paediatric CL fitting

Question 1

refractive indications for paediatric CL fitting

Answer 1

• aphakia
• high myopia
• anisometropia
• frequent chnages in rx

Question 2

pathology/therapeutic indications for paediatric CL fitting

Answer 2

• aniridia
• myopia management

Question 3

lifestyle indications for paediatric CL fitting

Answer 3

• cosmetic
• sports
• regular spectacle breakage

Question 4

what is aniridia?

Answer 4

congenital or traumatic defect where the iris or part of the iris is missing

Question 5

how would you use a CL to help with aniridia?

Answer 5

therapeutic - use a coloured CL to mimic the iris

Question 6

what are some common concerns from a parent?

Answer 6

• child’s ability to manage CLs
• potential harm to child’s eye
• are they old enough?
• financial consideration

Question 7

is there an age limit for the use of CLs?

Answer 7

no !!

Question 8

GOS3 and cls?

Answer 8

gos3 can be put towards cls but better used for specs as it will ocver the full cost of specs

Question 9

what are some common concerns for the child?

Answer 9

• painful
• difficult to handle
• disappointing others

Question 10

if a child has no motivation for wearing CLs, what do you do?

Answer 10

defer fitting to a later date or when the child is older and has appropriate conversations with their parents

Question 11

what are some concerns for the optom?

Answer 11

• financial impact of chair time
• how to take measurements and conduct clinical tests e.g lid eversion
• maturity
• consent from parent/guardian
• child’s hygiene

Question 12

in the world, where are paediatric CL fittings the highest? (top 3)

Answer 12

israel
colombia
spain

Question 13

which 2 studies investigates CL fitting and wear for children and teens?

Answer 13

CLIP and PREP

Question 14

what does CLIP stand for?

Answer 14

CL in Paediatrics

Question 15

what does PREP stand for?

Answer 15

Paediatric Refractive Error Profile

Question 16

what did the CLIP and PREP survey find?

Answer 16

• CL improved how children feel about their appearance and participation
• improvement in quality of life within 1 week (23-24%)

Question 17

what did the CLIP study find out about chair time?

Answer 17

chair time is greater for children by 15 mins compared to teens
- chair time is similar between children and teens
- insertion/removal took slight longer with children than it did with teens

Question 18

how do you adapt your approach?

Answer 18

• book a longer appointment
• book in school holidays so less tired
• some practitioners will use an anaesthetic to reduce chair time
• let the child touch lens
• MAKE IT FUN
• USE LAY TERMS

Question 19

do you use anaesthetic when fitting CL in kids?

Answer 19

no - will give the impression the lenses will hurt

Question 20

2 important qs to ask in h&S

Answer 20

• is anyone at home a CL wearer? : any pre-conceived ideas? adopted bad CL care habits
• who wants the contact lenses? ; is the child motivated enough to trial CL?

Question 21

what are some considerations for when you are doing slit lamp?

Answer 21

• darkness
• touching eyelids
• lid eversion
• instilling NaFl

Question 22

how would you explain keratometry to a child?

Answer 22

this machine checks how round your eye is

Question 23

how do you explain slit lamp to a child?

Answer 23

this is a giant torch/microscope to check how healthy your eye is

Question 24

what are some fitting considerations for RGPs?

Answer 24

BOZR same Ks as adult by 10 yrs old
TDs available in smaller values e.g. 9mm

Question 25

what are some fitting considerations for soft lenses?

Answer 25

- SiHy if available in power range - less change of hypoxia - daily disposable best option - steep BOZR and mini TDs available

Question 26

considerations when fitting babies with CLs

Answer 26

- usually in hospital - have smaller inter-palpebral apertures - infants normally have steeper corneas

Question 27

aphakia in babies/infants - what power do you give from 0-12 months?

Answer 27

+29-32D

Question 28

aphakia in babies/infants - what power do you give from 12-24 months?

Answer 28

+20-26D

Question 29

aphakia in babies/infants - what power do you give from >2 years?

Answer 29

+12-20D

Question 30

what happens to the power of the CL, as axial length increases?

Answer 30

decrease (emmetropise)

Question 31

if a baby has aphakia, what feature of a CL is a significant consideration?

Answer 31

DK

Question 32

how to explain the sensation of CLs to a child?

Answer 32

- explain procedure - explain lens may tickle when first inserted - explain its important they feel the lens - DONT USE THE WORD PAIN - if child is struggling rebook for another day

Question 33

how do you teach a child to put a lens in and out?

Answer 33

- be encouraging/be positive - make the procedure fun! - ensure child can complete insertion and removal - ensure child and parent have read instructions

Question 34

how do you ensure compliance in a child?

Answer 34

- explain procedures to parents AND child - written info for parent and child - written info for child should be age appropriate - provide emergency contact details - children tend to be more compliant than teenagers - at every AC ask child to demonstrate care regime

Question 35

why do infant aphakes need a more positive powered lens?

Answer 35

shorter axial length