pediatric and teen cl care

Noncompliant Eyeglass Wearer A Good Fit for Contact Lenses

BY MARJORIE J. RAH, OD, PHD, & JEFFREY J. WALLINE, OD, PHD

An 8-year-old girl presented for a comprehensive eye exam and what ultimately became her first contact lens fitting. When she first visited the clinic, her mother reported that spectacles had been prescribed previously, but that her daughter did not wear them because she felt they didn't help her see well.

Manifest refraction revealed a spectacle prescription of OD –2.25 –1.00 ×165 with 20/30 visual acuity and OS –2.50 –1.00 ×035 with 20/50 visual acuity. The reduced visual acuity couldn't be attributed to any pathological condition of the eye.

Although we recommended spectacles, her mother knew it was unlikely that her daughter would wear the glasses during school. We decided to fit her with contact lenses.

Initial Fitting

Initially, we fit the patient with spherical soft lenses with similar visual acuities to spectacles; 20/30 in the right eye and 20/50 in the left eye. Neither a spherical nor a spherocylindrical over-refraction improved the visual acuity in either eye. The initial goal was to encourage the patient to wear vision correction full time with the hope that visual acuity would improve.

We gave her contact lens training, dispensed the lenses and recommended a follow up in one week.

At the follow-up visit one week later, a spherocylindrical over-refraction of OD –0.50 –1.25 ×180 and OS –1.25 –1.50 ×015 improved vision to 20/25 in the right eye and 20/30 in the left eye with the contact lenses. We refit the patient into soft toric contact lenses. The lenses were stable with no rotation in both eyes and the visual acuity with contact lenses was 20/25–2 in the right eye and 20/25 in the left eye.

We dispensed the lenses and asked the patient to return for follow up in two weeks.

A Significant Improvement

After wearing the soft toric lenses for two weeks, she returned again for follow up. At this visit her vision was 20/25 in both the right and left eye. A plano over-refraction was noted in each eye. No changes were made to the contact lens prescription.

Because we observed significant improvement in visual acuity from wearing the vision correction on a regular basis, we asked the patient to continue to wear the lenses and return for follow up in one month.

One month later, further refinement of the prescription by over-refraction improved the visual acuity. After just two months of contact lens wear from the initial fitting, visual acuities improved to 20/20 in each eye.

Vision therapy was not recommended at that time and we advised the patient to continue to wear the contact lenses. We finalized a spectacle prescription and advised the patient to have a pair of spectacles to wear when she wasn't wearing contact lenses.

Improving Compliance

This 8-year-old patient is just one example of how contact lenses can benefit children. In this case, fitting contact lenses to improve compliance with wearing vision correction improved the visual acuity of the patient.

Parents frequently say that their child should not be fitted with contact lenses because the child cannot care for glasses. If the child hates wearing glasses, then contact lenses may be the perfect alternative.

Offering contact lenses as an option for patients such as the case presented here can improve not only compliance, but also can ultimately improve visual performance. CLS

Dr. Rah is a staff optometrist at the Massachusetts Eye and Ear Infirmary Contact Lens Service where she specializes in medically necessary and other advanced contact lens designs. Dr. Walline is an assistant professor at The Ohio State University College of Optometry, where he conducts studies of pediatric contact lens wear.