Making contacts child's play
OT poses a monthly scenario from a practitioner. This month, we look at fitting contact lenses as a newly-qualified optometrist
21 May 2019
Joseph, AOP member
“I am a newly-qualified practitioner and the experience that I have gained with contact lenses over the last six months in practice has been limited. It is an area that I am really interested in and would like to feel more comfortable both raising and discussing it with patients, as well as fitting children and ‘tweens.’ Would you have any advice or tips to share?”
Indie Grewal, optometrist and BCLA council member
When it comes to raising the topic of contact lenses with younger patients, I always ensure that I have done some initial exploration during the eye examination. During the test, I start to find out more about the child – what their hobbies are, what they do in and outside of school, if they play any sport and if they take their glasses off for any of these activities. A question that I also always like to ask is: “Can you tell me about a time when your glasses were a nuisance to you and why?”
Having done my research, at the end of the eye exam I will summarise my findings and raise the idea of contact lenses by saying something like: “Your eyes are healthy and I’m really glad to tell you that you would be a great candidate for contact lenses.” This is a good way to begin the discussion about contact lenses and what it means with both the parent and the child.
You should be ready to speak and reassure parents about some of the misconceptions that they may have. For example, a common response from parents can be that their child is too young for contact lenses. My response to this is that at our practice, we regularly fit children as young as six years old, and research shows that young children tend to be more compliant and likely to form good habits as contact lens wearers.
For some hesitant parents, I find it useful to make them physically aware of what their child will see when they are not wearing their glasses, for example, for sport. I do this by putting them in a trial frame and adjusting the prescription.
Motivation is of pivotal importance when fitting a child with contact lenses. The child must be motivated to wear contact lenses – there has to be a benefit to them wearing contact lenses otherwise they won’t do it.
When it comes to raising the topic of contact lenses with younger patients, I always ensure that I have done some initial exploration during the eye examination
If the parent and child are not keen on contact lenses when first raised, it does not mean that you have been dismissed. Often, if it is the first time that they have ever thought about contact lenses, they simply may wish to go away and think about it, or speak to others about it. Therefore, when they come in for their next six-month check, don’t be put off about raising it again as they may be more open to a conversation.
Age is just a number
Don’t be scared to raise contact lenses with a patient, regardless of their age. In fact, I would recommend that newly-qualified optometrists have the conversation with everybody regardless of age because everybody has the right to be informed that contact lenses, as a vision correction is a potential option. In addition, by mentioning it to everyone, you will find that a lot of people really are interested in having a conversation about contact lenses, it’s just that no one has raised it with them before. The more of these conversations you have, the more relaxed you will feel raising the topic in the future.
If the parent and child are open to having discussion about contact lenses, I would offer the child a comfort trial. We generally have daily disposable contact lenses to hand and can offer them to try them there and then in a controlled environment.
I make it clear that I am not asking them to go ahead with it, but to just wear them for an hour to feel what contact lenses are like. When they return after an hour, a measure of the child’s enthusiasm may be apparent. Many children may not remember clear vision without spectacles.
It’s really important to give children the opportunity to touch and feel a contact lens – let them have a play so they can see that it doesn’t break easily and that it’s really thin.
The journey from discussion to trial should not be too arduous or you may put young patients off. My preferred approach is to conduct a white light examination and fluorescein, prior to lens application. I perform other measurements after the initial trial, such as HVID and topography.
Motivation is of pivotal importance when fitting a child with contact lenses
In my experience, using the right language is key when discussing contact lenses with children. Avoid using terms like ‘this is not going to hurt.’ Negative language will give you a negative response and make contact lens fitting trickier. I simply explain that it is going to feel like a cold rain drop, for example, and once in you will not feel it at all.
If you are nervous about fitting children, seek out the easiest candidates first, create a need, establish the motivation and focus on explaining more to those who are interested. Maybe start by fitting a teenager and make it your mission to fit someone a year younger next time.
Remember that children are not scary, they will comply and they are a good sector of the market to target with contact lenses.
- As told to Emily McCormick.
Image credit: Trudy Loosman