On this episode of Inside Intrepid, Sophia Leung, OD, FAAO and Erin Tomiyama, OD, PhD, FAAO sit down to discuss the importance of corneal health in pediatric contact lens wearers and tips for communicating important information with children and families.
Dr. Leung practices in a surgical and medical cornea setting in Calgary, Alberta, Canada, and Dr. Tomiyama is an Assistant Professor of Optometry at Marshall B. Ketchum University.
Long-term effects of early contact lens wear
Although children wearing contact lenses is not a new phenomenon, there is limited research on the long-term effects on corneal health, especially in myopic children, including limbal stem cells1 and corneal curvature. However, the reported incidence of serious adverse events associated with contact lenses remains low.
In one study, wearing daily disposable hydrogel soft contact lenses full-time for 10 years did not result in any significant long-term effects on the central corneal endothelium in children who began wearing soft contact lenses at age 8 and were under regular follow-ups.2 Additionally, while orthokeratology is effective at reducing corneal curvature and slowing down axial length progression, it doesn’t seem to increase significant adverse effects on corneal endothelium.3
Safety reporting and standardized conventions
Comparing adverse event reporting across different studies can be challenging due to variations in study design, protocol definitions, and reporting methods.4 In some studies, reusable contact lenses have a higher rate of adverse events compared to daily disposable lenses.4
Although silicone hydrogel lenses provide improved oxygen transmissibility, the risk of corneal infiltrates is significantly higher with reusable silicone hydrogel lenses, around two times that of traditional hydrogel lenses, regardless of the wear mode (daily or extended).5
One thing to note is that because reporting contact-lens adverse events is voluntary, they may be underreported.5 A scoping review by Tomiyama et al. (2024) found that adverse events, such as corneal infiltrative events (CIEs), may be underreported because many studies focus on efficacy rather than safety.6
The review emphasizes that terms used to describe adverse events related to contact lenses can be ambiguous and vary significantly, which complicates the accurate assessment of the true prevalence of CIEs.6
Incidence of adverse events by age
Research suggests that children ages 8 to 12 have a lower incidence of contact lens/corneal infiltrative events,5,6 which may be largely attributed to higher levels of parental involvement and monitoring. In clinical trials, it may also be due to higher levels of subject education, recruitment bias, or the provision of free materials.7
Patients aged 15 to 25 are at the highest risk for contact lens-related adverse events.5 Poor care and maintenance habits among teenagers and college students, or changes in systemic inflammatory responses during this time, may be the source of this increase in the teenage years to young adulthood.7
Download the patient handout from the article Contact Lens Care for Patients with Take-Home Instructions to improve education on maintenance habits!
Parental involvement, communication, and compliance
Drs. Leung and Tomiyama emphasize the delicate balance required when explaining chronic conditions—such as myopia, keratoconus, or blepharoconjunctivitis—to families.
Effective management requires building trust with parents, who are often the primary drivers of compliance. For example, in patients with keratoconus, scleral lenses are an excellent option for pediatric cases and can improve parents' quality of life. Therefore, it is essential to prioritize the compliance of caregivers and parents when fitting pediatric patients.8
It is equally important to engage the child directly as the patient, tailoring communication to their age and understanding without inducing unnecessary stress or fear. Building long-term relationships through frequent follow-up visits helps doctors tailor their approach to different family personalities.9
Dr. Tomiyama believes that becoming a parent has given her a deeper understanding of family dynamics, thereby enhancing her ability to counsel families effectively and boosting her credibility in the eyes of her patients' parents, helping her build stronger relationships with them.
Finding a careful balance in patient education is essential—emphasizing compliance while avoiding unnecessary fear or stress for both parents and children.
