padiatric and teen cl care
A Lifetime of Contact Lens Wear
BY CHRISTINE W. SINDT, OD, FAAO
There's a whole generation of grade school children who want contact lenses, so who's holding them back? Let's take a look at the data. A survey conducted by Fairfield Research (on be half of Vistakon) analyzed 564 responses from Good Housekeeping Reader Advisory Panel members who had at least one child between the ages of 8 and 17 who required vision correction. The purpose of the survey was to gauge the attitudes and perceptions of parents as they relate to their children's vision care. Fifty-six percent of parents of non-contact lens-wearing children said their child was interested in wearing lenses. However, 58 percent said they've never thought of contact lens wear or given it serious consideration.
Forty percent of parents said they weren't comfortable with contact lenses for their children, with 77 percent believing eyeglasses are easier to keep clean and take care of compared to contact lenses, and 54 percent were concerned about their child's ability to care for the lenses. Despite this, 66 percent of parents believe that their eye doctor's recommendation is the right choice for their child's vision correction.
Interestingly, many eyecare practitioners are resistant to recommending contact lenses to children younger than 13 years old. Reasons cited include increased chair time, risk of adverse events, minimal benefit and concerns about motivation, maturity and hygiene.
In one study, 40 percent of parents said they weren't comfortable with contact lenses for their children but 66 percent of parents believe that their eye doctor's recommendation is the right choice for their child's vision correction.
The Contact Lenses in Pediatrics (CLIP) Study concluded that both children and teenagers benefit from contact lens wear. The primary benefits were related to quality of life improvements with respect to appearance, satisfaction with correction and activities. There were few differences in symptoms (teens being slightly more dry) and no significant biomicroscopic differences or adverse events between children and teens. Application and removal averaged a mere 10 minutes longer for children than teens, with no significant difference in actual fitting time.
The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) Study enrolled 484 myopic 8- to 11-year-olds and followed them for 3 years. The children were randomized to wear spectacles or contact lenses.
Over the 3 years of the study, self-perception about physical appearance, athletic competence and social acceptance were greater for the contact lens-wearing cohort, especially if they disliked eyeglasses. While at first glance an increase in self-perception may not seem unusual, other studies have shown that self-concepts change very little over time, even among children. Therefore, it's noteworthy that contact lenses may have significant psychosocial benefits.
In the ACHIEVE study, nearly 91 percent of children wearing contact lenses were successful over the 3 years, compared to 83 percent in adults followed for just 1 year in a separate study. Soft contact lenses did not increase myopia progression.
When it comes to 8- to 12-year-olds, don't use age as the sole criterion for contact lens fitting. Doctors participating in the CLIP study felt that their judgment on a child's motivation, anxiety, maturity, hygiene and aperature size, as well as parental enthusiasm, was predictive on the ease of fit. Actual fitting time is similar between children and teens, while children are just as, or more, likely to achieve success compared to adults. Contact lenses can have a significant impact on a child's self-perception.
I would argue that contact lenses are one of the most bio-inspired forms of visual correction, and in light of this, they're the optimal form of vision correction for children for a lifetime. Many contact lenses contain aspheric curves, much like the cornea itself, and this might optimize vision. Likewise, many contact lenses have UV-absorbing characteristics, much like the cornea and crystalline lens, but UV absorption by the contact lens might reduce the burden of UV absorption on young ocular tissue and reduce the long-term potential for UV-induced damage. Lastly, a contact lens mimics emmetropia such that patients often forget about their visual correction during the day. As noted above, this is associated with an impact on psychosocial development in children and might even improve performance in other areas such as sports. So don't hold back, you could make a lifelong impact by correcting children's vision with contact lenses. CLS
For references, please visit www.clspectrum.com/references.asp and click on document SE2010.
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.