Optometry

Look for motivation, maturity

Fred Sirotkin, OD: Recent studies have shown contact lenses to be a reasonable cosmetic alternative for children as young as 8 years old. However, there is no magic age that defines contact lens safety or low risk for children. What we are looking for is responsibility and good hygiene habits in a motivated, mature child.

Fred Sirotkin

If the parents are not impressed or comfortable with the reliability of their child in these areas, we will not encourage them to proceed with contact lenses. If the parents are strong supporters of their child’s responsibility and habits, that is a great place to start. We rely, to some degree, on parental supervision for very young children. The motivation to wear has to come from the child, however. Failure is almost guaranteed in an anxious younger child if the idea to wear contacts is exclusive to the parent or the doctor.

We, as well as many doctors, have fit very young children for contacts in specific circumstances such as monocular aphakia or amblyopia. We have had 3-year-old aphakes handling lenses and being very responsible about it.

As a cosmetic alternative, thanks to safer options, many doctors have begun fitting younger patients with contact lenses. Contacts with higher Dk values in soft and gas-permeable versions as well as daily disposable soft lenses have allowed doctors to feel comfortable with a larger safety margin for potentially noncompliant patients.

We tend to use disposable silicone hydrogel lenses or 1-day disposables for children and we never allow extended wear. In GP lens fits we rely on high Dk lenses as do those who perform orthokeratology. In addition, we always consider ease of lens handling in a young child.

For more information:

• Fred Sirotkin, OD, can be reached at 6350 Stevens Forest Rd., Suite #101, Columbia, MD 21046; (410) 964-8516; fax: (410) 740-8626; fsiro@comcast.net.

Evaluate five criteria

Mile Brujic, OD: Contact lenses offer our patients a number of benefits such as enhanced peripheral vision that is unattainable with eyeglasses, improved visual acuity in those with high prescriptions and not having to worry about damaging their glasses, because they simply are not wearing them. Realizing that these benefits are achieved by all ages of patients and that pediatric patients are more active than adults, I have removed age as a barrier to contact lens wear.

Mile Brujic

Instead, I analyze motivation for lens wear, maturity level of the patient, physical characteristics of the ocular surface, prescription requirements and the patient’s lifestyle. It is a combination of these five factors that will ultimately determine whether a child will be fit with contact lenses.

Parents have to be in agreement that contact lenses are the right thing for their child. This oftentimes involves educating them in the exam room of the safety of contact lenses when fit and worn properly and the fact that adverse events are usually caused by contact lens abuse. Parents will either be very supportive, neutral or opposed to contact lens wear for their child.

I explain to parents that I want to be an objective source for them and will give them the information that they need to make an informed decision about whether or not to proceed with contact lens wear for their child.

The modality of contact lenses that I prescribe for children is one that I do not try to pigeonhole to a certain age patient. So, I will usually not have one modality of lens that I recommend to a certain age group. Instead, I assess each patient individually utilizing my five criteria and determine from those factors what modality would be best for the patient, regardless of age.

For more information:

• Mile Brujic, OD, is a partner of Premier Vision Group, a four-location optometric practice in Northwest Ohio. He can be reached at 1222 Ridgewood Dr., Bowling Green, OH 43402; (419) 352-2502; brujic@prodigy.net.

Fit patients as young as 8 years

Mary Lou French, OD, MEd, FAAO: When I began my practice, gas-permeable lenses were the norm. Through trial and error I found that age 10 was the youngest patient I could successfully fit. Developmentally, a patient this age understood that the lenses would be more comfortable in a few days; younger patients were not capable of that level of understanding, thus had difficulties with the initial fitting, let alone continued wear of the lenses.

Mary Lou French

With the advent of soft lenses, then disposable lenses and now daily disposable lenses, I routinely discuss contact lenses as an alternative to eyeglasses with patients as young as 8 years of age.

In my community, sports are a large part of many children’s lives. This is the most significant reason I recommend contact lenses and the reason both the patient and the parents begin requesting them.

For my patients who will be wearing the contact lenses exclusively for sports, daily disposables are my lenses of choice, for ease of care and for lessened risk of adverse events. For patients who will be wearing contact lenses as their primary vision correction, I recommend 2-week disposable contact lenses, but I am seeing a trend in my office to the daily disposable contact lenses now that there are more options available in 90-packs.

While these young patients are fun to fit, challenges still exist in this age group. I could not be successful without the support of my staff, who performs the initial lens insertion at the diagnostic visit as well as the instruction. The rewards of improving a child’s life visually, psychologically, as well as socially are why I fit young children with contact lenses.

For more information:

• Mary Lou French, OD, MEd, FAAO, can be reached at 14315 S. 108th Ave., Suite 110, Orland Park, IL 60467; (708) 403-0123; fax: (708) 403-7593; mlfrenchod@comcast.net; www.childrenseyes.com.

Consider responsibility level

Pennye Stammer Doud, OD: I am not only a primary eye care provider but also the mother of two very active myopic children. I empathize with the frustration of glasses fogging up underneath a football helmet, not “fitting in” with the costume for the school play or getting mangled or broken on the soccer field.

Pennye Stammer Doud

Parents will often ask, “At what age do you recommend contact lenses?” My personal philosophy and standard answer is that contact lens success is typically not predicted by a child’s age but rather by his or her ability to follow rules and be an active participant in the responsibilities required to wear contact lenses. I have found that the 7- to 17-year-olds are typically the most reliable and responsible patients and that special attention should be paid to the college-age kids to make sure they are not sloppy in their compliance.

Once the interest in contact lenses has been established, the second part of my discussion includes recommending daily disposable contact lenses. Parents want to trust that their child is getting the healthiest lens on the market. Many of my youngest contact lens wearers start out using their lenses for a specific sport or activity a few times a week and evolve into full-time contact lens wearers. Regardless of whether the child is wearing the contact lenses once a week or every day, I stress that the contact lenses should be removed at least 1 hour prior to bedtime to give the eyes a chance to breathe and prepare for the next day.

My staff and I take every opportunity to reinforce the concept that contact lenses are another choice on the “vision correction menu,” and that given today’s lens technology, now is the best time for kids to try contact lenses.

For more information:

• Pennye Stammer Doud, OD, can be reached at the Annapolis Vision Center, 130 Holiday Court, Suite 109, Annapolis, MD 21401; (410) 266-0099; fax: (410) 266-8629; pdoud@annapolisvision.com; www.annapolisvision.com.

Introduce the topic with first pair of glasses

Ellen L. Weiss, OD: I mention contact lenses as an option to my pediatric patients when I prescribe their first pair of glasses. I do not pressure them; I just open the door to the child and their parents and say that this is an option, when they choose to pursue it.

Ellen L. Weiss

Is there an age where initial contact lens wear is appropriate? Kids are doing more these days, at an earlier age. Look at how many children start playing a select sport or are on a club team by the time they are 8 or 9 years old. If the child wants contact lenses, I have no problem fitting him or her at any age. What I have realized over the past several years is that younger children are the most compliant when it comes to following my instructions on proper handling, wearing schedule and care of their contact lenses.

I have personally never liked the term “cosmetic” contact lens, for any prescription. Optically there are certain prescriptions for which a child will function better wearing contact lenses vs. glasses. I have a little more encouraging conversation with parents when I feel that their child would see better in contact lenses.

There are so many great options now, so I fit some type of disposable contact lens whenever possible. If the patient has allergies or the parents are concerned about compliance or hygiene, I will recommend a daily disposable. Otherwise, I will offer this as an option along with some type of frequent replacement lens and let the parents be in on the decision. I do not recommend kids start out sleeping in their contact lenses, as I want them to have some experience with all aspects of their contact lenses first.

For more information:

• Ellen L. Weiss, OD, can be reached at Millard Family Eyecare, P.C., 12660 Q Street, Omaha, NE 68137; (402) 896-3300; fax: (402) 896-5931; ellenweiss@millardfamilyeyecare.com.

Suggested contacts to motivated children

Jason R. Miller, OD, MBA, FAAO: As long as the child’s eyes are healthy, with no corneal disease, and the refractive error is necessary to have correction full-time, contact lenses are an acceptable alternative to eyeglasses when the child is motivated to wear them. That is the response I give to most of the parents when I am asked in my office.

Jason R. Miller

I want this to be an incredibly positive experience. If I can make the transition to contact lenses extremely smooth for this young group of patients, they will likely tell many of their friends at school. Their friends who need glasses will likely start asking their parents for contact lenses and will hopefully turn into multiple referrals for my office.

For those reasons, I encourage daily disposable contact lenses most of the time when I am fitting a pre-teen contact lens wearer. I do not trust that the child will thoroughly clean their lenses or change them as recommended at a young age. Daily disposable contact lenses are much more convenient and will provide less stress on the parents.

If daily disposable contact lenses are not the best option for some reason, I immediately look to fit a silicone hydrogel material. In addition, I encourage an “extra” contact lens follow-up at about 3 months post-fitting. This enables me to check in with the child, trouble shoot any issues and make sure they are taking care of their eyes properly before I dispense an annual supply of contact lenses.

There are times when I will fit contact lenses at an even younger age if I am treating amblyopia or for myopia control. In that situation, I will provide thorough instructions to the parents on how to take care of the contact lenses in addition to taking them in and out of their child’s eyes.

For more information:

• Jason R. Miller, OD, MBA, FAAO, can be reached at EyeCare Professionals of Powell, 9711-C Sawmill Pkwy., Powell, OH 43065; (614) 793-0700; fax: (614) 793-0084; jasonrmiller@columbus.rr.com.