Contact lenses worthwhile option for preteens, children

Age 16 stands out among life's milestones: drivers' licenses, first jobs—and contact lenses?

It's not unusual for parents, or even doctors, to set this age limit, yet research shows that contact lenses are a safe, viable option for kids even half that age.

Published in the journal Optometry and Vision Science, a recent study shows that the safety risks of soft contact lenses may be lower in younger children than in teenagers, continuing to underscore a long line of research that extolls the benefits of contact lens wear in adolescents and preteens.

Analyzing nine prospective studies that included 1,800 "patient-years" of soft contact lens wear in patients ages 7 to 19, the research focused on signs of corneal infiltrative events that could lead to serious infections, such as microbial keratitis. The analysis found a low rate of corneal infiltrative events—only 136 events per 10,000 years; one large retrospective study found rates of events lower in younger children, 97 events per 10,000 years in 8- to 12-year-old children, vs. 335 events per 10,000 in 13- to 17-year-old children.

Importantly, microbial keratitis was uncommon with one retrospective study finding no rates of such infection in younger children and a rate of about 15 cases per 10,000 years in teenagers. The latter is similar to the rate found in adults, and the study chalks that up to behavioral factors, such as sleeping or showering while wearing contact lenses.

"The overall picture is that the incidence of corneal infiltrative events in children is no higher than in adults, and in the youngest age range of 8 to 11 years, it may be markedly lower," notes study author Mark Bullimore, MCOptom, Ph.D., of University of Houston College of Optometry, in a news release. "The lower rate of adverse events in this youngest group is a result of patient behavior rather than biological factors, and greater parental supervision also may help to mitigate risks."

Why contact lenses?

Count Ed Bennett, O.D., among the youngsters told that 16 was the magic number, partly for monetary reasons, he reflects, but also for a perception that the eye is still changing.

However, the reality is that 16, as an age limit, is arbitrary compared to what that number often represents: responsibility.

"Obviously, it is important for young people to be very compliant with the lens-wearing instructions as well as not overwearing the lenses and utilizing good hygienic practice," says Dr. Bennett, University of Missouri-St. Louis College of Optometry assistant dean and author of numerous contact lens texts. "That said, it should be emphasized that contact lenses are a very safe modality if they comply with the wearing schedule and lens care instructions provided by their eye care practitioner. The benefits greatly outweigh the risks."

Contact lenses are a proven, safe modality for children that come with a number of benefits, both tangible and intangible. Those benefits include a visual freedom from spectacles that have limitations in peripheral vision, induced prism and aberrations if looking away from the optical center, as well as possible problems with excessive minification/magnification; children can lead an active lifestyle without the hindrance associated with spectacles; and a higher self-esteem in social activities.

One such study, the Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) study, found that children 8 to 11 years old wearing contact lenses scored higher on the Self Perception Profile for Children, a validated scale for understanding self-esteem and self-concept. The study concluded that children felt better about themselves compared to spectacle wearers in areas including athletic competence, social acceptance and physical appearance.

But are parents and doctors doing more to prescribe contact lenses in this age group?

"No, we're not fitting enough children into contact lenses," Dr. Bennett says. "That's very evident. If we're not doing that, then we're not being proactive in recommending a modality that can improve children's quality of life."

What to consider when prescribing contact lenses to children

Contact lens educators do "an outstanding job" educating students, yet their hands are tied to a certain extent, Dr. Bennett says, considering only a handful of externship sites are devoted specifically to contact lenses and fitting children requires a degree of clinical experience. That's why the AOA Contact Lens and Cornea Section (CLCS) is driving an initiative to address this need and bolster awareness for externship sites, Dr. Bennett says. But, for doctors considering providing contact lens options for adolescents, there are a few recommendations.

1. Children must wear glasses first. Counterintuitive as it may seem, children should experience spectacles first to be motivated for contact lenses, Dr. Bennett says. Additionally, not every child is ready for contact lenses depending on his or her prescription or level of responsibility, therefore, starting with glasses can encourage children to work toward contact lenses.
2. Consider myopia control options. If the child is a progressive myope, or appears to be on the verge, Dr. Bennett suggests a contact lens with myopia control abilities, such as overnight orthokeratology or peripheral plus soft lenses. These options can safely slow myopia progression, ultimately, by several diopters in many circumstances.
3. Put in extra chair time. Expect to spend an extra 15 minutes or so with children when it comes to the contact lens-fitting process, Dr. Bennett says. Perhaps have a staff member demonstrate lens application and removal, and explain the eyelid sensations a child will feel when wearing the lens.
4. Stress good hygiene. Children may be less risky than teens when it comes to contact lens infection risks, but that's likely due in large part to an emphasis on proper hygiene education and awareness among both patient and parent. One study found children could remove lenses as early as 4 to 5 years, apply lenses at 6 to 8 years, and clean and care for lenses successfully at 10 to 12 years, which is why it's important to clue parents into the hygiene process.