Can A Child Wear Contact Lens? – Contact Lens Fitting In Paediatric Patients

Keya Chakrabarty, B. Optom

Student, NSHM Knowledge Campus, Kolkata, India

 

We often hear that people have many questions and concerns about paediatric contact lenses. Parents are often unsure and afraid of finding the right contact lenses for their children.

The primary function of contact lenses is to correct refractive errors. This blog aims to clarify the key purposes of utilising contact lenses for children.

Purposes of Contact Lenses in Children:

Figure 1: A child getting his contact lens fitted on his eyes.
(Image courtesy: https://www.opticuraeyecare.com/latest-update/pediatric-contact-le/14)

As patients with high myopia, hyperopia, or astigmatism require heavy, full-time eyeglasses, it can be challenging for children to bear. Therefore, contact lenses are a better option, providing a more manageable solution. Children who have amblyopia, contact lenses are one of the best options to enhance their amblyopic therapy routines.

In cases of congenital or paediatric cataracts after surgery, patients generally have a high-power prescription. In such cases, contact lenses emerge as the optimal choice.

For aphakic children, experiencing reduced focusing ability, it is advisable to use a contact lens precisely matching the prescribed optical power. For photophobic patient, who is not fond of patches or to reduce nystagmus, contact lens is very useful. ⁽¹⁾

IntraOcular Lens implantation in very young children can be difficult due to the variability and incomplete development of pupillary size. Since surgery is more complicated in children, using contact lenses may be a better option to avoid these challenges. ⁽²⁾

Types and factors of using contact lens to a child:

According to the prescription and size of the pupil of a child, soft or RGP contact lenses can be advised. Generally soft contact lenses are not employed to very young children due to their less oxygen transmissibility, difficulty in handling as compared to silicon or RGP contact lenses. But if some children start to use soft contact lenses, then it is recommended to closely observe ocular stresses such as hyperaemia. ⁽³⁾ Rigid gas permeable contact lenses are often recommended because children tend to tolerate these well. These lenses offer excellent oxygen permeability and effective astigmatism control. However, patients may experience initial difficulties, and it’s worth noting that these lenses are not readily available in multipacks. ⁽⁴⁾

A contact lens survey revealed that optometrists or eye specialists commonly prescribe more rigid lenses or recommend longer replacement intervals for infants aged 0 to 5 years, children aged 6 to 12 years, and teenagers aged 13 to 17 years compared to other age groups. ⁽⁵⁾

Fitting and cautions of wearing contact lens to a child:

To fit a contact lens, we must measure the ocular parameters such as base curve, HVID, contact lens diameter, proper prescription of contact lens, oxygen permeability of the lens (Dk/t), tear film & moisture content of lens etc. along with the patient’s eye’s refractive power. ⁽⁶⁾ General anaesthesia requires extra vigilance, and anaesthesia is completely restricted for youngsters who cannot be examined. ⁽⁷⁾

When wearing contact lenses, it is crucial to adhere to certain maintenance practices, which includes –

1. Washing hands properly before putting contact lens and if failed to maintain, the child may lead to allergic reactions in the eyes.
2. Parental controls are most important.
3. Regular follow up is needed.
4. If a patient is facing any irritation or allergic reaction, they should consult an eye specialist immediately.

Although while considering the use of contact lenses in children, it is essential to acknowledge that not all children may be able to handle it. It depends upon the age, proper guidance, and care. The ultimate decision rests with an eye specialist, considering the patient’s lifestyle, eye health, and refractive errors. ⁽⁸⁾

 

References:

1. Walline, J. J., Robboy, M. W., Hilmantel, G., Tarver, M. E., Afshari, N. A., Dhaliwal, D. K., … & Eydelman, M. B. (2018). Food and drug administration, american academy of ophthalmology, american academy of optometry, american association for pediatric ophthalmology and strabismus, american optometric association, american society of cataract and refractive surgery, and contact lens association of ophthalmologists co-sponsored workshop: controlling the progression of myopia: contact lenses and future medical devices. Eye & Contact Lens, 44(4), 205-211.
2. Paquette, L., Jones, D. A., Sears, M., Nandakumar, K., & Woods, C. A. (2015). Contact lens fitting and training in a child and youth population. Contact Lens and Anterior Eye, 38(6), 419-423.
3. Roach, L. (2012). Contact lenses in children: getting it right–lens, age and need. Pediatrics, 37-39.
4. Dolgin, E. (2015). The myopia boom. Nature, 519(7543), 276.
5. Woods, J., Jones, D., Jones, L., Jones, S., Hunt, C., Chamberlain, P., & McNally, J. (2021). Ocular health of children wearing daily disposable contact lenses over a 6-year period. Contact Lens and Anterior Eye, 44(4), 101391.
6. Ma, J. J., Morad, Y., Mau, E., Brent, H. P., Barclay, R., & Levin, A. V. (2003). Contact lenses for the treatment of pediatric cataracts. Ophthalmology, 110(2), 299-305.
7. Infant Aphakia Treatment Study Group. (2010). A randomized clinical trial comparing contact lens with intraocular lens correction of monocular aphakia during infancy: grating acuity and adverse events at age 1 year. Archives of ophthalmology, 128(7), 810-818.
8. Ma, J. J., Morad, Y., Mau, E., Brent, H. P., Barclay, R., & Levin, A. V. (2003). Contact lenses for the treatment of pediatric cataracts. Ophthalmology, 110(2), 299-305.