How young is too young?

[AdmiralKnight]

Something I've been torn about for quite a while... how young is too young for contacts? An incident yesterday actually caused me to write this and get everyone's opinions on the matter. We had a girl in, 12 years old, looked like she was about 10. I'm watching her going through her training, with her mother and sister, who both wear contacts as well, and can't help but think... geeze, she's awful young to be wearing those. We all know the dangers involved with improper cleaning of contacts... where do you draw the line though? This girl could have been the cleanest little girl in the world... but how do you know? Most kids I know are little dirt-bags. You can't trust what the parents say either. Especially in this case, the mother, being a wearer herself, wants her daughter to have them.

Glasses are becoming less and less of a stigma every day. It's almost gotten to the point where it's cool to wear glasses. So why the push to get kids into contacts? The most common answer that I get to this is sports. That's fair enough... to a point. If you're playing a sport, like hockey, where your glasses will fog up in the helmet, then I definatly understand that. Things like Soccer though? I really don't understand. If you're worried about breaking the glasses, get a second pair for when you play! It'd darned well close to the same price, or even cheaper depending on how often the contacts are used.

I guess this was a bit of a rant, as well as a question, so I'll leave this out there for you guys. What are your opinions on kids with contacts?

[For-Life]

To me, there is not an age, but maturity. Actually, I find kids are more mature with their contacts than 45 year old adults. Children are given rules, and they follow them. Adults think they know the rules, and will do whatever they want.

What I try to do is get the parents to decide. I give them all of the information, what is needed from the child, what is needed from the parent, and allow them to decide if it can happen.

[Johns]

I fit my 6 year old niece with contacts about 12 years ago. She's a neat freak, very mature, and at the time, she was playing the violin and the glasses got in the way.

She gave up the contacts when she was 9, as well as the violin, and now she's wearing them again, since she's involved with sports (and boys).

[drk]

12 +/- 2 yrs.

[Judy Canty]

Every time a parent asked me this question, I gave them the challenge that I gave my kids. If you can clean your room and keep it that way without me having to tell you, you're ready for the responsibility of contact lenses. Period...no deviations. Worked every time.

[ziggy]

She's a neat freak,

I tell parents when little Billy or Sally are able to keep their room clean then they are old enough for contacts. The youngest fit I've done is just under 9yo.

[Johns]

Every time a parent asked me this question, I gave them the challenge that I gave my kids. If you can clean your room and keep it that way without me having to tell you, you're ready for the responsibility of contact lenses. Period...no deviations. Worked every time.

That's what we do as well. That way, it's not on us.

[gunner05]

I fit a 7 year old hyperope with contacts, and she was the youngest I ever fit. She was a +6.00 and was made fun of by a lot of the kids at school for her glasses. She was extremely introverted and didn't say much while in the office. We put her in CLs and had her come back for a followup the next week. Total night and day difference. She was really boistrous the next week, running up to me and giving me a big hug when she came in. She was a special case, but I had absolutely no problem with fitting her.

[Kyle]

I'm not keen on putting patients in boxes like "how old is old enough". I might as well be asking "how tall is tall enough". Restrictions like that conflict with the very principle of individualized care.

I agree with everyone that maturity and habits are far better indicators and of course your determination of that can only go so far if, when you look at the patient, all you see is a number.

K

[chip anderson]

Actually unless the Rx is high (over 5 diopters) 14+ is the ideal age, those hormones are a tremdous motivation. Today the vogue is to try to get them before the O.D. down the street gets them first. Dispensing doctors have no problem loading them up with anesthetic slopping a pair on at 5.


Chip

[Happylady]

I tell parents when little Billy or Sally are able to keep their room clean then they are old enough for contacts.

Lots of adults wouldn't qualify, I know some pretty mess adults.

[icare]

...Today the vogue is to try to get them before the O.D. down the street gets them first. Dispensing doctors have no problem loading them up with anesthetic slopping a pair on at 5.
Chip

Man, where is that the vogue?

There must be some pretty lousy docs in your neighborhood. Or, we're way out of style.

As far as when to fit:

1. A soccer ball can beat the hell out of any dress frame. And whether the lenses are Trivex or Poly, when the frame breaks it can pierce the globe. Say bye, bye eye. It does not make sense to keep a patient railroaded into spex when their safety is at risk.
2. It does make sense to fit when the patient shows the maturity. I had an 8 year-old balance beam gymnast preparing for the olympics that had to be fit. She was organized and disciplined and needed to get out of her +8.00 spex to compete. Is that too young? She was more focused and mature than the majority of adults out there. I should have kept track of her competitions. She could be a gold medalist for all I know.
3. Contact lens wearers need to know that they are spex wearers first and that the contacts are a luxury. The younger they are, the less they ought to be permitted to wear contacts. I have them wear contacts only for the purpose permitted and return to spex wear for the majority of their needs. If they overdo the wear schedule, they know that they risk losing their contact lens wear privileges.

[karen]

my son was 10 and super motivated to wear them. My dad sneaked them on him when I was away for the weekend-I would have made him wait a year or two but he never had any problems and is a pretty good patient. (dang sneaky OD dads......)

[Happylady]

I got my daughter contacts a couple of weeks before her 10th birthday. She had braces and freckles and didn't want glasses, too. She did great with them until she broke her right arm a month later. I had to put her contacts in and out for her for several weeks until she got a shorter cast.

By the way, I still can't get her to keep her room clean.

[HarryChiling]

I'm glad to hear the responses that this thread is getting. I too was largely into a cutoff age or rule fo thumb for the age of the wearer. Then I went and worked at a pediatric practice and their was less non-compliance from the children than from adults. That includes the parents, on visits from child and parent wearers seen in the office the parent often confirme all the goo d cleaning regimines that the child followed and teh child was often very proud of themselves too and in the same note when the parent was asked about their care they would often give the same old boring excuses that they always give.

Like chip alluded to above in children with high Rx's if the choice comes down to contact or not wearing their glasses. It would be more beneficial to the patient to fit contacts then to risk amblyopia.

Newborn was the youngest I put lenses on and that was the easiest and the most heart wrenching training I had to do. She would not stop crying and the parents were looking at me like I was some sort of murderer, until I told them it was ther turn and that this would be the experience everyday and although it broke their hearts making their child cry they understood that it would allow their child to develop healthy vision.

[chip anderson]

Ok, I'm no trying to get you to agree with me but I have fit contact on tens of thousands of patients, from infantacy to 98. With probably every possible condition possbile. Been a Fellow member of the CLSA since the mid-60's and I was given you the benefit of my experience and observations over that time. Have I seen young, old, and middle aged exceptions to every rule in the book, sure. Have I seen parents beeming at thier "exceptionally mature" child and parents in doubt if thier child could handle the situation at hand? Sure. But give me 10,000 myopes (or hyperopes) under 14 years of age and under 5 diopters of correction and I will show you less than 50% success (success being patient happily wearing contact all waking hours after one year) rate. Give me the same patients at 14+ and I'll show you a 95% success rate.
Of course percentages don't matter when it's my Johnny or Susie or my patient hand handling the patient.

It's just the way things are.

Chip:hammer:

[klieg]

Not much to add, but the youngest I've had an OD fit successfully was 10. We wouldn't fit his 13 year old brother because of the maturity difference. Ten year old was a neat freak who had to keep everything perfect. Thirteen year old wasn't quite that clean. He wasn't a slob, but he didn't concern himself with such things as good personal hygiene. Tried to fit a 9 year old for sports use but he couldn't complete training. That was an incident where the parent wanted them and the child did not, but gave it a good try so mom wouldn't be upset with him.


I'd tend to agree on the 12 +/- 2 years, depending on the maturity of the child. I like the room cleaning idea, that seems like it would work very well.

[Nettie]

I was 11, and -5.00 ou. And in my....however many......years of cl wearing, I have never ripped or lost a lens. I am just so good.

[Jubilee]

The youngest we have done is 8. The child had her first eye examination after the school referred her in, and was +1.50 in one eye and +8.50 in the other..

Still made her glasses to have as a back up, but the difference in vision for her was 2-3 snellen lines..

Cassandra

[NC-OD]

Actually unless the Rx is high (over 5 diopters) 14+ is the ideal age, those hormones are a tremdous motivation. Today the vogue is to try to get them before the O.D. down the street gets them first. Dispensing doctors have no problem loading them up with anesthetic slopping a pair on at 5.
Chip

And this is the routine monthly doctor bashing post from the very insecure Mr. Anderson. Like I said, I leave for a month, come back and am guaranteed to see at least one bashing post on optiboard.

It's like clockwork :D

[Kyle]

[quote=chip anderson;209370]But give me 10,000 myopes (or hyperopes) under 14 years of age and under 5 diopters of correction and I will show you less than 50% success (success being patient happily wearing contact all waking hours after one year) rate. Give me the same patients at 14+ and I'll show you a 95% success rate.


I don't at all mean to be inflamatory here so take these as more rhetoric than retort:

Chip, are you saying the supposedly less than 50% success rate means there's no point in trying? Sounds like the voting percentage in the US...hm...

And are you also saying that college students are typically 95% compliant? (my guess is these would comprise 4.9999% of your 5% non-compliant)

SMILES

k

[icare]

...But give me 10,000 myopes (or hyperopes) under 14 years of age and under 5 diopters of correction and I will show you less than 50% success (success being patient happily wearing contact all waking hours after one year) rate.
Chip

You're success rates are outside the norm. You're welcome to spend some time in our office improving them.:D

You know what's weird, too? Success might be better measured by the patient's acceptance NOT to wear their contacts all waking hours.

[chip anderson]

Kyle:
I am saying that if you attempt (unsuccessfully) to fit a patient with contacts for whatever reason. When the patient becomes old enough to fit into the high success age group, the patient will remember the bad experience and fall into a much lower success group for his age. In effect you could be "poisioning" a potentially successfull patient.
Now remember my criteria is those who are still wearing thier contacts all thier waking hours after one year (actually decades).
To me success does not just mean the fee was paid in full.

I once was at an annual meeting of the CLSA in which the "ideal contact lens patient was described as well as I can remember below.

"It is easier to describe the non-candiates than the candiates.
Contact lenses are not for the stupid, the dirty, the unwashed, or the undisiplened.
The ideal contact lens candiate is:
a)16 years of age.
b) Has at least 3 diopters of correction.
c) Has negative partental permission. Negative parental permission means that the parents are against this but allowed the patient to get them after they baby-sat or whatever and earned thier own money for them.
d) The patient (not the parent, spouse or other) highly desires contact lenses. Failure rate amoung patients who get contacts because someone else wanted them to have them is atrocious.

There were probably other criteria but this is all I remember at the moment and this was set when 99% of all contact lens fittings were rigid.
And at this time very few M.D.'s, or O.D.'s fit contact lenses, most fittings were by opticians, contact lens technicians (I think, I didn't survery).

Chip

[harry888]

I use thirteen as the general target age, and use the "clean thier room without the parent asking" quote often, but routinely break that rule.

Had a seven year old that was a minus 10, had sores on his nose. Both parents wore contacts. No brainer. Was a "feel good" experience for me to help someone out.

Rules are made to be broken, it's why we have lawyers. Or you can use the term "professional judgement". Still always liked the "clean the room" quote, makes parents laugh.

Harry