CLINICAL

  pediatrics

Contact Lens Wear

The best candidates and parent education

LEONARD J. PRESS, O.D., F.A.A.O., F.C.O.V.D.

There is no such thing as “the right age” for contact lens (CL) wear in children, but some children certainly make better candidates than others.

Kids who play sports make ideal candidates for contact lenses, as spectacles can fall and move during sports, interrupting the activity.

Here, I discuss the conditions for which CL wear offers an advantage over spectacle wear and the education you should provide parents regarding CL wear.

Conditions

The following four conditions can benefit from CL wear:

► Myopia. The best candidates are children who (1) need to wear their prescription full-time, (2) engage in athletics, (3) have high amounts of anisometropia (greater than 2.00D), (4) are motivated to wear CLs — teenagers interested in cosmesis are a great example — and (5) have parents who wish to slow myopia progression. This is particularly true for children with esophoria or eso fixation disparity at near.

As compared with glasses, in which setting the seg height and knowing whether the child is using the desired region of the lens for near is uncertain, multifocal CLs offer a consistent therapeutic effect.

Daily disposable CLs are ideal for kids who aren’t as hygienic or responsible about lens cleaning and storage as others are.

Children as young as age eight with rapidly progressing myopia are ideal candidates for orthokeratology. The idea of putting on these “visual pajamas” before going to sleep, and not having to wear contact lenses during the day, provides a significant advantage for active children.

► Hyperopia. With moderate to high amounts of hyperopia (beyond +1.00), particularly when the AC/A ratio is high, a lens prescription is usually required to offset asthenopia. Of even more significance is optimizing binocular vision for a child who has accommodative esotropia.

As a bifocal prescription is typically an essential part of esotropia treatment, providing the child with a multifocal lens in the proper place is an attractive option to help keep the eyes in optimal alignment.

Keep in mind that there may be an advantage both cosmetically and functionally to combining spectacle prescriptions as an adjunct to contact lenses. This can be in the form of prism, sector occlusion or lens tints.

► Anisometropia. Contact lenses offer a huge advantage over eyeglasses for these children because the eyes are always looking through the optical centers of the lenses, enabling them to maintain binocular vision.

Something else to keep in mind: When a child has amblyopia due to anisometropia, it’s crucial that she looks through the lens prescription all waking hours.

While glasses can slip down a child’s nose, causing her to peer over the top of her glasses, contact lenses can ensure the child is looking through her lens prescription.

► Aphakia. Most surgeons prefer contact lenses to IOLs for infants because of the rapid changes in power that occur with eye growth during the first two years.

Glasses are undesirable in unilateral aphakia because of the extreme image size difference and prism imbalance between the two eyes. Even in bilateral aphakia, contact lenses are visually preferable to glasses.

Parent education

The right time for a child to try contact lenses is when you, his or her doctor, and the child’s parent(s) agree it is in the child’s best interest.

For parents of children who do not yet have the maturity to handle the responsibility of CL wear, educate them on the care and handling of lenses to ensure a beneficial outcome.

You can do this by providing written guidelines (wash your hands before handling, use the prescribed solution, don’t ignore “angry” eyes, etc.) or by having a staff member talk to the parent about the proper wear and care of CLs. There is no substitute, however, for a child being motivated to wear the lenses.

A group effort

CL wear in children truly “takes a village” to have the best outcomes. Be a member of that village. OM

DR. PRESS IS THE OPTOMETRIC DIRECTOR OF THE VISION & LEARNING CENTER IN FAIR LAWN, N.J. HE SPECIALIZES IN PEDIATRIC VISION. HE COMPLETED HIS RESIDENCY PROGRAM IN PEDIATRIC OPTOMETRY AT THE EYE INSTITUTE OF THE PENNSYLVANIA COLLEGE OF OPTOMETRY, AND HE SERVED AS CHIEF OF THE PEDIATRIC UNIT OF THE EYE INSTITUTE. IN ADDITION, HE’S A DIPLOMATE OF THE AAO AND HAS WRITTEN THREE TEXTBOOKS ENCOMPASSING PEDIATRIC OPTOMETRY AND IS A DIPLOMATE IN THE PEDIATRIC OPTOMETRY/BINOCULAR VISION AND PERCEPTION SECTION OF THE AAO. E-MAIL HIM AT VISIONLECTURE@GMAIL.COM, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.