Spring 2017

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22 CLSA EyeWitness Spring 2017 er worn" or "they are lost or broken again," these could be signs that per- haps a child is not quite ready to han- dle the responsibilities associated with contact lens wear. CAN WEARING CONTACT LENSES MAKE A CHILD'S EYES WORSE? For parents who show concern when the option of contact lenses is present- ed for management of their child's re- fractive error, they can be reassured that lens wear will not exacerbate the problem. For example, myopia typical- ly first occurs in school-aged children in conjunction with the natural develop- ment of a child and progresses with age. Research has shown that using soft con- tact lenses for vision correction does not cause a clinically significant increase in myopia 4 . In a multicenter, random- ized clinical trial, the rate of change per year in refractive error was only 0.06 D higher in soft contact lens wearers than subjects who were spectacle wearers 4 . Table 1 summaries some of the major studies that can be referenced to help address some of the apprehensions that parents may have to their kids using contact lenses on a regular basis. A 2010 survey administered by the American Optometric Associa- tion aimed to assess prescribing prac- tices among its members regarding their opinions on fitting contact lenses in younger age groups 6 . Over 95% of respondents indicated that they fit pa- tients under the age of 18, however less than 3% said they fit patients under the age of 9. When asked what is the appro- priate age to introduce contact lenses to children, nearly 25% of all those sur- veyed chose under 9 years of age. The discrepancy between actu- al fits and practitioner attitudes both globally and nationwide is likely im- pacted by the comfort level and will- ingness of a parent and child to pursue a contact lens fit even if presented in the office. Even though surveys show that practitioners would fit young pa- tients with contact lenses, the actual number of fits is quite low. These re- sults lead us to ask the following ques- of their consistency with completing repetitive tasks such as brushing their teeth, taking a bath or carrying out chores such as cleaning their room. A responsible 7-year-old may be a more appropriate contact lens candidate than an apparent rambunctious, care- less 9-year-old. In this sense, minimum age thresholds for contact lens wear are is variable in clinical practice and often depend on the comfortability of individual practitioners. Typically, elective fitting of con- tact lenses will occur with a child who has an established refraction. Parents should be reminded that glasses must always be brought into their child's annual eye exam. If glasses are not available for inspection at the eye exam due to reasons such as "they are nev- to start fitting a child in contact lenses. Excluding patients who need contact lenses, when would it be appropriate to start recommending contact lenses? Some eyecare professionals wait un- til they are teenagers while others use milestones such as the onset of mid- dle school. Regardless of the age of a child, if they are not mature enough to accept the responsibility of handling a medical device, then you may want to reconsider prescribing contact lenses even if a parent insists. Aside from observing the man- nerisms of a child in your exam chair, what other actions can be taken to de- termine if contact lens wear is appro- priate? It is helpful to directly involve the child in any exam room discussion whenever possible. They can be asked

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