Although common wisdom dictates that most children should wait until age 12, there is no hard and fast rule about when a child can begin using contact lenses. You can help your little patients and their families make this important decision. Unless the contacts are medically necessary, let the child’s maturity and motivation be your guide.
WHEN ARE CONTACTS MEDICALLY NECESSARY?
You all know the answers to this question: Anisometropia, nystagmus, congenital aphakia, amblyopia, ectopia lentis, degenerative myopia, irregular astigmatism, and a myriad of other conditions in which a child needs optical correction but cannot wear glasses.
Why not implant an IOL? While there is no statistically significant difference in grading visual acuity, at age 1, between the IOL and CL groups; complications occur more frequently in the IOL group. Most surgeons are therefore reluctant to place IOLs in children under 3.
WHAT SHOULD THE FITTING PROCESS ENTAIL?
This process will vary widely. We see babies monthly or even weekly because initially the lens is worn overnight and the fitting is quite complex. Parents are eventually taught to remove the lens nightly. Often, the lenses become integral to amblyopia treatment and one is removed for six to eight hours a day instead of traditional patching therapy. It seems daunting at first, but with the right guidance, all parents become experts more quickly than you can imagine.
When a tween asks about contacts, a thorough eye examination comes first, and if parents and doctor deem the child ready, a fitting is scheduled. The lapse allows the family to consider the child’s motivation and the doctor to preorder contacts. It also reduces fatigue for both parties, reinforcing the importance of the evaluation as a separate and crucial process for life.
When the child arrives at the fitting appointment excited and motivated, the doctor discusses rules and expectations, places a pair of lenses on the eyes and checks the initial fit, comfort and vision. The child, parent or both are then taught to insert, remove and care for the lenses.
I prefer to fit children in dailies, but it is not always feasible for all prescriptions or budgets. Depending on specific visual and lifestyle demands, some children are prescribed more than one type of lens.
Once a family demonstrates good facility with handling, we send them home with their first pair of contacts. Often, this process requires more than one visit. Prepare the family for the eventuality that you might ask them to return several times until proficiency is gained. We want the child to be safe and happy with their lenses for years to come.
On the follow-up visit, check fit and acuity, reinforce all instructions and encourage the parent and child to ask questions. Often a third or fourth visit may be needed. Remember, the goal is a perfectly healthy eye, a comfortable lens and clear vision. There is no rush to get there. I ask to see the child again in three to six months but this will vary and depend on many factors. Whatever the schedule, encourage the parents not to miss these visits and always, tell the kid you want to hear from them whenever problems arise.
Good luck, and enjoy the lifelong relationship of trust and respect you will form with your littlest patients.
This article originally appeared in the May 2016 edition of INVISION.
Dr. Viola Kanevsky grew up on Manhattan’s Upper West Side and has been serving her community for the past 25 years. With an OD from SUNY State College of Optometry, she specializes in pediatric and specialty contact lenses at her practice, Acuity NYC.