Pediatric and Teen CL Care

Get All Caregivers Involved

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

When children are fitted with contact lenses, it is important for at least one parent to be involved. Furthermore, the following cases show that it would be prudent to have all caregivers involved.

Case #1

A 9-year-old girl was fitted with orthokeratology lenses. She was very nervous with lens application and removal, so her mother was taught to help her perform these procedures.

During the course of the treatment, the mother had to leave town a few times for business for several days, and the father performed the lens handling procedures. The patient commented that her father was not very good with application and removal and that her eyes were usually not very comfortable after his handling of the lenses. We asked the father a few times to return to learn the procedures properly, but he was always “too busy.”

Finally, at one aftercare visit when the father had removed the lenses that morning, the girl presented with a mildly injected right nasal bulbar conjunctiva and significant conjunctival staining accompanied by mild corneal staining in the right eye, though the patient had no complaints. Vision was not affected and the lens was not damaged. Upon further questioning, the patient commented that her father hurt her eyes during lens removal that morning. The staining was likely due to poor lens removal.

The condition resolved after discontinuing lens wear for two weeks (weekly aftercare). We reeducated the father on proper lens handling skill and also provided written instructions.

Case #2

In another case, an 8-year-old boy was fitted with orthokeratology lenses. He was taught how to apply and remove his lenses, and his mother and domestic helper (who had been with the family since the boy was born) also learned how to handle the lenses. The patient performed lens application and removal himself while the domestic helper helped him clean the lenses every morning.

At an aftercare visit, following 12 months of lens wear, the patient was accompanied by his mother instead of the domestic helper. On questioning, the mother reported that the domestic helper had left the family and that she had taken over the lens cleaning procedures. We asked the mother to demonstrate the cleaning procedures and found that she did not clean the concave side of the lenses. Proper lens care was emphasized and she was re-educated accordingly.

Keep Everyone in the Loop

These two cases demonstrate the need for us to keep an eye on our young patients and their parents. Young patients do not complain much as demonstrated in the first case. It took a significant conjunctival staining episode to finally bring the father in for re-education, and unfortunately, “too busy” is a reality (excuse) with busy parents.

In the second case there were no signs or symptoms. Just from the routine aftercare and observation, we noted a change in the person accompanying the patient, which prompted a simple question that led to the discovery of incorrect lens care procedures by the mother. Taking this opportunity, we re-educated the mother and stressed the importance of clean contact lenses and the potential complications that can arise from noncompliance with lens care procedures.

When both parents have to work, it is common for them to leave the contact lens care procedures to a third party, e.g. domestic helper in countries such as Hong Kong. More frequent and regular aftercare for young patients can help identify problems earlier to minimize the risk of developing serious complications. These cases also demonstrated the importance of having a set of written procedures on how to care for the contact lenses and accessories. CLS

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Dr. Cho is a 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.