pediatric and teen cl care

Choosing a Lens Care System

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

We have many options available when selecting the best contact lens care system for our pediatric and teen patients. Hydrogen peroxide systems are effective disinfecting agents and are hypoallergenic, but are irritating when accidently instilled into the eye. Multipurpose solutions have good cleaning and disinfecting properties and are great for ease of use, but patients may have hypersensitivity reactions to the preservatives and often become noncompliant with the rubbing step or do not properly follow the rinsing instructions.

In some instances, care system choices must be altered to provide better comfort with contact lenses, as is evident in the following case reports.

Case 1

A 17-year-old male patient presented following a paint ball injury that left him aphakic in his left eye. With the aid of a diagnostic +13.00D monthly soft lens, he was able to achieve 20/20 vision. We dispensed the lens following instruction for application and removal, wearing time, and proper use of the hydrogen peroxide care system. Written instructions were sent home with the patient. We also recommended spectacle wear for protection along with UV protection, especially for the aphakic eye.

At the two-week follow up, the patient stated that he had been wearing the lens every day with good vision; however, initial comfort upon application was poor. Thoroughly rinsing with saline prior to application helped, but did not completely alleviate the symptoms. He reported that he was allowing the lens to soak in the solution for at least six hours as instructed and he was not using the hydrogen peroxide solution for rinsing; however, he admitted that he did not like the case that came with the system and had switched to a "regular" lens case.

Following further discussion about his current care system, we decided to switch to a multipurpose care system with a rubbing step for ease of use. When the patient returned for a second follow-up visit, the symptoms of discomfort upon lens application had resolved.

Case 2

A 15-year-old female patient presented to the clinic with a history of redness and irritation with her contact lenses. She had discontinued lens wear for approximately one month because of the symptoms. She had a history of moderate seasonal allergies for which she reported using an over-the-counter mast cell stabilizer with some alleviation of symptoms.

Slit lamp examination revealed mild to moderate papillae on the superior and inferior tarsal plates in both eyes. Prior to discontinuing lens wear, she reported using a multipurpose solution with a rubbing step. The patient and her mother preferred to keep her two-week replacement lenses rather than switching to daily disposables. Instead, she began using a hydrogen peroxide care system with a saline rinse to care for her contact lenses, resulting in comfortable contact lens wear.

Solution Troubleshooting

Occasionally, pediatric patients wearing daily disposable contact lenses will report burning or stinging upon lens application. A saline rinse prior to application typically solves the problem.

Some initially successful children may later have difficulty with lens application. If they answer "yes" to the question, "Does it hurt when you apply the lens and does your eye become red for a few minutes afterward?" then switching to a new care system may solve the problem and improve initial comfort.

Solution problems may cause discomfort after a patient has initially adapted to lens wear. These problems are frequently alleviated by changing solutions, adding a saline rinse, or switching to daily disposable contact lenses. 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. He is also a consultant or advisor and has received research funds from Paragon and Vistakon.