Paediatric contact lens fit Flashcards
list the 5 most common to the least common parental reasons for requesting CLs
- current vision correction interferes with sports
- child refuses to wear spectacles
- current vision correction interferes with daily activities
- friend or family member recently got CLs
- child is teased at school about wearing spectacles
what are the 4 refractive indications for paediatric CLs
- Aphakia
- High myopia
- Anisometropia (different size retinal images)
- Frequent changes in Rx
wha are the 2 pathology/therapeutic indications for paediatric CLs
- Aniridia (block light coming through, so not to correct vision)
- Myopia control
what are the 3 lifestyle indications for paediatric CLs
- Cosmetic
- Sports
- Regular spectacle breakage
list the 5 people involved in fitting CLs for a child and why you will want to ask who is involved
- Parents/Guardian
- Friends and family
- Child
- Optometrist
- Teachers
so everything must be explained to e.g. the parents as they’re involved in the care of the CLs
what are the 3 key points you want to ask during history and why for each
- who’s involved?
- Is anyone at home a contact lens wearer?
– Pre-conceived ideas
– Adopted bad CL care habits - to see if that other person is compliant as well - Who wants the contact lenses?
– Is the child motivated enough to trial CL
what are the 3 possible concerns of the parent/guardian
what 2 things can you do to help with these
- Financial burden
- Child’s ability to manage contact
lenses - Concerned about potential harm to eye
- Try and involve parent/guardian in all decisions and management
- Give parents time to ask all the questions they need to ask
what are the 2 possible concerns of the child
what 2 things can you do to help with these
- Concerned about pain
- Fear of disappointing family/optician/themselves
- Try and involve the child in all decisions and management and reassure them
- Give child time to ask all questions they need to ask
list 5 possible concerns that an optometrist may have about fitting CLs on a child
- Chair time - financial impact (child could keep coming back for teaches)
- How to take measurements
and conduct clinical tests e.g. lid eversion (may not reach SL) - Child’s hygiene
- Child’s maturity
- Does the parent/guardian give consent? (must ask)
which country fits CLs on children the least
china
which 2 studies investigated CL fitting and wear for 8-12 year olds
(children) and 13-17 year olds (teens)
- Contact Lenses in Paediatrics study (CLIP)
- Paediatric Refractive Error Profile (PREP)
list 3 things/facts that the CLIP and PREP study found about fitting CLs on children and teenagers
- CL wear improved how children and teens felt about their appearance and participation in
activities - Children and teens reported a significant improvement in quality of life within one week of being fitted with CLs
- After 3/12 the improvement in quality of life scores was ~23-24%
what did the CLIP study find about chair time, fitting time and insertion/removal
- Chair time was greater for children by ~15 mins compared to teens
- Overall fitting time was similar between children and teens
- Insertion removal took slightly longer with children than it did
with teens
(this took the most extra time out of everything)
list 5 things that you need to consider how the child will react to during your CL fit
- Darkness
- Slit lamp check
- Touching eyelids
- Lid eversion
- Instilling fluorescein (tell child it won’t hurt)
list 6 things that you can do to adapt the child’s approach during their CL fit
- Book a longer appointment as you expect more chair time
- Maybe book during school holidays (so child has time to come back for follow up appts)
- Some practitioners will use an anaesthetic to reduce chair time
- Use lay terms
- Make it fun!
- Let child touch lens
why do only some practitioners use anaesthetics to reduce chair time during a child’s CL fit
because you really shouldn’t do that, as the child needs to know what it feels like
how may you explain the use of each instrument in child-like/lay terms:
- keratometer
- slit lamp
- keratometer: this machine checks how round your eye is
- slit lamp: this is a giant torch/microscope to check how
healthy your eye is
between which 2 groups of children is fitting criteria more different and which 2 groups is fitting criteria more the same
More different between:
babies/infants and pre school children
More same between:
primary school and secondary school
who do adults not have a significant difference in fitting requirement with
children
what is the fitting criteria for children with RGP lenses
list 3 parameters
- High Dk needed and possibly high Ref index
- BOZR same Ks as adult by age ~10 yrs
- TDs available in smaller values e.g. 9.00mm (steeper lenses)
what is the fitting criteria for children with SCLs
list 4 parameters
- High Water Content
- SiHy if available in power range
Less change of hypoxia related problems such as neovascularisation - Daily disposable best option - simpler maintenance for child and lower rate of infection
- Steep BOZR and mini TDs available (as younger children do have steeper BCs)
where do babies/infants tend to have their CLs fitted
what are the 2 anatomical differences in their eyes compared to an adults
- Usually in hospital
- Have smaller inter-palpebral apertures
- Infants normally have steeper corneas
what is the main reason for fitting CLs on babies/infants
and which lenses do they require for this and why
Aphakia - due to congenital cataract being removed
- Infant aphakes usually require higher positive powers than adults due to a shorter axial length
- The highly plus powered
lens necessitates the use of high Dk materials
when teaching insertion and removal to a child, what 3 things must you explain to the child
what must you be careful of
what should you do if the child is struggling
- Explain procedure
- Explain how lens might feel on eye when first inserted e.g. tickles/feels like something in your eye
- Explain it is important they feel lens
- Be careful in your choice of words - don’t use the word pain
- Rebook for another day, or few
weeks time, if child is struggling
how should you teach insertion and removal for an RGP lens and why
place on the cornea to avoid placing lens on conjunctiva, to avoid scraping the cornea as the lens moves from conj to cornea
- Manipulate the lids for RGPs
how should you teach insertion and removal for a SCL lens and why
- may need to push up under the top lid - may need to place on conj first as its less sensitive and then can move to cornea as it won’t scar
- Pinch off cornea if necessary
for SCL
list 4 ways/things you can do to make insertion and removal easier
- Videos – YouTube, online
- Ask mum/dad to get involved
- Demonstrate on yourself first
- Demonstrate on toy
list 7 points/facts about insertion and removal of lens on a child
- Be patient, may take more time
- Can be a struggle
- Ask child to sit on hands?
- Rest head on headrest
- Helps if child fixates on something e.g. picture on wall
- Ask parent/carer to stand nearby or hold child’s hand
- Removal usually easier than insertion (but must make sure child can take CL out)
list 4 things you can do to ensure a successful CL teach
- Be encouraging/Be positive
- Make the procedure fun!
- Ensure child can complete insertion and removal
- Ensure child and parent have read instructions
list 6 pieces of advice/facts to improve compliance of CL with children
- 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
what 3 parts of the eye contribute to myopia
and which part is the most important in myopia
- Axial length
- Cornea
- Crystalline lens
- Axial length most important
what impact does a large axial length have on the degree of myopia
every 1mm our eye grows = get 3D of myopia
list 3 ocular conditions associated with high myopia
- Retinal detachment
- Posterior staphyloma
- Myopic maculopathy
As the whole eye grows, the tissues get stretched out
how many school leavers in urbanised areas of east asia are myopic
and how many in the UK
- 80-90% china
- 25-30% UK
what are the 5 theories of causes of myopia development
- Genetics
- Environment
- Gene-environment interaction
- Accommodative lag
- Peripheral hyperopia
how is genetics linked to myopia development
- it only occurs in small proportion of myopia
- linked more if parents is ~-6D or more
how is environment linked to myopia
lack of being outdoors, using iPads and staying indoors
how is Gene-environment interaction linked to myopia
if have the gene and stay indoors and does lots of close work = can become myopic
but if spends lots of time outside = does not become myopic so the gene does get or can get switched on or off, depending on the environment
how is accommodative lag linked to myopia and what theory is this linked to
how can you find if this is true
- as a myopic px doesnt accommodate enough
- linked to the theory of peripheral hyperopia
- would find this if did ret in the periphery of the px eye
list the 3 types of myopia control techniques and what is used/done in each one
- Optical
Contact lenses
Spectacles - Pharmaceutical
Atropine (low dose) and others - Environmental
Mainly outdoor play/time outdoors
what is a contradiction of using atropine for myopia control
when the child stops taking it, the myopia may get worse
how do some optoms prescribe their spectacle rx for aiding myopia control and what is a contradiction to this
- some optoms under corrected kids to deal with the accommodative lag
- some said the myopia progressed faster
what are the 2 contact lens options used for myopia control
- Orthokeratology
- Multifocal lenses
how are multifocal lenses used for myopia control,where is this used a lot and what is the lens called
- Some practitioners use concentric design (centre distance) multifocal lenses off-label
so child can see through the middle of the lens and treat the peripheral hyperopia at the same time - myopia inhibiting lens market at
present. Available in East Asia – MiSight lens
list the 3 indications/clinical reasons for paediatric CL fitting
- refractive
- pathology/therapeutic
- lifestyle
