pediatric and teen cl care

Napping in Contact Lenses—an Underestimated Risk

BY PAULINE CHO, PHD, FAAO, FBCLA, & SIN WAN CHEUNG, MPHIL, FAAO

A common question from contact lens wearers could be, “Could I take a quick nap in my contact lenses?”—except that most do not bother to ask and will take “a quick nap” anyway. Many patients unfortunately do not consider napping in their contact lenses an important issue as they “only napped for a few minutes anyway.” We present here the case of a 9-year-old girl who napped during contact lens wear on her way to/from school.

A Case of Daily Napping

Our patient's manifest refractive errors were OD −2.25 −0.50 x 180 (20/15) and OS −2.00 −0.75 x 180 (20/15). She was actively involved in extracurricular activities including daily piano practice and weekly choir and swimming practice. The choir group performs every two to three months. She also sometimes joins camps and outward bound activities.

There were no contraindications for soft contact lens wear, so she was fitted with daily disposable spherical lenses. We advised her not to wear contact lenses when participating in water sports and not to sleep or nap while wearing lenses. The fitting was successful and she wore the lenses 10 to 14 hours a day, seven days a week. Aftercare was scheduled for every six months.

Ocular health was unremarkable during the first 18 months of lens wear. But at the 24-month visit, fine and tiny neovascularization (Figure 1) had developed around the limbus. When questioned, the patient explained that since moving to a new apartment (three months ago) that is further from her school, she's had to take bus rides of 15 to 30 minutes to/ from school daily, and she slept to minimize motion sickness. She thought it was all right to do so as it was “just for a few minutes” and she felt no discomfort afterward.

Figure 1. Neovascularization resulting from napping daily during lens wear.

Wearing low-Dk/t hydrogel lenses under closed eye conditions can lead to growth of limbal vessels into the cornea (Papas, 2007). In this case, significant neovascularization occurred within three months of napping during contact lens wear.

We advised the patient to cease lens wear and resume wearing glasses because we were concerned that her likelihood of continuing to nap during contact lens wear was high, having formed the habit. However, she was keen to continue wearing contact lenses because of her involvement with the choir stage performances and because she does not like her appearance with glasses. We decided to refit her with silicone hydrogel lenses.

Prescribing Considerations

A recent survey that we conducted of 153 lens wearers revealed that more than 50 percent napped during lens wear at least occasionally. Now that high-Dk materials are available, e.g. silicone hydrogels, it may be prudent to consider fitting all children with high-Dk soft lenses as children may be more likely to nap during lens wear.

As young patients are unlikely to report everything they do with their contact lenses, ask questions related to compliance including, “Do you nap while wearing your lenses?” Probing questions about lens wear and care at each aftercare consultation can reinforce good compliance or detect non-compliance problems. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #171.

Dr. Cho is an associate professor of the School of Optometry at The Hong Kong Polytechnic University where she teaches Contact Lens Practice. Ms. Cheung is currently a research fellow at The Hong Kong Polytechnic University.