Pediatric and Teen CL Care
GP Contact Lenses for Kids
BY JEFFREY J. WALLINE, OD, PHD, FAAO
Children of all ages are capable of GP contact lens wear. Indications and contraindications for GP contact lens wear are not significantly different between children and adults, but some apply more frequently to children.
Approximately 80% of children are able to initially adapt to GP contact lens wear (Walline et al, 2003), which is better than the reported 70% for adults (Polse et al, 1999). However, over a two- to three-year period (Katz et al, 2003; Walline, Jones et al, 2004), approximately only 55% of children continued to wear GP contact lenses. Interestingly, girls were no more successful at adaptation compared to boys. The children who could not adapt had more against-the-rule astigmatism than those who adapted, but the average amount was less than 0.25D (Walline et al, 2003). The non-adapters were also younger compared to the adapters (average age of 9.8 years versus 10.5 years, respectively), but the difference was only about six months.
Unfortunately, there were no strong predictors of successful adaptation for children (Walline et al, 2003). Anecdotally, however, photophobia is a significant sign that adaptation is not possible.
Ocular Health Benefits
The improved tear exchange and enhanced oxygen permeability of GPs may lead to better ocular health than with soft contact lens wear in the long term, although one study indicates that children fit with soft contact lenses at ≤12 years exhibited no differences in indicators of corneal health after 10 years of wear compared to children fit between the ages of 13 and 17 (Walline et al, 2013).
Why to Fit GPs
Indications that children should be fit with GPs—as opposed to soft contact lenses—include poor dexterity and parents who wear GP contact lenses. Children should not be fit with GPs if they only want to wear them part-time or they swim frequently. Although microbes are thought to adhere to GP contact lenses less readily compared to soft contact lenses, GPs may be lost more frequently in swimming environments.
Aphakic children may be fit with GP contact lenses. In the Infant Aphakia Treatment Study, 21% of the children were fit with GP contact lenses as opposed to silicone elastomer (Russel et al, 2012). After one year of wear, there was no difference in the visual acuity between children wearing either type of contact lens. Although GP contact lens-wearing infants required an average of 16.8 lenses per patient, compared to just 10.9 lenses per patient for the silicone elastomer lens wearers (Russell et al, 2012), the total cost for the year was $1,275 for GP lens wearers compared to $1,925 for silicone elastomer lens wearers due to the lower cost per GP lens (Carrigan et al, 2013).
Myopia control is not a reason for alignment-fit GPs (Katz et al, 2003; Walline, Jones et al, 2004). However, several non-randomized trials (Cho et al, 2005; Santodomingo-Rubido et al, 2012; Walline et al, 2009; Chen et al, 2013) and randomized clinical trials (Charm and Cho, 2013; Cho and Cheung, 2012) have shown that corneal reshaping contact lenses slow the progression of myopia. They not only slow the growth of the eye, but may be beneficial for children who swim frequently because the lenses are not worn in the pool.
Children have proven that they are capable of wearing alignment-fit (Katz et al, 2003; Walline, Jones et al, 2004) and corneal reshaping contact lenses (Fan et al, 1999; Walline, Rah et al, 2004). And, although the utility of GP contact lens wear continues to be low in the United States, the evidence of myopia control with corneal reshaping contact lens wear may increase the number of parents asking for GP contact lenses for their children. CLS
For references, please visit www.clspectrum.com/references and click on document #227.
Dr. Walline is an associate professor at The Ohio State University College of Optometry. His research interests primarily involve pediatric contact lenses and myopia control. He has received research funding from Johnson & Johnson Vision Care. You can reach him at firstname.lastname@example.org.