Pediatric and Teen CL Care

Your Go-To Lens Isn’t the Way to Go for Every Patient

By Mary Lou French, OD, MEd, FAAO

Lest my colleagues think, from my last few columns, that most of my patients are in the special needs category, in this month’s column I will focus on patients more similar to those whom you probably see every day.

My philosophy is to fit patients in the best lens possible all of the time. However, as we know, this is an ideal goal to work toward. The real world is the one in which we live. Financial constraints, lens unavailability, and patient noncompliance are the reality for us and our patients. As much as I would strongly recommend daily disposable contact lenses for all of my patients, those three realities are part of daily practice life.

A Tale of Two Sisters

Two sisters were scheduled for exams. Though they’d had exams yearly, it had been four years since I had seen them. The older sister, Karly, had failed her driver’s license vision exam.Why she tried to pass the vision screening without her year-old glasses is a question that only a 15-year-old, −1.50D myope could answer. Her younger sister, Amanda, also has year-old glasses, which she wears in school and for homework. Her current glasses are +0.50 −1.75 × 180 OD, pl −2.00 × 170 OS.

The usual scenario in this case is for the astigmatic patient to be less compliant compared to the myopic patient.With these sisters, the opposite is true.

Exam results for Karly indicated a myopia increase to −2.25 sph OD and OS—definitely not someone who should be on the road without vision correction. Surprisingly, her mom seemed unaware of the importance of vision correction for her soon-to-be-driving daughter.

Amanda had no significant change in her vision correction, and, in fact, was close to my original exam from four years ago.

Now both want contact lenses: the myope who has a poor compliance history with wearing glasses, and the astigmat with a better history of compliance with glasses but fewer contact lens options. Low hyperopic astigmats, much as they say they want to wear contact lenses, are among the less successful fits, in my opinion.

I performed contact lens diagnostic evaluations on each patient. I discussed financial considerations with their mom, and daily disposable lenses are not in the budget. My second recommendation for lens modality is two-week replacement, which I easily managed with Karly. My go-to two-week lens fit well with excellent visual acuity.

I was not as lucky with Amanda. The lenses fit well but her visual acuity was unacceptable, at least to me. She was just happy to not be wearing glasses. I dropped back to a monthly lens, my less recommended option because I believe that this replacement option can lead to the most compliance abuse. However, the best fitting lens with the best visual acuity for Amanda was a 30-day lens. I am happy with her visual acuity and lens fit, and so is she.

A Successful Choice

Even though neither patient was fit with the “optimum” lens, all of us are happy. The roads are safe for Karly, and Amanda can see well all of the time, not just in school. CLS

Dr. French is a graduate of Illinois College of Optometry. After her doctorate, she completed post-doctoral programs in learning disabilities, early childhood development, and business management. She is a lecturer, author, and industry consultant specializing in children’s vision. She is also a consultant or advisor to Vistakon. You can reach her at mlfrenchod@childrenseyes.com.