Application and removal without the tears and tantrums
Experiences of getting younger patients to successfully handle their contact lenses
14 January 2021
It’s not what you do…
‘Kids are not small adults’ is a well coined phrase and never truer than when it comes to the contact lens application and removal session. Having said that, the core instruction content is the same for children as it is for adults. In either case, it is true that a thorough teach will generally lead to a successful contact lens wearer.
I tend to refer to these sessions as handling and hygiene appointments as it’s not just about getting the lens on and off of the eye. The first step is to try and break down any barriers and build a rapport, for instance, by chatting about what sports they like, if they have any pets, to make them comfortable as they are likely to be apprehensive. The language that you use should be determined by the maturity of the patient, so make it simple enough for them to understand and follow while taking time to repeat key points. Young ones can be encouraged to bring along their favourite cuddly toy to give them confidence.
The first step is to try and break down any barriers and build a rapport, for instance, by chatting about what sports they like, if they have any pets, to make them comfortable as they are likely to be apprehensive
If they haven’t had a lens on eye at this point, let them feel a trial lens to remove any fear that it will be uncomfortable. Ask if they have any concerns from the outset and deal with these before continuing. In the author’s experience, the time required at the handling and hygiene visit for children is about the same as an adult; sometimes a six-year-old will be successful in one appointment whereas some adults may need multiple visits.
The pandemic effect
With COVID-19 in mind, it is worth taking steps to limit face-to-face contact time where possible:
• Ensure patients take advantage of online resources to learn in advance how to handle and care for their lenses
• Advise patients to practise some of the techniques shown in the online tutorials, such as holding their eyelids
• Get the patient to gently touch the white of their eye with a clean, dry finger so they can familiarise themselves with the sensation
• Be prepared to run a series of shorter teaching sessions rather than expecting the patient to master the technique in a single sitting – manage expectations in advance in this regard to avoid disappointment.
…It’s how you do it
Ideally the space that you use should be quiet, well-lit and with the mirror at a suitable height for the patient. Have everything you need to hand including a checklist of the main points to cover. Try to limit the audience to one parent or carer to reduce any distractions.
Cleanliness cannot be stressed enough and make a point of explaining the importance of good hand hygiene, including why drying is as important as washing.
‘No tap water’ stickers available from the BCLA to mark the lens boxes ‘right’ and ‘left’ is a good way to remind them. Demonstrate how to tell if the lens is inside out or not and how to inspect the lens for damage or foreign objects.
It is useful for the patient to watch someone else, such as their parent or a practice team member, apply and remove a lens before they try. Then coach them how to apply and remove the lenses themselves. Be prepared to adapt the technique if the patient is struggling and work with them to find an approach that works best for them. If they are having difficulties, ask them to put a lens on their cuddly toy’s eye (if they’ve brought one) or even on your eye – it is amazing how gentle they can be. Remember: don’t press or criticise but offer encouragement as small increments are usually the way forward, for the first lens on eye at least. The second lens is usually applied much quicker. It is always a good idea to repeat the process to rule out any flukes. The instructions for lens and case hygiene is the same as for adults. However, after explaining and demonstrating the process, get the child to show you with a trial lens so that you can iron out any misunderstandings before they take the lenses home.
The instructions for lens and case hygiene is the same as for adults. However, after explaining and demonstrating the process, get the child to show you with a trial lens so that you can iron out any misunderstandings before they take the lenses home
An informed consent form should be read and signed by both the parent or carer and the patient. It should, therefore, be written in a concise, easy to understand language and include a check list of what has been covered during the appointment, wearing schedule, modality and application and removal techniques, with links to online resources. It should also give advice on what to do and where to go if they have any problems. Asking the child to sign it should reinforce the significance of the instructions and how important it is to be compliant. It is vital to remember that good compliance is crucial for safe and successful contact lens wear. To help monitor this, the author uses separate pictures of each stage of the process. At the aftercare appointments, these are placed in a pile and the patient is asked to put them in the correct order.
Time for take away
About the author
Keith Tempany is a multiple award-winning contact lens practitioner and former president of the BCLA