Myopia Profile


Contact lens fitting for an anxious child

Posted on November 7th 2021 by Connie Gan

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In this article:

Does contact lens fitting for an anxious child with ADHD seem impossible? Here is an inspiring case plus guidelines for clinical approaches.

Can an anxious child cope with contact lens forms of myopia management? The answer is YES. Here is an inspiring case study about myopia management for a child with ADHD whose cooperation was hard won, through caring clinical efforts. Here are the details.

PC I’m so grateful to have the opportunity to change lives. With his mother’s consent, I want to share this story of young Nithum, age 7, who was referred by a colleague to see me last month for myopia management. Wearing SVD glasses, his myopia had increased from R -3.00 L -2.75 in 2019 to now R -5.75 L -5.25. There is family history of low myopia. Highly inquisitive, he reads encyclopaedias in his spare time and dreams of building rockets 🚀 when he grows up. It was not easy to examine his eyes. With ADHD, he wouldn’t sit still and was highly fearful of the various instruments and machines. When it came to considering myopia control interventions, contact lenses seemed an impossibility. His mother was keen on the idea of OrthoK, but he squirmed at the mere mention of putting lenses into his eyes. Maybe we would need to start on MiyoSmart glasses and atropine? I decided to have a crack at inserting a soft lens in one eye. With great difficulty, lots of tears 😭 and screaming, we managed to put in one lens. Realising he could now see clearly from one eye, he jumped up and down and danced around. He was so happy. He now wanted the other lens in! Now a month later, using myopia controlling contact lens and 0.025% atropine, there’s been no change in axial length and he’s never been more happy. Every morning when he wakes up he asks for his lenses. His mum showed me a video, taken in the first few days of wearing his lenses, of him walking down the street and being amazed at what he could now see. Teachers at school have noticed a change in his learning and confidence. Even the school principal came to talk to them after hearing about his eyes. It gives me a warm and fuzzy feeling to think that, as optometrists, the decisions we make for our patients each day can change and enrich lives, more than we may ever know.

Contact lens myopia management options offer the benefit of slowing myopia progression as well as the boost in confidence which typically comes with childhood contact lens wear.1 However, contact lenses may not seem a viable option for anxious children who seem unlikely to be able to handle them.

"There are many things that seem impossible only so long as one does not attempt them" said French author André Gide, winner of the Nobel Prize in literature in 1947.

In this case, PC successfully managed to apply a contact lens for this child in-office, and this opened the window to successfully using contact lenses as part of the myopia control strategy. There were added benefits of contact lenses affecting a positive impact on this child's learning and personal confidence.

Contact lens modality and handling options

PW Awesome. Glad he is enjoyimg them! Just to ask though.Is he using the ones he has to insert in the mornings and remove at bedtime or they are the night and day kind of CLs?PC These are daily disposable lenses, his mum inserts and removes them for him

In this case, various myopia management options were discussed, from spectacles to atropine to orthokeratology and soft myopia controlling contact lenses. Whilst the comfort and adaptation to soft contact lenses versus orthokeratology have not been directly compared, there is likely to be less foreign body sensation with soft contact lenses2 - at least in the short daily period of orthokeratology wear before the eyes are closed overnight.

If the child is unable to apply and remove contact lenses themselves, their parent or guardian may do so for them, as is the case for this patient. There is no data on how parental lens handling may influence comfort or acceptance. One study of compliance in orthokeratology showed that children who were undertaking all aspects of lens handling and care themselves were slightly less compliant than when their parents were undertaking lens handling. This reinforces the importance of discussing lens handling and care steps with parents and children at each instance of clinical care.3

The clinical approach with anxious children

There is a dilemma in deciding on myopia management strategies for children who are anxious about myopia management options perceived to be 'invasive' (such as contact lenses or atropine drops) when their parents are otherwise supportive and motivated. It can be a challenge to demonstrate to the child that 'it is not as bad as they think' by balancing proactivity with sensitivity to avoid upsetting them.

Lerwick offers a useful tool in helping a clinician minimize trauma for children in a healthcare setting using CARE principles.4

  • C - Choices: Offering power to a child by helping them understand the process and giving them an ability to express a choice can help reduce their propensity for anxiety. An example would be "would you like me to put this contact lens on your right eye or left eye first?"
  • A - Agenda: Explaining the process of what is going to happen can help to reduce fear. An example of this is in this context is explaining to the child how the contact lens might feel on the eye, such as that they may expect a cold or wet sensation, which is normal.
  • R - Resilience: Identifying a patient's strengths and framing conversation with positive language help build trust and rapport.
  • E - Emotions: It is common for children to face the unknown with many emotions such as fear or anxiety. Normalizing these emotions and empathizing with them will help them feel understood and validated and calm their fears.

Applying a contact lens to an anxious child is no easy feat. Ultimately, children are the end users, so it is important to work with them as persons with autonomy. Patience is a virtue in such circumstances and perseverance can make the impossible possible.

Take home messages:

  1. Contact lens fitting for anxious children may seem impossible, however it can be done with trial fitting and patience.
  2. Parents play a very important role in guiding their children on their contact lens journey to increase likelihood of success, including support with handling as required.

Further reading on kids, contact lenses and communication

Meet the Authors:

About Connie Gan

Connie is a clinical optometrist from Kedah, Malaysia, who provides comprehensive vision care for children and runs the myopia management service in her clinical practice.

Read Connie's work in many of the case studies published on Connie also manages our Myopia Profile and My Kids Vision Instagram and My Kids Vision Facebook platforms.

About Kimberley Ngu

Kimberley is a clinical optometrist from Perth, Australia, with experience in patient education programs, having practiced in both Australia and Singapore.

Read Kimberley's work in many of the case studies published on Kimberley also manages our Myopia Profile and My Kids Vision Instagram and My Kids Vision Facebook platforms.

This content is brought to you thanks to unrestricted educational grant from


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