paediatric CL fitting Flashcards
refractive indications for paediatric CL fitting
- aphakia
- high myopia
- anisometropia
- frequent chnages in rx
pathology/therapeutic indications for paediatric CL fitting
- aniridia
- myopia management
lifestyle indications for paediatric CL fitting
- cosmetic
- sports
- regular spectacle breakage
what is aniridia?
congenital or traumatic defect where the iris or part of the iris is missing
how would you use a CL to help with aniridia?
therapeutic - use a coloured CL to mimic the iris
what are some common concerns from a parent?
- child’s ability to manage CLs
- potential harm to child’s eye
- are they old enough?
- financial consideration
is there an age limit for the use of CLs?
no !!
GOS3 and cls?
gos3 can be put towards cls but better used for specs as it will ocver the full cost of specs
what are some common concerns for the child?
- painful
- difficult to handle
- disappointing others
if a child has no motivation for wearing CLs, what do you do?
defer fitting to a later date or when the child is older and has appropriate conversations with their parents
what are some concerns for the optom?
- financial impact of chair time
- how to take measurements and conduct clinical tests e.g lid eversion
- maturity
- consent from parent/guardian
- child’s hygiene
in the world, where are paediatric CL fittings the highest? (top 3)
israel
colombia
spain
which 2 studies investigates CL fitting and wear for children and teens?
CLIP and PREP
what does CLIP stand for?
CL in Paediatrics
what does PREP stand for?
Paediatric Refractive Error Profile
what did the CLIP and PREP survey find?
- CL improved how children feel about their appearance and participation
- improvement in quality of life within 1 week (23-24%)
what did the CLIP study find out about chair time?
chair time is greater for children by 15 mins compared to teens
- chair time is similar between children and teens
- insertion/removal took slight longer with children than it did with teens
how do you adapt your approach?
- book a longer appointment
- book in school holidays so less tired
- some practitioners will use an anaesthetic to reduce chair time
- let the child touch lens
- MAKE IT FUN
- USE LAY TERMS
do you use anaesthetic when fitting CL in kids?
no - will give the impression the lenses will hurt
2 important qs to ask in h&S
- is anyone at home a CL wearer? : any pre-conceived ideas? adopted bad CL care habits
- who wants the contact lenses? ; is the child motivated enough to trial CL?
what are some considerations for when you are doing slit lamp?
- darkness
- touching eyelids
- lid eversion
- instilling NaFl
how would you explain keratometry to a child?
this machine checks how round your eye is
how do you explain slit lamp to a child?
this is a giant torch/microscope to check how healthy your eye is
what are some fitting considerations for RGPs?
BOZR same Ks as adult by 10 yrs old
TDs available in smaller values e.g. 9mm
what are some fitting considerations for soft lenses?
- SiHy if available in power range - less change of hypoxia
- daily disposable best option
- steep BOZR and mini TDs available
considerations when fitting babies with CLs
- usually in hospital
- have smaller inter-palpebral apertures
- infants normally have steeper corneas
aphakia in babies/infants - what power do you give from 0-12 months?
+29-32D
aphakia in babies/infants - what power do you give from 12-24 months?
+20-26D
aphakia in babies/infants - what power do you give from >2 years?
+12-20D
what happens to the power of the CL, as axial length increases?
decrease (emmetropise)
if a baby has aphakia, what feature of a CL is a significant consideration?
DK
how to explain the sensation of CLs to a child?
- explain procedure
- explain lens may tickle when first inserted
- explain its important they feel the lens
- DONT USE THE WORD PAIN
- if child is struggling rebook for another day
how do you teach a child to put a lens in and out?
- be encouraging/be positive
- make the procedure fun!
- ensure child can complete insertion and removal
- ensure child and parent have read instructions
how do you ensure compliance in a child?
- explain procedures to parents AND child
- written info for parent and child
- written info for child should be age appropriate
- provide emergency contact details
- children tend to be more compliant than teenagers
- at every AC ask child to demonstrate care regime
why do infant aphakes need a more positive powered lens?
shorter axial length
