Pediatric and Teen CL Care

Reconsidering Extended Wear for a Pediatric Patient

BY MARY LOU FRENCH, OD, MED, FAAO

Generally speaking, I do not recommend continuous wear for any patient, especially for a 6-year-old. That said, there is a time and place for thinking about what is best for each patient, weighing the overall risks versus the benefits. My concern for one young amblyopic patient overrode my reservations about prescribing extended wear lenses for young patients.

My patient presented one day with a deep amblyopia of his left eye caused by 6.00D of myopia, contrasted with the plano refractive error of his right eye. Generally, I see this more often with 6.00D of hyperopia in one eye and minimal refractive error in the fellow eye.

His parents were concerned with the development of his visual system and improving the vision of his left eye. They understood the importance of treating the amblyopia at his age. He was an energetic, lively child, and glasses were not going to fit in his active life, even at the tender age of 6.

Optimal treatment was to prescribe a generally available continuous wear lens for his left eye only, having his mom actively engaged in the fitting and instruction process. Home they went after scheduling a progress evaluation for one week following. At that point all was well and I released him, emphasizing the need to monitor the appearance of his eye for any adverse events. Multiple follow-up visits over the subsequent months indicated an improvement in his visual acuity from 20/100 to 20/40.

An Adverse Event

One day this patient’s name was on my schedule as an emergency office visit for a painful red eye. My worst fear of a corneal ulcer reared its head. Fortunately, it was only a moderate case of keratitis managed well with lens removal and a course of antibiotic therapy. Also, fortunately, his parents had removed the lens immediately when they saw that the eye was red and inflamed. He did not apply the lens during treatment, but resumed the extended wear modality when the treatment was completed.

It was with much trepidation that I recommended returning to the extended wear modality. However, I modified the wearing schedule to weekly rather than monthly. Significant improvement in his visual acuity and his parents’ quick response to the painful red eye combined to give me the confidence to continue with this treatment plan.

A Good, Short-Term Option

That single incident was the only adverse event noted in the nine years that he has worn contact lenses. He wore the continuous wear lens for only about a year, during the more active treatment plan for the amblyopia. Once I determined that the amblyopia had improved and was stabilized, I recommended a two-week lens modality.

Fast forward to today. The patient is a strapping 15-year-old young man soon to get his driver’s license. The refractive error of the left eye has remained stable, and the visual acuity, with treatment, improved ultimately to 20/25. The right eye developed myopia with astigmatism, and he is currently wearing single-use lenses on each eye. 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.