Children and Contact Lenses

Where Do They Fit into the
Spectrum of Care?
Christina Newman, OD
Memphis, Tennessee

Many improvements have been made by the contact lens industry in the past decade. Eye care providers should
take a fresh look at the use of contact lenses as part of their vision correction plan for the pediatric population. It
is not uncommon for practitioners to tell parents that their child cannot be fitted into contact lenses until at least 13
years of age. Recent studies are proving that children are at no additional health risk, are just as satisfied, and are
as capable of caring for their lenses as compared to teens. Children and teens benefit equally in self perception and
confidence in terms of appearance and correction during their given activities. Beyond normal vision correction,
contact lenses are also being examined for their ability to halt the progression of myopia, as well as their role in
correction of infant aphakia. The following article provides a review of the latest findings and attitudes for fitting
children into contact lenses.
Key Words
ACHIEVE, aphakia, contact lenses, daily disposable, CLIP, orthokeratology, pediatrics

Introduction an infant or difficult patient.2,3 This modality is often avoided
Vision correction can have a significant impact on a child’s since it can be more challenging and require more attention
life and development. Improving vision in young children and adaptation time.
affects how the individuals interact with the world.1 Evolv- Soft contact lenses are the most popular choice and come
ing technologies raise new questions regarding the safe use in a variety of materials and, wearing modalities and offer fea-
of contact lenses in pediatric eye care. Practitioner attitudes tures like ultraviolet protection. Daily disposable lenses are
are changing as multiple recent studies have concluded that a great choice for children since they decrease some respon-
fitting contact lenses in children improves a child’s self-per- sibility of lens care by eliminating the need for disinfection
ception, does not increase the risk of adverse events, and is and solutions. Given its simplicity, this option can improve
not anymore demanding of a practitioner’s time. In the not compliance with care and replacement of the lenses. Daily
too distant past there were many fears, as well as limited lens disposables are also an excellent alternative for those who
options, that made an optometrist reluctant to fit a child into participate in sports and wear glasses. Giving the patients
contact lenses. Common concerns included a child’s lack of and their parents the chance to purchase contacts to wear on a
responsibility to care for lenses, decreased ability to success- part-time basis for sports, special events, and occasions such
fully insert or remove lenses, and an increased risk of adverse as vacations or summer activities, can often be a practice
effects such as contact lens-induced acute red eye (CLARE) building opportunity. Explaining the added benefits of this
or, infiltrative or microbial keratitis. Prescribing contact replacement modality to parents can usually allow them to
lenses was reserved for children on a medically necessary ba- overcome the extra cost of these lenses. In a study performed
sis or until the child had reached the teenage years. to determine whether daily disposable lenses were a feasible
Lens Options for Children option for children ages 8 to 11, the subjects reported both
Vast improvements have been made in contact lens tech- good vision and comfort while wearing contacts. Ninety per-
nology in the past decade. New lens materials increase oxy- cent of the children rarely reported having problems handling
gen permeability, improving comfort and physiology. Mul- their lenses.4
tiple replacement options exist, including daily, biweekly, Extended wear (EW) lenses are not a viable option for chil-
and monthly. There are not only options such as soft or rigid dren for many reasons. The most obvious reasons are the
lenses, but also a myriad of choices for materials and designs. increased risk of complications and long-term effects, such
Many children perform without complication in gas per- as corneal neovascularization, and increased incidence of mi-
meable (GP) lenses, especially infants, aphakes, and those crobial keratitis. Not providing a child with enough practice
with high refractive errors or irregular astigmatism. GP lens- inserting and removing lenses can be an issue since it is not
es can be easier to insert and remove in smaller eyes, have a done on a daily basis.4 On the other hand, EW lenses may be
lower risk of microbial keratitis, and can correct any cylinder a practical option for infants, since insertion and removal (I
present that may not have been found during refraction of & R) may not be feasible at all times with the frequency of
nap times.2 This option ensures consistent refractive correc-
Journal of Behavioral Optometry Volume 23/2012/Number 5-6/Page 145

6 Even with this new evidence. Daily disposable lenses were the most popular 63% of children used lenses three months after the conclu- modality prescribed in this age group. physiological.25D slowing of myopic progression daily disposables after getting out of the pool. ages 8 to 14. Parents need to be educated on contact lens wear and hy. frequent atropine. This was evaluated from a prac- Proper hygiene in children when deciding to suggest con- tice management. contacts. a det- of adverse events. In the United States about 25% of the population is myopic. Recent studies show promising results in halt- This communication can help the child realize that contact ing myopic progression with this treatment modality.tion while the child is awake and aids in the convenience of fants. also found that during the three-month study period. sleeping in lenses. an extremely important area of research for many reasons.15. While contacts are a healthy option. Instilling a rewetting drop can help aid in re- er or not it possibly leads to a progression of myopia.12.7 This demonstrates that wearing contact lenses does in teaching I & R. on simple common issues such as with treatments including progressive addition lenses (PALs). 8-12 years old. determine if it was appropriate to fit children under the age of 12 into contact lenses. and peripheral retinal defocus. members regarding the practicing optometrist’s opinion about physiologically. most practices. Both fitting contacts on a younger age group. recting myopia. sharing contact lens solutions. multi- swimming. Reiterate that it is important to take out the lenses once Dk/t soft contact lenses in the pediatric population and wheth- they wake up. They found that there is still a great difference in the way practitioners fit infants and children compared to teenagers Educating Your Patient and adults. These findings should relieve some fears that so the time spent directly with the practitioner for the fitting practitioners and parents may have about increased risk of remained the same between children and teens. The researchers of this study noted that in not alter the normal microbacterial content of external ocu. but this increased time was only in the time spent tion. ed.4 Of even more concern is progressive myopia.5 Education and extra supervision on common day to day activities such as Orthokeratology is gaining popularity as an option for cor- hand washing and lens care can help prevent adverse events. One portion of the CLIP study investigated whether ered. A recent study showed that wearing watertight focal lenses. one should stress the of axial length or change in choroidal thickness). more frequent steepening of corneal curvature leading to increased myopia. This in children fit with soft contact lenses versus glasses. giene techniques along with the child. the micro biota found on the ocular surface of young contact compared to a teenager. children. lar structures. and psychological stand- tact lenses as an option for vision correction must be consid- point.11 goggles over contact lenses appears to reduce the opportunity Questions remain on whether the changes being reported are for bacteria to attach to the contact lenses. regardless of lens clinically relevant and the effect on ocular growth (decrease material. children were most likely to drop out of contact lens lenses. children still require a certain amount of rimental and visually debilitating condition. while teen- ting children into contact lenses as primary vision correction. I & R training is performed by staff members. follow-up visits are needed for children than for adults. an important step that should not be overlooked. There compliant than adults. teens and children adjusted equally. eye care professionals are realizing the benefits of fit. agers dropped out of contacts due to the added expense. and teenagers was performed by Efron et al. tients that continued in contact lenses found 80% of teens and tact lenses. The majority of children were prescribed either Although there is little evidence that kids and teens are less daily disposable lenses or lenses for part-time wear. there Results of Recent Studies were no significant differences in serious contact lens related The American Optometric Association (AOA) recently adverse events between the two age groups.13 a child sleeping in their lenses against the doctor’s instruc- There is a theory that exists concerning the fitting of low tions. orthokeratology.2 care for the parent. was made up of normal younger children can take up to 15 minutes longer to fit into flora and was similar to bacteria found in the adult popula. Even with improved with over half of those becoming myopic around the ages of contact lens materials and studies reporting no increased risk 8 to 16. It has been found tient about problem signs to look for and what to do if those that there is no clinically significant change in axial length or occur. and soft lenses in reducing myopic progression. Progress is being parental supervision. Some stud- necessity either to disinfect lenses immediately or to discard ies are reporting only a 0.9 (Table 1) Greater groups proved they were able to care for their lenses properly.16 is necessary in order to observe changes due to child growth or refractive error and to prevent complications by catching The Contact Lenses in Pediatrics study (CLIP) sought to problems early. and have not shown whether the effects can be sustained long- Children and parents need to be educated on how to handle term. wear because they preferred wearing their glasses.14 New moving the lens.18 According to the surveys filled out by the with the advent of improved materials and daily disposable parents. It is necessary to educate your patients.17 The study infection in children. made in the attempt to halt myopia progression in children the children and parents. The study found that sion of the study. Recent focus has case replacement. Even more significant is informing the pa- studies have finally answered this question. 13-17 years old. such as dual-focus lenses.8. to the contact lenses fitted in the study. than a half of AOA optometrists responded that they were A survey of participants to determine the number of pa- comfortable fitting children 10-12 years old into soft con. A recent study explored this issue and concluded that more chair time was necessary to fit a child. Both Another survey concerning prescribing contact lenses for in. and removing lenses prior to showering or been placed on investigating the use of different contact lens modalities. taking extra precautions and time to was little difference in the fitting profile between teenagers pick out the most appropriate lens type for each individual is and adults. When examin- distributed the Children & Contact Lenses survey among its ing slit lamp findings. It was found that lens wearing subjects.10 This is lenses are a medical device that should not be taken for grant. groups reported wearing their contacts “often” or “always” Volume 23/2012/Number 5-6/Page 146 Journal of Behavioral Optometry .

This goes beyond allowing them other studies. contact lens wearers spent the same for infants with unilateral congenital cataracts after surgery. and satisfaction in wearing the contact lenses or intraocular lens (IOL) placement. but there is or spectacle correction.21 The ACHIEVE study also aphakia in infants or toddlers. athletics. Uncertainty remains as to what is the optimal treatment tacts.23 amount of time wearing correction as did spectacle wearers. impacting the way they feel among their expected. Contact lenses were proven to be contact lens correction to account for aphakia. In recent years. Contact Lenses in Pediatrics Study Should children between the ages of 8-12 Compared to teens. Study Purpose Outcome Adolescent and Child Health Initiative for Investigated what advantages contact lens Contact lenses provide improvements in Vision Empowerment (ACHIEVE) wear has over glasses on a child’s vision vision specific quality of life in the areas of specific quality of life.Table 1: Summary of recent studies concerning contact lenses and children. The Infant Aphakia Treatment survey included a wide range of questions covering care and Study (IATS) was performed to determine which correction. years old into contacts. from a practice take up to 15 minutes longer to fit. quality of vision. to function with good. only in the management and physiological standpoint. A child may be concerned The Adolescent and Child Health Initiative to Encourage about their appearance when wearing glasses while at school.Associated Adverse Events tion to present to the emergency depart. results of IATS about correcting refractive error and providing great vision. AOA survey Survey done to establish attitudes and prac. No significant differences in serious contact lens related adverse events between chil- dren and teenagers. The second a beneficial option for primary vision correction since they group underwent IOL implantation and was given a spectacle had a major impact on a child’s motivation to wear vision over correction for any remaining refractive error. A very important consideration is a child’s per- symptoms less often than what has been reported for adults in formance in the classroom. Emergency Department Visits for Medi. Contact lenses can increase motivation to wear vision correc- vantages of contact lens wear over glasses on a child’s vision. This study sought to determine the effectiveness of IOL im- since they wore their glasses when not in contacts. the longer contact lenses versus IOLs. tion in the classroom. The study plantation in infancy and to compare the visual outcomes of also showed that the higher the refractive error. area of I & R. Determine reasons for the pediatric popula. patching regimens were implemented in either group to Fitting children and teens with contact lenses is not simply allow maximum visual development. routinely fit contact lenses tion was examined over a three-year period. difference in visual acuity between the two treatment groups.>50% were comfortable fitting a child 10-12 tices of practicing AOA optometrists con.22 This cal intervention among the IOL group. As self-confidence. cerning fitting children into contact lenses. Journal of Behavioral Optometry Volume 23/2012/Number 5-6/Page 147 . have been collected at age one and show no significant dif- This mode of correction empowers children by boosting their ference in visual acuity between the two treatment groups. Contact lens wearers in the ACHIEVE study had the best visual outcome. All patients underwent lensectomy and were wore their contact lenses for shorter periods than spectacle placed into one of two groups.20 More specifically. gery. The children on children as young as eight years old. Based on the aforementioned studies. athletics and satisfaction with correction. practitioners can now confidently. traction is currently the most common mode of correction of and satisfaction with correction. To date. Contact lenses vs IOLs. giving the self-confidence needed to specific quality of life. handling.19. On the other hand. but this did not have can be a major advantage in a child’s social development and any effect on the overall visual outcome. provided correction. To date. Most popular: daily disposables Infant Aphakia Treatment Study Which correction. there were more complications that required surgi- peers and their involvement in activities such as sports. surgeons have looked at the amount of time participants wore contact lens increasingly implanted IOLs in young children. Vision Empowerment (ACHIEVE) study researched the ad. and that younger participants seven weeks old. results of the IATS have been col- will provide the child with the best visual lected at age one and show no significant outcome. The for the pediatric age group. Therapeutic or medically necessary contact lenses make up file (PREP) survey while using glasses at the baseline visit the majority of contact lens fittings being performed currently and then again when using contacts at follow up visits. tions. Contact lens fitting after cataract ex- greater improvements in the areas of appearance. MDAE (23%) Among Children ment for medical device associated events (MDAEs) over 80% of the time. 8-12 year old children (CLIP) be fit into contact lenses. clear vision. Children & Contact lenses. appearance. Spectacle wearers on average wore still concern as to whether this option increases complica- their glasses more than contact lens wearers did their con. the impact of succeed academically. After sur- correction. Contact lenses were the most common cal Device. contact lens versus spectacle wear on a child’s self percep. in the study completed the Pediatric Refractive Error Pro.18 Children and teens also experienced self esteem. The first group was provided wearers wore their glasses. The average study patient was the wearing time for correction.

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Pediatrics (CLIP) Study: chair time and ocular health. Proper education.