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Contact lenses: A rite of passage?
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“Doctor, at what age do you recommend contact lenses?” I’m sure many of you – like me – hear that question at least a dozen times a day. It’s usually a concerned parent who is, undoubtedly, feeling the pressure from an interested child. A parent who is trying to make an informed decision while not being overly protective or granting too many liberties. When you think about it, parental concern is justifiable. Quite possibly, neither parent has ever worn contact lenses. Or worse yet, they may have limited experience, recalling the days of PMMA or homemade saline for thermal disinfection. Simply put, they may be unaware of the safety and efficacy of today’s contact lenses.
So, how do you answer the question? Do you simply draw the line at 16 years of age or do you prescribe for younger patients as well? Is your response based upon anecdotal observations or is it well rooted in scientific research? Though the question has no definitive answer, the response is actually quite important. Important in that the answer must reflect your prescribing confidence while allaying any parental concerns.
The reality is that the appropriate contact lens age varies with each patient. It’s based upon clinical facts regarding safety and efficacy, the “readiness” of each youngster and our willingness to assume responsibilities inherent in providing these services. And while the age isn’t found in a text, it’s fairly easily determined. Let me explain.
Consider safety, efficacy
First, consider safety and efficacy. Prescribing contact lenses for baby boomlets is vastly different than it was for their parents. Twenty years ago contact lens materials were few, care systems rudimentary and our understanding of the physiologic impact of lens wear limited. Further more, there were relatively few wearers and virtually no long-term follow-up.
Today, this has all changed. Disposable contact lenses, superpermeable rigid lenses and effective care systems have proven tremendously successful. We better understand the physiologic – and pathologic – consequences of contact lenses, their treatment and — more importantly — their prevention. Additionally, we have an entire generation of contact lens wearers, many with more than two decades of experience, as testimony of this modality’s safety and efficacy. Indeed, although not entirely risk-free, contact lenses are a very viable choice, regardless of age.
Compliance issues
Of course, underscoring any prescribing endeavor is our assessment of patient “readiness.” After all, a contact lens is a medical device, and any user should respect it as such. To imply that everyone achieves this degree of maturity by a certain age is, at best, arbitrary. Whereas parental opinion is important, even parents are often pleasantly surprised by their child’s commitment to proper contact lens use. In fact, it’s not uncommon to find pre-teens more compliant than many adults with respect to contact lens wear and care. Compliance is attainable, regardless of age.
Risky for minors?
Finally, there’s the issue of risk. Certainly, the easiest – and least risky — approach is to not prescribe contact lenses for minors. Period. Practically speaking, it’s not the best policy and a tremendous disservice to certain young patients. Of course, prescribing contact lenses for children should never be carried out in a cavalier fashion. There’s no substitution for competency and diligence in prescribing contact lenses, regardless of age.
In the final analysis, I see no reason for arbitrarily denying pre-teens the privilege of wearing contact lenses. Given the proper ocular profile, maturity, responsibility and parental support, is there really any reason to do so? Reassuring parents of contact lens safety and efficacy makes their decision an easier one. Entrusting young patients with this privilege instills a sense of responsibility and self-esteem. Indeed, prescribing contact lenses for pre-teens is often more than an issue of correcting refractive error. For many, it’s part of growing up.