Assessing a Pediatric Patient for Contact Lens Readiness

May 3, 2022
9 min read
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Parents can have a spectrum of thoughts regarding contact lenses for their glasses-wearing children. Some are apprehensive to breach the topic, while others are as motivated as their children for a contact lens fitting.

Contact lenses can be a safe and effective option for children wanting to be glasses-free.1 When the lenses are cared for properly, children can enjoy clear vision to increase self esteem or to play sports and improve overall quality of life.2,3 However, the complications of poor contact lens care, such as giant papillary conjunctivitis4 and infectious keratitis,5 have consequences ranging from irritation to vision debilitating problems.

Thus, moving forward with a soft contact lens fitting should be a shared decision amongst the provider, parent, and patient. Arriving at the lens type involves many considerations, including capacity, motivation, wear schedule, and safety as well as other factors.

Capacity

Every child who is not wearing contact lenses for medical indications should be prepared to be the boss of their own lenses. As the parent cannot follow the child to school to troubleshoot unexpected problems, the child should be fully responsible for lens insertion, removal, and care.

Parents can evaluate their child’s maturity level in other aspects of life that can translate to their ability to handle contact lens wear and care.

Questions to consider are:

  • How well does the child take care of the glasses?
  • How diligent is the child with personal hygiene?
  • How does the child handle other responsibilities?

Age can also often be a proxy for maturity level; in my clinical experience, middle school is a great age group to introduce contact lenses. There certainly are impressive elementary school-aged children, and studies have shown children as young as age 8 independently caring for lenses.6 On the other hand, there are also sheepish older teenagers, so it is important to fairly assess each individual child’s capacity.

Motivation

While a huge responsibility, wearing contact lenses can be a memorable and proud step in growing up. The child should be excited to be in charge of the lenses and is often the driver of the conversation. However, there are scenarios in which the parent is the over-enthusiastic one and the child is hesitant.

A self-motivated, engaged child will generally have the endurance to overcome the initial challenges with contact lenses, specifically adaptation as well as insertion and removal. Gauge the conversations in the exam room to determine if everyone, both parent and child, are on board to pursue the contact lens journey.

Wear schedule

It is important to understand how often the child plans to wear contact lenses.

Daily contact lenses

Because daily and monthly disposable contact lenses perform similarly in terms of comfort and effect on ocular physiology,7 daily lenses have advantages that make them a great first choice of lens. Daily disposable lenses are convenient, catering well to pediatric wearers—no regular care system, no need to keep track of when the lens was first opened. It offers the flexibility of use as needed or every day.

Other

Certain monthly disposable lenses come in extended parameters, which can be a reason to turn to this lens type. Soft lenses for overnight or continuous wear are typically for medical indications, like exposure keratopathy or certain corneal disorders. Pediatric patients wearing lenses for standard use should expect to take out lenses every night to reduce hypoxia-related complications.8

Safety

It is important that both the parent and child fully appreciate contact lens safety, with full discussion in the appointment and an instruction sheet to take home.

An extra level of understanding is to have the parent take it home and bring a signed copy to the training appointment. This could be separate from financial and policy agreements or outfitted all-in-one.

The routines developed early in the learning process for contact lenses are critical, because the lenses are on the eyes, instead of in front of the eyes. Consider the cornea, the eye’s windshield, in which any damage can permanently affect how the child sees. The best assurance to know how a child uses the lenses is to have the child actually show you at every appointment how lenses are removed, inserted, and cared for.

Having the child demonstrate proficiency at every appointment can allow you to steer a child away from unideal habits and reiterate the importance of lens care and safety every time.

Other considerations

Cost

As there are added financial responsibility for lens supplies and care systems, costs should be thoroughly discussed with parents. Before starting the process, parents should be fully aware of out-of-pocket fees and insurance coverage, if applicable.

Monthly disposable lenses and spherical lenses tend to be less expensive than daily disposable lenses and toric lenses. Lens cleaning systems are an out-of-pocket expense that need to be accounted for also. As costs can affect lens compliance,9 it could be a factor when selecting the lens type.

Having transparent conversations about wear schedule will help you determine the most appropriate lens type. For example, prescribing a 3-month supply of daily disposable lenses for a child who just plans to wear them on weekends for sports can align their vision needs and financial circumstances.

UV-blocking contact lenses

A child’s lifestyle and hobbies can direct the consideration for UV protection, which is an added benefit in some but not all lens brands. Even if they are not outdoor athletes, most children spend parts of the day outside, even if it is just for recess or lunch. UV exposure is cumulative and can contribute to the formation of pterygia, pinguecula, and cataracts when the child is older.10

Although UV-blocking lenses are not a substitute for UV protective eyewear, they still serve as a first-line barrier to the eye. Fortunately, most of the major contact lens manufacturers have UV-blocking lenses in their portfolios.

List of brands with UV-blockers

Lens Manufacturer Lens Brand
Alcon
  • Precision 1(+ for astigmatism)
  • Total 30
Bausch & Lomb Biotrue ONEday (+ for astigmatism)
Coopervision
  • Avaira Vitality (+ Toric)
  • Clariti 1day (+ Toric)
  • MyDay (+ Toric)
Johnson & Johnson
  • 1-Day Acuvue Define
  • 1-Day Acuvue Moist (+ for astigmatism)
  • 1-Day Acuvue TruEye
  • Acuvue Oasys 1-Day (+ for astigmatism)
  • Acuvue Oasys (+ for astigmatism, + with Transitions**)
  • Acuvue Vita (+ for astigmatism)
  • Acuvue 2

** Acuvue Oasys with Transitions integrates photochromic technology to reduce sensitivity to bright lights.

When to revisit the contact lens conversation

Set expectations about the timeline of how long the fitting and training process might take. With patience and clear instructions, many children can learn to insert and remove their lenses on their first visit, on average in 30 minutes.11 Multiple unsuccessful training attempts can be discouraging, so consider bringing back the child the following month or on an upcoming school break to try again with a renewed outlook.

If there are hesitations about capacity, reassure the child and the family that it is not “no”, but, rather, “not yet.” Create a plan to re-assess readiness in a reasonable timeline so that the child can safely and confidently enjoy the benefits of contact lenses at the proper time. Many families appreciate touching base every 4 to 6 months to re-discuss the possibility of contact lenses.

The contact lens experience should be a positive and exciting one for the parent and for the child. Determining a child’s readiness for contact lens use involves clinical discretion and fair conversation. Appropriately judging when to start the journey, by weighing out the above factors, will help set up the child for success.

References

  1. Bullimore MA. The Safety of Soft Contact Lenses in Children. Optom Vis Sci. 2017 Jun;94(6):638-646
  2. Rah MJ, Walline JJ, Jones-Jordan DA et al. Vision specific quality of life of pediatric contact lens wearers. Optom Vis Sci. 2010 Aug;87(8):560-6.
  3. Walline JJ, Jones lA, Sinnott L et al. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci. 2009 Mar;86(3):222-32.
  4. Kenny SE, Tye CB, Johnson DA et al. Giant papillary conjunctivitis: a review. Oculi Surf. 2020 Jul;18(3):396-402.
  5. Zimmerman AB, Nixon AD, Ruff EM. Contact lens associated microbial keratitis: practical considerations for the optometrist. Clin Optom (Auckl). 2016 Jan 29;8:1-12.
  6. Walline JJ, Long S, Zadnik K. Daily disposable contact lens wear in myopic children. Optom Vis Sci. 2004 Apr;81(4):255-9.
  7. Sapkota K, Franco S, Lira M. Daily versus monthly disposable contact lens: Which is better for ocular surface physiology and comfort? Cont Lens Anterior Eye. 2018 Jun;41(30:252-257.
  8. Imayasu M, Petroll WM, Jester JV et al. The relation between contact lens oxygen transmissibility and binding of Pseudomons aeruginosa to the cornea after overnight wear. Ophthalmology. 1994 Feb;101(2):371-88.
  9. Bui TH, Cavanagh HD, Robertson DM. Patient compliance during contact lens wear: perceptions, awareness, behavior. Eye Contact Lens. 2010 Nov; 36(6): 334-339.
  10. Bergmanson JP, Soderberg PG. The significant of ultraviolet radiation for eye diseases. A review with comments on the efficacy of UV-blocking contact lenses. Ophthalmic Physiol Opt. 1995 Mar;15(2):83-91.
  11. Paquette L, Jones DA, Sears M et al. Contact lens fitting and training in a child and youth population. Cont Lens Anterior Eye. 2015 Dec;38(6):419-23.
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About Tiffany Yanase Park, OD

Dr. Tiffany Yanase Park graduated magna cum laude from Southern California College of Optometry and completed a pediatric optometry residency at Children’s Hospital Colorado. Her training focused on pediatric primary care, ocular disease, low vision, and specialty contact lenses. Dr. …

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