Dispensing Contact Lenses to Children

With more children wanting or needing to wear contacts, we thought this article on working with pediatric lens wearers provides good information for parents and their kids

The right steps in the beginning can make all the difference There are few things more gratifying than knowing you’ve made a difference that will last a lifetime. One is the joy of dispensing pediatric contact lenses. Even the best contact lens fit, however, will only be as successful as the dispensing.

TIPS ON APPLICATION
• The caregiver should remain calm and work efficiently before the child (or caregiver) becomes upset. The contact lens fitter may find himself working in a dual role as instructor and counselor. The caregiver’s fears need to be addressed and handled or the child will pick up on the anxiety, causing more stress during the application. It is helpful to give the caregiver specific focusing techniques, such as breathing exercises or counting to three before the lens goes on.

• The caregiver should find a comfortable position and immobilize the child if necessary. In most cases, immobilization techniques are not needed after a couple of weeks.

• The eye does not have to be completely open to get a gas permeable (GP) or high plus soft lens on. If the lens can be placed under a gap in the upper lid, the lens can be pushed up and on, while remaining parallel to the eye. Once the lens is on halfway, the lower lid can be pulled out from under the lens.

• Reassure the caregiver that a misplaced lens will not cause injury to the eye or pain to the child. It will eventually move down on its own. The worst thing a caregiver could do is to go “fishing” for the lens. Lens fishing will cause swelling and increase the anxiety of the child. Gently squirting sterile saline under the upper eye lids will increase comfort and generally cause the lens to float down.

• Praise the child and let him know that he did a good job with the application, removal and wear.

• Lids should be handled at the lid margins (think eyelashes). If force is put on the lids elsewhere, the eyelids may flip. The lid margins give the most stable surface for lens manipulations and for pushing under the lens for removal.

DAILY ROUTINE
Practices will vary in theory on whether the lenses should be removed daily, but there are several reasons the lens should go on and off on a daily basis.

• Children work better within a daily routine. This is less of a contact lens tip and more overall parenting advice. Children like to know what to expect.

• The caregiver is more proficient at handling if the lenses are removed daily.

• The child is better at having the lenses applied. The contact lenses will certainly come out at inconvenient times. It is best if they can go back on without a fuss.

• The lenses stay cleaner, which will lead to better comfort, less inflammation and infection and better optics.

• Caregivers who cringe at the thought of the daily application and removal fight will be surprised at how quickly a daily routine becomes, well, routine.

• Keep in mind that continuous wear may be an option for certain children and/or situations.

WHAT TO WATCH FOR
• Fit changes can be expected at around six to eight weeks, four to six months, nine to 12 months and two to three years of age. Caregivers should watch for the lenses to de-center or pop out.

• The caregiver must be made aware that they will need a back-up lens and to carry the lenses with them, in case the others are lost. Children have been known to eat their lenses.

• The acronym RSVP stands for redness, secretions, visual blurring (if the child can communicate this) and pain. The caregiver needs to be aware of these symptoms, remove the lenses immediately and notify the doctor.

WEARING TIME
The wearing time should be about six to eight hours the first day, 10 hours the second day and then all waking hours. The child may nap in the lenses, but they should be removed at night.

WHEN DOES THE CHILD TAKE OVER?
Children may take over lens removal at ages four to five, application at six to eight and cleaning and care at 10 to 12 years. Of course, all of this depends on the maturity and dexterity of the child, as well as lens type.

FOLLOW-UP CARE
• Caregiver compliance is necessary for follow-up appointments. During the progress evaluation, the doctor needs to obtain a good lens history. Every attempt should be made to access visual function, keeping in mind caregiver impression is important.

• Re-education in certain aspects of contact lens care or application and removal may also need to take place at these appointments. Lens care in children is time consuming and can be stressful, but also rewarding. If the dispensing is done correctly, it sets the parents and child up for years of positive vision.

Excerpted from a feature that originally appeared in October 2005 Review of Cornea & contact lenses Anita Miller is a certified paraoptometric assistant, who has worked in the Contact Lens Clinic at the University of Iowa for 18 years.

Reprinted Courtesy 20/20 magazine

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