Welcome to question of the day #217

Eyetools question of the day #217

An 11-year-old male patient desperately wants to wear soft contact lenses for football. He is a goalkeeper and plays at a high level in the regional league. He is myopic in each eye and I have fitted him with -3.00 DS lenses. The problem is that he is fearful of putting them in. He can’t bear the thought of touching his eye with his finger or with a lens. He has tried in the practice but cannot insert a lens. He is well motivated to succeed and his mother is an experienced soft contact lens wearer. How can I help him succeed?

In my experience when a person struggles with the technique of inserting and/or removing soft contact lenses then persistent practice in the practice and at home usually prevails and the patient eventually learns the correct techniques. I call this a physical block and I can be overcome by an injection of time and effort. However, if a patient is fearful of inserting and/or removing contact lenses, then this psychological block is much more difficult to overcome. Sometimes it cannot be overcome and it prevents the patient from using contact lenses.

In your patient’s case these are the positives:

He has powerful motivation to succeed; he wants to see well when he is playing football.

He has a mother who is an experienced soft contact lens wearer.

But the negative, a physiological fear of touching the eye, will be difficult to overcome.

Firstly, I would start by encouraging him to practice at home, with his mother demonstrating how to insert and reinforcing that it is not painful nor harmful to the eye. It is important not to berate the patient for his fear but to be always encouraging, understanding, and supportive. It may take many weeks to overcome his fear but if he sees that his mother can insert lenses easily and without discomfort then this will help him.

Secondly, I would encourage him to watch an online video that goes through the process of insertion and removal. One that I have recommended to patients in the past can be found at https://www.youtube.com/watch?v=M1UrPVARtu0

I have found that patients often accept information from people who are similar to their own age than from people who are much older and/or who are in a position of authority. Also, this video shows a girl effortlessly inserting her contact lens and this may encourage some male vs female competition with your patient. It is very well filmed and may provide an angle or a perspective that neither you nor his mother can provide in real life.

I think the key is to gently persist as long as the patient has the motivation to do so.