Contact Lens Spectrum
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C O N T A C T L E N S S P E C T R U M S P E C I A L E D I T I O N 2 0 1 6 c l s p e c t r u m . c o m 54 PEDIA TRIC & TEEN CL CARE Dr. Frogozo specializes in adult and pe- diatric specialty contact lenses. She is the director of the Contact Lens Institute of San Antonio and the owner of Alamo Eye Care in San Antonio, Texas. You can contact her at contactlensinstitutesa@gmail.com. LIFELONG WEARERS FROM THE START M any young patients are motivated to wear con- tact lenses. In fact, children as young as 8 years old are capable of wearing soft contact lenses (Soni,1995). For a variety of reasons after youth, adult patients frequently discontinue contact lens wear. Here, I will discuss five strategies for get- ting our young population into contact lenses and keeping them healthy, lifelong wearers. #1 Choose Ideal Young Candidates Creating successful lifelong wearers starts by choosing good candidates. First, the child should be motivated and show an interest in contact lenses. Next, make sure the patient is mature enough for contact lens wear. Note if the child converses easily. Ascertain if he or she excels in academics, sports, or arts — all of which are signs of maturity. Third, ensure the child is able to han- dle the lenses and follow care instruc- tions. Fourth, choose candidates with good hygiene. Also consider prescription require- ments. Myopic, hyperopic, and astig- matic children are good candidates for contact lenses. Of note, athletes are great potential patients. Not only do contact lenses improve central and peripheral vision, but they often make the child more confident while play- ing sports (Walline et al, 2014). #2 Prescribe the Best Material and Modality The healthiest lens material and modality for the patient will provide the best comfort. Often, patients will discontinue wearing contact lenses because they are uncomfortable (Rueff et al, 2016). There is a signifi- cant connection between the level of available oxygen during contact lens wear and improved comfort (Dille- hay, 2007). Therefore, consider fitting your young patients in a lens made of address the need for presbyopic cor- rection in their contact lenses. Even emerging/early presbyopic patients report better satisfaction with multi- focal optics in comparison with their habitual single vision soft lenses and versus monovision correction (Woods et al, 2009). #4 Address Ocular Health Concerns Primarily, wettability of the ocular surface is a main factor causing con- tact lens drop out (Best et al, 2013). Therefore, prescribe artificial tears to aid in management of dry eye symptoms and address any addition- al surface conditions, such as aller- gic conjunctivitis and anterior and posterior blepharitis. Also, consider certain systemic conditions, such as Sjögrens syndrome and rosacea, which can cause surface disease if not addressed appropriately. # 5 Listen to the Patient Taking a thorough history that includes patient expectations from contact lens wear, social history, daily routine activities, and medical his- tory will guide in prescribing the best contact lens for the patient. Addi- tionally, updating this information as the patient ages will aid in creating a contact lens plan to keep them life- long wearers. For references, please visit www. clspectrum.com/references and click on document #SE2016. silicone hydrogel material, which of- fers more oxygen to the corneal sur- face compared to conventional hy- drogel materials. Additionally, if the prescription permits it, a daily disposable lens is — without argument — the healthi- est soft lens modality. The sever- ity of infection (Carnt and Stapleton, 2016) and allergic papillary con- junctivitis (Donshik and Porazin- ski, 1999) risk is decreased with daily disposable versus longer planned replacement soft lenses. #3 Maximize Vision Correction Make every effort to provide the best quality of vision with contact lenses. If their contact lenses don't provide better quality of vision, pa- tients will revert back to wearing spec- tacles (Rueff et al, 2016). Correcting fully for astigmatism goes a long way in providing sharper optics. In fact, prescribing low amounts of astigma- tism with toric contact lenses shows improvement in acuity compared to prescribing the spherical equivalent alone (Richdale et al, 2007). Additionally, as the patient matures in age, make sure to appropriately U F P. 0 2 5 7 . U S A . 1 6 M E L A N I E FR O G OZO, O D, FA AO