…on a case-by-case basis, keeping these factors in mind

Daytime multifocal/dual-focus (MF/DF), extended-depth-of-focus (EDOF) soft contact lenses (SCLs), and orthokeratology (ortho-k) contact lenses are options to correct children’s vision and slow myopia progression and its accelerated axial elongation. Given the younger age of onset for myopia and, thus, the need for earlier intervention, the minimal age a child can safely start wearing contact lenses has become a popular topic for discussion.

I have found that the age consideration should be evaluated on a case-by-case basis, taking into account the following factors:

CONTACT LENS TYPE AND WEARING MODALITY

Ortho-k, due to its overnight wear, which provides complete freedom from daytime contact lens wear, can be considered for younger children, as early as kindergarteners. This is because the whole period of contact lens wear is at home under parent supervision. Should contact lens application, removal, and cleaning become challenging, parents can take over.

SCL wear, on the other hand, requires the child to handle the contact lenses proficiently, especially in situations where dirt enters the eye, or the contact lens accidently comes off at school. Asking a child how well they would be able to handle the contact lenses, which is something they may have never experienced before, is not very helpful. A useful indicator of ability is the time and effort by the practitioner regarding applying the contact lenses to the child’s eyes. Being able to sit still, withhold the urge of turning their head away, or making jerky movements etc. are very promising signs of the child's ability for fast adoption to contact lens wear.

MOTIVATION OF THE CHILD

I have found that the more eager the child is to see clearly without glasses, the more likely they will invest the time and effort into contact lens wear and care. As a result, a thorough understanding of the child’s attitude prior to prescribing contact lenses is critical to the successful initial adaptation and long-term contact lens wear.

Auspicious signs of such motivation could be the child walking into the exam room with his or her glasses in their pocket, parents complaining of the child’s reluctance to wear the glasses, or an affirmative statement from the child, such as “I would do anything to not have to wear my glasses.”

VERBAL ABILITY OF THE CHILD

As optimal contact lens fit, proper contact lens wear and care, and the early detection of minor issues, such as mild redness, foreign body sensation, or blurry vision are significantly associated with the long-term safety of wear, it’s imperative the child have the verbal ability to clearly ask questions about proper wear and care, and plainly explain any contact lens-related problems they may be experiencing.

Some contact lens issues, such as blurry vision, for example, may not be easily detectable by the parent, so the child must be able to inform their parent of the nature and the severity of those issues. This way, an appointment can be made quickly to address such issues.

AGE ALONE IS JUST A NUMBER

The three factors discussed above play significant roles in predicting patient success with contact lens wear for myopia management. I have seen plenty of kindergartner and preschool-aged children successfully wear ortho-k or daytime MF contact lenses, and I have seen multiple cases where adolescent wearers fail to wear or maintain their contact lenses safely or effectively. Needless to say, the decision to prescribe contact lens wear for myopia control must be a balance of the immediate, as well as the long-term benefits of wear and the potential risks associated with the treatment in each specific patient and, more importantly, thoroughly discussed with both the child and their parents prior to the initiation of the treatment. OM

DR. LIU is an associate professor at Pacific University College of Optometry and is the founder of UC Berkeley’s Myopia Control Clinic. She received her bachelor’s degree of Clinical Medicine from Peking University, her OD from Pacific University, and her PhD and MPH from UC Berkeley. She is a world-recognized clinical researcher in myopia. Dr. Liu is a consultant for CooperVision and Essilor International.