Fitting Children with Extended Wear GP Contact Lenses
BY MARJORIE J. RAH, OD, PHD
Recently, a 12-year-old male patient came to my clinic for a contact lens fitting. He made it perfectly clear that he wished to sleep in his lenses. I've fit many children in daily wear lenses or in overnight wear for corneal reshaping, but this was my first true extended wear for non-therapeutic use in a child.
Reading the Situation
After taking a complete history from both the child and his mother, it became apparent that I had a choice to make. I could either fit this child with lenses, knowing that he was going to wear them on an extended wear schedule, or I could refuse. If I refused, he'd likely go elsewhere to find someone who would fit him with contact lenses.
I had previously established a relationship with this patient in my clinic. He's always made it to his regularly scheduled appointments, and his mother doesn't hesitate to contact me when they have questions or concerns. But I have no doubt that he would find a way to wear contact lenses if I refused him, so I decided to fit him with extended wear contact lenses.
After discussing the options, I was pleased to find that the patient preferred GP lenses. I ordered his in the Menicon Z material. Even though I didn't mention 30-day extended wear, we did have a healthy debate about the acceptable number of consecutive nights of wear. In the end, I decided to start with one to two consecutive nights maximum. I'll follow him closely and adjust the wearing schedule as we go.
Reviewing the Facts
There's a paucity of literature on the topic of extended contact lens wear and children. Most studies include only patients 18 years of age and older. In one study, Shaughnessy et al (2001) reported on the use of GP lenses for treating refractive abnormalities in children. In this study, two of the 10 children wore the lenses on an extended wear schedule. They found no adverse events secondary to contact lens wear over a mean follow-up period of roughly 18 months. While we can't take this as a generalization for all children, it is reassuring.
Extended wear in children isn't a new concept -- at least when it comes to therapeutic purposes. Practitioners have fit aphakic children with contact lenses on an extended wear basis for many years. The biggest difference is that practitioners fit most infants with silicone elastomer or hydrogel lenses rather than with GPs.
We have information on the safety of extended wear GP lenses in adults. As a result of the recent FDA approval, the safety of the Menicon Z lens for 30-day extended wear has been a topic of current research. In the pre-approval clinical trial, researchers found a significantly lower rate of adverse events related to lens wear for GPs when compared to hydrogels worn for seven days (six nights). The literature shows that the Menicon Z lens is relatively safe for extended wearing schedules, especially compared to extended wear of hydrogel lenses. Unfortunately, these data are based on adult subjects, so we can only assume the safety is similar in children (the FDA approval doesn't have an age restriction).
Get Yourself Ready
I'm not advocating routinely prescribing extended wear contact lenses for children, but I can sleep at night knowing that I've thoroughly educated both the child and his parent about the increased risks of extended wear and that I've chosen the best possible contact lens materials for extended wear in the rare cases that arise in my clinic.
For references, visit www.clspectrum.com/references.asp and click on document #104.
Dr. Rah is an assistant professor at the New England College of Optometry where she works primarily in the Cornea and Contact Lens Service in patient care, teaching and researching.