CHILDREN & CONTACT LENSES Doctors’ Attitudes & Practices in Fitting Children in Contacts The Children & Contact Lenses study was conducted by 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. 60% 50% The purpose of the survey was to gauge current trends in prescribing contact lenses to children ranging in age from 8 to 17, and to understand factors that influence an optometrist’s decision to fit a child in contact lenses. 40% 30% 20% 10%MAJOR FINDINGS SUMMARY OF 0% Current contact lens patients by age <8 introduce 8-9 a child 10-12 13-14 15-17 Appropriate age to to soft contact lenses Nearly all (97%) optometrists surveyed currently fit contact lens patients under the age of 18. Children up to the age of 17 account for about 41% of respondents’ total contact lens patient population. On average, optometrists say that about 59% of their contact lens patients are 18 years of age and older and report less than 1% of their contact lens patients are younger than eight-years-old, less than 2% are 8-9 years old, 7% are between 10-12, 13% are 13-14 year olds, and 19% of contact lens patients are between 15 and 17 years old. More than half (51%) of optometrists feel it is appropriate to introduce children to soft contact lenses between the ages of 10 and 12 years old, while nearly one in four (23%) feel 13-14 years old is a suitable age for a child to begin wearing contact lenses. One in ten doctors surveyed think it is proper to introduce 8-9 year olds (12%) or children younger than 8 (11%) to soft contact lenses. Figure 1 below visually displays the age which optometrists say is the appropriate age to introduce a child to soft contact lenses. Age Group Influence of gender The majority (74%) of optometrists surveyed say that gender does not influence their decision to fit a child in contact lenses, while one in four (26%) say they are more likely to fit younger children when they are girls. Appropriate Age to Introduce Soft Contact Lenses Figure 1 <8 11.9% 8-9 12.4% 10-12 51.2% 13-14 22.6% 2.9% 15-17 Support provided by VISTAKON®, Division of Johnson & Johnson Vision Care, Inc. 0% 10% 20% 30% 40% 50% 60% Optometrists’ approach to vision correction Two out of three (67%) doctors surveyed fit children under the age of 8 in glasses only. At ages 8-9 (51%) and 10-12 (71%), optometrists most often fit children in glasses as the primary method of vision correction and prescribe contact lenses as a secondary correction. As children get older, optometrists begin to change their approach to vision correction with one in five (20%) prescribing contact Figure 2 lenses as the principal form of vision correction for 10-12 year olds, half (49%) prescribing contact lenses first for 13-14 year olds and two-thirds (66%) recommending contact lenses as the main form of vision correction for 15-17 year olds. See figure 2 below. Optometrist’s Approach to Vision Correction in Children GLASSES ONLY GLASSES AS PRIMARY, CONTACT LENSES AS SECONDARY CONTACT LENSES AS PRIMARY 80% 70% 71.1% 65.6% 67.1% 60% 51.1% 50% 40% 50.5% 49% 43.5% 34.2% 30% 30% 20.4% 20% 10% 5.4% 2.9% 8.5% 0.5% 0.2% 0% <8 8-9 10-12 13-14 15-17 Age Group Changes in fitting criteria for children A key purpose of this survey was to determine if, in the last year, optometrists have changed contact lens fitting criteria in children and what has caused such changes. Doctors were asked to indicate if they are more likely to fit, less likely to fit, or if they have not changed their fitting criteria for children over the last year. For each of the age groups presented, more than three-fourths of doctors say they have not changed their contact lens fitting criteria for children. More doctors indicated their contact lens fitting criteria has changed for 10-12 year olds than any other age group, with 21% of respondents more likely to fit children in this age group with contact lenses versus a year ago. Table 1 details how contact lens fitting criteria has changed in the last year for each age group. Table 1 More likely to fit Criteria has not changed Less likely to fit Younger than 8 8.1% 88.6% 3.3% 8 - 9 years old 15.9% 82.2% 1.9% 10 - 12 years old 20.9% 77.8% 1.3% 13 - 14 years old 14.3% 85.6% 0.1% 15 - 17 years old 12.4% 87.4% 0.2% Patient Age What’s changed? Three in ten (30%) doctors who are “more likely to fit” children with contact lenses attribute their change in fitting behavior to daily disposable lenses; 23% of doctors cite “improved contact lens materials”; 19% say they are more likely to fit children with contact lenses because of requests from the child and/or parent, and 10% say that “recent research/studies” on the subject and children’s participation in activities/sports have influenced their Figure 3 decision to fit more children in contacts. Figure 3 shows top reasons provided by doctors who are more likely to fit children with contact lenses. While only a small percentage of doctors say they are less likely to fit contact lenses in children, those that provided an explanation of why attribute their change to the poor hygiene and maturity levels seen in younger children. Why Optometrists Are More Willing to Fit Contact Lenses in Children ACTIVITIES / SPORTS 9.6% RECENT STUDIES 10.3% CHILD AND / OR PARENT REQUEST 23.3% DAILY DISPOSABLE LENSES 29.5% 0% 5% 10% 15% Nearly all (96%) respondents point out 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%), the child’s ability to take care of contact lenses by themselves (89%), and the child’s personal hygiene habits (89%). Participation in sports (84%), the child’s prescription requirement (77%), and the impact of contact lens wear on a child’s self-esteem (71%) round out the top seven factors seen as most important to optometrists. The least important factors that doctors consider when choosing to fit a child with contact lenses are patient gender (74%) and the annualized cost of contact lenses (68%). Table 2 (below) illustrates each of the factors measured in order of their importance to optometrists. 19.2% BETTER / SAFER MATERIALS Factors that influence contact lens fitting for children 20% 25% 30% Table 2 Properties that influence doctors’ decisions in fitting children in contact lenses Doctors ranked various contact lens properties that they consider when fitting a child in contact lenses. One-hundred percent of respondents cite the visual acuity (i.e., clearness of vision) achieved with a contact lens as important, and virtually all respondents rate ease of handling (99%), oxygen permeability (99%), comfort (98%), and replacement schedule (96%) as properties that influence their decision to fit a child in contact lenses. While not rated as high as the other properties, three-fourths (75%), say contact lenses that offer ultraviolet protection influence their decision to prescribe contacts for children. See Table 3. Table 3 Contact Lens Properties Very Important Somewhat Important Factors Influencing Contact Lenses Fitting Very Important Somewhat Important Not Important Child’s interest / motivation to wear contact lenses 96% 4% 0% Child’s maturity level 93% 6% 0% Child’s personal hygiene habits 89% 10% 1% Child’s ability to take care of contact lenses by him / herself 89% 10% 1% Participation in sports 84% 12% 4% Prescription requirement 77% 17% 6% Impact of contact lens wear on child’s self-esteem 71% 22% 7% Age 64% 18% 18% 45% 31% 24% Comfort 75% 23% Parental interest in having child wear contact lenses Oxygen Permeability 64% 35% Frequent frame loss or damage 42% 32% 26% Ease of Handling 53% 46% Frequent spectacle lens damage 40% 32% 28% 35% 34% 31% Visual Acuity 53% 47% Parental experience with contact lenses Replacement Schedule 47% 49% Annualized cost of contact lenses 19% 13% 68% Ultraviolet Protection 30% 45% Gender 5% 21% 74% Contact lens modalities frequently prescribed for children Daily disposable contact lenses are the most frequently prescribed lenses for children 12 years old and under. For children 13-14 and 15-17, doctors tend to prescribe reusable contact lenses (i.e., two-week and monthly replacement) more often than daily disposables. Who initiates the conversation about contact lenses Nearly three in five (57%) respondents indicate that the parent initiates a conversation regarding fitting the child with contact lenses in children less than nine-years-old. Doctors say that the percentage of parents initiating the contact lens conversation falls as the age of the child increases. At ages 10-12, children and doctors begin to start the contact lens discussion more often than before and by ages 13-14, either the child or the doctor generally initiates the conversation. Why parents want contact lenses for their children Two out of five (39%) optometrists say that parents requesting their child be fit in contact lenses do so because the child refuses to wear his or her glasses; 36% say parents note that the child’s current vision correction interferes with sports, and 16% say parents want their child in contact lenses because the current form of vision correction interferes with daily activities. Overnight wear Seven in ten (71%) doctors say overnight wear of contact lenses is not appropriate for children under the age of 18. Cosmetic (non-therapeutic) contact lenses Nearly three-fourths (73%) of doctors believe that cosmetic (non-therapeutic) contact lenses are appropriate for children under the age of 18. Of these respondents, seven in ten (69%) say they would fit children ages 15-17; 40% say they would fit children ages 13-14, and 16% say they would fit 10 to 12-year-olds in these lenses. (Multiple responses were allowed for this question) ABOUT THE SURVEY Survey Method and Sample Respondent Demographics A random stratified, sampling of 4,004 American Optometric Association practicing optometrists was mailed a survey on July 6, 2010. Optometrists invited to participate in the study were asked to complete and return the survey using the self-mailer to the AOA no later than August 2, 2010. Two reminders to complete the survey were posted in AOA First Look on July 23rd and again on July 30th. 576 surveys were returned for a response rate of 14.4% and an error level of 4% at the 95% confidence interval. Responses were received from all AOA affiliates with the exception of the District of Columbia. Survey results were analyzed using SAS Statistical Software and correlation analysis was conducted using Chi-Squared and Cramer’s V. Differences in prescribing patterns were not found when correlation analyses were conducted on practice location and the number of years the optometrist has been in practice. Nearly eight in ten (78%) respondents are currently practicing in major metropolitan areas, 14% are practicing in micropolitan areas (population more than 10,000 but less than 50,000) and 8% are practicing in rural areas. About two-thirds (63%) of respondents are male and 37% are female. Geographically - 31% of respondents are located in the Midwest, 17% in the Northeast, 29% in the South and 23% in the West. Three in ten (29%) respondents are solo practitioners; 28% are employed in a non-retail; 28% are group practitioners; 14% are employed in a retail setting, and 1% are in other practice settings. The majority of responses (39%) received were from optometrists who have been in practice for more than 25 years, 30% of responding optometrists have been in practice 11 to 24 years, 13% have been practicing for 6 to 10 years and 18% have been in practice 5 years or less. © American Optometric Association. All Rights Reserved Limitations Several limitations of this study should be noted: (1) Survey participants were invited to complete a paper survey which was distributed by the United States Post Office. Incorrect addresses or delays experienced in delivering the survey may have excluded selected doctors from participating in, or receiving the survey. (2) Member optometrists who chose to participate in the survey were self-selected which may mean that the survey attracted responses from optometrists with strong opinions about fitting children in contact lenses. (3) The response rate is only 14.4%; results of this study may not be generalizable to the entire population of AOA member optometrists.