Dr. Kanevsky and Doug Dinger are back in New York, after a successful trip to the barriadas around Lima, Peru.

Joined by a team of two optometrists, one retinologist, two cataract surgeons, one dentist, five american students and a local group of volunteers, we ran a three day eye and dental clinic at a community center in one of the poorest areas of Peru. Each day, close to 500 patients were examined. Most received sunglasses (donated by Bevel Spectacles) to protect them from the ravages of the Peruvian sun and dry wind, and many received prescription glasses (donated by our patients and team of volunteers). With the help of donations from Alcon, Allergan and B+L pharmaceuticals, we were able to treat pterygia, devastating ulcers and infections, glaucoma, allergies, and remove blinding cataracts.

On the second day, we borrowed two optometry students and led an away team to an outlying orphanage. Unfortunately, political unrest and guerrilla warfare leave many children orphaned in Peru. This particular group of 250 girls were housed and cared for by Franciscan nuns. All were examined and Dr. Kanevsky is pleased to report that the new hand-held microscope she purchased for this mission and for use with infants and patients with mobility problems, helped her to remove several foreign bodies, and to diagnose and treat an infectious ulcer in a seven year old girl which, untreated, would have caused her to lose an otherwise perfectly healthy eye.

The young ladies needing correction were fitted for pretty glasses (all new and fashionable frames donated by Bevel) which we brought back to NY. Doug is now quite busy edging prescription lenses (donated by Acuity NYC) and the package is due to be sent back to the orphanage shortly for distribution to the girls.

On day four, part of the group was flown by military helicopters into the jungles near Cusco where an additional 1000 patients were examined and treated.

Tired but happy, we are back at work on the Upper West Side with a renewed appreciation for all of our privileges and gifts.

There are many reasons for children to wear contact lenses. Sometimes they are medically necessary, more often they are needed for cosmetic reasons or for activities which require freedom of movement and good peripheral vision. In all cases, the parent or caretaker must be willing and able to share the burden of responsibility with their teenager, or be wholly responsible for a baby or toddler.

Although common wisdom states that most children should wait till age 12, there is no hard and fast rule about when a child can begin using contacts. Always ask your eye doctor for guidance and unless the contacts are medically necessary, let your child’s maturity and motivation be your guide.

When Are Contact Lenses Medically Necessary?

A child is not born being able to see. Vision develops as an image is formed in the eye and is transmitted to the brain. If the brain is denied an image (due to a congenital cataract or unfocused image), pathways are not formed which will allow the brain to process the picture. This is called amblyopia and is often referred to as a “lazy eye.” If the brain is denied vision in both eyes from birth, the eyes may develop a jumpy, searching movement. This is called nystagmus. If the eyes have very different prescriptions (for instance if one is very nearsighted and one very farsighted) this is called anisommetropia and the brain has a difficult time reconcilling and fusing the two images. Sometimes, a weak muscle or high refractive error causes one eye to turn in or out. This is called strabismus.

There is a critical period in a child’s life during which these pathways can be formed. The first year of life is crucial. After the first year it becomes increasingly difficult to improve vision, but with proper correction, patching, surgery and or vision excersizes, improvement can be made up to about 7 years of age. After this time it becomes difficult to impossible to improve sight.

Let’s look at one example when contact lenses can aid in this process. Cataracts diagnosed at birth must be removed immediately if they are hindering vision development. However, without a lens inside the eye, incoming light will not focus to form an image on the retina. Spectacles or a contact lens must be fitted quickly so the visual pathway to the brain can start to form. The high power spectacles necessary to replace the 30-40 diopter natural lens that was removed, can cause distortion. This effect can be minimized by using contact lenses. A contact lens acts as if it were part of the eye; wherever a child looks, he will be looking through the lens center. Spectacles are not possible in cases of unilateral aphakia because of the image size difference induced (aniseikonia).

Why not place an implant into the eye after cataract surgery? Unlike an adult aphake (person without a natural crystalline lens), a child’s eye continues to grow. As the eye length increases, the power needed to correct the child’s vision will decrease. This causes frequent changes in power and size. Contact lenses can be readily changed while an implant is permanent. It is very important to follow the baby with frequent examinations to monitor the lens fit and the child’s visual development.

There are many other reasons a toddler or tween may do better with contacts than glasses. It is always best to ask the opinion of a doctor experienced in fitting pediatric contact lenses.

What Does the Fitting Process Entail?

Depending on the age of your son or daughter, the process will vary widely. Babies are seen every month or even more often because initially the lens is worn overnight and the fitting is quite complex. Parents will eventually be taught to remove the lens nightly and replace it daily at home. Although it seems an impossible and frightening task at first, with the right guidance, all parents become experts in this process more quickly than you can imagine.

In the more common circumstance, when your tween or teen asks about contacts, your child should have a thorough eye examination first, and if you and the doctor both feel that he or she is ready for the responsibility, a fitting can be scheduled. Usually, the doctor will select and place a pair of lenses in the eyes and check the initial fit, comfort and vision. Then, you or your child (or both) will be taught how to insert, remove and disinfect the lenses. Most doctors prefer to fit children in daily disposable lenses. This is safer, cleaner and easier in the long run, but not always possible with all prescriptions or all budgets. Sometimes children are given prescriptions for more than one type of lens, depending on their specific visual and lifestyle demands. If your child demonstrates good facility during this first training session, he or she might go home with their first pair of contacts! Often, this process requires more than one visit. Don’t be discouraged if the doctor asks you to return several times until proficiency is gained. We want your child to be safe and happy with their lenses for years to come. Once the wearing process begins, you will return to the clinic in a week or two for a progress check. It is very important to listen carefully and follow all of your doctor’s instructions. There will be many details so please ask questions about anything that is confusing or unclear. Try not to assume that if you yourself are a contact lens wearer, your child can use your cleaning solutions or wear the same type of lenses on the same wearing schedule. Patience and perseverance yields success!

At the first follow-up, your doctor will check the fit, corneal health, comfort and vision. Sometimes the fit will need to be altered or adjusted. Often a second or third visit may be needed. Remember, the goal is a perfectly healthy eye, a comfortable lens and clear vision. There is no rush to get there. Once everyone is satisfied, a final prescription will be written and a contact lens supply can be ordered. Most doctors will ask to see your child again in 3-6 months but this will vary widely and depends on many factors. Whatever the schedule, please don’t miss these visits as many problems can be identified early and corrected before they turn into something more serious. And ALWAYS, your doctor will want to see or hear from you WHENEVER problems arise.

Good luck and enjoy this new experience with your little one!

Viola Kanevsky, O.D.