Pearls that make it easier to fit pediatric eyes

Reviewed by Vicky Sheppard, NCLE-AC, FCLSA

Most children who wear contact lenses do so because they have special needs that have arisen from surgery or an injury. Your challenge is not so much fitting lenses on pediatric patients, but dealing with parents or guardians and convincing them of the long-term benefits, according to Vicky Sheppard, NCLE-AC, FCLSA. She is contact lens manager, Kaiser Permanente of Southern California.

Fitting children in contact lenses (CLs) demand both clinical skills and a bit of psychology, Sheppard said. You’ll often be more successful when examining a young patient or checking the fit of CLs if you make it a game. Before you ask the child to look in the slit lamp, offer to check the eyes of a teddy bear, or mom or dad.

Gain parental approval
The greatest hurdles in treating these children can be the parents and guardians, Sheppard noted.

“Parents typically are the most difficult part of the process. The most successful cases are those in which parents understand the medical necessity of having their children wear the lenses every day and buy into the whole program,” she said. “It’s not just getting rid of glasses. It may mean the potential to be able to drive a car some day or whether or not they’ll be able to have the job they want because they have vision that’s usable in both eyes.”

To get parents on your side, couch your explanations about lenses and vision improvement in terms they can grasp. For instance, make it clear that in most states, the child will need 20/40 or better vision to drive and probably won’t reach that level without corrective contact lenses. Also, explain that poor vision in one or both eyes could hinder a child’s ability to play sports.

Educate parents about proper insertion, removal, and cleaning the lenses infants and young children wear, and how to monitor the wearing and hygiene habits of older kids. This is especially important following surgery for a congenital cataract.

Emphasize regular lens wear. Parents may be lax about inserting the lenses or insisting that older children wear them every day, Sheppard said. It may help to explain the difference between wearing lenses for medical and cosmetic lenses. With the latter, the child often can switch to glasses for the day if he or she doesn’t feel like wearing lenses. But when the child is recovering from ocular trauma or surgery, glasses may not be an option, and wearing the contact lenses regularly is the only route to improved vision.

If parents are hesitant to insert the lenses because their children cry, reassure them that the problem is usually not the lens itself but having to open the eye wide enough for insertion, and that the child will soon adjust, Sheppard advised.

Tricks of the trade
A few other tips you can share with parents:

• Swaddle a very young child while inserting and removing lenses. Or, leave the child in the crib until the lenses are inserted. Not only is it easier to deal with a child in this confined area, but also he or she will learn that lens insertion is part of the routine before getting out of bed. And because the lenses will help the child see better, he or she is likely to develop a tolerance for the insertion process fairly quickly.

• Use positive reinforcement at home. Tell the parent to let the child play with a special toy after lens insertion and removal. With a slightly older child, the parent can offer small rewards if they are able to help with lens care.

• Don’t punish a child for misbehavior associated with lens wear. Punishing a child for resisting lens wear or removing lenses at the wrong time reinforces the idea that wearing contact lenses is a negative experience, Sheppard said.

• It will get easier. While a parent assumes much or all of the responsibility for lens wear and care when the child is very young, inform them that the child will be able handle it as he or she gets older. “Kids are usually better patients than adults are,” Sheppard said.

FYI
Vicky Sheppard, NCLE-AC, FCLSA
E-mail: vicky.l.sheppard@kp.org

Sheppard did not disclose any relevant conflicts.

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