pediatric and teen cl care

Patience Pays Off

BY PAULINE CHO, PHD, FAAO, FBCLA, & SIN WAN CHEUNG, MPHIL, FAAO

Franklin P. Jones once said, "You can learn many things from children. How much patience you have, for instance." Most of us would agree that managing children can be challenging, and some kids can really try our patience.

This is especially true when fitting contact lenses, as children must have a comprehensive examination and assessment beforehand. Unfortunately, many children have issues with some of the procedures in a comprehensive examination. And of course there are children who simply cannot sit still. It is hard to obtain a good VA or corneal topography when a child's head is bobbing up and down or the eye is fixating on anything but the fixation target.

Nevertheless, we've found that for some difficult cases, if we have strong parental support, it does pay to have patience. Here we present a few cases in which time and effort spent on understanding or communicating with the child paid off.

Case #1: the Nervous Kid

A mother requested overnight orthokeratology for myopia control for her 8-year-old boy. The boy was very nervous with lid eversion and the idea of putting something on his eyes. He tried hard but failed to successfully apply and remove the lenses even after eight visits (two sessions per week). His mother finally took over lens handling and care. The boy was successful with ortho-k lens wear and delighted with his spectacle-free vision, especially when playing soccer. With this motivation, he not only learned to apply and remove the lenses by himself, he also learned to take care of the lenses every day.

Case #2: the Bossy Kid

As in Case 1, a mother requested overnight ortho-k for myopia control for her 6-year-old myopic boy. This boy was not nervous like the boy in Case #1, but simply refused to do anything that he did not like. He refused to cooperate and was initially turned down for ortho-k. However, his mother called back later requesting a reassessment.

At the next visit, the boy refused to enter the examination room. It took 45 minutes for his mother to persuade him to have his eyes examined. For lens handling, he refused to learn and insisted that his mother do it for him. As the mother was able to do this well, lenses were ordered for the boy. He succeeded with ortho-k lens wear, and like the boy in Case 1, he enjoyed spectacle-free vision so much that he learned to apply, remove, and care for his lenses every day.

Case #3: the Fearful Kid

A 9-year-old boy was examined for contact lenses for myopia control. The examination went smoothly until he was behind the slit lamp. He absolutely refused to have fluorescein instilled for external eye examination. He was fearful that the fluorescein would hurt his eyes. To allay his fears, the practitioner applied the drop to her own eye, but the boy was not convinced. She then performed the procedures on his father's eye, and only then was he convinced that it would not hurt. The rest of the examination was completed successfully.

Don't Give Up

Children come with different temperaments. Some are easy going and ready to try anything. However, many are fearful, fussy, and slow to warm up. When kids are not receptive at the first visit, think twice before sending them away. Maybe all they need is more time to understand, and with experience they can react positively to novelty. Keeping the examination short and engaging kids in the examination procedures can make things more fun and enjoyable for both you and the kids. So, be flexible and be prepared to deviate from your normal routine.

You may ask "Why bother?" Well, when we bother we secure more loyal patients. Satisfied parents will not only patronize our services, but will also refer us to their relatives and friends. CLS

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Dr. Cho is an associate professor of the School of Optometry at The Hong Kong Polytechnic University where she teaches Contact Lens Practice. Ms. Cheung is currently a research fellow at The Hong Kong Polytechnic University.