Fitting Kids With Contact Lenses

It's doesn't take as much time as you think.

By Mary Lou French, OD, FAAO, MEd

HOW MANY OF YOU remember being fitted with your first pair of contact lenses? Is that one reason you may have chosen optometry as a career? I remember my first pair of contact lenses vividly. They were PMMA and extremely uncomfortable, but I could see without my eyeglasses, which at the time was motivation enough to deal with the discomfort.

With today's contact lenses available in multiple modalities and variable wearing schedules, there's no reason a young child has to endure what I did to rid myself of eyeglasses. Recent studies — specifically Contact Lenses in Pediatrics (CLIP) and the Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) — prove that even children as young as 8 years old can be successfully fitted with contact lenses. With the proper training and staff, even if your practice isn't a pediatric practice, these patients will benefit from wearing contact lenses for vision correction, and those same patients will be a source of practice growth as a niche in a general practice.

Children are a Growing Market

Twenty-five percent of the population in the United States is myopic. Almost 60% of this population becomes myopic around age 8 and continues their progression into increased myopia until they've reached their mid-teens. The majority of these young there's an untapped market of patients younger than 12 who are interested in wearing contact lenses.

This article isn't aimed at those who specialize in working with the patients who have critical medical reasons for wearing contact lenses but to those of us who want to expand our practices to a larger segment of the communities in which we work.

Throughout the country — beginning with InfantSee, and initiatives in many states, Kentucky being the first, and Illinois more recently — eye exams are being mandated for all children beginning school. These initiatives will create an immense impact on our offices to care for children who require vision correction — and not just with eyeglasses but with contact lenses as well. I believe it's important to recognize the cosmetic value of fitting young children. This is a valuable and viable patient population.

When optometrists are asked why they don't offer contact lenses for vision correction in young children, the reasons most often cited are: patients aren't responsible enough, they're unable to handle the lenses properly, there's a lack of adequate hygiene, and there's a risk of the patient being lazy and sleeping in the lenses. All of these reasons for reluctance to fit a young patient, in reality, apply to all lens wearers — regardless of age.

All Patients Take Time

Many doctors and staff members fear this patient population will take a significantly longer amount of time during the fitting process. There's a perception that fitting young children will require too much valuable time in our busy offices. The doctor may believe that these young patients will require more chair time than a teenager for the diagnostic evaluation: extra time spent with the patient, extra time with the parent, explaining the insertion and removal techniques, the solutions, the wearing schedules and the follow-up visits. Some doctors think all of this perceived extra time will slow the practice down.

However, the data published in the CLIP study mirror my own clinical experience, which is that young children don't take any more chair time in the diagnostic process than any other patients. I have an equal amount of teens and 9-year-olds who take 2 to 3 office visits for their insertion and removal training.

The results of the CLIP study established that the fitting time of this age group was only 15 minutes longer than with the teen group. Further analysis of the data indicates that this time occurs in the instruction portion of the fitting process. Conversations I've had with the authors of the study, in addition to my own practice experience, show that this increase in time is mostly due to outliers we all have in our practices. There are always some patients — regardless of age — who take more time to learn to handle contact lenses. I don't find that 8- or 9-year-olds take any longer than my 13- or 14-year-olds. The key is patient selection, which should be guided by the patient's maturity level and ability and willingness to communicate.

As with any professional recommendation, whether a style of bifocal, a LASIK procedure or a referral for a surgical consult on cataract, the ability of the patient to communicate his needs is crucial. What patients communicate to us directly affects our ability to make a treatment decision and explain our recommendations. Contact lenses should be one of the options we provide for all patients who require vision correction. When we're talking about young children, the difference is that the parents are the decision makers, so the actual patient — the child — has less (or no) say in the final outcome.

Indicators of Readiness

Parents, doctors and staff all have reservations and contact lenses aren't for everyone. There are many criteria I employ in the decision-making process when recommending contact lenses for young patients. What are their grades in school? Can they have a reasonable conversation with me about why they want contact lenses? Do they play sports? How active are they?

The parent is part of this equation as well. If it's only the parent requesting the contact lenses for the child, it's a very poor indicator of a successful fit. If the child is begging the parent for lenses, that is an excellent indicator. Even if the parent is reluctant to schedule a diagnostic evaluation, planting the seed for a future contact lens evaluation is still worthwhile.

When I broach the subject of fit- there are two different reactions. Some parents immediately know their child won't be ready for a long time. Other parents understand the benefits — perhaps because they have personal experience with contact lenses. Sometimes, even those parents are surprised we can fit children as young as 8 or 9 years old.

Kid Considerations

Since we all know that patients generally are non-compliant with solutions, wearing time and recommended replacement schedules, we might assume that the younger patients would be less compliant, when, in fact, the opposite is true. These patients are at an age where following rules is very important, so they're prepared to handle and care for contact lenses by following the rules of lens care.

Kids themselves have questions about the lenses. Typically, their biggest fears are that the lenses will hurt or that they'll get lost in their eyes. These fears are easily assuaged. I let the patient touch the lenses to see how soft they are.

I rely extensively on the parent's evaluation of their child's readiness to wear contact lenses. Sometimes, in my opinion, the patient is more than ready but the parent has reservations. In this case, I advocate for the child because the child is my patient.

In order to minimize the slightly increased amount of total fitting time with this age group, your staff must be involved with the diagnostic steps and the instructions for insertion and removal. It's important to find a staff person who enjoys working with young patients. This is paramount if you want to be successful working with this age group.

After the initial exam, when I have determined that the patient is a good candidate for a contact lens diagnostic visit and everyone is on board, we prepare to perform the diagnostic evaluation that day, if the parent has the time, or we reschedule for another visit. Either way the process is the same. I record the chosen diagnostic lens parameters. I strongly recommend having an extensive diagnostic fitting inventory but occasionally I have to order a lens which I may not have readily available. At the time of the diagnostic evaluation, one of my assistants inserts the diagnostic lens. Once the lenses are on the eyes comfortably, the patient returns to the reception area for 10 minutes for the lenses to equilibrate. After that time, the patient returns to an exam room and I evaluate the fit, the over refraction and visual acuities. I make my recommendations to the patient and the parent. My staff will then remove the lenses while I'm discussing the next visit, the lenses recommended and the replacement schedule. I also discuss the solutions we recommend and the progress evaluation. I answer any other questions the patient or parents may have. If the initial diagnostic lens requires modification, I have the staff remove the initial lens and insert the newly selected lens. When the final lenses are decided upon, the staff will escort the patient to the charge desk and schedule the instruction visit.

My staff manages the entire process, other than the decision on the final prescription. I see the patient again in 1 week to determine how he's doing and answer any questions that inevitably come up during the initial week of lens wear. This process is identical with all of our contact lens patients. We don't differentiate based on age. We don't schedule any more or less time for the instruction visit for our 8-year-olds than with our 14-year-olds. Patients can return as many times as needed until they can successfully handle their lenses. There's an even spread among the ages for those needing to return for a second or third visit.

The reward? The smiles on the faces of these young patients who are wearing contact lenses for the first time! nOD

Most Kids' Eyes Are Not Protected from UV Rays

In a recent survey, 85% of Americans reported that they understand ultraviolet (UV) rays can damage their eyes. And while 59% put sunblock on their kids, only 39% make sure their kids wear sunglasses. Parents can buy sunglasses for their kids, but it isn't easy to get kids to keep them on. Kids who wear eyeglasses have an advantage. Since they need their eyeglasses to see, they usually keep them on. Parents have a few options for combining vision correction and UV protection: ■ Eyeglasses with UV lens coatings provide UV protection, but they don't reduce glare or the amount of visible light entering the eyes. ■ Prescription sunglasses provide UV and glare protection, but they give parents an enforcement challenge. Will their child switch from eyeglasses to sunglasses at recess or for outdoor gym class? And how will the child handle the responsibility of two pairs of glasses? It's best to make the decision based on the child. ■ Junior Transitions lenses give kids vision correction indoors and at night, and then adjust quickly to darken in sunlight. They block 100% of UVA and UVB rays and enable kids of all ages to stay in a single pair of glasses all day long. Parents pay for one pair of glasses, and kids don't have a chance to break two pairs. — Erin Murphy, contributing editor Source: Global Attitudes & Perceptions About Vision Care, The Vision Care InstituteTM, LLC, 2009. www.thevisioncareinstitute.com/pages/globalsurvey.aspx