Obinwanne Chukwuemeka Junior (OD, FAAO, FLVPEI, FSLS)
Head Of Cornea, Specialty Contact Lenses and Myopia Control Services, De Lens Ophthalmics Family Eye and Vision Care Centre, Febson Mall, Abuja, Nigeria.
There are several reasons optical corrections may be prescribed to children, however, in some cases, contact lenses (CLs) may be indicated or preferred. These cases include high refractive errors where spectacles may give poor cosmesis and unwanted prismatic effect, high anisometropia, unilateral surgical aphakia, especially in children less than 6 months, pediatric aphakic CLs are indicated when an intraocular lens implantation (IOL) is difficult to achieve. CLs have been shown in randomized controlled trials to yield lesser complications compared to IOL implantation in infants.1 Contact lenses are also indicated in corneal ectasias in children such as keratoconus.2 Other indications for CLs in a pediatric population include diseases such as congenital corneal anesthesia, and neurotrophic keratitis,3 and more recently, myopia management.4
Despite these benefits and indications, there is still hesitation to fit contact lenses when they are indicated mostly due safety concerns. The issue of contact lens safety in children centers on the fear of infections; however, the Centers for disease Control and Prevention (CDC) states that ‘contact lenses are safe and effective forms of vision correction for children, teenagers, and adults so long as they are worn and cared for properly’.5
In a multi-center retrospective study involving 3549 patients between the ages of 8 to 33 years, contact lens wear was noted to be safe especially in the 8-12 years age group and no episode of microbial keratitis (MK) was reported in this age group; in the age group of 13-17 years, only 0.15% (15 per 10,000 patient years) of contact lens wearers were noted to have developed MK.6 While these numbers are similar to that reported in adult populations, the absence of this complication in children aged 8-12 years is likely due to frequent lens replacement in this age group, adherence to lens care hygiene regimen, the presence of parents or guardians enforcing adherence to rules and use of prescribed lens care products.
In a systematic review, Mark Bullimore noted that in 9 prospective studies reviewed which represented 1800 patient years of contact lens wear, no cases of microbial keratitis were reported.7 The American Academy of Optometry Microbial Keratitis Think Tank committee report noted that the use of extended wear contact lenses significantly increases the risk of infection while daily disposable contact lenses carry the least risk.8 Though daily disposable contact lenses carry the least risk for infections, they account for only 35% of the contact lenses currently worn.
Regarding corneal infiltrative events however, the incidence of this condition was estimated to be 0.83% in a randomized controlled trial.9 Other complications associated with contact lens wear in children include contact lens peripheral ulcers, contact lens associated red eyes with or without infiltrates.6 Corneal infiltrative events though not sight threatening as microbial keratitis, may cause significant discomfort. A large scale multi-center study reported that corneal infiltrative events were associated with the use of multipurpose solutions, silicone hydrogel and extended wear contact lenses.6
In most cases, the infections or complications that occur with contact lenses are a result of risky behavior of the wearers or lack of adherence to the instructions given by the managing physician. Improper hand washing, infrequent contact lens case replacement, reusing of contact lens solution, and use of tap water are some of the behaviors that have been identified.
As seen from the data above, contact lenses are safe in children, especially within the age group of 8-12 years of age and in cases where complications have been reported, poor adherence to contact lens hygiene is often implicated.
In view of recent evidence suggesting superior efficacy of contact lens options for myopia control over spectacle options, the number of children fit with contact lenses is bound to increase. In order to minimize the risk of infections, daily disposable contact lenses are advised whenever possible, considering the low risk of infection associated with this lens modality. In most patients who continue to use daily wear, overnight or extended wear contact lenses, detailed explanation and training regarding lens hygiene and care regimen, frequent replacement of lens cases, hand washing before handling lenses or lens products and prompt discontinuation of contact lens wear when patients experience significant discomfort is advised.
Contact lenses are safe and very effective in children and when indicated practitioners should be proactive fitting them, keeping in mind the precautions necessary to avoid infectious complications.
REFERENCES
1. Lambert SR, Lynn MJ, Hartmann EE, DuBois L, Drews-Botsch C, Freedman SF, et al. Comparison of Contact Lens and Intraocular Lens Correction of Monocular Aphakia During Infancy: A Randomized Clinical Trial of HOTV Optotype Acuity at Age 4.5 Years and Clinical Findings at Age 5 Years. JAMA Ophthalmol. 2014;132(6):676–82.
2. Severinsky B, Lenhart P. Scleral contact lenses in the pediatric population—Indications and outcomes. Contact Lens Anterior Eye. 2022;45(3).
3. Mantelli F, Nardella C, Tiberi E, Sacchetti M, Bruscolini A, Lambiase A. Congenital Corneal Anesthesia and Neurotrophic Keratitis: Diagnosis and Management. 2015; Available from: http://dx.doi.org/10.1155/2015/805876
4. Huang J, Wen D, Wang Q, McAlinden C, Flitcroft I, Chen H, et al. Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis. Ophthalmology. 2016;123(4):697–708.
5. CDC. Children and Contact Lenses | Contact Lenses | CDC. 2021 [cited 2022 Jun 27]. Available from: https://www.cdc.gov/contactlenses/children-and-contact-lenses.html
6. Chalmers RL, Wagner H, Lynn Mitchell G, Lam DY, Kinoshita BT, Jansen ME, et al. Age and Other Risk Factors for Corneal Infiltrative and Inflammatory Events in Young Soft Contact Lens Wearers from the Contact Lens Assessment in Youth (CLAY) Study. Invest Ophthalmol Vis Sci. 2011 Aug 1;52(9):6690–6.
7. Bullimore MA. The Safety of Soft Contact Lenses in Children. Optom Vis Sci. 2017;94(6):638.
8. Szczotka-Flynn LB, Shovlin JP, Schnider CM, Caffery BE, Alfonso EC, Carnt NA, et al. American Academy of Optometry Microbial Keratitis Think Tank. Optom Vis Sci. 2021;98(3):182.
9. Walline JJ, Jones LA, Sinnott L, Chitkara M, Coffey B, Jackson JM, et al. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci. 2009;86(3):222–32.
