaluation revealed healthy, clear lids, lashes and corneas.

I reviewed Katie's ocular and visual condition with her and her parents, as well as the types of contact lenses and their modes of wear. I stressed the importance of parent interaction and support during the proposed fitting, follow-up and future appointment requirements. The parents' and patients' concerns regarding increasing myopia and the advantages of rigid contact lenses indicated an initial evaluation with RGP contact lenses.

RGPs in Fluoroperm 30 in the Oxyflow design were fitted as follows:

OD:7.46, base curve: -3.75, DS: 8.8/7.5, 20/20. OS: 7.50 base curve: -4.00 DS: 8.8/7.5, 20/20.

Katie initially adapted to the contact lenses well, although she demonstrated initial difficulty in lens handling, which is not unusual for a young first time contact lens wearer. In order to ensure that the confidence and skill of the young patient is reinforced at all times and that there is adequate proficiency demonstrated with all phases of the care and handling of the lenses, we usually schedule a second training session.

Melissa -- Unsurprisingly, Melissa's ocular and general health were unremarkable as well. She also had no history of allergies or other health issues that might complicate contact lens wear. Her subjective refraction was: OD -1.75, -0.25 x 85, 20/20; OS
-2.00 -0.25 x 85, 20/20 and her keratometry was: OD 45.12/45.00 @ 90; OS 44.75/45.00 @ 89. Slit lamp evaluation also revealed healthy, clear lids, lashes, conjunctivas and corneas.

Melissa's exam review took the same course as her sister's. RGPs in Fluoroperm 30 in the Oxyflow design were fitted as follows: OD 7.50BC, -2.00 DS, 8.8/7.5, 20/20; OS 7.50 BC, -2.25 DS, 8.8/7.5, 20/20. She also demonstrated a good ability to adapt to the lenses. There was some concern about lens handling, however, a second session provided enough time to allow for the development of good care and handling skills.

Subsequent follow-up visits showed excellent adaptation to the contact lenses for both Melissa and Katie. Both girls demonstrated excellent compliance and proved to be excellent RGP contact lens wearers. The lenses provided them with good vision and helped them perform well in all of their activities.

Follow-up Care for Teens with RGPs

The typical 1-week/3-week follow-up schedule for RGP patients is utilized (which is always a review of progress), and if necessary, a final visit is scheduled at 6 weeks for RGP-wearing teens.

I always have a parent present at the initial delivery of the contact lenses. At this time, I cover all of the goals of the fitting process with both the patient and the parents. Each patient is given a complete care and handling form which includes all contact lens solutions, wearing schedule and procedures for insertion, removal, cleaning and storage of the lenses. A signed and dated copy of this form is placed in the patient's chart for future reference. A brochure describing correct blinking procedures is included in the patient's fitting packet. A fact sheet on the use and types of cosmetics found to be compatible with RGPs is also provided for all female contact lens wearers.

Results of Follow-up Care

The results of the twins' subsequent visits indicated that both Katie and Melissa adapted to their RGP contact lenses well. They were dismissed at the conclusion of the 6-week fitting period and were given a 6-month check-up date for a routine cornea and contact lens visit.

Katie and Melissa continue to wear their RGP contact lenses for at least 14 hours of every day, without any related complications. Each year, they have comprehensive eye exams and also 6-month intervals for cornea and contact lens visits.

The most recent eye examinations in the spring of 1998 showed the following changes: Melissa and Katie have worn the same Oxyflow F-30 design RGP lens for 6 years and were recently refitted with Pliaflex 02 design lenses utilizing the Boston ES material, which provides a thinner lens with a lower edge profile. Melissa has shown an increase in myopia of
-1.50D OU and Katie has had an increase of -2.00D OU since their initial fitting exams in 1992.

Advantages of Fitting Teens with RGPs

RGP contact lenses offer young patients the possibility of controlling myopia and the lowest risk for complications. The low annual cost of RGP lenses due to their longevity is also a very appealing factor to the parents. Actually, one of the twins had an average of one contact lens replaced per year and her sister had a replacement average of 1.6 contact lenses per year.

This case report illustrates two examples of very successful RGP contact lens fittings. Both of the patients have worn their contact lenses for all of their activities and have not experienced any related contact lens complications. They continue to be enthusiastic about their RGP lenses even after 6 years of full-time wear.

Dr. Baker is in private practice in Lafayette, Calif. He is a member of the American Academy of Optometry, the American Optometric Association Contact Lens Section and the RGPLI advisory committee. He is currently also a member of the clinical faculty at the University of California at Berkeley.