Eunice Myung Lee, OD, FAAO, presented strategies for streamlining the task of fitting more children in contact lenses at the annual meeting of the American Academy of Optometry. "Although the chair time needed with the eye-care practitioner varies depending on the child's age, it is about an extra hour at most," said Dr. Myung Lee, assistant professor and chief, Stein Family Cornea and Contact Lens Service, Southern California College of Optometry, Fullerton.
"Training on lens application, removal, and care are the more time intensive components of pediatric CL fitting, especially with infants or special needs patients," she said. "However, these are tasks that can be handled by other well-trained office staff, and all of the added time and energy spent with these patients should be reflected in an appropriate professional fee."
Teens, tweens, toddlers, infants
If you're just getting started with pediatric CL fitting, you might consider starting with elementary school age children and then working with younger patients as your comfort level grows, she said. She drew on results of the Contact Lenses in Pediatrics Study that showed the chair time was similar for 8 – 11 year olds and 13 – 17 year olds. (Optom Vis Sci 2007;84:896-892)
However, she added that working with babies is usually easier than toddlers, because fitting infants is based purely on objective evaluations with no subjective patient feedback. "Infants also tend to fight less than toddlers," she said.
Parents, however, can present additional challenges. They might be anxious because they're concerned that what they're doing benefits the child and that the child is getting the best possible care. Once the lenses are in, pointing out how the child is now focusing on the parent's face or other objects can be reassuring. "I like to give a lot of positive reinforcement in ways that will bring immediate gratification to the parents," Dr. Myung Lee said.
Parents also play a key role in training for lens application, removal, and care, Dr. Myung Lee said. Invariably, despite how common CL wear is in the adult population, parents of children fit with medically necessary CLs are not typically lens wearers, she said. They may have heightened anxiety about handling the lenses and will need extra encouragement and explanations.
You also need to be prepared for the overbearing parent pushing for CL fitting in an elementary school age child who is not yet ready. These parents need to be carefully monitored during the examination, fitting, and lens care training period to make sure they are supportive in their interactions.
"Sometimes the optometrist needs to serve as a mediator, encouraging parents when appropriate, but also stepping in when the parents need to back off," Dr. Myung Lee said. "Occasionally it is necessary to tell parents bluntly that they are making the situation more difficult, but all parents can be told that training the child to use their lenses generally becomes easier at home than in the office."