When selecting an optical treatment for myopia management, contact lens options appear to be the most consistent, with OrthoK and multifocal soft contact lenses offering around a 50% efficacy for controlling refractive and axial change in myopia.1 And it’s not just the important benefit of modifying lifelong risk of vision impairment through successful myopia control which should be top of mind – contact lens wear for myopic children can offer significant immediate benefits to their self-perception and satisfaction with vision correction.
While Harry Potter has done a lot for the popular image of spectacle wear, pre-teen children aged 8-11 years feel that their physical appearance, athletic competence and social acceptance is improved with contact lens wear.2 While children this age perceive their spectacle wearing peers as smarter and more honest,3 children with lower satisfaction with their spectacles felt their scholastic competence improved with contact lens wear.2 Yes, the spectacle wearing kids prefer contact lenses, even if their peers may prefer them in spectacles!
With the multitude of optical, visual developmental and psychological benefits of paediatric contact lens wear, the practitioner must balance the risks and also consider their own barriers to fitting children. Perceived complexity of management, increased chair time and cost to the patient’s parents can be key concerns. In addition to discussing myopia control options, the first conversation about contact lens wear can start as a simple explanation to parent and child that contact lenses are also an option for vision correction, and giving examples of situations where contact lens wear is preferable to spectacle wear – for example, when playing sport. This is commonly the initial foray into contact lens wear for children, opening the door to consistent part- or full-time wear in future once experience is gained.
Having a contact lens on hand to allow the child to touch and look at helps to remove a fear of the unknown. When ready to proceed, fitting children (8-12 years) compared to teens will require an extra 10-15 minutes of time spent on contact lens application and removal instruction, which if delegated to a staff member, does not increase the eye care practitioner’s chair time.4 However as a key hurdle to contact lens success, the practitioner may prefer to spend this instruction time with the paediatric patient, to encourage persistence and enhance the relationship of trust between practitioner, parent and patient.
Regarding ongoing contact lens wear, parents of teens are more likely to continue purchasing contact lenses than parents of children.5 This is likely due to concerns about young age and long term duration of contact lens wear – these misconceptions are easily countered with the evidence described above, including our blog on contact lens safety in children, where research has indicated that children (aged 8-12) may actually be safer contact lens wearers than teens. Parent-facing resources on the same are available on the My Kids Vision Blog, which includes a wealth of information written by practitioners across the world on contact lens safety and benefits.
Part-time wear is more common in children than in teens according to large prescribing surveys.6 This can be a significant issue in myopia management, where one study found that wearing myopia controlling contact lenses for less than 8 hours a day decreased efficacy.7 Concerns about cost can be shared by parents and practitioners, particularly in view of daily disposable contact lens wear. This conversation with the parents can include discussion of how often they are replacing glasses for their child, how this may be different with the introduction of part- or full-time contact lens wear, and of course the long term health benefits of successful myopia management.
Each parent and child, will hold different attitudes and misconceptions about contact lens wear, particularly related to age, suitability and safety. There is a wealth of scientific data indicating that paediatric contact lens wear is safe and beneficial beyond simple correction of acuity; especially for myopia management. Practitioner discussion of other successful cases, called social proof, alongside research results will reassure the parent in making the right decision for their child’s visual and personal development, and lifelong eye health.
- Huang J, Wen D, Wang Q, McAlinden C, Flitcroft I, Chen H, Saw SM, Chen H, Bao F, Zhao Y, Hu L, Li X, Gao R, Lu W, Du Y, Jinag Z, Yu A, Lian H, Jiang Q, Yu Y, Qu J. Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis. Ophthalmol. 2016;123:697-708.
- Walline JJ, Jones LA, Sinnott L, Chitkara M, Coffey B, Jackson JM, Manny RE, Rah MJ, Prinstein MJ. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci. 2009;86:222-32.
- Walline JJ, Sinnott L, Johnson ED, Ticak A, Jones SL, Jones LA. What do kids think about kids in eyeglasses? Ophthalmic Physiol Opt. 2008;28(3):218-24.
- Walline JJ, Jones LA, Rah MJ, Manny RE, Berntsen DA, Chitkara M, Gaume A, Kim A, Quinn N. Contact Lenses in Pediatrics (CLIP) Study: chair time and ocular health. Optom Vis Sci. 2007;84:896-902.
- Jones LA, Walline JJ, Gaume A, Rah MJ, Manny RE, Berntsen DA, Chitkara M, Kim A, Quinn N, Group CS. Purchase of contact lenses and contact-lenses-related symptoms following the Contact Lenses in Pediatrics (CLIP) Study. Cont Lens Anterior Eye. 2009;32:157-63.
- Efron N, Morgan PB, Woods CA, International Contact Lens Prescribing Survey C. Survey of contact lens prescribing to infants, children, and teenagers. Optom Vis Sci. 2011;88:461-8.
- Lam CS, Tang WC, Tse DY, Tang YY, To CH. Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. Br J Ophthalmol. 2014;98:40-5.