WITH THE RECENT popularity of contact lens options for myopia management, practitioners are encouraged to pay closer attention to a segment of the population that might have been previously overlooked. It is becoming easier for patients, parents, and practitioners to advocate for kids using contact lenses because of their proven safety (Bullimore, 2017) and positive effects on quality of life (Dias et al, 2013). But are you offering your pediatric population contact lenses only when it comes to myopia management? Are we missing other opportunities?

Most would agree that spectacles are an adequate and common first line of treatment. But when we really think about it, the success of spectacle wear as refractive intervention is mostly reliant on patient compliance. We can educate the child and parent, but success is only determined if the child is faithful and consistent about continuous wear (when indicated).

Children can be very resistant to wearing spectacles, whether it is due to not liking their appearance or having trouble forming the habit of wearing them. Enthusiasm can also be limited with fear of being part of the minority, especially when not many of their classmates wear glasses. This is where contact lenses can provide a suitable alternative to spectacle wear.

In practice, some may propose contact lenses as an option when a child is of a certain age. Children as young as 4 years old can start handling contact lenses, and by the age of 10 can be fully independent with them (Walline and Sindt, 2014). If we are going to commit to fitting this population, our approach should be a little different. Children are not just small adults. They generally view success and rewards differently and tapping into that understanding makes for an enjoyable experience for all parties involved. Here are a few tips on how we handle the application/removal process differently with children.

1. Limit high expectations. Let the child know it may take a few visits to master the application/removal process. If they get it the first day—great! If they don’t, there is no surprise, and they don’t feel defeated.
2. Be aware of time. Children can become exhausted quickly. If the training is unsuccessful, instead of pushing them further, commend their progress and recommend rescheduling for another day.
3. Increase confidence during the visit. Find ways to give the child quick wins during the training process. Simple tasks may include using their hands to hold their eyelids open for five seconds or having them gently touch the conjunctiva with their fingertip. Learning lens removal before lens application is sometimes easier as well.
4. Increase confidence between visits. Using artificial tears between visits can get patients comfortable touching their eyelids and bringing foreign objects closer to the eyes.

Age should not be the primary reason for a child’s eligibility for contact lenses. When full-time refractive correction is indicated, introducing contact lenses is an excellent option for your young patients. Because contact lenses offer a constant visual correction, this method can assist with compliance and overall visual performance. CLS

References

1. Bullimore MA. The Safety of Soft Contact Lenses in Children. Optom Vis Sci. 2017 Jun;94:638-646.
2. Dias L, Manny RE, Weissberg E, Fern KD. Myopia, contact lens use and self-esteem. Ophthalmic Physiol Opt. 2013;33:573–80.
3. Walline J, Sindt C. Children and Contact Lenses. Bennett E and Henry VA, eds. 2014. Clinical Manual of Contact Lenses Fourth Edition, Lippincott Williams and Wilkins.