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Contact lenses: a good option for active myopic children
Contact Lenses and Eyewear
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Myopia affects 2% of children as they enter kindergarten, and the prevalence increases progressively until grade 12, when it reaches 15%, according to Jeff Walline, OD, MS, principal investigator of the National Eye Institute-sponsored Contact Lens and Myopia Progression (CLAMP) Study. “Contact lenses should be presented as an option to young myopes,” he added.
A large body of previous research indicates that rigid gas-permeable (RGP) materials may effectively slow myopia’s progression by as much as 50%. “We are seeking a more definitive answer to this question,” he said. “Children younger than 12 are wearing contact lenses, with the vast majority being fit with soft lens materials, which do not prevent myopic progression,” he said.
“Myopia is just as common as it ever has been in the United States, and many researchers believe its prevalence is on the increase in Asia,” said Don Mutti, OD, PhD, co-investigator of the National Eye Institute’s Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study.
According to Dr. Walline, “Parents of Asian children are especially worried about their children becoming high myopes like themselves and are eager to control myopia with contact lenses.”
“RGP contact lenses are easier for children to handle,” said Loretta Szczotka, OD, MS, clinical center investigator of the National Eye Institute’s Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. “From infancy to 5 to 6 years old (for medically indicated contact lenses), children will need an average of four contact lenses per eye annually, while 7- to 10-year-olds will need 1.5 pair per year. Intralimbal RGPs are now available for many of these young keratoconus patients,” she added.
Treating anisometropia
Practitioners should also consider using contact lenses for children with anisometropia, especially when it is more than 2 D, said Dr. Szczotka. “The earlier anisometropia is treated, the greater the likelihood of preventing vision loss,” she added.
“Untreated anisometropia, whether more than 2 D or from high or unilateral oblique astigmatism, becomes a risk factor for developing amblyopia and causes amblyopia’s prevalence to reach 2.5% in the pediatric population,” Dr. Szczotka continued. “Occluder contact lenses provide a successful treatment alternative and prevent poor compliance with patching.”
Performance, motivation, maturity
School performance may improve and physical activity may increase with contact lens wear. “Kids who have high astigmatism, myopia, hyperopia, anisometropia and amblyopia are more likely to succeed in school when they are fit with contact lenses, because they are more visually comfortable,” Dr. Walline said. “Soccer players who were previously limited when using their heads to hit the ball while wearing glasses play better.”
Parents tell Dr. Szczotka that their children want to wear contact lenses for cheerleading, for tap and ballet dancing, in school plays and for many sports.
The 9- to 14-year-old age group is the one developing refractive error and should be considered for first-time contact lens wear, said Dr. Mutti.
Dr. Walline added that maturity and motivation should be factored in as well. “Improvement in self-esteem may also occur as a result of children being fit with contact lenses,” he said.
“Children should be treated with respect, be treated as individuals and be spoken to directly,” Dr. Mutti said.
Dr. Szczotka said that before selecting a soft or RGP material, “I always talk with children to ask why they want to wear contact lenses as well as to identify their motivation, maturity and self-awareness levels.”
Fitting techniques
Many of Dr. Szczotka’s pediatric contact lens fits are for medically indicated conditions. For the initial fit and follow-up care, “I do not have these young children sit behind a phoropter. Instead, they sit on a parent’s lap in the exam chair,” she said.
“Prescriptions can be determined with retinoscopy and over-refraction with trial lenses, and contact lens fit and ocular health can be evaluated with a Burton lamp or by shining the Cobalt Blue filter beam from a slit lamp on the cornea and contact lens with fluorescein instilled,” she said. These provide options to traditional diagnostic equipment.
Motivation and tolerance by the child’s parents are equally important to ensure good ocular health for children as contact lens wearers. “This often means waking the child up earlier to insert the contact lenses,” Dr. Walline said. “Additionally, if children see parents using proper care techniques with their contact lenses, they are more likely to do the same.”
“If a child is a soft lens wearer, I emphasize that the lenses must be taken out before bed,” Dr. Walline added. Because RGP lens wearers are more aware of their contact lenses, “they are more likely to remove their lenses before bed,” he said.
“When a child is first starting to wear contact lenses, consult with the school nurse and teachers, because during this time, a child will have more problems with a contact lens falling out or needing to be removed,” Dr. Walline said.
The optometrist should provide education about red eyes and referrals “because the teacher or nurse may be concerned that this condition is contagious and may automatically send the child home,” he said. Contact lens information, including the eye care professional’s name, address and phone number should be included in the child’s health records at school.
For Your Information:
- Jeff Walline, OD, MS, may be reached at 338 W. Tenth Ave., Columbus, OH 43210-1240; (614) 292-6603; fax: (614) 292-4705; e-mail: walline.1@osu.edu.
- Don Mutti, OD, PhD, may be reached at 338 W. Tenth Ave., Columbus, OH 43210-1240; (614) 247-7057; fax: (614) 247-7058; e-mail: mutti.2@osu.edu.
- Loretta Szczotka, OD, MS, can be reached at University Hospitals of Cleveland, Department of Ophthalmology, 11100 Euclid Ave., Cleveland, OH 44106; (216) 844-3609; fax: (216) 844-7117; e-mail: loretta.szczotka@uhhs.com.
- Drs. Walline, Mutti and Szczotka have no direct financial interest in the products mentioned in this article, nor are they paid consultants for any companies mentioned.