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Truth or myth: Young children are less successful in contact lenses? Answer: Myth

Contact lenses Contact Lenses Practice
This month, in our series looking at common myths concerning contact lenses, Jill Woods and Dr Monica Jong look at attitudes about fitting junior patients

The international survey of contact lens fitting for myopia management in children reported that more children are being fitted with contact lenses than ever before.1 The global interest in myopia management has been a significant catalyst for this.1

Survey results from eye care professionals (ECPs) about fitting children with contact lenses offer individual ECPs a way to review the attitudes and practices of their peers, both within their own country and across the world. These also inform the wider eye care community about differences in prescribing across the world.

In 2020, Sulley and colleagues reported results from their survey of 402 ECPs across six counties.2 They found that 50% of ECPs were comfortable fitting children as young as eight years old with contact lenses. When considering children aged 10 years and older, the percentage of ECPs comfortable to fit contact lenses rose to 78%.

A global survey of 1,336 ECPs published by Wolffsohn et al in 2020, supported these findings and reported that, on average, ECPs in most regions considered eight to 11 years as the minimum age they would consider fitting contact lenses for myopia management.3

Interestingly, ECPs in Asia were more conservative than all other regions towards fitting contact lenses for myopia management and, specifically for soft lenses, with their minimum age for first fitting being 11 to 13 years old.

 

Professional Belief Survey Results

A recent survey of over 1,000 ECPs conducted by Johnson & Johnson Vision assessed the prescribing beliefs of ECPs in six countries in 2022, expect Russia, which was conducted in 2021.4

Across the entire group, on average 51% of ECPs agreed with the statement: ‘I believe children seven to 12 years old can experience safe and healthy contact lens wear as part of treating myopia progression’, and 25% on average disagreed.

It is very interesting that responses from ECPs in South Korea (figure 1) illustrated an opposing polarity to responses from every other country surveyed, with 82% disagreeing and none agreeing. This may, in part, be due to licensing restrictions limiting the age of first fit in young children and lack of experience in fitting children in general in South Korea. Japanese ECPs were also less positive in their responses, with only 31% agreeing and 39% disagreeing.

The other four countries provided similar data to each other, with 51-77% agreeing and 4-10% disagreeing (figure 1).

 

What the Evidence Shows

Large global variations in attitudes to fitting children with contact lenses exist. Hence reviewing the evidence for contact lens wear in children is important to reassure ECPs that children can wear contact lenses safely.

The past decade has produced many publications reporting on adverse events in children and youth who wear contact lenses. The most serious and significant adverse response to contact lens wear is corneal infection, as it has the potential to result in permanent reduction in visual acuity.

The incidence of microbial keratitis (MK) is low in the contact lens wearing population as a whole and when Bullimore reviewed the data from several publications, he concluded that the incidence of MK in children wearing soft lenses is similar (or perhaps even lower) in children than in adults; approximately 2.7 per 10,000 lens wearing years in children that were aged between seven and 17 years and fitted before the age of 12 years.5

After corneal infection, the next highest safety concern is generally related to ocular inflammatory events, particularly corneal infiltrates. One study in adults wearing silicone hydrogel lenses for daily wear found corneal infiltrative events typically occur at a rate of 300 per 10,000 lens wearing years.6

In a review of multiple data sets, Bullimore reported that this rate per 10,000 lens wearing years was 42 per 10,000 years in children of seven to 17 years.5 Chalmers et al reported the rates were six per 10,000 patient years for eight to 12-year-olds with various CL designs.7

Other than infection and inflammatory events, additional types of reversible ocular adverse responses reported in children wearing soft contact lenses are like those reported in adults. The vast majority of these events are readily manageable by ECPs and include blepharitis, dryness, redness, chalazion and conjunctivitis.7

Some literature has gone so far as to state children under 13 years of age may be at lower risk for contact lens related complications compared to teenagers and adults, because parental oversight is typically higher in the younger age group.5,8,9

Additionally, there was no evidence of clinically relevant signs of corneal hypoxia in children aged eight to 12 years who wore hydrogel daily disposable lenses full-time for myopia control over six years,8 which aligns with reports of no corneal hypoxia in healthy adults wearing hydrogel daily disposable lenses.10,11

ECPs may also regard younger children as potentially less successful candidates for contact lenses because of concerns surrounding their ability to follow instructions and understand the importance of good habits with regards to handling and hygiene.

However, in 2007, Walline and colleagues showed that, compared to teenagers, it takes just an extra 10 minutes to teach eight to 11-year-olds how to care for and handle their contact lenses.12  Additionally, in 2015, it was reported that children as young as eight years old can independently wear and care for their soft contact lenses.13

 

Conclusion

Upon reviewing the literature around this topic, the evidence clearly shows that children have already demonstrated they can experience contact lens wear with great success. This is true whether soft contact lenses are used for myopia management or to simply correct refractive error. 

  • Jill Woods is the head of clinical research and senior clinical scientist at the Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo. Dr Monica Jong is director of global professional education myopia for Johnson & Johnson Vision Care, Inc.

 

References

  1. Efron E, Morgan PB, Woods CA et al. International survey of contact lens fitting for myopia control in children. Contact Lens Anterior Eye 2020;43:4-8.
  2. Sulley A, Venezia C, Gardner J et al. Global survey on eye care practitioner perceptions and attitudes regarding myopia and its management. Cont Lens Anterior Eye 2020;44:13.
  3. Wolffsohn JS, Calossi A, Cho P et al. Global trends in myopia management attitudes and strategies in clinical practice – 2019 update. Cont Lens Anterior Eye 2020;9:17.
  4. Johnson & Johnson Vision. Online survey of 1028 eye care professionals across United States, United Kingdom, Russia, China, Japan and South Korea. JJV data on file; 2021 (Russia) and 2022 (other markets).
  5. Bullimore, Mark A. Richdale, Kathryn. Incidence of Corneal Adverse Events in Children Wearing Soft Contact Lenses. Eye & Contact Lens: Science & Clinical Practice 2023;49(5):204-211.
  6. Szczotka-Flynn L, Jiang Y, Raghupathy S et al. Corneal inflammatory events with daily silicone hydrogel lens wear. Optom Vis Sci 2014;91:3-12.
  7. Chalmers RL, McNally JJ, Chamberlain P, Keay L. Adverse event rates in the retrospective cohort study of safety of paediatric soft contact lens wear.; the ReCSS study. Ophthalmic Physiol Opt 2021;41:84-92.
  8. Woods J, Jones D, Jones L et al. Ocular health of children wearing daily disposable contact lenses over a 6-year period. Cont Lens Anterior Eye 2021;44:101391.
  9. Chalmers RL, Wagner H, Mitchell GL 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;52:6690-6696.
  10. Moezzi AM, Varikooty J, Luensmann D et al. The short-term physiological impact of switching reusable silicone hydrogel wearers into a hydrogel daily disposable multifocal. Clin Ophthalmol 2019;13:1193-1202.
  11. Diec J, Tilia D, Thomas V. Comparison of silicone hydrogel and hydrogel daily disposable contact lenses. Eye Contact Lens 2018;44(Suppl 1). S167-S72.
  12. Walline JJ, Jones LA, Rah MJ et al. Contact lenses in pediatrics (CLIP) study: chair time and ocular health. Optom Vis Sci 2007;84:896-902.
  13. Paquette L et al. Contact lens fitting and training in a child and youth population. Contact Lens Anterior Eye 2015;38:419-646.