Shared Care in a Dedicated Paediatric Contact Lens Clinic

Abstract

Abstract: : Purpose:Contact lenses are an extremely valuable tool in the management of a wide spectrum of childhood ocular pathology. We report our experience in establishing a dedicated paediatric contact lens service with shared optometry, orthoptic and medical care. Methods:A retrospective case note review of 47 consecutive children referred to a paediatric contact lens clinic commencing December 2001. Data collection included demographic characteristics, indications for contact lens wear, lens management (education, fitting, lens care), visual & orthoptic outcome, and contact lens related complications. Results:Case notes for 79 eyes of 47 children were reviewed. Mean age at referral to clinic was 4 years (range 6 days to 15 years and 4 months). The indications for contact lens wear included aphakia (20); anisometropia greater than 5 dioptres (6); Keratoconus (2); occlusion (2); high refractive error alone (5), or with glasses intolerance (3), or for sports wear (5), or to improve squint control (1), or for cosmesis (3). 16 children were transferred from other contact lens practitioners. 14 were wearing soft contact lenses with weekly to monthly continuous wear regimes. 9 of these children had extensive corneal neovascularisation and giant papillary conjunctivitis at presentation. In 8 cases these complications resolved after changing lens regime. Rigid gas permeable lenses were prescribed for 5 children; toric lenses in 4 children and soft lenses in 36. Contact lenses were abandoned in 13 cases; parental request (5), child’s request (3), patient developed aphakic glaucoma (3), emmetropisation of myopia (1), eye blind (1) In soft lens wearers, a daily wear regime was established on average by 1 month. 3 children remain on an extended wear regime. Visual outcome was good when associated ocular pathology was accounted for. No serious contact lens related complications occurred during the study period (2 years). Conclusions:The use of contact lenses in the paediatric population requires close cooperation and dedication by the parents, children and health care team. Establishing a daily wear regime is a realistic aim and significantly reduces contact lens related complications. We discuss the methods we have employed to achieve this goal.

Keywords: contact lens • clinical (human) or epidemiologic studies: health care delivery/economics/manpower • clinical (human) or epidemiologic studies: outcomes/complications