Risk for corneal adverse events similar in children, adults who wear soft contacts
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Key takeaways:
- The incidence of microbial keratitis in children was comparable to adults, while the incidence of corneal infiltrative events was lower.
- Eye care professionals should educate all patients about modifiable risks.
The incidence of microbial keratitis in children wearing soft contact lenses is no higher than that reported in adults, while the incidence of corneal infiltrative events is lower, according to a literature review in Eye & Contact Lens.
“Historically, ophthalmology has had reservations about the safety of fitting children with contact lenses,” Mark A. Bullimore, MCOptom, PhD, and Kathryn Richdale, OD, PhD, both of the University of Houston College of Optometry, wrote. “Specifically, the concern was that the risk of microbial keratitis may not outweigh the improved quality of life or other perceived benefits offered by contact lens wear.”
They continued, “Recent analyses have demonstrated that the risks of contact lens wear are clearly outweighed by the potential reduction of visual impairment associated with lowering a patient’s ultimate level of myopia.”
To evaluate the risk vs. benefit of soft contact lens wear in children, Bullimore and Richdale conducted a literature review of prospective and retrospective studies reporting the incidence of microbial keratitis and corneal infiltrative events (CIEs) in children with a history of at least 1 year of soft contact lens wear.
They identified seven prospective studies published between 2004 and 2022 of 1,756 children, most of whom were fitted at 12 years or younger. There was one case of microbial keratitis and 53 CIEs, of which 16 were symptomatic, resulting in an overall incidence of 2.7 and 42 per 10,000 patient years, respectively.
In addition, researchers identified two retrospective studies of 1,025 children, also fitted at 12 years or younger. Two cases of microbial keratitis were reported in one study, yielding an incidence rate of 9.4 per 10,000 patient years.
Bullimore and Richdale concluded that the overall incidence of CIEs is lower than that reported in adults, while the incidence of microbial keratitis is comparable to reports in adults.
“Prescribing and promoting healthy contact lens wear in children will allow them to achieve the added benefits of improved quality of life and help the slowing of myopia progression with certain lens designs to mitigate risks of associated visual impairment, while minimizing the incidence of adverse events,” they wrote. “The opportunity to help slow progressing myopia using proven soft contact lenses needs to be proactively considered by all those involved in providing eye care to young myopic children.”
Perspective
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Celia Gong, OD, MS, FAAO, FSLS
“Are soft contact lenses safe for my child?” If you fit contact lenses in children, then this is a familiar question. More practitioners are fitting children in contact lenses, partly due to a growing need for providing myopia management, and safety is a vital consideration. This updated review of literature confirms that the overall incidence of corneal adverse events in children is still extremely rare, with significantly lower rates of corneal infiltrative events in children when compared with that of adults. Therefore, the short answer to the question is a resounding, “Yes!”
Of course, the risk of soft contact lens-related adverse corneal events, both infiltrative events and microbial keratitis, is not zero. Modifiable risk factors that clinicians can follow when fitting children in soft contact lenses include fitting daily disposable lenses and emphasizing the importance of contact lens compliance and proper wear and care. While the authors in the review quantify the incidence as low, it is our job as clinicians to ensure that the children in our chair do not become part of the statistic. Providing comprehensive education on safe contact lens practices should remain a priority to maximize ocular health outcomes.
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