pediatric and teen cl care
Are Kids Safe from Dry Eye?
By Katie L. Greiner, OD, MS, & Christine W. Sindt, OD, FAAO
Children who wear contact lenses generally report fewer dry eye symptoms and less discomfort than their adult lens-wearing counterparts, and there are several possible reasons for this discrepancy. In a study conducted at The Ohio State College of Optometry and the New England College of Optometry, we administered the Contact Lens Dry Eye Questionnaire (CLDEQ) short form to 94 pediatric contact lens wearers, ages 8 to 14 years. The CLDEQ classifies dry eye by assessing the frequency and intensity of dryness and light sensitivity at various times throughout the day. This questionnaire has been validated among adult contact lens wearers (Nichols, 2002).
Of the 94 pediatric contact lens-wearing subjects, the mean (±SD) CLDEQ composite score was +0.25 ± 0.50 (range = −1.20 to +1.45), which is significantly lower than a sample of adult contact lens wearers (Nichols, 2004) with a mean (±SD) CLDEQ composite score of +1.02 ± 0.80 (range:–0.74 to +4.50; Students t-test, P<0.0001). In our study, 4.3% of the children were classified by the survey as having dry eye compared to 56.2% of adults (x2, P<0.001) (Nichols, 2004).
It's not surprising that pediatric patients report less dry eye given the difference between the lens-wearing populations. The lacrimal system of a child produces more tears than does the lacrimal system of an adult, although it was once shown that proteins and lipids deposit less often on contact lenses in pediatric wearers than in adult wearers (Enoch, 1972). Fewer deposits on the lenses may explain fewer dry eye symptoms reported by children.
Contact lens replacement modality and materials may also be related to dry eye symptoms. A majority of the children in our study wore daily disposable contact lenses, which are likely to have fewer deposits. This may explain the lower frequency of dry eye classification in this sample. However, a large study of contact lens-related dry eye found no difference between daily disposable contact lenses and 2-week, monthly or quarterly replacement contact lenses (Ramamoorthy, 2008). A comparison of specific contact lens materials showed no association to dry eye classification, but hydrogel contact materials were associated with a higher frequency of dry eye in patients than did silicone hydrogel contact lenses. And hydrogels may deposit more overall than silicone hydrogels.
In another study, adult contact lens wearers reported that 39 ± 30% of their workday involved use of computers, 7% were taking oral contraceptives, 11% reported using blood pressure medications, and another 7% reported taking antidepressants (Begley, 2000), all medications which are never or rarely used in pediatric populations. It's likely that adults also consume more caffeinated beverages, wear contact lenses for more hours per day, and experience artificial environments in airplanes and hotels more frequently than children, all of which may contribute to dry eye symptoms and are not typical in the pediatric population.
Children may report fewer dry eye symptoms because they have less basis for comparison or they may not know how to verbalize their discomfort, so they may report fewer symptoms because they do not yet understand the concept of discomfort or because they may be highly motivated to continue wearing their contact lenses for psycho-social reasons.
Children's relative comfort during contact lens wear is likely multifactorial, possibly relating to a combination of better tear film components than adults, contact lens modality worn, and/or poorer ability to identify discomfort. CLS
For references, please visit www.clspectrum.com/references.asp and click on document SE2011.
Dr. Greiner is a part-time clinical attending at The Ohio State College of Optometry in the Contact Lens and Primary Vision Care Clinics. She also serves as Clinical Director for TLC Laser Eye Center in Columbus, Ohio and works in a joint MD/OD practice with a refractive surgeon. Dr. Sindt is a clinical associate professor of ophthalmology and director of the contact lens service at the University of Iowa Department of Ophthalmology and Visual Sciences. She is also an AOA Contact Lens and Cornea Section Council Member. She is a consultant or advisor to Alcon, Ciba Vision, and Vistakon and has received research funds from Alcon.