the contact lens exam
Fitting Infants with CLs
BY LOUISE A. SCLAFANI, OD, FAAO

We definitely have all of the skills and tools needed to fit contact lenses on infants and therefore, we can and should be part of the process. Developing a pediatric contact lens practice is first a matter of making our skills available to the babies, the families and the surgeon. Develop a referral network with the local pediatricians and, more important, make mutual care with a pediatric ophthalmologist routine.

Figure 1. Contact lens intervention at an early age can help restore binocularity.

Getting Realistic

Many of the tools we use for contact lens fitting aren't amenable to the small stature of an infant, so many practitioners are reluctant to fit them. A portable slit-lamp is helpful, but not absolutely necessary. A Burton lamp is inexpensive and receives a huge "Wow" factor from kids and their parents. You can gather the information just as easily by using a penlight and a 10X magnifier -- voila, your own Burton lamp.

Portable instruments work well on adults, but they're less effective with infants because they're cumbersome, they scare the baby and even mom seems a bit concerned about the use of a huge tool near her child. You may have the opportunity to examine a child under anesthesia, but it's still a challenge to get close enough to the globe with the lid retractor and anesthesia tubing. Although I have the convenience of being in a hospital setting, I've been able to fit 90 percent of my infant patients without an exam under anesthesia.

General Guidelines

Published nomograms are available that we can use for determining initial lens parameters. These are the result of studies that have consistently measured corneal curvature changes and effectively predicted appropriate base curve based on a patient's age. In general, the younger the child, the steeper the cornea.

Approach with Confidence

I think that the greatest fear of fitting an infant with contact lenses is putting it on the eye. Not just for the parent, but also for the doctor who's not accustomed to doing this. The child has come to trust you, and the more comfortable we make the child and the more we engage him, the easier it becomes.

	Figure 2. The Burton lamp is fun and diagnostic.

When training a patient or his family to apply and remove lenses, you need support from parents and/or siblings. Because training can get slightly loud (because children often cry, especially infants), you may want to schedule this appointment for after hours so as not to scare other potential lens wearers. On the other hand, if these tiny patients are visible in your practice, then other families realize the importance of eye care at an early age.

Give it a Try

Visual assessment in this population is difficult; however, vision goes beyond the Snellen chart. We can measure restored vision in many ways. As you see a child achieve developmental milestones, as you observe him inspecting things that are important to him, you know you've made a difference. We may not know for years the impact we've had on their lives, but we know that without our skills, these children have no chance. The tools are right in front of you and so are the rewards.

Dr. Sclafani is associate professor of ophthalmology at the University of Chicago Hospital.