Pediatric and Teen CL Care
Refractive Error Considerations
BY MELANIE FROGOZO, OD, FAAO
Children and teens are great candidates for contact lenses. In comparison to spectacles, this population has better self-image and greater satisfaction in their overall quality of vision with contact lenses (Walline et al, 2009). This article addresses at what refractive error you should consider recommending contact lenses to this special population.
Hyperopia and Myopia
In high-plus prescriptions, spectacles cause ring scotomas, magnification, and prismatic effects (Augsburger, 1987; Moore, 1990). Prescribing contact lenses for high hyperopia (≥ +5.00D) significantly decreases these problems (Figure 1). In addition, if a child who has low-to-moderate hyperopia shows signs of decreased acuity or binocular or functional vision problems, you should also consider contact lenses (Moore et al, 2008).
Figure 1. A 9-year-old girl who has a high-plus prescription in spectacles (left) was fitted into contact lenses (right). Note the magnification effect with spectacles.
Strongly consider prescribing contact lenses to high myopes (> –6.00D). Contact lenses reduce minification of images and prismatic effects caused when patients wear their glasses off axis (Goss et al, 2006). Additionally, low-to-moderate myopic children and teens also benefit from contact lens wear, especially if they are active in sports or extracurricular activities.
Uncorrected astigmatism that is ≥ 2.50D is a risk factor for isoametropic amblyopia in children. (Rouse et al, 2004). GP lenses are great for correcting large amounts of astigmatism. The sharp and stable optics ensure good quality of vision in children and teens who have high astigmatism. Nonetheless, low-to-moderate astigmatic patients also can benefit from contact lens wear and do well in either soft or GP lenses. I start correcting children and teens who have astigmatism as low as 0.75D with contact lenses.
Anisometropia and Aniseikonia
Anisometropia may obstruct fusion due to aniseikonia, putting children at significant risk for amblyopia (Sindt, 2006). Hyperopic children who have as little as l.00D difference of anisometropia are at risk for developing amblyopia. For myopic children, 3.00D to 4.00D disparity can cause amblyopia to develop. Additionally, a difference greater than 1.50D of astigmatism between the eyes can also cause amblyopia (Rouse et al, 2004). Contact lenses reduce amblyopia risk in anisometropia by decreasing image blur and size (Sindt, 2006).
Contact Lenses Benefit Kids
Children benefit from lens wear because it improves vision, cosmetic appearance, and helps self-image. When examining this special population, we should be aware of the refractive benefits that contact lenses have to offer and for what refractive errors to recommend them (Table 1). CLS
• High hyperopia (≥ 5.00D)
• High myopia (≥ 6.00D)
• High astigmatism (≥ 2.50D)
– Disparity of ≥ 1.00D in hyperopia
– Disparity of ≥ 3.00D in myopia
– Disparity of ≥ 1.50D in astigmatism
For references, please visit www.clspectrum.com/references and click on document #237.
Dr. Frogozo specializes in adult and pediatric specialty contact lenses. She is the director of the Contact Lens Institute of San Antonio and the owner of Alamo Eye Care in San Antonio, Texas. You can contact her at firstname.lastname@example.org.