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July 15, 2024
By Ilana Gelfond-Polnariev, OD, FOVDR
When I put my teen patients into NaturalVue Enhanced Multifocals, which are cleared for correcting up to 2.00D of astigmatism, I know that their visual needs are fully taken care of.
While a great deal of myopia management focuses on the youngest population, teenage myopes have their own unique set of needs. In my practice of nearly 9,000 patients, roughly 20% of them are between the ages of 13 and 19, and educating parents about the contact lens options available to them is of the utmost importance as a practitioner.
The teenage years are a critical period for emotional and social development. Contact lenses are my go-to treatment option for teens because I can see firsthand how much it boosts their self-esteem, allows them to stay active in their favorite sports, and even enables them to wear non-prescription sunglasses for the first time. We know that teens often struggle with their mental health, and I want to be able to give them that confidence in their own skin — they’ll be able to see well without glasses, and we’re helping their long-term visual health.
Prioritize Education
The biggest challenge I encounter among teenagers is the general lack of knowledge about their options for contact lenses at a young age. When I see late teens, I often get asked about the possibility of putting them in contact lenses, and parents are shocked to learn that we can start kids in contacts well before their teenage years.
Also, for physically active teens in sports, I strongly believe that contact lenses are often the best option. Patients don’t need to worry about their lenses fogging or the temple blocking peripheral vision. There’s even the added benefit of the confidence that comes with being free of glasses or sports goggles.
If there’s motivation on the patient’s end, I am a proponent of fitting kids into contact lenses early and educating them on proper hygiene and care.
Another thing I’ve noticed among this age group is a general lack of confidence in their motor skill abilities to properly handle contact lenses. Many kids struggle with this because they engage in less physical activity and spend more time on social media these days, resulting in less developed dexterity.
Fitting Astigmatic Teens in Contact Lenses
Many of the teenagers I’m seeing do have astigmatism, though most of them are under 1.00D of astigmatism. If they have more than 1.00D of astigmatism, I give them options. I always try a spherical lens first to assess their acuity. However, my ultimate decision depends on the age group and the patient’s needs. If the patient is driving age, that’s a different conversation. For non-driving teenagers, if their prescription is a bit under-corrected in a multifocal lens for myopia management, we usually stick with that.
If they’re struggling to see, we switch them, and at that point there are a few options. One option is a pair of glasses in the astigmatism component that they only wear as needed. Another option is to refit them entirely. And the final option would be to have the patient wear their contacts socially and for sports, and have glasses for their academic needs.
Using NaturalVue Enhanced Multifocal 1 Day Contact Lenses for Astigmatic Patients
I typically wouldn’t prescribe a multifocal lens for an astigmatic patient, but VTI’s NaturalVue Enhanced Multifocal has really surprised me. I’ll always be straightforward with my patients and let them know that their vision might not be the best in these types of lenses because there isn’t an astigmatism component. However, my astigmatic patients have had great acuity in the NaturalVue Enhanced Multifocal.
I was introduced to NaturalVue Multifocal lenses about seven years ago, and the unique design of the lens is what first intrigued me. At that time, there wasn’t a lot of clinical research about soft contact lenses for myopia management. Still, I liked the idea of giving children this option and possibly slowing down their myopia. Our practice started using it for any young myope who had the potential of progressing. It was an early adaptation for me, and our practice quickly saw clinical changes. The continued stability in my patients’ prescriptions drove me to continue prescribing them.
Fitting Teens into NaturalVue Multifocal Contact Lenses
The process of fitting my teen patients into NaturalVue Multifocal contact lenses is straightforward. I start the process by inserting the lens into their eye first, which helps them be less afraid to do it themselves. I show them the visual acuity right away. The parents are always part of this process, so they get to share in their child’s joy of being able to see clearly. Then, once the patient understands how well they see with the lenses, I assess the fit in the slit lamp to make sure it’s accurate. The patient then sits with my training technicians to go through the whole process.
From there, I start the training process with removal, not with insertion. For most patients, it’s easier to remove a lens than to insert it. Once they can master that, and they see their vision go back to blurry, they’re motivated to get the lens back in. I make sure they’re able to successfully do the insertion and removal twice in my office, and then I give them trial lenses for one week to do it on their own. They come back for a follow-up visit one week later.
I’ve found that this process works well for my teens, and about 90% of them will master it in that first training session. I give them 45 minutes at that first appointment, because anything more than that, they start to get frustrated. They’re getting hungry and they feel like they’re a failure. I always let them know there’s an option of coming back to train, and I relate it to riding a bicycle. Not everybody sits on a bike and can ride it right away — they need some training. They need a couple of times to figure out how to do it. So, this is riding a bicycle, but once you get it, you’ll never forget how to do it.
When I put my teen patients into NaturalVue Enhanced Multifocals, which are cleared for correcting up to 2.00D of astigmatism, I know that their visual needs are fully taken care of. Having peripheral vision in a contact lens is a huge advantage, and especially when kids are active in sports or are starting to drive. It’s a win for my patients because they feel confident without wearing glasses, regardless of what activities they’re involved in, and it’s a win for me as a doctor because I know they’re seeing the best they possibly can.
For over 20 years, Dr. Ilana Gelfond-Polnariev has been dedicated to treating patients and promoting comprehensive eye exams to all children. Her practice, NYC Pupil, offers Neuro-Optometry, Vision Therapy rehabilitation, Myopia Management, and contact lenses for both children and adults. Dr. Gelfond-Polnariev is also an active contributor to her field, publishing and presenting on the importance of vision to various local organizations. Her most recent publication is a children’s book titled The ABC’s of How You and I See. A graduate of the Pennsylvania College of Optometry, Dr. Gelfond-Polnariev completed a residency in Vision Therapy and Rehabilitation. She maintains a faculty position at SUNY College of Optometry, where she continues to teach students skills in pediatrics and vision therapy. Additionally, she was honored with the 2015 New York State Young Optometrist of the Year award for her commitment to the visual welfare of children in the community. She is currently serving on the InfantSee Board at AOA, she is the national treasurer for Beta Sigma Kappa, and is a past Chair of the International Examination and Certification Board for Vision Therapy. Outside of her professional life, Dr. Gelfond-Polnariev is raising two teenagers, playing pickle ball, and enjoys traveling. |
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Dr. Gelfond-Polnariev was compensated for her time in preparing this article
This information may describe uses for this product, i.e., Myopia Progression Control, which have not been approved by the FDA for use in the United States and is intended for educational purposes only. US Indication: NaturalVue (etafilcon A) Multifocal Daily Disposable Soft Contact Lenses are indicated for daily wear for the correction of refractive ametropia (myopia and hyperopia), and/or presbyopia in normal eyes. The lenses may be worn by persons who exhibit astigmatism of 2.00 diopters or less that does not interfere with visual acuity. OUS Indication: NaturalVue (etafilcon A) Enhanced Multifocal 1 Day Disposable Soft Contact Lenses are indicated for daily wear for the correction of refractive ametropia (myopia and hyperopia), and/or presbyopia, and myopia progression control in normal eyes. The lenses may be worn by persons who exhibit astigmatism of 2.00 diopters or less that does not interfere with visual acuity.