Pediatric and Teen CL Care

Make Sure That it is the Patient Who Wants the Lenses

BY MARY LOU FRENCH, OD, MED, FAAO

Frequently I am asked by parents at what age do I recommend fitting contact lenses. My usual answer is beginning at age 8. However, that is very much dependent on the maturity and activities of the patient, the desire of the patient rather than the parents for the contact lenses, and sometimes it depends on the parents’ experience with contact lenses.

A Study in Contrasts

This is a tale of two patients. Both of them are 8 years old; one is a boy, and one is a girl. Interestingly, I saw them both on the same day.

The first patient’s exam had been six months ago. Her myopia was increasing every six months, and her mother was concerned about the consistent worsening of her daughter’s prescription. Having attended the recent American Academy of Optometry meeting at which I learned that current research on myopia control is leading toward the use of a multifocal contact lens design (Rodgin, 2011; Guthrie, 2011), I discussed this research with the mother, and we decided that this was an option to attempt to control the patient’s myopia progression. Mom wears lenses herself, and the young patient is mature enough to follow directions and comply with a lens wear regimen.

The second patient is a very active young man. He visits my office frequently to get his glasses fixed, adjusted, and replaced, even though he wears his rec specs for all of the sports in which he is engaged year round. Although there was a mild increase in his myopia, it was not as significant as the first patient’s change in prescription. In this case it was the patient himself who was interested in trying contact lenses. His mom wears contact lenses. The patient was mature for his age, does well in school, and understands the advantages of wearing contact lenses for sports. He was tired of visiting us for his glasses adjustments, too.

Success Depends on What the Patient Wants

In my list of criteria for gauging the potential for success in young contact lens patients, I consider age and maturity as very important. But rule No. 1 is that the patient must be the one desiring the contact lenses, not the parents.

In the case of the first patient, I neglected to follow my own rule. My most patient assistant tried and succeeded in getting lenses applied among the tears. However, the young patient did not want contact lenses. Her mother offered to take the trial lenses home to work with her daughter, but this was unacceptable for many reasons. Even with instruction to mom from my staff on lens application, the patient was not convinced that contact lenses are for her.

The young man did great! He was very successful at his contact lens instruction, and when last seen was grinning from ear to ear.

Never Forget Rule No. 1

Moral of the story is to always remind myself of rule No. 1: the patient has to want lenses. This is a difficult rule to keep when I know the benefit of fitting children with multifocal lenses to potentially control myopia. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #208.

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.