pediatric and teen cl care

Bad Decisions, Poor Compliance

By Pauline Cho, PhD, FAAO, FBCLA, & Sin Wan Cheung, MPhil, FAAO

Noncompliance in lens wear is a challenging issue, especially when fitting children. Some think we should treat children like adults to show that we respect and believe in them. It's true that some are more mature than others are, but they're still children and they don't have the understanding and life experiences to make decisions that adults often have to make. In this month's column we highlight two cases that make this point.

Case 1

A 12-year-old boy and his parents came to our clinic for an orthokeratology follow up. He had been wearing ortho-k lenses for myopia correction/control for more than two years.

His initial manifest subjective refraction was −2.00DS in each eye. He loved ortho-k and the parents were happy with the ortho-k results.

Ocular health was unremarkable and the lenses centered well. Unaided visual acuity was log-MAR VA −0.08 in each eye with no residual refraction. However, the parents asked if their son could stop treatment because they were concerned about his lens wear habits. Their son enjoyed clear, unaided daytime vision so much that a few times when he was feeling ill he continued lens wear, insisting that he was feeling all right. After some discussion, we decided to terminate the patient's treatment for the moment and told him to resume spectacle wear.

Case 2

An 11-year-old girl came to our clinic for a regular follow-up consultation. She was 9 years old when she started ortho-k treatment for myopia control.

Her initial manifest refraction was −3.00DS (OD) and −4.00DS (OS). Both the parents and the girl were happy with the treatment effect—she had unremarkable ocular health, well-centered lenses and good unaided vision (logMAR VA −0.08 in each eye with residual refraction of +0.25DS [OD] and plano [OS]). However, during routine questioning about her handling procedures, she informed us that in the last two months she hadn't used artificial tears prior to lens removal or checked for lens binding before lens removal in the morning. We advise all our ortho-k patients to check for lens binding in the morning before lens removal and to use artificial tears to aid lens removal in case of binding.

The girl admitted that she ran out of artificial tears but forgot to tell her parents. Because she didn't want to stop lens wear because of this, she decided to continue without artificial tears. She "got used" to not using the artificial tears and did not bother to check for lens binding before lens removal as she "felt okay."

The mother was surprised to learn about this noncompliant behavior, though she expressed ignorance herself with regard to the necessity of checking for lens binding and artificial tear use. Both parent and child were re-educated about this issue.

Reinforcing Compliance

With young patients, practitioners are really dealing with two parties—patients and their parents. Compliance is essential for safe and healthy lens wear and requires effort from all parties.

Practitioners should respect children by involving them during the consultation and educating them about the importance of compliance and the potential consequences of noncompliance. How can we expect them to be compliant if they don't understand what it means?

These two case examples demonstrate that like adults, children can enjoy spectacle-free vision so much that they may take unnecessary risks. Mild flu and fever are common in children and they may not understand why they can't wear their lenses when they only feel "a little bit tired."

Remind parents to be vigilant at home and to keep a strict eye on their children to monitor lens compliance. 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. You can reach her at sopaulin@inet.polyu.edu.hk. Ms. Cheung is currently a research fellow at The Hong Kong Polytechnic University. You can reach her at sopeggy@inet.polyu.edu.hk.