Article Date: 11/1/2007

Find Success in Pediatric Contact Lens Fittings Fittings
contact lenses

Illustration by Nick Rotondo

Find Success in Pediatric Contact Lens Fittings Fittings

Readiness for lens wear is more important than an arbitrary age for initial fits.

BY MARY LOU FRENCH, O.D. Orland Park, Ill.

Typically, I start discussing contact lenses as soon as my child patients require a refractive correction. Even if the patient isn't yet ready for contact lenses, the conversation plants a seed for the future.

About 25% to 30% of my patients ages 18 and younger wear contact lenses. With the healthy lens materials and the variety of disposable modalities now available, there is no reason you shouldn't offer contact lenses to your child patients as soon as they're ready.

Ready … or not?

So, when are they ready? That varies tremendously. A large percentage of my initial contact-lens fits are around age 10, but some 10-year-olds lack the responsibility to handle contact lenses, while other children — especially athletes — can start as early as age six. For me, the deciding factor is the child's maturity and whether his visual needs are best served by contact lenses. (See "How to Talk With Parents")

For example, I recently fit a six-year-old accommodative esotrope who was very motivated to wear contact lenses. With her new lenses for hyperopic astigmatism, the esotropia has resolved, and both eyes now fixate normally.

In general, I look for motivation, presentable hands and hair (to indicate good hygiene) and age-appropriate maturity. If the parents don't think their child is ready for the responsibility of contact lenses, I respect that. In some cases, I may recommend contact lenses as a backup or secondary option to glasses, specifically for activities, such as sports.

The Contact Lens in Pediatrics (CLIP) study demonstrated that teenagers and children ages eight to 12 derive a number of quality-of-life benefits from contact lenses. The most significant: an increased confidence in their ability to participate in sports and other activities.1 That has certainly been my experience.

Years ago, one of my young patients, a competitive gymnast, said her glasses kept flying off when she used the vault. We fit her in soft contact lenses at age eight, and it had an immediate impact. She's now a contact-lens wearing college gymnast.

Dos and Don'ts for Pediatric Fittings
DO choose staff members who are comfortable working with children.

DO take the pressure off learning insertion and removal.

DON'T tell children they won't feel a thing. Be honest, and give them plenty of information about what to expect.

DON'T rush things if the child or parent isn't ready.

DO choose healthy materials and wearing schedules.

As practitioners, we need to be prepared to help young patients learn contact-lens insertion and removal in a no-pressure setting. (See "Dos and Dont's for Pediatric Fittings," below.) CLIP study results show that chair time at fitting and follow-up visits are similar for eight to 12-year-old children and teenagers. Following training on insertion and removal, the study's children and teens demonstrated excellent understanding of contact-lens care.

In my office, we invite children to come back two or three times to practice insertion and removal. We also make it clear that contact lenses aren't a one-shot deal. We tell patients: "If it doesn't work out now, you can try again in six months or a year, or maybe just try the lenses for occasional use when glasses aren't practical." It's been my experience that teenagers who start wearing their lenses as children maintain healthier contact-lens habits during their teen years.

Choosing the right products

Daily disposable lenses are my first choice, due to the improved hygiene of a clean lens every day. Silicone hydrogel material is my first choice, due to its high oxygen permeability. I do, however, also prescribe two-week disposable lenses to some of my young patients. Also, given recent research on the harmful effects of Ultraviolet (UV) radiation, I recommend UV-protective contact lenses, along with UV-blocking sunglasses and a wide-brimmed hat for all patients.

How to Talk With Parents

As soon as a child gets his or her first pair of glasses, mention contact lenses as an option for the near future. Parents like the idea of contact lenses, once they understand the options and are comfortable with the child's readiness. Here is how we address two common barriers:

BARRIER 1: Lack of knowledge
Many parents remember that as children they had to wait until their vision stabilized to obtain contact lenses. Let them know that inexpensive disposable options and healthier materials now make initial fits possible at much younger ages.
Some children are too shy to ask about contact lenses. Make it easy by routinely mentioning this modality.
Also, make it easy for time-pressed parents to have the child fit right away during an annual visit or to make a second appointment, whichever is more convenient.

A child's greatest fear about contact lenses is that they won't be able to remove them. They expect the lenses to hurt or to get "lost" in their eyes. Once the child tries the lenses in the office, however, that fear is gone. We fit children at the first visit. Then, we have them return a couple days later after for insertion and removal training and care instructions. At this visit, we send patients home with their lenses.
Parents may fear the lenses won't work or that their child will lose or not properly care for them. Quell these concerns by giving parents some no-pressure options for their child to get started:
► Try contact lenses just for part-time wear for sports or other activities.
► Wear the trial pair for a week before committing to purchase a year's supply.
► Start with single-use lenses that don't require cleaning and re-wear.

I never prescribe extended-wear for anyone under age 18, as patients who wear these lenses are at a greater risk for corneal ulcers, and those younger than 18 can't share in the responsibility for lens wear and care. Otherwise, my lens selection depends on what best fits the patient.

I typically recommend a multipurpose solution (MPS) care regimen for my two-week disposable lens patients. If the child has any sensitivity to the solution, I try another MPS before moving to a hydrogen peroxide system. I think convenience and simplicity instill compliance.

I tend to fit more daily disposable lenses, as this is a great modality to turn to if parents are concerned about cleanliness or responsibility. It eliminates the need for a care system. Also, with the recent MPS recalls, parents appreciate one-day lenses. I also recommend daily disposables for children who have allergies and those who are very athletic. (Lenses can accumulate allergens and sweat every day.)

Be prepared to adjust contact-lens prescriptions at every visit, particularly in children between ages eight and 12, when the rate of refractive change is greatest. A new prescription is a great opportunity to try new, advanced materials and lens designs.

Remember: Keep children in the healthiest, most comfortable lens material available. OM

References furnished upon request.

Dr. French's private practice, Children's Eyecare, is located in Orland Park, Ill. E-mail her at

Optometric Management, Issue: November 2007