Multipurpose and hydrogen peroxide-based systems can help children care for their contact lenses.
At one time, we believed that children had to be at least age 12 or older to begin contact lens wear. Not so. In 2006, Jeffrey Walline, OD, of Ohio State University, and colleagues announced results of the Contact Lens in Pediatrics, or CLIP, Study, in which they compared children ages 8 to 12 and teenagers ages 13 to 17. They found that the younger children could be just as successful as the teenagers when it came to contact lens wear. And, while insertion and removal training initially was about 14 minutes more when fitting children with contact lenses, by the end of the training both groups showed excellent understanding of contact lens care, the study found.
These results instilled a greater sense of confidence among practitioners fitting children in contact lenses. When deciding whether to fit a child in contact lenses, I ask the parents whether they believe their child is responsible enough for contact lenses and whether their child is motivated for contact lenses. I also consider whether the child’s prescription is available and if the ocular surface is healthy enough to proceed with contact lenses.
Whenever possible, I like to fit patients in daily disposable contact lenses, as the patient puts on a fresh new lens each day without having to worry about care regimens. However, if the patient’s prescription is not available in a daily disposable or if the parents don’t want to incur the cost, it may become necessary to fit the child in a two-week or monthly disposable option. In some instances, we may place the child in gas permeable lenses, usually orthokeratology for myopia control.
As with adults, a discussion about the care regimen and patient education becomes essential.
FIRST UP: MULTIPURPOSE
Essentially, there’s no significant difference in what I consider when recommending a care regimen to a child or adult. I typically start the patient with a multipurpose solution such as Alcon’s OPTI-FREE Puremoist Contact Lens Solution, Bausch + Lomb’s Biotrue Multipurpose Solution or Johnson & Johnson’s Blink RevitaLens Multi-Purpose Disinfecting Solution, as a first-line regimen. These tend to be easy for patients to use, and there are few adverse events. These solutions were developed in an era of silicone hydrogel lenses. As such, they have been optimized for this material.
While patients should follow the manufacturer’s recommended soak time (four to six hours), there is a low risk of adverse events if the patient needs to insert the lenses before that time has expired. This is especially helpful for individuals with irregular schedules. (For more on multipurpose solutions, see “The Solutions for Cleanliness,” July 2017.)
SWITCHING TO PEROXIDE
If the patient has allergies or if we suspect hypersensitivity to the preservatives in a multipurpose solution, we switch that patient to a hydrogen peroxide-based system such as Alcon’s CLEAR CARE Cleaning and Disinfecting Solution and CLEAR CARE PLUS Cleaning and Disinfecting Solution with HydraGlyde. (Other available peroxide-based systems include Refine One Step from CooperVision and Oxysept Disinfecting Solution/Neutralizer Ultracare Formula from Johnson & Johnson Vision.)
When using a peroxide-based system, the solution starts out as 3% hydrogen peroxide, but after a full six-hour soak, the solution is neutralized, leaving minimal amounts of peroxide. Essentially, the solution transitions to a saline bath, making it gentle on the patient’s eyes.
One precaution, however: Failure to follow the recommended soak time means that the solution won’t be completely neutralized. That means, the individual will place large amounts of hydrogen peroxide on the eye and is at risk of corneal staining or a corneal burn. (For more on hydrogen peroxide-based systems, see “Why Hydrogen Peroxide is My First Choice,” October 2017.)
As with adults, you’ll need to give pediatric contact lens wearers some additional reminders:
• Digitally rub each side of the lens for about 10 seconds using the solution.
• Rinse each side of the lens using a continuous stream of solution for five to 10 seconds after digitally rubbing the lens.
• Replace contact lens cases approximately once every three months. (Even though cases are readily accessible, I’ve seen patients stockpile them and continue using the same case for much longer periods.)
Children are among the most compliant contact lens patients I have in my practice. That’s because their lives are about following instructions from parents and educators. So, they generally do well at following rules for caring for contact lenses. It’s when patients get older that they may start being less compliant with their wear schedule or care regimen, but hopefully by this point you’ve educated them well about the importance of compliance.
Mile Brujic, OD, FAAO, is a partner of Premier Vision Group, a three-location practice in northwest Ohio. He has authored more than 250 articles for publication and given more than 1,300 lectures, including lectures about contact lenses and about contact lenses for children.
WHERE TO FIND IT
800.451.3937 | Alcon.com
Bausch + Lomb
800.828.9030 | Bausch.com
800.341.2020 | CooperVision.com
Johnson & Johnson Vision
800.843.2020 | JJVision.com