pediatric and teen cl care

Dry Eyes Are Less of a Problem in Young Contact Lens Wearers

BY JEFFREY J. WALLINE, OD, PHD, & MARJORIE J. RAH, OD, PHD

Dry eye is a widespread problem, affecting up to one-third of the population. Many factors are associated with dry eye symptoms including increased age, female gender, allergies, computer use, hormone levels, and medications.

Another very strong risk factor that exacerbates dry eye symptoms is contact lens wear. Approximately half of all contact lens wearers experience dry eye symptoms, compared to one-fifth of non-contact lens wearers. In the United States alone, approximately 18 million contact lens wearers experience dry eye symptoms.

As more evidence accumulates regarding the benefits of contact lens wear for children, more parents are seeking that modality of vision correction for their kids. You should be aware of the potential side effects of contact lens wear in children to help them maintain optimal eye health over a lifetime.

Children and Dry Eye

One potential side effect experienced by many adults is increased dry eye symptoms with contact lens wear. Patients may report discomfort, dryness, redness, grittiness, or burning. In fact, discomfort and dryness are the leading factors that result in contact lens discontinuation.

However, anecdotal evidence indicates that children complain of dry eyes less often than adults do, and a strong correlation between age and dry eye symptom reports confirms this observation.

Doughty et al (1997) reported that among both contact lens wearers and non-contact lens wearers in Canada, there was approximately a two-fold increase in the proportion of dry eye patients in the adult population compared to children younger than 11 years. A study of Hispanic optometric patients by Hom and De Land (2005) found that approximately eight times more adults report dryness compared to children.

A study reported by Griener and Walline at the American Academy of Optometry (2006) found that only 4 percent of pediatric contact lens wearers were classified as dry eye sufferers, compared to more than half of adult contact lens wearers (Nichols et al, 2004).

Most pediatric dry eye is associated with systemic disease and rarely occurs in the healthy population. Thirteen percent of children who had juvenile rheumatoid arthritis and 15 percent of children who had Type 1 diabetes reported dry eye compared to less than 2 percent of the age- and gender-matched healthy controls (Akinci et al, 2007).

More Reason to Fit Kids With Contact Lenses

Because of the relatively low frequency of dry eye in children who are free of systemic disease and the requirement of subjective symptoms for diagnosis, dry eye is rarely evaluated in children. However, when children do complain of dry eyes, consider systemic conditions.

It is not currently known whether children have superior tear film for combating dry eye symptoms; they do have less hormonal imbalance that may result in dryness, they require fewer medications that may make eyes dry, or they may simply complain less about similar dry eye symptoms. However, the scarcity of dry eye symptoms in children provides yet another reason for the success of fitting children with contact lenses. CLS

To obtain references for this article, please visit http://www.clspectrum.com/references.asp and click on document #164.

Dr. Walline is an assistant professor at The Ohio State University College of Optometry, where he conducts studies of pediatric contact lens wear. He is also a consultant or advisor and has received research funds from Paragon and Vistakon. Dr. Rah is a staff optometrist at the Massachusetts Eye and Ear Infirmary Contact Lens Service where she specializes in medically necessary and other advanced contact lens designs.