pediatric and teen cl care

Clinical Pearls for Fitting Children

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

Fitting children with contact lenses is similar in many ways to fitting adults. However, we've found the following valuable clinical pearls to be very helpful when fitting kids.

1 Select the Best Patients Although we routinely fit children as young as 7 or 8 years of age with contact lenses, we're selective about which children we fit. For instance, a child and his parent(s) both need to be motivated. If the child isn't interested, it's not a good idea to proceed. Trying to teach application and removal to a child who doesn't want contact lenses is no easy task.

Although the child needs to be responsible, the parent needs to help make certain the child is compliant with lens care. It's also wise to have a discussion with both parent and child about hygiene. Check the child's fingernails for cleanliness and ask about routine hygiene such as tooth brushing. If the child has established a good routine of hygiene, he'll likely be a good candidate for contact lenses.

2 Learn to Handle Anxiety It's important to remember that some children will cry during the contact lens fitting. This usually happens either before you attempt to place the lens on the eye or near the end of an unsuccessful application and removal training. Patience is the key to success, and working efficiently helps maintain a comfortable level of anxiety for the child. Take a moment to calm an anxious child or reassure him that it's not supposed to be easy to put a foreign object in the eye. Repeated visits may be necessary.

3 Choose the Right Lens Several lens modalities are appropriate when fitting children. Many parents feel more comfortable with one-day disposable lenses because no care system is necessary. If you prescribe two-week or onemonth replacement lenses, encourage children and parents to mark their calendar to remember to change lenses routinely.

Don't forget that GP lenses are an option. Many families are enthusiastic about corneal reshaping lenses and the potential for slowing myopia progression.

4 Use Anesthetic Drops for GPs Bennett et al (1998) have shown that using one drop of anesthetic at the fitting and one drop of anesthetic at the dispensing visits can improve initial satisfaction and success with GP lens fitting. We've found this to be especially true when fitting children with GP lenses. Not only does it aid adaptation for the child, it also makes assessing the fit much easier for you.

5 Provide Lasting Care Instructions Teach care instructions to both the child and the parent. Also consider providing instructions in writing or on a computer CD. A true/false test at the training and follow-up visits can also serve as a tool to review proper procedures with children.

6 Application and Removal Tips Using a cosmetic mirror at a vanity or desk is easier for many children than standing over the bathroom sink. This also eliminates the chance of a lens going down the drain. We recommend a maximum of 45 minutes to one hour for application and removal training. Beyond this, frustration often takes over and the session is no longer productive.

7 One Last Hard Fast Rule For elective contact lenses, children must be able to remove the lenses themselves before they can take them home. If a child has a problem during contact lens wear, it's essential that the child be able to remove the lens without assistance. Help with application is initially acceptable, but the goal should be independent contact lens care for the child. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #147.

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Dr. Rah is an assistant professor at the New England College of Optometry where she works primarily in the Cornea and Contact Lens Service in patient care, teaching and research. Dr. Walline is an assistant professor at The Ohio State University College of Optometry, where he conducts studies of pediatric lens wear.