Pediatric and Teen CL Care

If at First You Don't Succeed, Try, Try Again

By Mary Lou French, OD, MED, FAAO

Paul, age 11, arrived for his annual comprehensive eye exam. It was his first visit to my office. He was a nice young man who had some complaint of blur at distance with his current glasses from his last exam about a year ago. There was a strong family history of myopia on both maternal and paternal sides, but otherwise he was healthy, good in school, and a very active athlete. Results of the eye exam indicated that there was a mild increase in myopia, well within the range of what I commonly see at his age. There was nothing remarkable in his history, except for an attempt at wearing contact lenses the prior year. A very unsuccessful attempt according to both mother and patient.

Paul was a straightforward myope—no significant astigmatism and nothing significant about the amount of myopia or the corneal topography. Both parents were successful lens wearers, and the desire to wear contact lenses came from Paul himself—not from his parents. His glasses were interfering with his success in sports. My advice to anyone fitting young children is to make very sure that it is the patient, not the parents, who wants the lenses.

Get a Good Start

I fit a significant number of young children with contact lenses. That said, I am very diligent in my case history. How mature is the patient? Does he do well in school? Good grades alone are not an indication of the intelligence of a patient, but they do indicate his willingness to follow instructions and his motivation to succeed at what is important to him. Does he play sports? Again, I don't look for whether a patient is an athletic star, but whether he appreciates the need to practice to achieve a skill—such as learning contact lens application and removal techniques. I often tell patients that it is challenging at first, but soon they will wonder why it was so difficult initially.

Let Young Patients Set the Pace

At Paul's previous practitioner's office, everyone was frustrated and Paul most of all. What went wrong? Just about everything. The practitioner was impatient in the initial fitting process. The staff was impatient with the time it was taking for him to learn the application and removal techniques. When he did not immediately learn to apply the lenses properly, he was chastised for his poor skills. This is not the way to work with young children—or, in fact, with any patient. I give this young patient and his parents a lot of credit for pursuing his desire to wear contact lenses in spite of his prior poor experience with contact lens instruction.

It took two or three instruction visits until Paul learned the proper techniques for lens application and removal, but he did it and has been proudly wearing his lenses for three years. Generally, it requires only one visit, but in these rare cases we work with the patients until they are successful. I tell them that my worst case required six visits to learn how to care for her lenses—but she did it. I tell them this story to relax them, and so far my worst case has kept her record.

Worth the Extra Effort

My point in sharing Paul's story is to encourage you to work with these young patients. Paul was the exception, in my opinion, in that he pursued his desire for contact lens wear despite a very poor initial experience. Most young patients will give up when they get discouraged initially. Wearing contact lenses can be a positive, life-altering experience for our young patients. Be patient with them to be a positive change in their lives. CLS