Pediatrics Caring For the Developing Eye Kids and Contact Lenses: What is the Right Age? Leading voices rate the child’s maturity and interest level ahead of any particular age. By W. Lee Ball J r ., OD G etting contact lenses used to be a teenage rite of passage, like braces and driving lessons. But the availability of multipurpose solutions and frequent-replacement soft contact lenses made from highly oxygenated materials has made contact lens wear easier and more comfortable than ever before. In recognition of this, many practitioners are lowering the age at which they typically initiate lens wear. “I am very comfortable fitting kids who are 8 or 9 years old,” says Mary Lou French, OD, MEd. “For me, the child’s maturity level and interest in contact lens wear are far more important factors than age.” In a 2010 survey conducted by the American Optometric Association Research and Information Center in conjunction with the association’s Sports Vision Section and Contact Lens and Cornea Sections (with support from Vistakon Division of Johnson & Johnson Vision Care, Inc.), optometrists said they were more likely than they had been the previous year to fit children in every age group, beginning with children as young as 8 years of age.1 More than half (51%) felt it was appropriate to introduce children to soft contact lenses between the ages of 10 and 12 years. One-quarter (24.3%) were comfortable fitting kids at age 8, and nearly another quarter (22.6%) said that 13 to 14 years old was a more suitable age. Nearly all respondents (96%) say that a child’s interest and motivation to wear contact lenses is the most important factor to consider in fitting a child with contacts. Also very important to doctors are a child’s maturity level (93%), ability to take care of contact lenses by themselves (89%), and personal hygiene habits (89%). “There is a spectrum of readiness for contact lens wear that has very little to do with age. Some 8-year-olds have the maturity to handle contact lenses, while some 13-year-olds do not.” There is a spectrum of readiness for contact lens wear that has very little to do with age. Some 8-year-olds have the maturity to handle contact lenses, while some 13-year-olds do not. Taking into account the readiness of the child—and his or her parents—is part of providing individualized, patient-centered health care. BENEFITS OF CONTACT LENS WEAR “Research shows that both children and teens can benefit from wearing contact lenses and that there are minimal age-based differences in safety or ease of fit,” says Jeffrey J. Walline, OD, PhD. “The doctor’s chair time in fitting and following 8- to 12-year-olds is about the same as the chair time to fit teens, and concerns about contact lens problems in these younger age groups are largely unfounded,” he says.2,3 As co-investigator of the Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) Study, Dr. Walline found that the benefits of contact lens wear extend well beyond vision. In the 3-year, multisite ACHIEVE Study, the largest randomized trial of its kind, nearsighted children ages 8 to 11 years old felt better about their physical appearance, April 2013 Advanced ocular care 17 Pediatrics Caring For the Developing Eye acceptance among friends, and athletic competence when they wore contact lenses.4 I know from personal experience that contact lenses can make a huge difference in self-esteem and performance. As a child, I liked to exercise but rarely did because my glasses slipped around on my face. Being moderately myopic, I could not see without them, but the smaller image size and impaired hand-eye coordination while wearing glasses made sports challenging. Contact lenses empowered me to become much more active and successful in team sports. As a practitioner, I have often seen contact lenses boost a child’s confidence—or give him or her back that crisp vision that he or she lacked when trying to play sports without glasses. Dr. French also likes to fit active kids, because they are highly motivated to succeed in contact lenses. “These patients are used to rules and schedules and accustomed to taking care of their sports gear, so they tend to be compliant contact lens wearers, too,” she says. Even when young patients do not ask her directly, Dr. French plants the seed by talking about contact lenses as soon as there is a need for vision correction. Many parents do not realize that contact lenses are an option for kids, so it is a good idea to start that education process from the beginning. To assist practitioners in helping new and current contact lens wearers better understand how to safely wear and care for their contacts, Johnson & Johnson Vision Care, Inc., developed “Healthy Vision & Contact Lenses,” an educational resource for in-office, website, and social media use. In a patient-friendly way, it offers tips for caring for contact lenses and lens cases, and has space for writing in the lens brand and replacement schedule. It is important to share with parents all the technological advancements in today’s contact lenses, such as breathable materials, ultraviolet light protection, and shorter wearing schedules. Daily disposable contact lenses have become the most frequently prescribed lenses for children 12 years old and younger,1 in part because they alleviate parental concerns about whether children can clean and maintain the lenses properly. W. Lee Ball Jr., OD, is the associate director of professional affairs for Vistakon Division of Johnson & Johnson Vision Care, Inc. Dr. Ball may be reached at (904) 443-1383; [email protected]. Mary Lou French, OD, MEd, is in practice at Children’s Eyecare located in Orland Park, Illinois. She has no financial interests or consulting relationships related to this article, but has served as a consultant to Vistakon. Dr. French may be reached at 708-403-0123; [email protected]. Jeffrey J. Walline, OD, PhD, is an associate professor at The Ohio State University College of Optometry and served as principal investigator on both the CLIP and ACHIEVE studies. He has received honoraria from Johnson & Johnson Vision Care Inc., and the ACHIEVE study was supported by funding from Johnson & Johnson Vision Care, Inc. and The Vision Care Institute, LLC. Dr. Walline may be reached at (614) 247-6840; [email protected] AN IMPORTANT DEMOGRAPHIC Dr. French’s practice is made up almost entirely of pediatric patients, but even in a general practice setting, children make up a substantial part of the practice, with children up to 17 years of age accounting for about 41% of contact lens patients.1 As that number grows, practitioners who set an arbitrary age limit of 13 1. Children & Contact Lenses: Doctors’ Attitudes and Practices in Fitting Children in Contacts. The American Optometric Association (AOA) Research and Information Center in conjunction with the Sports Vision Section and Contact Lens and Cornea Sections of AOA, with support from Vistakon, Division of Johnson & Johnson Vision Care, Inc. 2010. http://www.aoa.org/documents/npr10520_Executivesummarychildrenandcontactlensesstudy_final. pdf. Accessed March 20, 2013. 2. Walline JJ, Gaume A, Jones LA, et al. Benefits of contact lens wear for children and teens. Eye Contact Lens. 2007;33(6 Pt 1):317-321. 3. Walline JJ, Jones LA, Rah MJ, et al; CLIP Study Group. Contact Lenses In Pediatrics (CLIP) Study: chair time and ocular health. Optom Vis Sci. 2007;84(9):896-902. 4. Walline JJ, Jones LA, Sinnott L, et al. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci. 2009;86:222-232. 18 Advanced ocular care April 2013 “I know from personal experience that contact lenses can make a huge difference in self-esteem and performance.” or 14 may be missing some important opportunities for practice growth. According to Dr. French, “If you don’t fit kids, you are missing out not only on potential revenues and opportunities for referrals to friends and family members, but you are also missing the joy of changing a child’s life for the better.” “Healthy Vision & Contact Lenses” is available in a customizable PDF at www.acuvueprofessional.com/ hvcl or as a printed pad of tear sheets, which can be obtained by emailing [email protected]. n