|Avaira from CooperVision is a two-week replacement lens that is easy for kids to
handle and has UV protection.
|Menicon’s Miru 1day’s thin package (1mm)
was specifically developed to reduce the
risk of contamination.
|Alcon’s DAILIES Total1 features water
gradient technology to reduce friction
on the lens and ocular surface.
Children are my favorite contact lens patients. They are more compliant and complain less than some of my adult contact lens wearers””and I am referring to children as young as eight. I do not mean all patients this age are going to be good contact lens patients, but the successful ones are great.
The criteria we may use for deciding on the best age for recommending contact lenses can be based on what we learned in school and our own biases on working with young children. Most often it is based solely on the patients’ chronological age, without consideration for their maturity nor the current lens modalities available. While this made some sense when rigid lenses were the only option, the multiple lens modalities available now reduce the argument of waiting for the teenage years to a non-issue.
Still, some challenges persist. The maturity of the patient, compliance, hygiene, lens handling, the epidemic of myopia, UV protection, and occasionally the patient’s prescription and comfort of the lenses may deter you from fitting younger patients. However, the range of lenses available from Alcon, Johnson & Johnson Vision Care, Bausch + Lomb, Menicon and CooperVision covers almost all of your complaints. Here is a list of eight common obstacles and how to address them.
The Issue: Maturity
The Solution: Ask about grades in school and participation in sports, and look at their behavior to determine maturity. Be wary, however, if it is the parents who are asking about the contact lenses for their child. You are doomed for failure if the parents are the ones who want contact lenses and not their son or daughter.
The Issue: Compliance
The Solution: This issue is mitigated largely by the use of daily disposable lenses. All of the major lens manufacturers have daily disposables that are suitable for children. My over-riding philosophy is to fit all of my patients in the best lens possible all of the time, and that means daily disposables for kids.
The Issue: Hygiene
The Solution: Daily disposable lenses are the best, for the same reason as for compliance. Not all children (or adults for that matter) wearing frequent replacement lenses clean their contact lenses before putting them in their case, even when instructed. Some patients even place their lenses back into the blister pack instead of a contact lens case. Menicon’s Miru 1day’s thin package (1mm) was specifically developed to reduce the risk of contamination. The lens, in addition to being oriented for proper insertion directly from the packaging, has the added benefit of ensuring that the flat pack is not available for reuse, unlike blister packs.
The Issue: Lens handling
The Solution: When the goal is to fit these young patients with a daily disposable lens, I recommend performing the insertion and removal instruction using two-week or monthly lenses as “training wheels” prior to ordering their final lenses. Since a one-week follow-up visit is also recommended in our office, this allows the patient time to become comfortable handling the lenses before transitioning to the final lenses. Two-week replacement lenses, such as Avaira from CooperVision and ACUVUE OASYS Brand Contact Lenses from Johnson & Johnson Vision Care, and monthly lenses, such as Alcon’s Air Optix, CooperVision’s Biofinity and Bausch +Lomb’s Ultra, handle more easily for most young patients. The daily lenses are more of a challenge, with the exceptions of Alcon’s Dailies Total1 and CooperVision’s Proclear, in ease of handling.
The Issue: The myopia epidemic
The Solution: There has been a significant increase in research on myopia management with contact lenses. While still an off-label use, multifocal lenses have been used in many practices to manage their patients who are getting increasingly myopic.
The Issue: UV protection
The Solution: Young children are much more susceptible to UV rays, plus exposure over a lifetime has been linked to cataracts and macular degeneration. While sunglasses and hats are basic recommendations, all of the ACUVUE brand contact lenses, as well as the clariti, Avaira and MyDay family of lenses from CooperVision, are available with UV protection, which should be a consideration when fitting young children.
The Issue: Prescription availability
The Solution: What is the patient’s prescription, high myopia, high hyperopia, astigmatism? There is an impressive range of prescription parameters available in all lens modalities. CooperVision’s Biofinity and Biofinity Toric now each have an XR, and 1-DAY ACUVUE MOIST Brand for Astigmatism from Johnson & Johnson Vision Care is also available in a larger range of parameters.
The Issue: Oxygen permeability
The Solution: Some corneas require more oxygen than others. Some of this may be prescription related, and some may be patient specific. Silicone hydrogel material lenses such as clariti from CooperVision and ACUVUE OASYS 1-DAY are available, and the specific lens design of Alcon’s DAILIES Total1 allows more breathability. Although the possibility of patient allergies to silicone hydrogel material is debated, some young patients have apparent allergies to this material and require a hydrogel lens such as Proclear (CooperVision), DAILIES AquaComfort PLUS (Alcon) and Biotrue (Bausch + Lomb).
Fitting young children is the same as fitting any of your patients. Considerations of lens handling, hygiene and a willingness to be patient with these patients are all that you need. The one exception: comfort. An adult or older child can understand that comfort will improve, but with a younger child there should be immediate comfort. The above suggestions should make that a non-issue. OO
Mary Lou French, OD is in private practice in Orland Park, IL. She would like to acknowledge the help of the optometrists who are members of the Facebook page, Pediatric Optometry, for sharing their opinions on appropriate contact lenses for children.
WHERE TO FIND IT:
800.451.3937 | alcon.com
Bausch + Lomb
800.828.9030 | Bausch.com/ecp
800.341.2020 | coopervision.com