Fitting children with contact lenses

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					               Contact Lens Monthly CET

Fitting children with contact lenses
Part 2
In the second and final part of our series on paediatric lens fitting, Anna Sulley describes the
process of patient assessment, lens selection and fitting, and the management of follow-up
appointments. Module C11178, two contact lens points suitable for optometrists and CLOs

           ontact lenses (CLs) can have
           a large impact on a child’s
           development and confi-
           dence, in addition to the visual
           benefits. The first article on
fitting children (March 6) described
how this provides a tremendous oppor-
tunity to develop a practice, in addition
to giving a sense of satisfaction by
making a difference to their lives. It
reviewed compliance, motivation and
recent research into the benefits lenses
offer children. This second article will
discuss strategies when fitting children
in practice.
   There are clinically no differences in
the fitting of young children compared
to teenagers or adults, and ocular
parameters and physiological needs are
the same. However, the way to manage
the child will be different; this should
be done ‘through the eyes of a child’.
We have all been there, some longer ago
than others, and many are now parents.
Empathy with their needs, attitudes and
concerns is essential, in addition to creat-
ing a child-friendly environment.
                                               Ocular parameter assessment is the same for children as for adults
Consumer information
The child and their parents may be             although the College website does have           different to that with older potential
well-informed about lens wear prior            detailed advice on orthokeratology.              CL wearers (Table 1). The procedures
to the fitting from personal experience        Providing additional, useful and child-          should be explained using layman’s
or through access to a range of infor-         friendly consumer information on lens            terms. Use the same routine to ensure
mation online. Consumer and practi-            wear will help prepare them for their            it flows smoothly and does not take too
tioners’ websites provide details on           appointment; this can include leaflets,          much time. When fitting the lenses,
lens benefits, when children can start         posters and even videos. The videos              don’t be tempted to say they won’t feel
wearing CLs and dispelling common              could also be loaned to patients to view         anything; once they then do, they will
myths. Manufacturer websites                   in more detail at home if required.              not trust you! Be honest; let them know
also have similar information specific                                                          they will feel the lens for a few seconds,
to children (including www.acuvue.             Fitting routine                                  but that it will get better., and                Practitioners need to be tolerant, positive         Some children will cry initially; this Alcon has launched            and honest when fitting children. As             does not mean that they will not be
a user-friendly website including facts        during an eye examination, the child’s           successful, but are anxious. It is impor-
about how to look after lenses, details        parent or guardian needs to be present           tant to work quickly and confidently
on ‘Kids & contacts: is your child ready?’     and included in all stages of the fitting,       to minimise any build-up of concern.
and ‘teen-scene’ pages (www.optifree.          from initial consultation to the teach-          If they do cry, let the child and parent However, there is not a large          ing appointment. Not only from a legal           take a break from the fitting process. If
amount of information available on             perspective and to help make decisions           a child will not let you insert lenses, try
professional organisation websites. The        about lens type, but to learn about the          teaching insertion first to continue with
College of Optometrists, BCLA and              procedures carried out during a fitting          the fitting procedure.
ABDO website cover general advice on           and to encourage them to ask questions;
lens wear and the regulations govern-          this all helps to develop a relationship         Lens handling
ing sale and supply, but no information        with the practitioner.                           Once the fitting is completed, explain
specifically on children wearing lenses,         The fitting procedure will be little           lens handling instructions. The CLIP

22 | Optician | 03.04.09                                                                                  
                                                                              CET Contact Lens Monthly

study1 showed younger children took           TAbLe 1
longer to fit than teenagers due to differ-   Fitting routine
ences in teaching time, so this could be
carried out by a support staff member to
                                              ● Accurate refraction
reduce practitioner chair-time. If optical
assistants help with teaching, make sure      ● Keratometry and other necessary ocular measurements
they are happy and confident dealing          ● Slit-lamp biomicroscopy
with children. Areas to cover during the            ● Examine tarsal conjunctiva for baseline assessment and excellent indicator of success on child’s
teaching appointment are summarised                   reaction to having lids everted!
in Table 2.                                         ● Fluorescein staining for baseline assessment and gets child used to having drops in eyes
  Although a child’s parents will always
be involved in the education process to       ● Explain any findings, such as lid margin disease, that may need managing
improve compliance, it is important to        ● Understand patient (and parent) needs, ensuring parent does not answer all questions!
consider the child’s level of understand-
ing when giving instructions. A child         ● Discuss lens options and agree on best lens type to fit
with poor comprehension or literacy           ● Insert different designs or base curves in each eye to reduce the number of times lenses need
skills may not be considered an ideal            be inserted, and allows comfort comparisons between lenses
CL wearer, especially since those who
misunderstand diagnosis or treatment          ● When fitting RGPs, ask child to hold chin up while looking down to improve comfort; some
plans usually exhibit poor compliance,2          advocate use of topical anaesthetic on the lens before insertion
but CLs may be their best option for          ● Once lens is inserted, ask child questions to take their mind off the lens
refractive error correction and their
level of understanding should not             ● Suggest a tolerance trial away from the clinical environment while child adapts to lenses
prevent them from trying lenses. Use          ● Final fit assessment, over-refraction and visual acuities
simpler language, repeat instructions
and demonstrate key points. Combine
this with short, easy-to-read, written        TAbLe 2
materials to enhance their understand-        Advice for children and parents on handling and lens wear and care
ing and encourage good behaviour.
                                               ● Teach insertion and removal
Wearing times                                       ● Prior to appointment, child can practice touching conjunctiva with clean finger and instilling
Wearing times for children need be no                 rewetting drops
different than with adults, although CLs            ● Handle and tear lenses discarded during fitting process
are likely to be worn for fewer hours,              ● If parents ask to insert or remove CLs for child (if they are lens wearers), advise not recommended
or even on a part-time basis if used just             as child must be able to handle CLs independently
for sporting activities. Initiating the             ● If unsuccessful, let child and parent know they just need to wait a while until handling techniques
fitting process during school holidays                are improved
allows time for appointments and both
parents and child will be more relaxed         ● Educate on hygiene
                                                     ●   Hand-washing
putting lenses in without the usual                  ●   Advise no tap water should be used
pre-school chaos. Parents often allow
a small contingency for running late           ● Explain about replacement schedules and wearing times
in the morning; an extra five to 10                 ●    Parents need initially to remind child to remove and clean CLs at night
minutes for lens insertion may push a               ●    Parents need to arrange regular aftercare appointments, even if no symptoms
busy family over the edge. Suggest that        ● Demonstrate use of care regimen (if required) and case care
lens care become a part of the child’s
routine; routines are important to             ● Give easy to understand, written instructions
most children and they may feel more                 ●   Ask child to answer questions to ensure comprehension of steps involved
comfortable with certain guidelines for        ● Give rewards for success as added incentive, along with stickers and novelty take-homes in
an unfamiliar concept. If the intention           starter packs
is for the child to wear the lenses on         ● Advise that patient must maintain up-to-date spectacles
a part-time basis, they should ideally
wear the lenses every day for the first        ● Swimming – remove lenses, use daily disposables or wear tight fitting goggles and disinfect
couple of weeks to get used to handling           lenses after swimming (or use prescription swimming goggles)
them.                                          ● Advise of potential, although rare, risks involved and to seek advice if any signs or symptoms
The first aftercare appointment needs
to be within a week or two of being                           and lens care; review the condition of         independence, and parental involve-
fitted; established wearers should be                         their CL case. Repeat questions asked          ment will help decide whether the child
seen at least every six months. As with                       during the teach appointment to check          is likely to wear them successfully.3
the fitting, the aftercare is as for older                    they remember what is required for safe
patients. Visual acuities and an over-                        lens wear.                                     Supply of CLs to children
refraction, including regular refractions                       There are no strong indicators of            Children need permission from their
and binocular vision status, are impor-                       successful adaptation to CL wear, but          parents to wear lenses, and some
tant since these may change frequently.                       anecdotal feedback such as the child’s         practitioners may wish to document
Children should demonstrate handling                          reaction to discomfort, the child’s            this on the patient’s records. The latest                                                                                                                 03.04.09 | Optician | 23
               Contact Lens Monthly CET

guidance on the sale and supply of                                                           Essential features of a CL for children
CLs for wearers under 16 years states        TAbLe 3                                         are listed in Table 3. Parents may have
that lenses can only be bought under         Contact lens features                           certain expectations as to the lens they
the direct supervision of a registered                                                       would like their child to wear; this may
optometrist, contact lens optician or         ● High oxygen performance for corneal health   be the lens type they wear. If an alterna-
medical practitioner.                         ● High comfort levels                          tive product is indicated, careful expla-
   Some practitioners may decide to                                                          nation is needed of the lens features
use an informed consent form with             ● Minimal deposition and wettable material     and benefits, and it may also become
children and their parents. This written      ● Good vision quality and stability            an opportunity to upgrade the parents
document should be in easy language to                                                       to a different lens.
understand with legible font style and        ● Frequent replacement or daily disposable
size, and could include statements that       ● Wide range parameters                        Lens material
the child will wash their hands before                                                       Soft or RGP materials can be prescribed,
handling lenses, remove lenses at night       ● Good handling                                with soft materials having a significant
and let their parents know if problems        ● Simple, yet effective, care regimen          comfort advantage. Silicone hydrogels
arise.                                        ● Handling tint and inversion indicator        (SiH) have the additional advantage of
                                                                                             superior oxygen performance compared
Lens type selection                           ● UV block                                     to traditional hydrogel materials, with
Practitioners need to determine with          ● Good value                                   comparable oxygen performance to high
young patients and their parents the                                                         Dk RGPs, and are often easier to handle
best modality and lens type to fit their                                                     than hydrogels. This allows confidence
personality, maturity and lifestyle, in                                                      when prescribing for full time wear and
addition to satisfying visual and ocular                                                     with higher prescriptions. SiH materi-
needs. Studies show that children are       needs, lifestyle (wearing time, sport),          als are mostly prescribed on a daily wear
able to wear frequent-replacement,          refraction, ocular conditions (lid margin        basis4 and are available in a wide range
daily disposable and rigid gas-perme-       disease), health conditions (atopy) and          of parameters and designs. There are
able (RGP) lenses. They can be worn         any budget constraints. There are a              now several SiH torics to choose from
part time, which is ideal for sports, and   range of features that may indicate a            and a daily disposable option.
are an affordable option for the major-     particular lens type, including handling            RGPs were historically considered
ity of patients.                            properties (design, material, handling           the main lens option for children, offer-
   The lens type selected will depend       tint and inversion indicators), comfort          ing excellent vision and ocular health
on a range of factors including patient     levels or UV-blocking properties.                benefits. They are ideal for higher or

24 | Optician | 03.04.09                                                                             
                                                             CET Contact Lens Monthly

more unusual refractions. Material           fewer overall complications, increased         Solutions
developments for improved wettabil-          patient satisfaction and fewer unsched-        If frequent replacement lenses
ity and improved comfort with larger         uled aftercare visits.7 They also have         are worn, a cleaning regimen is
diameters, thinner profiles and better       the additional advantages of a no-care         required. This should be simple yet
edge design will help to improve success,    regimen and they can simply be thrown          effective; the easier the instructions
although there are always going to be        away at the end of each wear. Young            for use, the more likely the child is
a less popular lens type for comfort         children wearing a daily disposable in a       to comply, hence single-bottle multi-
compared to soft lenses. Around four         three-month wearing study were able to         purpose solutions or one-step perox-
in five myopic children aged eight to        care for and wear the CLs successfully.8       ide systems are ideal. Lens wearers
11 years can adapt to RGP lens wear5         Despite the increase in cost, parents          have been shown to have poor levels
and 70 per cent of those will wear them      will often request daily disposables for       of compliance,9 in particular chang-
for three years.6 It can usually be deter-   convenience over the lower cost of             ing solutions daily and lens cases
mined whether or not RGP wear is             frequent replacement lenses.8 They are         being neither air-dried nor replaced
going to be successful within the first      ideal for those wishing initially to wear      regularly. Advise the child and the
few weeks of wear.3                          lenses on a part-time basis, although          parents on the correct use of solutions,
   It is estimated that 80 per cent of       this often then increases to full-time         in particular when prescribing SiHs.
a lifetime’s ultraviolet radiation is        wear with more experience with the             There has been some concern over
absorbed into the eye by the time a          lens, as refractive error increases and        incompatibilities between some
child is 18, and larger pupils and clear     the obvious benefits of lens wear are          surface-treated SiH materials and
media in children mean that up to 70 per     realised by the child and parent.              MPS care regimens with reports of
cent more UV-R reaches the retina than          Two-weekly or monthly replacement           solution induced corneal staining
in adults. Some lenses materials now         lenses are a cost-effective option for full-   with certain combinations,10-17 in
include a UV-blocker and this feature        time wear, although there is an increase       particular some formulations contain-
can be offered when selecting lens type      in the possibility of lens damage, loss        ing polyhexamethylene biguanide
for all year round protection.               or deposition with the associated reduc-       (PHMB). Hence, if a multipurpose
                                             tion in wearing time, comfort and visual       solution is prescribed, parents should
Replacement frequencies                      acuity compared to daily disposable            be advised not to switch their children
The benefits of frequent replacement         lenses. They are available for a large         to another brand without consulting
lenses are widely documented, includ-        proportion of refractive errors. The           their practitioner.
ing comfort, vision and few complica-        majority of children (93 per cent) who
tions. Compared to longer replacement        wear this lens type will continue with         Lens wear in atopic children
schedules, daily disposables result in       them for at least three years.6                Some children keen to try CLs are                                                                                             03.04.09 Optician | 25
               Contact Lens Monthly CET

likely to be allergy sufferers; this may                                                                           and 2007,24 which were mostly in

                                             Alix/Phanie/Rex Features
lead to discomfort and symptoms when                                                                               2001, in school age children from
wearing their lenses. However, with                                                                                Asia, with non-compliance and use
careful management, most children                                                                                  of tap water significant risk factors.
can wear lenses, even during the peak                                                                              A more recent paper reported 38
season for allergies.18 Daily dispos-                                                                              incidents between 2005 and 2007.25
ables, with minimal deposition and                                                                                 The incidence and prevalence of MK
no-care regimen, are excellent choice                                                                              with OK is still unknown,26 although
for children with allergies and have                                                                               the risk of serious complications with
been shown to be effective in minimis-                                                                             lens wear increases significantly with
ing allergy symptoms and signs.19                                                                                  overnight wear. What is not yet known
Lens wear may need to be temporar-                                                                                 is whether infection risk is greater
ily avoided during seasonal flare-ups,                                                                             with OK than other overnight wear,
during which time topical medication                                                                               or whether children are at greater
may be needed. An exception to this                                                                                risk of vision-threatening complica-
would be with vernal keratoconjunc-                                                                                tions. Large, well-designed, control-
tivitis where lens wear is contrain-                                                                               led studies are still needed to give the
dicated. Extended wear should be                                                                                   risks of treatment. If this lens type is
avoided. For those able to wear lenses,                                                                            fitted, the parent needs to evaluate the
they should be monitored carefully                                                                                 benefit of temporary myopia reduction
and regularly, and the importance of                                                                               compared to the risk of infection. Both
compliance should be stressed. With                                                                                parent and child should be educated on
reusable lenses, children should use                                                                               safety, lens disinfection, eliminating tap
unpreserved solutions to minimise                                                                                  water and reacting early to any signs of
potential hypersensitivity or toxicity                                                                             complications.
reactions to certain preservatives.         The child must be able to handle contact lenses independently
                                                                                                                   Myopia progression
Orthoptic indications                                                   Orthokeratology                            The incidence of myopia varies depend-
Lenses are an ideal option when manag-                                  Orthokeratology (OK) uses reverse-         ing on a wide range of factors including
ing certain orthoptic anomalies. They                                   geometry RGP CLs worn overnight            age, country, sex, ethnicity, occupation
are the preferred optical approach                                      to alter corneal shape and provide         and environment. The prevalence of
for anisometropia, which should                                         the temporary reduction of refractive      myopia has been reported as high as
be corrected as young as possible.                                      error, eliminating the need for correc-    70-90 per cent in some Asian countries,
However, there may be less motivation                                   tion to be worn during waking hours.       30-40 per cent in Europe and the US,
with anisometropic amblyopes to wear                                    Recent studies to investigate OK and the   and 10-20 per cent in Africa;27 a recent
CLs as their use will not offer immedi-                                 temporary control of myopia showed         study of students in the UK found
ate binocular acuity improvement,                                       they are efficacious for young myopes,     around half were myopic.28
although there will be a reduction in                                   with no children experiencing a serious       Soft lenses have previously been
image sizes. In a study to investigate if                               adverse event.21 Also, young children      reported to increase myopia progres-
lenses with full-time occlusion provided                                had comparable safety and efficacy         sion; this was likely due to corneal
successful therapy for anisometropic                                    results when compared to teens and         oedema from long-term hypoxia.
and strabismic amblyopes aged seven                                     young adults.22 Although the range of      Fitting children with SiH or high
to 10 years,20 best visual acuities were                                correction is somewhat limited (around     oxygen permeability CLs will elimi-
improved in all and binocularity was                                    -1 to -5D and <1.5DC), the procedure is    nate this ‘myopic creep’. A recent three-
maintained or improved for six out of                                   becoming more popular, in particular in    year study29 to determine the effect
10 patients.                                                            the Asia-Pacific region where it is used   of soft lenses on myopia progression
                                                                        primarily as a means of myopia control     in children (as part of the ACHIEVE
Cosmetic indications                                                    in children.                               study) found no statistically significant
The majority of young children will be                                     They are popular with parents as        difference between lenses and spectacle
interested in lens wear to remove the                                   their children only wear lenses in a       wearers and also no clinically relevant
burden of spectacle wear, in particular                                 controlled environment at home, and        increases in axial length or corneal
for sport, and improve visual perform-                                  after a few weeks most children only       curvature, further dispelling the myth
ance. However, as they get older,                                       need wear lenses every few nights          that soft lenses increase myopia progres-
children may well also be interested                                    to maintain clear vision during the        sion in children more than other vision
in lenses to alter or enhance the colour                                day. Cho23 detailed how practitioners      correction options.
of their eyes. Recent changes to the                                    can improve their OK practice and             The use of bifocal or multifocal CLs to
regulations on contact lens sale and                                    minimise unnecessary or preventable        reduce myopia progression in esophoric
supply mean that plano sales fall under                                 complications with proper education        children has been described where the
the same scrutiny as powered lenses,                                    and the use of appropriate equipment.      add power reduces the accommodative
so emmetropic children interested in                                    A trial overnight is recommended to        effort and reduces the stimulus for axial
wearing cosmetic CLs will need to seek                                  assess the physiological response before   growth; this gives a modest yet signifi-
advice and be fitted in practice. Tinted                                starting treatment, with regular after-    cant reduction.30
or opaque, coloured lenses can also offer                               care and written information to aid           It was thought that RGP CLs could
clinical benefits by masking abnor-                                     compliance.                                slow myopia progression in children
malities or minimising photophobia in                                      However, there have been reports        due to transient corneal flattening.31-33
certain pathological conditions such as                                 of microbial keratitis with OK. Watt       Lenses would need to be worn consist-
aniridia and albinism.                                                  reported on 123 cases between 2001         ently at least eight hours a day, and

26 | Optician | 03.04.09                                                                                                   
                                                                     CET Contact Lens Monthly

 TAbLe 4
                                                    (Table 4). Practitioners and parents               reducing the risk of keratitis. Optician, 6 July
                                                    need to balance the potential risk with            2007, 20-25.
 Modifiable and non-modifiable risk factors         significant benefits that CL wear offers           10 Jones L, Jones D, Houlford M. Clinical
 for microbial keratitis for contemporary contact   children. In addition to minimising risk           comparison of three polyhexanide-preserved
 lens types38-41                                    factors for serious infection, children’s          multi-purpose solutions. Contact Lens Ant
                                                    ocular health can be maintained by                 Eye, 1997;20:23-30.
  ● Modifiable factors                              fitting certain lens types, such as high           Jones L, MacDougall N, Sorbara LG.
  Overnight wear; >6 nights overnight wear          oxygen performance SiH or high Dk                  11 Asymptomatic corneal staining associated
  Use while on holidays                             RGPs, or frequent replacement or daily             with the use of balafilcon silicone hydrogel
                                                    disposable CLs to minimise deposit                 contact lenses disinfected with a biguanide-
  Swimming without goggles/disinfection             related complications.                             preserved care regimen. Optom Vis Sci, 2002;
  Hand-washing                                                                                         79:753-761.
                                                    Conclusion                                         12 Pritchard N, Young G, Coleman S, Hunt C.
  Low hygiene
                                                    Fitting children with lenses makes                 Image analysis of corneal staining related to
  Poor case hygiene                                 a significant difference to younger                multipurpose care systems. Cont Lens Ant
  Internet purchase                                 patients’ lives in addition to being               Eye, 2003: 26: 3-9.
                                                    rewarding and developing a practice.               13 Lebow KA, Schachet JL. Evaluation of
  Poor health                                       With appropriate strategies to fit                 corneal staining and patient preference with
  Smoking                                           children with a wide range of lenses               use of three multi-purpose solutions and two
                                                    and teach them how to wear them                    brands of soft contact lenses. Eye Cont Lens,
                                                    safely, contact lenses can have a large            2003; 29:213-220.
  ● Non-modifiable factors                          impact on a child’s development and                14 Papas EB, Carnt N, Willcox MD, Holden BA.
  <6 months in extended wear                        confidence, in addition to the visual              Complications associated with care product
                                                    benefits. ●                                        use during silicone daily wear of hydrogel
  Male gender
                                                                                                       contact lens. Eye & Contact Lens, 2007;
  Wearing lenses during winter months               References                                         33:392-393.
  High socioeconomic status                         1 Walline J, Jones L, Rah M et al. Contact         15 Andrasko GJ, Ryen KA. A series of
                                                    Lenses in Paediatrics (CLIP) Study: Chair Time     evaluations of MPS and silicone hydrogel lens
  Young age                                         and Ocular Health. Optom Vis Sci, September        combinations. Rev Cornea & Contact Lenses,
                                                    2007; 84 (9): 896–902.                             March 2007; 36-42.
                                                    2 Mayeaux EJ Jr, Murphy PW, Arnold C et al.        16 Garofalo RJ, Dassanayake N, Carey C, Stein
stopping lens wear for more than two                Improving patient education for patients with      J, Stone R, David R. Corneal Staining with
months had a minimal effect on refrac-              low literacy skills. Am Fam Physician, 1996;       Multi-Purpose Solutions as a Function of
tion, highlighting that the effect was              53(1): 205-11.                                     Time. Optom Vis Sci, 2004; 81(12S): 84.
not purely due to corneal changes.32                3 Walline JJ, Jones LA, Mutti DO, Zadnik K.        17 Andrasko G, Ryen K. Corneal staining
However, recent evidence contra-                    Use of a run-in period to decrease loss to         and comfort observed with traditional and
dicts this and found alignment-fitted               follow-up in the Contact Lens and Myopia           silicone hydrogel lenses and multipurpose
RGPs do not slow axial growth of the                Progression (CLAMP) study. Control Clin Trials,    solution combinations. Optometry, 2008
eye or slow myopia progression over                 2003;24:711-718.                                   Aug;79(8):444-54.
three years.6,34 OK lenses may slow                 4 Morgan P. International Contact Lens             18 Veys J. Managing the CL wearing allergy
myopia progression35-37 although well-              prescribing in 2008. Contact Lens Spectrum,        sufferer. Optician, 2004.
conducted randomised clinical trials                February 2009.                                     19 Hayes V, Schnider C and Veys J. An
are needed to fully investigate efficacy            5 Walline JJ, Mutti DO, Jones LA et al. CLAMP:     evaluation of 1-day disposable CL wear
before parents can be told confidently              Contact Lens and Myopia Progression Study:         in a population of allergy sufferers. CLAE,
that this method of correction may                  design & baseline data. Optom Vis Sci, 2001        2003;26:85-93.
reduce the myopia progression.                      Apr;78(4):223-33.                                  20 Orthoptic indications for CLs - Mintz-
                                                    6 Walline JJ, Jones LA, Mutti DO, Zadnik K.        Hittner H. Successful amblyopia therapy
Risks of CL wear in children                        A randomized trial of the effects of rigid         initiated after age 7 years: compliance cures.
Microbial keratitis is the only serious             contact lenses on myopia progression. Arch         Arch Ophthalmol, 2000 Nov;118(11):1535-
adverse reaction seen during CL wear as             Ophthalmol, 2004;122:1760-1766.                    41.
it is potentially blinding, and this would          7 Veys J & French K. Health Benefits of Daily      21 Walline JJ, Rah MJ, Jones LA. The Children’s
be devastating for a child wearing                  Disposable Lenses. Optician, 2006; 231;            Overnight Orthokeratology Investigation
lenses. The incidence remains low,                  6050: 16-20.                                       (COOKI) pilot study. Optom Vis Sci,
although parents and the wearers must               8 Walline JJ, Long S, Zadnik K. Daily disposable   2004;81:407-413.
be informed of the risk and advised of              contact lens wear in myopic children. Optom        22 Lipson MJ. Long-term clinical outcomes for
the signs and symptoms. They should                 Vis Sci, 2004;81:255-259                           overnight corneal reshaping in children and
also be advised of the risk factors                 9 Morgan P. Contact lens compliance and            adults. Eye Contact Lens, 2008 Mar;34(2):94-9.

School time, term time, part time, or annualised day contracts, with no weekend
work, for employed Optometrists available UK wide with the country’s leading
provider of domiciliary eyecare. To discuss phone Glenn Tomison on 07912 307926.                                                                                                          03.04.09 | Optician | 27
                Contact Lens Monthly CET

23 Cho P, Cheung SW, Mountford J, White P.
Good clinical practice in orthokeratology. Cont   MuLTiPLe-ChOiCe queSTiOnS – take part at
Lens Anterior Eye, 2008 Feb;31(1):17-28.
24 Watt K & Swarbrick. Trends in MK
associated with microbial keratitis. Eye
Contact Lens, 2007. Nov 33(6 part 2): 373-
                                                  1   Which of the following is the first step
                                                      in the fitting routine when dealing with
                                                                                                      7   What is the ideal time between check ups
                                                                                                          for existing child contact lens wearers?
                                                                                                      A Three months
377.                                              A Discussion of lens types                          b Six months
25 Van Meter WS, Musch DC, Jacobs DS, et          b Assessment of tarsal conjunctiva                  C One year
al. Safety of overnight orthokeratology for       C Accurate refraction                               D Two years
myopia: a report by the American Academy          D Tolerance trial
of Ophthalmology. Ophthalmology, 2008
26 Walline JJ, Holden BA, Bullimore MA et al.     2   Which of the following statements about
                                                      fitting children is false?
                                                                                                      8   What percentage of myopic 8-11
                                                                                                          year-olds have been found able to adapt
                                                                                                      to RGP wear?
The current state of corneal reshaping. Eye       A Fluorescein is instilled to acquire baseline      A 10 per cent
Contact Lens, 2005;31:209-214)                      data                                              b 20 per cent
27 Fredrick DR (May 2002). ‘Myopia’. BMJ 324      b Response to fluorescein may indicate future       C 50 per cent
(7347): 1195–9.                                     response to drops                                 D 80 per cent
28 Logan NS, Davies LN, Mallen EA, Gilmartin      C RGP lenses will be less uncomfortable if the
B (April 2005). ‘Ametropia and ocular biometry
in a U.K. university student population’. Optom
Vis Sci, 82 (4): 261–6.
                                                    child is encouraged to gaze downward
                                                  D Bulbar conjunctiva examination may indicate
                                                    future response to lid eversion
                                                                                                      9    Which of the following is
                                                                                                      A Children’s crystalline lenses absorb less blue
29 Walline J et al. A randomised trial of the                                                           and ultraviolet light than adults
effect of soft contact lenses on myopia
progression in children. IOVS, 2008; 49(11):
                                                  3   Which of the following does not apply if
                                                      the child wearing contact lenses wishes
                                                  to swim?
                                                                                                      b Around 50 per cent of a lifetime’s UV radiation
                                                                                                        is absorbed in the first 18 years of life
                                                                                                      C Larger pupils will help reduce the UV impact
30 Aller T, Wildsoet C. Bifocal soft contact      A Swimming should not be undertaken by the            by the Stiles-Crawford effect
lenses as a possible myopia control treatment:      child                                             D 40 per cent more UV reaches the retinas of
a case report involving identical twins. Clin     b Daily disposable lenses are preferred               children than adults
Exp Optom 2008 Jul;91(4):394-9.                   C Tight fitting goggles may be worn over lenses
31 Grosvenor T, Scott R. Three-year changes
in refraction and its components in youth-
onset and early adult-onset myopia. Optom
                                                  D Even if protected by goggles, lenses should
                                                    be disinfected after swimming                     10        Which of the following statements
                                                                                                                is true?
                                                                                                      A Allergy history disallows a child from lens
Vis Sci 1993;70:677-683.
32 Khoo CY, Chong J, Rajan U. A 3-year study
on the effect of RGP contact lenses on myopic
                                                  4    Which of the following statements is
                                                  A Teenagers take the most chair time to fit with
                                                                                                      b Vernal keratoconjunctivitis contraindicates
                                                                                                        contact lens wear
children. Singapore Med J, 1999;40:230-237.         lenses                                            C A mast cell stabiliser should not be offered to
33 Stone J. The possible influence of contact     b Pre-teens take longest to fit because data          a child
lenses on myopia. Br J Physiol Optics,              gathering takes longer                            D Extended wear is the best modality for
1976;31:89-114.                                   C Pre-teens take longer to fit because of extra       allergy sufferers
34 Katz J, Schein OD, Levy B et al. A               time required for teaching
randomized trial of rigid gas permeable
contact lenses to reduce progression
of children’s myopia. Am J Ophthalmol,
                                                  D There is no significant variation in chair time
                                                    when fitting lenses to patients of any age        11       Which of the following statements
                                                                                                               is true?
                                                                                                      A Orthokeratology (OK) is illegal for children
35 Cho P, Cheung SW, Edwards M. The
Longitudinal Orthokeratology Research in
                                                  5   Which of the following statements about
                                                      wearing times is true?
                                                  A Children should wear lenses for no more than
                                                                                                      b Cylinders up to -5.00DC may be corrected by
                                                                                                      C There have been reports of microbial keratitis
Children (LORIC) in Hong Kong: a pilot study        two hours                                           associated with OK in children
on refractive changes and myopic control. Curr    b Children should wear lenses for no more than      D Infection risk is greater in OK than other
Eye Res, 2005;30:71-80.                             six hours                                           overnight wear
36 Cheung SW, Cho P, Fan D. Asymmetrical          C Children should wear lenses for no more than
increase in axial length in the two eyes of a
monocular orthokeratology patient. Optom
Vis Sci, 2004;81:653-656.
                                                    12 hours
                                                  D There should be no difference in wear times
                                                    for adults or children
                                                                                                      12       Which of the following is not a
                                                                                                               modifiable risk factor for microbial
37 Reim TR, Lund M, Wu R. Orthokeratology                                                             A Female gender
and adolescent myopia control. Contact Lens
Spectrum, 2003;18:40-42.
38 Stapleton F, Keay L, et al. The incidence
                                                  6   What is the ideal gap between lens
                                                      collection and first aftercare?
                                                  A 24 hours
                                                                                                      b Young age
                                                                                                      C High socioeconomic status
                                                                                                      D Less than six months in extended wear
of contact lens-related microbial keratitis in    b One to two weeks
Australia. Ophthalmology, 2008; 115 (10):         C One month                                         The deadline for responses is April 30 2009
1655-62.                                          D Three months
39 Dart JK, Radford CF, et al. Risk factors for
microbial keratitis with contemporary contact
lenses: A case-control study. Ophthalmology,
2008; 115 (10): 1647-54.                          Ophthalmol Vis Sci, 2005; 46;9: 3136-3143.                 ● Optometrist Anna Sulley is a clinical
40 Morgan PB, Efron N, et al. Risk factors for    41 Stapleton F, Keay L, et al. Risks of contact            affairs consultant, works in independent
the development of corneal infiltrative events    lens related microbial keratitis. Optom Vis Sci,           practice and is past president and fellow of
associated with contact lens wear. Invest         2005; 82 E-abstract 050068.                                the British Contact Lens Association

28 | Optician | 03.04.09