Address the research, the numbers and risk mitigation in your discussions

You’ve probably heard the question: “Are contact lenses safe for my child?” If you’re the parent of a myopic child, then you may have asked yourself the same question. The increased interest in myopia control has elevated the numbers of children who are candidates for lens wear. Thus, it’s an increasingly common question.

Here is a basic outline, along with resources for having this discussion with your patients and their parents.

THE RESEARCH

The bottom line — and your first words — should be: “Contact lens-related infections are a well-researched area of eye care. Recent research shows that contact lens wear is safer in children than in any other age group, including adults.”

If the parent is a contact lens wearer, that may end the conversation. This statement can be supported by having copies of or a link to my review of the topic handy, if the parent wishes to do their own reading.¹ It’s available at bit.ly/BullimoreOVS072017 .

Thereafter, I recommend two approaches: (1) Provide the data and (2) describe how the risks can be minimized.

THE DATA

The risk of microbial keratitis with daily wear soft lenses is two per 10,000 patient years.² Recognize that a percentage of 0.02% per year is difficult to digest. It can be restated as the annual risk of a serious infection is 1 in 5,000.

Furthermore, not all cases of microbial keratitis result in loss of vision. The risk of a patient losing vision as a result of an infection is 10%; so the annual odds of an infection with vision loss is one in 50,000.²

For overnight orthokeratology, the risks of infection are a little higher, with the annual risk of an infection closer to one in 750, and with associated vision loss, one in 7,500.³ Of course, this must be balanced with the benefits of this modality, which include the child not wearing contact lenses to school. These studies also can be readily available for patients’ parents. (See references.)

RISK MITIGATION

After presenting the odds to the patient and his parents, be ready to discuss risk mitigation. I found in my research that the greatest factor associated with increased risk of infection is sleeping in lenses, so that needs to be stressed, specifically with regard to soft contact lens wear.² Other factors that increase the risk of infection are not cleaning contact lens cases and not replacing solutions. Here, you can explain, a daily disposable modality can remove these issues.

URGENT CONSULTATION

Finally, it is important to remember that infections can happen. If a pediatric contact lens wearer has a painful red eye, an urgent consult is needed. Not all these events will be microbial keratitis — fewer than one in 10 — but mention that you are available to provide care in a timely fashion. Most important, exhibit empathy as you’re discussing the care of someone’s child. OM

REFERENCES

1. Bullimore MA. The Safety of Soft Contact Lenses in Children. Optom Vis Sci. 2017;94:638-46.
2. Stapleton F, Keay L, Edwards K, et al. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008;115:1655-62.
3. Bullimore MA, Sinnott LT, Jones-Jordan LA. The risk of microbial keratitis with overnight corneal reshaping lenses. Optom Vis Sci. 2013;90:937-44.

DR. BULLIMORE writes about myopia and other topics, is an adjunct professor at the University of Houston, a consultant for Alcon Research, Allergan, CooperVision, Essilor, Eyenovia, Genentech, Johnson & Johnson Vision, Novartis, Presbia and Wells Fargo Securities and owner of Ridgevue Publishing, Ridgevue Technologies and Ridgevue Vision.