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Contact lenses year 3 > Paediatric contact lens fit > Flashcards

Paediatric contact lens fit Flashcards

1
Q

list the 5 most common to the least common parental reasons for requesting CLs

A
  • 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
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2
Q

what are the 4 refractive indications for paediatric CLs

A
  • Aphakia
  • High myopia
  • Anisometropia (different size retinal images)
  • Frequent changes in Rx
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3
Q

wha are the 2 pathology/therapeutic indications for paediatric CLs

A
  • Aniridia (block light coming through, so not to correct vision)
  • Myopia control
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4
Q

what are the 3 lifestyle indications for paediatric CLs

A
  • Cosmetic
  • Sports
  • Regular spectacle breakage
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5
Q

list the 5 people involved in fitting CLs for a child and why you will want to ask who is involved

A
  • 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

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6
Q

what are the 3 key points you want to ask during history and why for each

A
  • 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
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7
Q

what are the 3 possible concerns of the parent/guardian

what 2 things can you do to help with these

A
  • 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
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8
Q

what are the 2 possible concerns of the child

what 2 things can you do to help with these

A
  • 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
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9
Q

list 5 possible concerns that an optometrist may have about fitting CLs on a child

A
  • 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)
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10
Q

which country fits CLs on children the least

A

china

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11
Q

which 2 studies investigated CL fitting and wear for 8-12 year olds
(children) and 13-17 year olds (teens)

A
  • Contact Lenses in Paediatrics study (CLIP)

- Paediatric Refractive Error Profile (PREP)

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12
Q

list 3 things/facts that the CLIP and PREP study found about fitting CLs on children and teenagers

A
  • 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%
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13
Q

what did the CLIP study find about chair time, fitting time and insertion/removal

A
  • 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)
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14
Q

list 5 things that you need to consider how the child will react to during your CL fit

A
  • Darkness
  • Slit lamp check
  • Touching eyelids
  • Lid eversion
  • Instilling fluorescein (tell child it won’t hurt)
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15
Q

list 6 things that you can do to adapt the child’s approach during their CL fit

A
  • 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
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16
Q

why do only some practitioners use anaesthetics to reduce chair time during a child’s CL fit

A

because you really shouldn’t do that, as the child needs to know what it feels like

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17
Q

how may you explain the use of each instrument in child-like/lay terms:

  • keratometer
  • slit lamp
A
  • keratometer: this machine checks how round your eye is
  • slit lamp: this is a giant torch/microscope to check how
    healthy your eye is
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18
Q

between which 2 groups of children is fitting criteria more different and which 2 groups is fitting criteria more the same

A

More different between:
babies/infants and pre school children

More same between:
primary school and secondary school

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19
Q

who do adults not have a significant difference in fitting requirement with

A

children

20
Q

what is the fitting criteria for children with RGP lenses

list 3 parameters

A
  • 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)
21
Q

what is the fitting criteria for children with SCLs

list 4 parameters

A
  • 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)
22
Q

where do babies/infants tend to have their CLs fitted

what are the 2 anatomical differences in their eyes compared to an adults

A
  • Usually in hospital
  • Have smaller inter-palpebral apertures
  • Infants normally have steeper corneas
23
Q

what is the main reason for fitting CLs on babies/infants

and which lenses do they require for this and why

A

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
24
Q

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

A
  • 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
25
Q

how should you teach insertion and removal for an RGP lens and why

A

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
26
Q

how should you teach insertion and removal for a SCL lens and why

A
  • 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
27
Q

list 4 ways/things you can do to make insertion and removal easier

A
  • Videos – YouTube, online
  • Ask mum/dad to get involved
  • Demonstrate on yourself first
  • Demonstrate on toy
28
Q

list 7 points/facts about insertion and removal of lens on a child

A
  • 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)
29
Q

list 4 things you can do to ensure a successful CL teach

A
  • Be encouraging/Be positive
  • Make the procedure fun!
  • Ensure child can complete insertion and removal
  • Ensure child and parent have read instructions
30
Q

list 6 pieces of advice/facts to improve compliance of CL with children

A
  • 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
31
Q

what 3 parts of the eye contribute to myopia

and which part is the most important in myopia

A
  • Axial length
  • Cornea
  • Crystalline lens
  • Axial length most important
32
Q

what impact does a large axial length have on the degree of myopia

A

every 1mm our eye grows = get 3D of myopia

33
Q

list 3 ocular conditions associated with high myopia

A
  • Retinal detachment
  • Posterior staphyloma
  • Myopic maculopathy

As the whole eye grows, the tissues get stretched out

34
Q

how many school leavers in urbanised areas of east asia are myopic
and how many in the UK

A
  • 80-90% china

- 25-30% UK

35
Q

what are the 5 theories of causes of myopia development

A
  • Genetics
  • Environment
  • Gene-environment interaction
  • Accommodative lag
  • Peripheral hyperopia
36
Q

how is genetics linked to myopia development

A
  • it only occurs in small proportion of myopia

- linked more if parents is ~-6D or more

37
Q

how is environment linked to myopia

A

lack of being outdoors, using iPads and staying indoors

38
Q

how is Gene-environment interaction linked to myopia

A

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

39
Q

how is accommodative lag linked to myopia and what theory is this linked to
how can you find if this is true

A
  • 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
40
Q

list the 3 types of myopia control techniques and what is used/done in each one

A
  • Optical
    Contact lenses
    Spectacles
  • Pharmaceutical
    Atropine (low dose) and others
  • Environmental
    Mainly outdoor play/time outdoors
41
Q

what is a contradiction of using atropine for myopia control

A

when the child stops taking it, the myopia may get worse

42
Q

how do some optoms prescribe their spectacle rx for aiding myopia control and what is a contradiction to this

A
  • some optoms under corrected kids to deal with the accommodative lag
  • some said the myopia progressed faster
43
Q

what are the 2 contact lens options used for myopia control

A
  • Orthokeratology

- Multifocal lenses

44
Q

how are multifocal lenses used for myopia control,where is this used a lot and what is the lens called

A
  • 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
45
Q

list the 3 indications/clinical reasons for paediatric CL fitting

A
  • refractive
  • pathology/therapeutic
  • lifestyle

Contact lenses year 3 (15 decks)

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