close up on contacts
Kid-Ready: CL Checklist
by Karlen McLean, ABOC, NCLC
Most practitioners have fit contact lenses for young children for clinical, medically necessary reasons such as band-aid CLs or post-cataract CLs. But recent studies and ECPs who are experts in children's care encourage fitting CLs for kids who simply want them.
With the right introduction, approach, and procedures, the grade-school set can be model patients.
Using daily disposable CLs may be the best material and modality to maintain eye health, says Carla Barnett, OD, in Newport Beach, Calif. "Daily disposables have several advantages: clean, fresh lenses daily, no case to contaminate lenses, no cleaning requirement, no disinfecting solution irritating eyes, no schedule to remember, and spare CLs are easy to store in lockers and backpacks."
Explaining to young patients and their parents why certain lens materials and modalities are being recommended is mandatory, as is following your young patients more closely and often.
PERSONALLY PROFESSIONAL
Observing, assessing, and working with identifiable personality traits is the path to success for every patient. Knowing what to look for can save time, money, and sanity along the way.
Kids' motivation: "It is important to know the child is motivated to learn proper insertion and removal techniques, proper lens disinfection, and is willing to adhere to an appropriate wearing schedule," says Millicent L. Knight, OD, of North Shore Eye Center in Evanston, Ill.
Athletic children can benefit from the comfort and convenience of contact lenses
Parents' motivation: From cost to supervision, parents also have to be ready for the challenge. "Parents must be involved in CL care," says Jon Scott Walker, OD, of Dr. Brink & Associates, Jacksonville Beach, Fla.
Lifestyle: With parents in the room, Walker speaks candidly and questions patients about their activities, hobbies, and environments.
"I understand and support active kids in CLs so that they can perform at a higher level," he says."I don't support parents who don't want their kids in glasses because of a personal image issue. If I have a -6.00D 10-year-old, I understand the issues. But a -1.00D 10-year-old is a different story."
CL companies are increasingly aware of the appeal of CLs to youngsters
| What to Choose? |
|---|
| Most recommended lens designs and modalities for kids include: DAILY DISPOSABLE SOFT CL: CLs are thrown out at the end of wear each day and replaced with brand-new lenses the next day, with less handling and care issues. SILICONE HYDROGEL SOFT CL: SiHy lenses allow for flexible wearing schedules. WEEKLY TO TWO-WEEKLY SOFT DISPOSABLE CL: Viewed as a better option than monthly disposable CLs for eye health. OXYGEN-PERMEABLE (GP) CL: Good for kids who can't handle soft CLs but are still highly motivated to wear CLs. |
Cost issue: In children, Rx changes within a year are likely. Updates with new CLs can actually be more affordable than purchasing multiple pairs of eyewear or repairing broken frames and scratched lenses.
"Sometimes parents are concerned about the cost of daily disposable CLs," Barnett says. "I suggest that I consider daily disposables essential for eye health, but new back-up spectacles optional. The expense saved by not purchasing additional glasses can be used to buy daily CLs."
| The Youngest Patient |
|---|
| How young is too young for CLs? Personal maturity is the decider, not chronological years. The lowest end of the age range is from six to about eight years old. THE SUCCESS DEPENDS ON TWO DECIDING FACTORS: KID PERSONALITY: One doctor fit a precocious eight-year-old patient. The ECP teams spent extra time with training sessions and on insertion and removal over several office visits. PARENTAL SUPPORT: Discuss the importance of parents helping the kids set up a special CL area and care rituals. They need to understand the process, care, and involvement needed from child and parent. If evidence of parental support is sketchy, hold off on starting the young CL wearers. |
Maturity: Personal hygiene is another issue. Walker notes: "If a kid needs to be told to brush his teeth or take a bath, how can I expect him to take reasonable care of his CLs?"
GROW UP
Maintaining optimal eye health is a top priority, as is managing parents, not just kids. This means open, frank discussions about potential risks to eye health by not complying with proper CL wear and care.
Children must be ready to communicate the following in order to successfully adapt to CL use:
- I need more contact lenses
- I need more solution
- My eyes hurt
Also evaluate how parents will respond to these requests. Walker asks: "When kids ask for more CLs, are parents going to tell them to try to extend the life of the lenses?"
With kids and CLs, time smooths the process. "Probably the most common obstacle to overcome with kids is CL training," says Barnett. "I inform the child and parent from the start that it may take more than one visit to accomplish the training. I watch for the point where the child isn't making progress and stop the session for the next visit."
Confidence is key to CL success with kids. Until a measurable level of confidence is reached, for example, being able to insert and remove CLs properly three times, kids shouldn't be able to leave the practice with CLs.
Knight says: "A patient who is successful and happy with CLs is good advertisement for your practice. The patient and their family are also a great long-term annuity." EB
![]({"src":"/media/moldkqbj/62007.jpg","focalPoint":null,"crops":[{"alias":"thumbnail","width":1110,"height":700,"coordinates":null}]})