Kids and contacts

Fitting patients aged 8 to 11 years with contact lenses and teaching them how to insert and remove the lenses require slightly more time than they do with teens. The difference should not affect the productivity of a practice because staff members, rather than ophthalmologists, customarily handle the instructional aspects of those patient visits, according to a recent study.

Key Points

Columbus, OH-Results from a recent study reduce concerns that children will require significantly more chair time with an ophthalmologist during contact lens fitting and follow-up visits.

Although the multi-site Contact Lens in Pediatrics (CLIP) study showed that the chair time required for fitting and four follow-up visits averaged 15 minutes longer for children aged 8 to 12 years than for teenagers, this difference probably would be less in a practice setting than in a study protocol. Also, staff members rather than physicians are more likely to spend the extra time working with younger patients on proper insertion and removal techniques, said Jeffrey J. Walline, OD, PhD, assistant professor, College of Optometry, Ohio State University (OSU), Columbus.

In addition, the study showed that both the younger children and teens perceived an improvement in quality of life after switching from eyeglasses to contact lenses and that wearing times between the two groups were similar at follow-up visits.

CLIP is the first clinical investigation to compare children and teens using silicone hydrogel contact lenses.

"The main reason we did this is that we have many kids who are aged 8 to 11 years or so who say that their doctor wouldn't fit them unless they were 12 or 13," Dr. Walline said. "We've done many studies that have shown [that] kids in that age group are capable of wearing contact lenses. Our hypotheses as to why ophthalmologists would not fit the 8-to-11 age group were that they thought children would take too long or maybe they thought kids wouldn't benefit as much as teenagers and, therefore, the risk/benefit ratio wouldn't be in the right direction."

When researchers compared the two groups of children, they found that it takes about 15 minutes longer to fit and manage contact lenses for those aged 8 to 12 years than the time needed to complete these activities with teenagers, Dr. Walline said.

"The vast majority of that difference-about 11 minutes-is due to teaching them how to put in and take out contact lenses," he said. "That's typically done not by doctors but by staff members, so we really don't think it will decrease the doctor's productivity to fit kids with contact lenses. Ophthalmologists should be able to see as many patients as they would have otherwise, although someone from the staff will have to teach these younger patients."

The CLIP study included 84 children aged 8 to 12 years and 85 teenagers aged 13 to 17 years; all required vision correction to see optimally. Following baseline examinations, participants were fitted with one of two types of contact lenses (Acuvue Advance with Hydraclear or Acuvue Advance for Astigmatism, Johnson & Johnson Vision Care Inc.). Insertion and removal training consisted of discussion about contact lens care as well as practice with the insertion and removal of three contact lenses.

Total chair time required for lens fitting and evaluation after four visits averaged 110 minutes for the younger children and 96.3 minutes for teens. Mean fitting time was 43.3 minutes for the younger children and 41.1 minutes for teens, whereas total follow-up time during exams at 1 week and 1 month averaged 27 minutes for the younger children and 24.9 minutes for teens.

The 3-month study was conducted at OSU; the New England College of Optometry, Boston; and the University of Houston School of Optometry, Houston, TX.

Results also showed that the advantages to children and teenagers are the same, Dr. Walline said. "They both benefit in the same areas, and they both show a strong benefit with contact lenses."

Getting results

All study participants completed the Pediatric Refractive Error Profile (PREP) survey at their baseline visit and a PREP for contact lens wearers at the 1-week and 1-month visits. The survey compared the vision-specific quality of life between children wearing contact lenses and those wearing glasses. Scores were calculated on a scale that ranged from 0 (indicating poor quality of life) to 100 (excellent quality of life).