Long-term Contact Lens Wear of Children and Teens

Jeffrey J. Walline, O.D., Ph.D., F.A.A.O.; Kathy Osborn Lorenz, O.D., M.S., F.A.A.O.; Jason J. Nichols, O.D., M.P.H., Ph.D., F.A.A.O.

Disclosures

Eye Contact Lens. 2013;39(4):283-289. 

In This Article

Abstract and Introduction

Abstract

Objective: To compare current symptoms, compliance, ocular health, and previous adverse events between current successful long-term contact lens wearers fit as children or as teenagers.

Methods: People who had successfully worn soft contact lenses for at least 10 years completed an online survey about demographics, current wearing status, compliance, symptoms, and previous adverse events. A subset reported for a slit-lamp examination, autorefraction, autokeratometry, and specular microscopy. Statistical comparisons were made between those fit as children (12 years or younger) and those fit as teenagers (13 years or older).

Results: Of the 175 subjects completing the online survey, 86 (49.2%) were fit as children and 89 (50.8%) fit as teenagers. Those fit as children wore their contact lenses for an average of 14.8 ± 3.4 hours per day, compared with 14.7 ± 3.6 hours per day for those fit as teenagers (P=0.74). Eighteen (20.9%) fit as children and 17 (19.1%) fit as teenagers reported ever having had a painful, red eye that required a doctor visit (P=0.76). Overall, there were no differences in ocular health between the groups. Those fit as children were more myopic than those fit as teenagers (-4.30 ± 1.69 and -2.87 ± 2.75, respectively; P=0.02).

Conclusions: Successful contact lens wearers fit as children are no more likely to report previous contact lens–related adverse events, problems with compliance, decreased wearing time, or worse ocular health than those fit as teenagers, so practitioners should not use age as a primary determinant in fitting children in contact lenses.

Introduction

In recent years, there has been an increased interest from the clinical community about fitting children in contact lenses, primarily as a result of advances in contact lens materials and modalities, requests from parents or children, and evidence-based results.[1] Despite evidence that children are capable of wearing most contact lens modalities,[2–10] only approximately 3% of new contact lens fits in the United States are performed on children between the ages of 6 and 12 years.[11]

Recent research has shown that 7-year-old to 12-year-old children require, on average, a total of 15 minutes more for the fitting, care instruction, and follow-up visits than 13-year-old to 17-year-old teenagers,[12] and the primary difference in time is because of the care instruction training. Office staff can perform this training, so the overall productivity of the office is not affected. The same study also showed that the short-term ocular health effects[12] and the benefits of contact lens wear[13] were similar between children and teenagers.

Contact lenses also provide other benefits beyond simply vision correction for children, such as improved self-perceptions in the areas of physical appearance, athletic competence, and social interaction.[14] Furthermore, contact lenses improve children's quality of life, particularly in the area of appearance and recreational activities.[15]

Teenagers are often fit with contact lenses, but many contact lens practitioners do not fit children, resulting in the low rate of patients fit with contact lenses before 13 years of age.[11] This is despite evidence that children experience ocular events that precipitate disruption of soft contact lens wear[16] and corneal infiltrative events[17] less often than teens and young adults. Overall, the risk-to-benefit ratio of short-term contact lens wear is similar between children and teenagers, children require only a small amount of extra staff time to fit with contact lenses, and children experience contact lens benefits beyond vision correction. So why would not contact lens practitioners be as likely to fit a child with contact lenses as a teenager? Wang et al.[18] showed that the most common reason for emergency room visits for medical device–associated adverse events among children was contact lens wear, which comprised 23% of the cases. However, they did not state the total number of contact lens wearers, so the relative safety of the medical device could not be determined. Instead, eye care practitioners may believe that contact lenses pose greater long-term ocular health consequences for patients fit as children than for those fit as teenagers, so they believe that age should be the primary criterion for determining whether a child can be fit in contact lenses. The purpose of this study was to compare current symptoms, current contact lens care systems, ocular health, and self-reported prior adverse events (e.g., complications) between current successful long-term contact lens wearers who were fit as children or as teenagers.

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