We all realize that contact lens wear is a highly safe and effective means of vision correction. However, questions still exist about the use of contact lenses in children.

Eyecare professionals are often asked, “How early can my child wear contact lenses?” and there are a variety of responses, depending on the case. Are the risks worth the benefits? Do the benefits of contact lens wear for kids go beyond cosmetic appearance and the convenience of not wearing glasses while participating in physical activities? Perhaps we can look to research in the field to help us address these questions and others.

What Does the Lay Media Say?

All a parent must do to find out about kids and contact lenses is seek out “Dr. Google.” A posting on the U.S. Food and Drug Administration (FDA) website from August 2020 reads: “What to Know if Your Child Wants Contact Lenses: Improper use of contact lenses can cause serious injury. Is your child ready?”

In December of last year, a Centers for Disease Control and Prevention (CDC) posting stated, “Children can safely and successfully wear contact lenses if they care for them properly. This often means having the support of a parent or other adult to help encourage healthy wear and care behaviors and reduce the risk of eye infections and other complications.”

And a post on WebMD, also from August 2020, reads, “At first glance, the words ‘contacts’ and ‘children’ may not seem like they belong in the same sentence. In reality, they’re often a perfect match. That being said, the kid in question is usually a teenager. And whether contacts are a good idea depends on how mature and responsible they are.”

These are representative of the mixed messages that we find online in terms of contact lens wear in children. Age and maturity play an important role as well as how involved the parent may want to be with care and management. Although it should always be stated that there are risks associated with contact lenses, the benefits in most cases significantly outweigh the risks and, as the research shows, the risks of serious complications are quite low.

Quality of Life with Contact Lens Wear in Children

In 2007, Walline and coworkers published a study of the impact of contact lens wear in children on their quality of life (Walline et al, 2007). The purpose of the study was to examine the benefits of contact lens wear for children and teens to determine whether children benefit as much as teens.

Neophyte contact lens wearers were categorized as children (8 to 12 years of age) or teens (13 to 17 years of age). Participants completed the Pediatric Refractive Error Profile (PREP), a pediatric quality-of-life survey for subjects affected only by refractive error. Subjects also completed questions regarding wear time and satisfaction with contact lenses during specific activities.

Results indicated that after wearing contact lenses for three months, the overall PREP score increased from 64.4 for children and 61.8 for teens while wearing glasses to 79.2 and 76.5 while wearing contact lenses, respectively (P < 0.0001 for both groups). There was not a significant difference between children and teens (P > 0.05). The areas of most improvement were satisfaction with correction, activities, and appearance.

Contact lens wear dramatically improves how children and teens feel about their appearance and participation in activities, leading to greater satisfaction with their refractive error correction. The improvement in quality of life after contact lens wear indicates that children should be offered contact lenses as a treatment for refractive error as routinely as teenagers are, if appropriate otherwise.

CL Safety and Children

Since it has been established that contact lenses provide benefits over spectacles, it becomes imperative to confirm that lenses are a safe option when used with children. In a paper published by Bullimore in 2017, data were collated from studies to estimate the incidence of complications, specifically corneal infiltrative events and microbial keratitis, in soft lens wearers under 18 years of age. The author concluded that the incidence of corneal infiltrative events in children is no higher than in adults; and, in the youngest age range of 8 to 11 years, it may be markedly lower. No cases of microbial keratitis were reported in any of the prospective studies analyzed.

A recent paper was published that looked at pediatric microbial keratitis during overnight orthokeratology treatment (Bullimore et al, 2021). The authors reviewed 23,049 overnight orthokeratology fits between 2010 and 2018 in Russia. Among the 1,368 records surveyed, 1,078 (79%) were younger than 18 years at initial fitting.

Amazingly, the analysis of this large sample found that the incidence of microbial keratitis in children wearing overnight orthokeratology was lower than that found in a previous U.S. study and similar to rates associated with use of daily wear soft contact lenses!

Pediatric Myopia Management with Contact Lenses

Control of myopia progression in children is a topic that has become highly evidence-based. Two modalities of contact lens wear have been shown to be effective in slowing myopic progression and axial length (AL) elongation—daytime wearing of multifocal contact lenses and overnight orthokeratology.

A study looked at center-distance multifocal contact lens wear and the influence of peripheral blur through add power on the ability to control myopic progression (Walline et al, 2020). The 294 subjects, aged 7 to 11 years, were randomly assigned to wear high add power (n = 98), medium add power (n = 98), or single vision (n = 98) contact lenses. The researchers concluded that treatment with high add power multifocal contact lenses significantly reduced the rate of myopia progression over three years compared with both medium add power multifocal and single vision contact lenses. However, further research is needed to understand the clinical importance of the observed differences.

Currently, there is only one FDA-approved contact lens design for myopia progression control in the United States. A recent study was published that investigated which baseline factors are predictive for success in controlling myopia progression in a group of children wearing those lenses (Prieto-Garrido et al, 2022).

Subjects were followed for two years and patients were classified based on a specific range of AL change at the end of each year of treatment as “responders” (AL change < 0.11 mm/year) and “non-responders” (NR) (AL change ≥ 0.11 mm/year). Analysis showed that the only factor associated with smaller AL growth was more time spent outdoors (p = 0.008) in the first year of treatment. The decision tree analysis showed that the responding groups spending more than three and four hours of outdoor time per week were associated with the best response in the first year and in the second year of treatment, respectively.

Orthokeratology has been confirmed to have a significant effect on slowing myopia progression. However, most studies published had a relatively short-term follow up, typically only up to three years.

One study looked at long-term follow up of orthokeratology effect on myopic progression (Lee et al, 2017). The retrospective study of 66 school-aged children who received overnight orthokeratology correction between January 1998 and December 2013. Thirty-six subjects whose baseline age and refractive error matched with those in the orthokeratology group were selected to form the control group.

The researchers found that overnight orthokeratology was effective in slowing myopia progression over a 12-year follow-up period and demonstrated a clinically acceptable safety profile. Initial higher astigmatism power was found to be associated with increased change in refractive error during follow-up years.

In Conclusion

Contact lenses are a wonderful option for children. Research supports their safety and efficacy. New uses, such as for myopia management, will continue to further expand the range and age of utilization of contact lenses for children. CLS

For references, please visit www.clspectrum.com/references and click on document #317.