Let’s begin with the impracticality of spectacles for children. Apart from the frequent repairs – we all have at least one child in practice whose file is a foot thick – there’s also frame fitting.
How often do we fit a spectacles frame to a child in the certain knowledge that it won’t look anything like this in a month’s time? Maybe it’ll be bent in a fall or left on a chair to be sat on, tried on by all of their friends to prove how rubbish their sight is, or perhaps the child has the effrontery to grow. Whatever happens, the frame is likely to not stay put, at which point the back vertex distance (BVD) will probably be wrong, giving rise to a different effective power, which is a big problem for any child trying to do their homework.
First, find a reason
When approaching the conversation on contact lenses for my younger patients, I often begin by asking a child how their spectacles are for sports and PE, with the most common response being: “The teacher makes me take them off.” In my experience, I would estimate that in 75% of cases this is the first time that mum or dad has heard this, and once they are aware that the reason little Herbert has never made the rugby team is because he can’t see the ball, they’re enthusiastic about finding a solution. At this point, contact lenses almost suggest themselves.
We also have the reluctant young spectacles wearers who may end up amblyopic for want of correction, and the anisometropes who may struggle with their full prescription in a frame, yet find it easier in contact lenses.
So, having established some reasons why contact lenses are of benefit – and trust me, there are many more – I move on to the how.
The answer is simple – keep talking. For example, if we see that little Herbert’s frame is sliding down his nose like Eddie the Eagle on greased skis, we can explain to him and his parents exactly what this is doing to her vision, and why school work seems so tiring and difficult. The conversation can then progress to the benefits of a lens placed directly on the eye, which will stay put and give a constant prescription. They also allow the use of sunspecs to reduce the risks of UV damage, not to mention the fact that he may now make the football/rugby team. The fact that her level of self confidence will probably be raised enormously is a mere happy accident on the side.
"During a consultation, all questions are aimed at the child, and while mum is welcome to chip in, I insist that the child gets the first go at answering"
Getting the parents on board
As previously stated, most parents are happy to find a solution once they know there is a problem. However, they do understandably have concerns that their little treasure may be permanently damaged by what is effectively a foreign body in the eye, or that previous experience of little Herbert’s personal hygiene suggests he won’t take proper care of the lenses.
I give both the parent and child a lens to hold, squeeze and generally play with, and I reassure parents that, in my experience, an eight-year-old with a parent standing behind them is way more compliant than almost any 28-year-old you can find. And, if they’re not, there are usually some tell-tale signs, partly because mum will share stories, and partly because I have a slit lamp so I can see if a lens is clean.
I explain clearly that the role of supervision belongs to the parent, while responsibility must be the child’s. On the subject of responsibility, I need to know that the child is capable of answering questions for themselves. Sometimes when I ask a child if they take medication for anything, they look at mum as if they sincerely entertain the idea that she might be secretly drugging them. I want to make sure that when I ask a contact lens wearer how it’s going, they can tell me, not rely on mum to guess. Therefore, during a consultation, all questions are aimed at the child, and while parents are welcome to chip in, I insist that the child gets the first go at answering. This is often a crucial part of building the practitioner-patient relationship, which is vital to successful contact lens wear.
Finally, if a child bites you, they’re probably not ready for contact lenses yet. Yes, that happened…