Children and Contact Lenses

Children represent one of the fastest growing segments of the contact lens wearing population. Out of an estimated 24 million contact lens wearers in the United States, about 10% are children. Infants through adolescents can be successfully fit with contact lenses.

Why Do Children Wear Contact Lenses?

Children wear contact lenses for basically the same reasons as adults: to see better or to look better. Most children wear contact lenses for cosmetic reasons, that is, to make the child look better, not necessarily to see better than he or she would with eyeglasses.

What Kind of Contact lenses Should Children Wear?

Children can wear all types of contact lenses. The choice of lens depends on the patient. With most children, soft contact lenses are preferred. In general, soft contact lenses are more comfortable and are easier for the eye to adapt to. They do require more meticulous care and tend to wear out sooner than rigid contact lenses. Because soft lenses are less likely to pop out or move around on the eye, they are often preferable for the rough and tumble world of the athletic child.

In young patients with astigmatism (where the shape of the cornea is not perfectly spherical), specially designed soft contact lenses which correct astigmatism (toric lenses) or rigid gas permeable lenses provide for better visual correction.

Will Wearing Contact Lenses Prevent Vision from Getting Worse?

No. Neither soft nor rigid contact lens wear will prevent myopia (nearsightedness) or hyperopia (farsightedness) from progressing with age. In some cases, rigid lenses may affect astigmatism, but this is usually not on a permanent basis.

Are There Any Special Circumstances for Contact Lens Wear in Children?

There are a number of special situations where contact lenses are necessary to produce good vision or treat eye disease as follows:

Cataract: A cataract is the development of cloudiness in the lens of the eye. With a cataract there is the potential for permanent visual loss. A dense cataract will prevent visual stimulation and development and produce a condition called amblyopia (lazy eye). After a cataract is removed surgically, a contact lens can be fit to begin visual rehabilitation.

Strabismus: Strabismus is the misalignment of the eyes (crossed eyes or wall eyes). It can sometimes be treated with contact lenses or eyeglasses, especially if the condition is associated with excessive nearsightedness or farsightedness. Lazy Eye: This frequently develops in children with strabismus. Treatment often involves patching the good eye to force the child to use the lazy eye. An alternative is for the child to wear a black (non-light transmitting) contact lens on the good eye. This can be especially helpful in school-age children who are resistant to wearing an eye patch.

Unequal Refractive Error: If a child is born with unequal vision in the two eyes (for example, one eye is extremely nearsighted or farsighted) the resulting unequal images (on the retina) may lead to development of lazy eye. Contact lenses decrease the discrepancy in image sizes and can thus help prevent development of lazy eye.

How Old Must a Child Be to Wear Contact Lenses?

In a recent survey of contact lens practitioners, most ophthalmologists did not routinely fit contact lenses for cosmetic reasons in children younger than 10 years old. The appropriate age for lens fitting, however, must be determined on an individual basis, with input from the child, parent, and practitioner.

What about the Parents?

Perhaps the most importance difference between fitting contact lenses in children and adults is the concept of the "dual patient." The child and the parent(s) are both patients and both must be involved in all stages of lens fitting, care, and follow-up. Many practitioners insist upon an informed consent from the parent or guardian before fitting contact lenses on a minor.

Who is Responsible for Taking Care of Cosmetic Contact Lenses: the Parent or the Child?

The child. It is a serious mistake to fit contact lenses for cosmetic reasons in any child who is not mature enough to be totally responsible for the day-to-day care and maintenance of contact lenses. The parent should have a supervisory role in monitoring the child and should be involved in all follow-up care. Only when contact lenses are fit for non-cosmetic reasons (for example, in cases of strabismus or cataract) should the parent assume responsibility for contact lens care and maintenance. Parents must be aware that contact lens wear can be associated with potential serious complications. They should actively participate in the selection and fit of their child's contact lenses and the recommended follow-up care. Both parent and child must be comfortable with all aspects of contact lens handling, care, and professional follow-up. It is especially important that the parent be warned of signs of potential lens-related problems, such as red, irritated eyes, discharge, foreign body sensation or change in vision. The child's ophthalmologist or eye care provider must be contacted immediately should any such symptoms develop.

What about Extended Wear Contact Lenses in Children?

Extended wear lenses must be prescribed with caution in the young patient because of increased risk of infection and corneal disease as compared to daily wear lenses. If the choice is made to use extended wear contact lenses, possible complications must be carefully discussed by the eye care professional with the child and the parent before a final decision is made.

A Final Word

With the appropriate choice of contact lens, regular follow-up, and careful adherence to all recommended lens care guidelines, many children are able to successfully continue to wear their contact lenses long into their adult lives.

The above information is taken from the CLAO Patient Information Pamphlet titled CONTACT LENSES AND CHILDREN. Pamphlet Advisors were Leonard Rich, MD and Susan M. Stenson, MD. Copyright 1994-2004, Contact Lens Association of Ophthalmologists, Inc.