Lecture 16 Paediatric fitting Flashcards
What are refractive indications for peadiatric contact lens fitting?
-aphakia
-high myopia
-anisometropia
-frequent changes in rx
What are the pathological/therapeutic indications for paediatric contact lens fittings?
-aniridia (congenital/traumatic defect where parts of iris is missing. Colour contact lens can be used cosmetically or to treat glare.)
-myopia control
What are the lifestyle indications for paediatric contact lens fitting
-cosmetic
-sports
-regular spectacle breakage
What are the concerns of the parent?
*Is there child old enough to wear lenses? A common misconception of age limit.
*Childs ability to manage contact lenses
*Concerned about potential harm to the eye
*Financial consideration. Gos 3 can put towards contact lenses but limited supply.
What can the concerns of the child be?
*Vary with age of the child
*Concerned about pain
*Concerned about difficulty handling
*Fear of disappointing others
What are the concerns of the optometrist?
*Chair time- they fell children need longer in testing room and this can financially impact business
*How to take measurements and conduct clinical tests e.g., lid eversion
*Childs maturity-
*Does the parent/guardian give consent? E.g., for fluorescein, lid eversion etc.
*Childs hygiene
What did the CLIP study find about chair time?
*Chair time was greater for children by 15 minutes approx. compared to teens
*Overall fitting time was similar between children and teens
*Insertion/removal took slightly longer with children than with teens
*Overall time for appointments between the groups is similar
How can you adapt your approach to cater for paed CL fittings?
*Book a longer appointment as you expect more chair time
*Can book during school holidays so child is less tired, more relaxed so more likely to engage
*Some practitioners will use anaesthetic to reduce chair time and reduce “pain”. Anaesthetic itself stings.
*Let child touch, hold, and have a play around with the contact lens. “Touch and be amazed” concept is recommended by contact lens industry.
What are the key points to pick up during a paeds CL history?
*Is anyone at home a contact lens wearer? (Important to know about influences, may have pre-conceived ideas? If parents wear lenses, ask them how they care for their lenses. this stops child adopting bad CL care habits)
*Who wants the contact lenses? Where has the motivation come from? (is it just from the parent)
What are the fitting considerations for children?
RGP: Smaller TD available
SOFT: dailies best option. steep BOZR and small TD available.
What must you consider when fitting babies/infant?
require high plus power so DK of material important to consider as the thickness of the lens is in the middle.
babies will be sleeping in lenses
How can you ensure good compliance?
*Explain procedures to parents AND children
*Written information for parent and child
*Written information for child should be age appropriate
*Provide emergency contact details
*Children tend to be more compliant than teenagers
*At every aftercare, ask child to demonstrate care regime
How can you do a successful teach?
explain procedure
explain how lens might feel on eye (tickles)
rebook for another day if child is struggling
be encouraging and make it fun
