Paediatric contact lens fit Flashcards
(45 cards)
list the 5 most common to the least common parental reasons for requesting CLs
- current vision correction interferes with sports
- child refuses to wear spectacles
- current vision correction interferes with daily activities
- friend or family member recently got CLs
- child is teased at school about wearing spectacles
what are the 4 refractive indications for paediatric CLs
- Aphakia
- High myopia
- Anisometropia (different size retinal images)
- Frequent changes in Rx
wha are the 2 pathology/therapeutic indications for paediatric CLs
- Aniridia (block light coming through, so not to correct vision)
- Myopia control
what are the 3 lifestyle indications for paediatric CLs
- Cosmetic
- Sports
- Regular spectacle breakage
list the 5 people involved in fitting CLs for a child and why you will want to ask who is involved
- Parents/Guardian
- Friends and family
- Child
- Optometrist
- Teachers
so everything must be explained to e.g. the parents as they’re involved in the care of the CLs
what are the 3 key points you want to ask during history and why for each
- who’s involved?
- Is anyone at home a contact lens wearer?
– Pre-conceived ideas
– Adopted bad CL care habits - to see if that other person is compliant as well - Who wants the contact lenses?
– Is the child motivated enough to trial CL
what are the 3 possible concerns of the parent/guardian
what 2 things can you do to help with these
- Financial burden
- Child’s ability to manage contact
lenses - Concerned about potential harm to eye
- Try and involve parent/guardian in all decisions and management
- Give parents time to ask all the questions they need to ask
what are the 2 possible concerns of the child
what 2 things can you do to help with these
- Concerned about pain
- Fear of disappointing family/optician/themselves
- Try and involve the child in all decisions and management and reassure them
- Give child time to ask all questions they need to ask
list 5 possible concerns that an optometrist may have about fitting CLs on a child
- Chair time - financial impact (child could keep coming back for teaches)
- How to take measurements
and conduct clinical tests e.g. lid eversion (may not reach SL) - Child’s hygiene
- Child’s maturity
- Does the parent/guardian give consent? (must ask)
which country fits CLs on children the least
china
which 2 studies investigated CL fitting and wear for 8-12 year olds
(children) and 13-17 year olds (teens)
- Contact Lenses in Paediatrics study (CLIP)
- Paediatric Refractive Error Profile (PREP)
list 3 things/facts that the CLIP and PREP study found about fitting CLs on children and teenagers
- CL wear improved how children and teens felt about their appearance and participation in
activities - Children and teens reported a significant improvement in quality of life within one week of being fitted with CLs
- After 3/12 the improvement in quality of life scores was ~23-24%
what did the CLIP study find about chair time, fitting time and insertion/removal
- Chair time was greater for children by ~15 mins compared to teens
- Overall fitting time was similar between children and teens
- Insertion removal took slightly longer with children than it did
with teens
(this took the most extra time out of everything)
list 5 things that you need to consider how the child will react to during your CL fit
- Darkness
- Slit lamp check
- Touching eyelids
- Lid eversion
- Instilling fluorescein (tell child it won’t hurt)
list 6 things that you can do to adapt the child’s approach during their CL fit
- Book a longer appointment as you expect more chair time
- Maybe book during school holidays (so child has time to come back for follow up appts)
- Some practitioners will use an anaesthetic to reduce chair time
- Use lay terms
- Make it fun!
- Let child touch lens
why do only some practitioners use anaesthetics to reduce chair time during a child’s CL fit
because you really shouldn’t do that, as the child needs to know what it feels like
how may you explain the use of each instrument in child-like/lay terms:
- keratometer
- slit lamp
- keratometer: this machine checks how round your eye is
- slit lamp: this is a giant torch/microscope to check how
healthy your eye is
between which 2 groups of children is fitting criteria more different and which 2 groups is fitting criteria more the same
More different between:
babies/infants and pre school children
More same between:
primary school and secondary school
who do adults not have a significant difference in fitting requirement with
children
what is the fitting criteria for children with RGP lenses
list 3 parameters
- High Dk needed and possibly high Ref index
- BOZR same Ks as adult by age ~10 yrs
- TDs available in smaller values e.g. 9.00mm (steeper lenses)
what is the fitting criteria for children with SCLs
list 4 parameters
- High Water Content
- SiHy if available in power range
Less change of hypoxia related problems such as neovascularisation - Daily disposable best option - simpler maintenance for child and lower rate of infection
- Steep BOZR and mini TDs available (as younger children do have steeper BCs)
where do babies/infants tend to have their CLs fitted
what are the 2 anatomical differences in their eyes compared to an adults
- Usually in hospital
- Have smaller inter-palpebral apertures
- Infants normally have steeper corneas
what is the main reason for fitting CLs on babies/infants
and which lenses do they require for this and why
Aphakia - due to congenital cataract being removed
- Infant aphakes usually require higher positive powers than adults due to a shorter axial length
- The highly plus powered
lens necessitates the use of high Dk materials
when teaching insertion and removal to a child, what 3 things must you explain to the child
what must you be careful of
what should you do if the child is struggling
- Explain procedure
- Explain how lens might feel on eye when first inserted e.g. tickles/feels like something in your eye
- Explain it is important they feel lens
- Be careful in your choice of words - don’t use the word pain
- Rebook for another day, or few
weeks time, if child is struggling
