pediatric and teen cl care

Emphasizing Lens Care

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

Compliance with contact lens care is an important issue, and you need to take a more detailed approach when discussing it with children. Telling children to dispose of their lenses every two weeks or monthly doesn't provide enough information. They don't keep track of time very well, so specific times such as "the first and fifteenth days of the month" work better. Or, have children put a sticker on a calendar or write the days on their lens box to make it easier to keep track.

Also ask parents to provide children with incentives if they throw away their lenses on time. That way children will take an active role in lens disposal.

Compliance Points

Here are some specific rules to emphasize with children.

Rinsing lenses Tell children never to rinse their lenses in tap water — not even GP lenses. Telling children it's okay as long as they rinse their GP lenses with solution before putting them on the eye only makes compliance more confusing. Advise children never to put their lenses in their mouth to rinse them. A small bottle of solution in a child's desk or locker is a good idea, especially while he's adapting to lens wear.

Sleeping Discuss not sleeping in lenses and what to do if they accidentally fall asleep in lenses.

Cleaning Stress rubbing lenses to clean them every night as well as disposing solutions in the case every day to avoid solution contamination.

Symptoms Tell children to remove lenses if their eyes become red, irritated or they're unable to see clearly. Advise them that if problems don't improve after lens removal they should talk to a parent about calling you.

Swimming Depending on how conservative you wish to be, tell children never to wear contact lenses when swimming, to wear them only with swimming goggles, or to remove the contact lenses immediately after swimming to clean them.

Write these "rules" and give them to parents and children for reference. When children return for follow up in six months, consider giving them a "test." This can be a true/false test, which children are used to taking (Table 1). Don't correct or grade it in front of them. Instead, if they miss a question, ask it again in a different way. If they still don't know, discuss the answer without letting them know it was incorrect. Testing re-educates children and also helps you identify what you may not emphasize enough because you'll see what questions most children are missing.

If your young patients still have difficulty with compliance after implementing these methods, consider prescribing daily disposable lenses, which remove the need for care and therefore enhance compliance. CLS

Dr. Walline is an assistant professor at The Ohio State University College of Optometry, where he conducts studies of pediatric contact lens wear. 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.