Spring 2017

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CLSA EyeWitness Spring 2017 25 ticipate in high impact activities, the risk of injury if hit in the face is rela- tively high. The same emergency room survey mentioned earlier re- vealed that 9% of all medical device related pediatric admittances were secondary to eyeglass related inju- ries 2 . Increased sweat causes glasses to slide down the nose or they can fall off and break, leaving the child unable to see clearly which can be debilitating. Spectacle lenses can fog up in humid conditions and wet lenses in the rain can lead to a decrease in visual quality. Depending on style, some frames can even limit peripheral vision. Contact lenses may provide a comfortable solution to these limita- tions. Additionally, they can improve visual quality by providing consistent- ly clear, crisp vision and can be used in conjunction with protective eyewear. The spectrum of daily disposable op- tions that are available today allows for a wide range of refractive errors to be corrected, with some even offering a modest amount of UV protection. This modality is the top choice when it comes to contact lens fitting for ev- eryday use in children. Protective eye wear should always be recommended in addition to contact lens wear. III. Kids and Self-Perception If a child is asking to wear contact lens- es, parents may want to consider that a child may not be comfortable with their appearance while wearing eyeglass- es, or perhaps they are getting teased by their peers. In the Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) study, nearly 500 children between the ages of 8- and 11-years-old were ran- domized to either contact lens wear or spectacle lens wear and were followed for three years. This clinical trial found that children who wore contact lenses felt significantly better about them- selves and felt more confident in athlet- ic competence, social acceptance and physical appearance. The social pressures of growing up today can negatively impact and hinder social development and overall Dr. Stephanie Ramdass is a clinical researcher at the Vision Research Institute and adjunct faculty member at the Michigan College of Optometry (MCO). She completed her Bachelor's Degree in Human Biology at the University of Toronto, Canada. She obtained a Master's Degree in Biomedical Sciences at Rosalind Franklin University of Medicine and Science in Chicago, Illinois before receiving her Doctorate of Optometry at the Inter American University of Puerto Rico School of Optometry. Upon graduation from optometry school, she completed a residency in Cornea and Contact Lens (MCO) and is a fellow of the American Academy of Optometry. Her research interests include myopia control, presbyopic lens designs, and the application of scleral lenses for normal eyes and in tinted form. performance both inside and outside of school. Practitioners should take this into consideration when discuss- ing types of refractive error correction with patients. REINFORCING CARE & HANDLING PROCEDURES It is no surprise that children do well with a routine, as most of us do. It is important for both practitioner, par- ent, child, as well as staff to be on the same page when it comes to contact lens fitting. Children take a little more time on the front end in order to allow them to master the insertion and re- moval process and understand the care system when applicable. This is one of the reasons why daily disposables are preferred due to the low maintenance and lack of cleaning steps involved. Children should not be rushed during contact lens teaching sessions. They should be taken to a designated area to learn to insert and remove their lenses. It is best to have the child demonstrate that he/she can insert and remove their lenses on their own prior to leav- ing your office. In the case of over- night orthokeratology, if a parent will be the one inserting and removing the lenses, ensure they are taught the ap- propriate methodology to be success- ful with the specific treatment regimen. Two-week and one-month dispos- able modalities, if necessary to pre- scribe, should be accompanied by a simple, all in one contact lens solution for ease of use. Avoid hydrogen perox- ide based systems as the steps involved in these options may be too complicat- ed for a young child to follow. In such cases, lens case hygiene is also import- ant to address. FOLLOW-UP & LONG-TERM PLAN OF ACTION After a fitting visit for myopia correc- tion, a follow-up office visit should be scheduled in 1-2 weeks in order to as- sess how the patient is doing. Remind parents and/or patient that lenses should be worn into the office for their visits. During the initial fitting visit, an adequate number of contact lenses should be provided. In the case where myopia control is the prescribed treatment, follow-up is more frequent and should include the first day following overnight wear with orthokeratology. Corneal topography should be performed at each follow-up visit. Topography can also be per- formed over a soft multifocal contact lens and in both cases, the subtractive maps feature of your topography can allow you to monitor the extent of treat- ment and position of lens on the eye. CONCLUSION Children who begin to wear contact lenses at a young age can easily transi- tion into adulthood as a successful con- tact lens wearer. Contact lens fitting in children can be extremely rewarding for both practitioner and patient, as it can be the building blocks for a lifetime of successful contact lens wear. EW References on file at the CLSA office

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