By far, my most memorable patients are children who present for medically necessary scleral lenses. Although pediatric patient encounters can be particularly challenging—whether because of poor patient cooperation or elevated parental stress—the life-enhancing impact makes the struggle worthwhile. Here are some helpful tips that I utilize in clinic to help ease the fitting process.

Be Prepared for an Unconventional Fitting Process

The initial biomicroscopy exam is often a good indicator of ocular responsiveness and patient cooperation. Ocular preference and sensitivity can be determined by a child’s response to light. Utilize topical proparacaine before a diagnostic scleral lens fitting if patients complain of pain during biomicroscopy. Consider fitting both eyes simultaneously if a child cooperates well behind the slit lamp and tolerates eyelid manipulation with minimal signs of photophobia. On the other hand, if strong ocular preference is observed and parents report greater difficulty administering drops in one eye, fit the less sensitive eye first. This gives the preferred eye time to desensitize while parents become accustomed to application and removal.

Murphy and colleagues (2021) describe an alternative fitting process in which a 6-year-old patient who struggled with scleral lens application was initially fit with a daily disposable soft lens alone before transitioning to a scleral lens piggyback system. Shortly after, the patient reported successful scleral lens application without the soft lens cushion.

Fitting one eye at a time or following an incremental approach may not be an ideal option for all patients and will require additional chair time.

Bubble Trouble

Parents may be apprehensive about scleral lens handling and may struggle to achieve a bubble-free application. Application tools such as plunger stands and fixation lights may increase success. Recommend in-office training sessions for all parents and caregivers; even school nurses can benefit from a course.

Another helpful trick is temporarily swapping out the traditional preservative-free saline filling solution for a preservative-free lubricant eye gel instead. The increased viscosity eases scleral lens application by preventing spillage and subsequent bubble formation. Some patients even report a cushioning effect with greater lens edge comfort. Be wary of blurred vision, and reassure both patients and parents that vision quality will improve when transitioning back to a preservative-free saline filling solution.

Age Is Just a Number

Alipour et al (2021) reviewed the medical records of 52 pediatric patients who had ages ranging from 4-to-18 years and wore mini-scleral lenses over a nine-year period. They found the 15.8mm diameter contact lenses to be safe and to provide statistically significant improvement in vision, with a mean difference of 0.55 logMAR when comparing best spectacle-corrected vision and best scleral lens-corrected vision. Surprisingly, caregivers reported mini-scleral lenses as being easier to handle compared to soft lenses.

The authors recommend viewing patient age as an obstacle to overcome rather than a contraindication to lens wear. Additionally, consider the socioeconomic situation and compliance of caregivers before fitting lenses.

Pediatric scleral lens fitting presents unique challenges that can be overcome with unconventional fitting tactics. CLS

For references, please visit www.clspectrum.com/references and click on document #312.