Spring 2017

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CLINICAL PEARLS: OVERCOMING CONCERNS OF POTENTIAL SCLERAL LENS PATIENTS Why are some patients hesitant to wear scleral lenses and how do I overcome the barriers they present? Your ability to recommend scleral lenses when you believe they are the best choice, and your skill in confidently overcoming patient concerns will be a big determinant of your success with the modality. Patient: They cost too much! My response: I would show them the cost of a two year supply of soft lenses versus one pair of scleral lenses. The cost is usually very similar. Combined with the advantages of the design responsible for my recom- mendation, the scleral lens provides excellent value to the patient. Patient: They are difficult to handle! My response: If a current CL wearer, I remind them how difficult it was to learn to wear lenses when they first became a wearer. If new to contacts, I relate it to a new skill such as driving or a sport. I tell the patient everything has a learning curve, but I feel the advantages of this modality are worth the effort required by you to be successful. Remember to be patient and a good coach should they decide to take the challenge! Patient: Aren't they hard lenses? My response: I avoid using the word "hard" lenses while still being honest. I describe the lenses to the patient as oxygen permeable lenses with leading edge technology that combines the best attributes of soft lenses (comfort) and rigid lenses (vision). Offer the patient a chance to expe- rience the feel of a diagnostic lens with no obligation. Choose your diagnostic lens wisely making sure you do not put a lens on that is too flat. You may spend an extra 5-10 minutes of chair time, but once the patient experiences the comfort, they are often convinced. 15 CLSA EyeWitness Spring 2017 findings in the publication was that ad- verse events were low and that the young- er children took a little longer to train application and removal of the contact lenses. The more impressive outcomes from this study were determined by a tool used more frequently in child psycholo- gy referred to as the Pediatric Refractive Error Profile (PREP) survey. The PREP survey is a clinically validated quality of life instrument to assess how a child "sees" him or herself. This 26-question survey revealed that contact lenses improved the child's self-image in regards to their ap- pearance, increased confidence in them- selves while participating in activities, and overall improved satisfaction of their form of vision correction. These findings were consistent in both age groups. More than 80% of both age groups found con- tact lenses easy to clean and take care of as all participants were fitted with 2-week disposable soft lenses and used a multi- purpose disinfection care system. The ACHIEVE Study The Adolescent and Child Health Ini- tiative to Encourage Vision Empower- ment (ACHIEVE) study was published in 2009. Jeff Walline, OD and his col- leagues designed this study to find out the affects that glasses and contacts had on the self-perception of the child. This study examined 484 myopic chil- dren 8-11 years. The participants were randomized to spectacles (n=237) or contact lenses (n=247) and followed for three years. The children were eval- uated at baseline, 1 month and every 6 months for three years by a validated psychology tool for self-perception re- ferred to as the Self-Perception Profile for Children (SPPC). The SPPC instru- ment allows a 4-point self-assessment in 6 categories – scholastic competence, social acceptance, athletic competence, physical appearance, behavioral con- duct and global self-worth. The partic- ipants revealed the most dramatic areas of improvement with contact lenses compared to spectacles in the areas of physical appearance, athletic compe- tence, scholastic competence and social acceptance. Similar to the low occur- rence of adverse events with contact A LITTLE CASE STUDY: A delightful 3.5-year-old little girl presented to the clinic wearing spectacles with a cyclo-refraction of OD -24.00 + 6.00 x 100 and OS -23.00 +4.75 x 85. She was successfully fit into bitoric gas permeable contact lenses and has continued to do well on follow-up. On evaluating these young children, I find using +10.00 readers with base-in prism and a blue cobalt flashlight tends to work better for me than a burton lamp.

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