Children and contact lenses of
in one morning transfer of the St. Petersburg television leaders interviewed Not so long ago the ophthalmologist called in studio. During conversation the speech came about children and points. Leaders brought up such question: what to do to the short-sighted child for whom, it seems, and points are required, but schoolmates laugh at him, call “four-eyes“? What can the expert advise? The doctor was confused a little and answered that if points are required, then parents can explain to the child why they need to be carried. It is a pity that in this conversation contact lenses were forgotten - they could help many children.
As the question of contact correction of sight at children is very actual today, the Veko magazine decided not to stand aside and to bring to your attention opinion on this subject of the associate professor of ophthalmology of PF RGMU of the Ministry of Health of the Russian Federation, the full member of IACLE, the full member of the European academy of natural sciences, the member of the American academy of ophthalmology, the candidate of medical sciences Bella Aleksandrovna NISAN and the consultant for professional questions of the Grandee Lenz company of the doctor of medical sciences Nina Leodorovna Plygunova.
of Advantage of contact correction
If to speak about quality of correction of sight, then, perhaps, contact correction it is possible to consider as one of the most effective methods. A contact lens, being directly on an eye, creates with it uniform optical system, excepting restriction of fields of vision and optical distortions of objects at a look sideways and practically without changing image size. Besides, lenses allow to avoid such known problems of “four-eyes“ as fogging of glasses, pressure of points upon a nose and ears, and do not influence appearance of the patient.
at the end of 1990 - x years only by method of correction of short-sightedness, available to most of the Russian doctors, children and teenagers had points. On a question what to do if the child hesitates of points and from - for it refuses to carry them, doctors made a helpless gesture and urged parents to be more strict with the children. Emergence in the Russian market of high-quality soft contact lenses, in particular contact lenses of planned replacement, lenses with very high coefficient of a kislorodopronitsayemost (Dk / L), expanded possibilities of children`s ophthalmologists. Emergence of more perfect means for care of contact lenses which simplified the treatment of them made contact correction the best exit for the children and teenagers having problems with sight.Contact lenses are shown by
to children and teenagers at various violations of a refraction, ambliopiya, afakiya (lack of a crystalline lens), and also in cases when-point correction does not give the expected results.
Optimum age of children for correction of refraction violations by contact lenses - 6 - 7 years. The patient choosing contact correction for correction of anomalies of a refraction has to be able to look after independently the contact lenses, appointing contact lenses to children is younger than this age, doctors - kontaktolog, without fail have to train in care of contact lenses of parents. However, today`s children quite often not on age are reasonable, and even shestiletka can belong to contact lenses and care of them is very responsible whereas teenagers, on the contrary, less honestly. Unfortunately, it is quite difficult to give accurate definition to the fact that there is “a successful adaptation of children to contact lenses“. However, as paradoxically it sounds, most often rough direct reaction of the child to possible discomfort helps us to define, carrying soft contact lenses is how successful in this case.
Contact lenses - an optimum method of correction for the children leading active lifestyle, who are engaged in different types of sport. Points considerably reduce a peripheral field of vision, complicating spatial orientation therefore they are not suitable for occupations by mobile and command sports, such as artistic and rhythmic gymnastics (in these cases it is simply difficult for points to keep on a nose bridge), hockey (here points are incompatible also with a protective helmet), soccer. During games at playgrounds points can become dusty, mist over and even to lead to a face injury. As a rule, the main reason for which parents with children often visit the ophthalmologist is loss, breakage or deformation of points. Besides, quite often soft contact lenses are not only the unique means of correction of violations of sight of children, but also means of economy of finance of parents.It is important for
also the fact that glasses wearing, especially with “strong“ glasses, is unprofitable distinguishes the child from peers, doing it vulnerable and generating complexes. And his motivations are defining at the choice of contact lenses as sight correction method. It is necessary to consider also perhaps already available experience of carrying contact lenses at parents. If it is planned that the child will carry contact lenses only during sports trainings and active recreation, it is worth choosing soft contact lenses, and it is better one-day as in this case the problem of care of contact lenses is excluded. (By the way, rigid contact lenses demand individual selection and production; at sports activities, unlike soft contact lenses, it is easy to scratch, split these lenses or in general to lose - eyes of the child are in the continuous movement, and in such conditions it is especially difficult to keep the situation of stability of contact lenses on an eye.)
Feature of children`s eyes - lower sensitivity of a cornea, than at adults. Therefore it is better for child to select contact lenses with high coefficient of a kislorodopronitsayemost (Dk/L). The day mode of carrying contact lenses is preferable to children of all age as at it risk to injure eyes or to receive any complication from - for wrong carrying much less.
Regular putting on and removal of contact lenses - actions, quite available to the child. Having even small practice, it is capable to make independently it, without resorting to the help of adults.
of the Indication to purpose of contact lenses
Contact lenses are appointed to children in the following cases.
Short-sightedness (miopiya) . Results of many researches showed that carrying both soft, and rigid gas-permeable contact lenses promotes delay of progressing of short-sightedness, and in certain cases even its stabilization. One-day soft contact lenses and lenses of long carrying are available to correction practically of any degrees of short-sightedness.
Far-sightedness (gipermetropiya) . Correction of a gipermetropiya of high degrees contact lenses - not only more esthetic type of correction, but also more physiologic. In contact lenses the child sees objects of the true sizes and perceives them at that distance at which they really are, unlike-point correction which increases and brings closer objects (and it negatively influences mentality of the child and increases danger of street traumatism).For children with a gipermetropiya the choice of rigid gas-permeable and soft contact lenses, however contact inza of one-day carrying and from silicone - hydrogel to children at whom the gipermetropiya exceeds +6,0 dptr is possible
, are inaccessible.
the Astigmatism - one of the frequent reasons of low visual acuity at children of preschool age. It is anomaly of optical system of an eye at which in two mutually perpendicular meridians of eyes has the different refracting force. The mixed astigmatism when in an eye in two mutually perpendicular meridians two different refractions are combined korrigirutsya most difficult: miopiya and gipermetropiya. Except that the astigmatism reduces visual acuity, it sometimes leads to development of squint and an ambliopiya and can be the reason of indispositions of the child. Existence of the astigmatism making more than 2 dptr the intolerance of rigid contact lenses and existence of a lenticular astigmatism are direct indications to application of soft torichesky contact lenses. Emergence, in particular, of soft torichesky contact lenses of the class “Biomedics Toric“ which selection is possible by an empirical method expanded possibilities of doctors and simplified process of the order of contact lenses, having made them more available to a wide range of children. Today soft torichesky contact lenses it is possible to otkorrigirovat an astigmatism to 5 dptr.Correction of a corneal astigmatism at children is possible
also rigid gas-permeable contact lenses, however owing to chronic traumatizing an upper eyelid a contact lens can develop ptoz an upper eyelid, but also, under a rigid contact lens the foreign matter can get and cause a cornea epithelium trauma. All this does more preferable application for children of soft contact lenses.
of Anizometropiya - a state at which the refraction of the right and left eyes is various. Anizometropiya of small degree (to 1,5 - 2,0 dptr) is rather easily transferred and korrigirutsya by points. In cases of a difference of refractions in more than 3,0 dptr the child uses the best - prepotent - an eye, and the image from worse the seeing eye is suppressed with a brain, and this eye does not participate in formation of a vision. The congenital anizometropiya, as a rule, is one of the reasons of development of an ambliopiya. The high anizometropiya is the direct indication to selection of contact lenses.
of Ambliopiya (lazy eye) . As a rule, children of school age with an ambliopiya hardly agree to carry out one of the main recommendations of the doctor - it is better to close an okklyuder or to stick with an adhesive plaster the seeing eye. Elementary inconvenience and not esthetic appearance is the reason for that. In this case, as the alternative to zakleyka, to the child can be carried successfully out a penalization by means of soft contact lenses. Penalization (from fr. penalite - punishment, a penalty), artificial deterioration (zatumanivaniye) in sight is better than the seeing eye by means of correction, - one of effective methods of treatment of an ambliopiya.Ambliopiya`s
meets at children more often with a gipermetropiya therefore, as a rule, it is necessary to korrigirovat both eyes. Force of a contact lens by means of which the seeing eye grows dim better has to be much more, than its refraction. When using soft contact lenses for carrying out a penalization at the doctor ampler opportunities, than at purpose of-point correction. The difference in the optical power of contact lenses will be easily transferred by the child. Only, to what he has to get used, - it is worse to look the seeing eye. It is better to spy an opportunity the seeing eye from - under a contact lens as it is done by children wearing spectacles, it is completely excluded.
of Afakiya . Optimum correction of sight for children after removal of both a congenital, and traumatic cataract is contact correction today. At a unilateral afakiya correction by points is simply impossible. In - the first, from - for the fact that the child has very big difference in a refraction between eyes and in the optical power of glasses of points, respectively, and the difference in the weight of glasses is very big, so, one glass is heavier and therefore points on a face will be constantly warped. Besides, glasses wearing at a unilateral afakiya is the reason of an anizeykoniya - a state at which the image of the same subject is perceived in size by each eye differently. Sight of children with a bilateral afakiya theoretically can be korrigirovano “plus“ points, as well as at a gipermetropiya. However at the same time points in a bigger degree will increase and bring closer objects, considerably limiting a lateral field of vision and promoting development in the child of an inferiority complex.During removal of a congenital cataract to children the intraocular lens can be implanted to
, however the question of application of this method of correction for children still remains disputable. Making the decision in favor of this or that method of correction, parents have to have a clear view of advantages and shortcomings of each of them, and knowledge of parents completely depends on the doctor.
Selection of contact lenses by the doctor
Exists eight main stages of selection of contact lenses to children and teenagers:
- Survey on a slot-hole lamp for an exception of pathology of a forward piece of an eye which serves as contraindication to selection of contact correction.
- Determination of parameters of an eye for selection of a trial contact lens (determination of diameter of a cornea and choice of diameter of a contact lens; determination of radius of curvature of a cornea on the keratometer and the choice of basic curvature of a contact lens).
- Definition of a clinical refraction of eyes for the choice of optical power of a contact lens.
- Carrying out an oftalmoskopiya - identification of not optical reasons of low sight.
- Fitting of a contact lens - an assessment of situation and mobility of a contact lens on an eye (children have to have a mobility of a contact lens slightly less, than at adults), determination of visual acuity.
- Specification of final optical power of a contact lens after definition of a residual refraction on an eye with a contact lens.
- Final choice of a contact lens. To be convinced of correctness of the choice like a contact lens, it is necessary to try on several contact lenses of various designs and to choose among them that by means of which optimum centering and mobility and the maximum visual acuity and comfort are received. The soft contact lens has to adjoin to a cornea at the child more densely, than at the adult, in order to avoid its loss from an eye and loss.
- Instructing of children and their parents on carrying contact lenses and care of them.
that if necessary parents will manage to remove a contact lens from the child`s eye.for
I at last, to the doctor it is necessary:
- to Have full contact with parents. Parents have to understand accurately objective need of contact lenses for their child, they have to be aware of all positive and negative sides of contact correction. to Train in
- parents to put on contact lenses together with the child that in case of need they could help it to put on or remove a contact lens.
- to Instruct parents how to clear and store contact lenses. Simplicity is very important, effectiveness and safety of means for care of contact lenses, the preference has to be given to multipurpose solutions. to Carry out by
- the next change of contact lenses with obligatory control of visual acuity, every time to check landing of new contact lenses. To control correctness of operation, clarification and storage by contact lenses and to be convinced that they do not cause any undesirable manifestations.