When do you prescribe contact lenses for children.
Historically optometrists do not prescribe contact lenses to children until they are at least twelve years old. Children represent one of the fastest growing segments of the contact lens wearing population. Infants through adolescents can be successfully fit with contact lenses. We will take a look at some medical and ocular conditions and also cosmetic indications where optometrists do prescribe from soft lenses to rigid gas permeable (RGP) lenses to children.
According to Salame et al 2004, the incidences for medical indications were higher than optical or cosmetic reasons for contact lenses wear. Congenital cataracts have the potential to lead to amblyopia, strabismus or permanent visual loss. After cataract removal implanting intraocular lenses may prove futile because of the still growing eye. Since the power of the contact lenses can be easily changed they are commonly prescribed for aphakia. The irregular astigmatism caused by keratoconus requires correction with rigid contact lenses. (Harris, l99l) There are many comeal epithelial conditions that require therapeutic soft contact lenses. From mild recurrent corneal erosions to severe alkali burns hydrogel contact lenses are used as therapeutic bandages. (Harris, 1997) Contact lenses have also shown to reduce the magnitude of nystagmus. (Allen & Davies, 1983)
Pediatric patients with leucoma, ectopia lentis, typical iris coloboma can benefit from custom-made contact lens treatment. Schornack et aL.2007, concluded that tinted contact lenses relieve photophobia associated with any disorder, including achromatopsia.
Children who need constant visual correction and are more likely to remove their glasses can benef,rt from contact lenses. A controversial issue is the usage of rigid gas permeable (RGP) contact lenses to slow the progression of myopia in children. Young patients with astigmatisms may benefit from toric soft contact lenses or RGPs. Anisometropic patients with unequal refractive (not axial) effors between the two eyes should be corrected with contact lenses to reduce the retinal image size differences. A hyperopic anisometropia should be corrected with contact lenses, otherwise the more hyperopic eye often becomes amblyopic. (Bennett & Weissman,2005) Pediatric patients who have strabismus, esotropia or exotropia are in danger of developing amblyopia. Children who are non compliant with the patch therapy may conform to a dark nonlight transmitting contact lenses.
Lastly, children wear contact lenses for aesthetic purposes. Spectacles may be cosmetically unattractive, causes visual disturbances and sometimes uncomfortable to wear. Hetelochromia irides may be an indication for some, while some may just want to change their natural eye color. Young children involved in sports, find it difficult and uncomfortable to compete with their glasses sliding down on their face. Jurkus’ (1996) study was able to treat aniridia, albinism and corneal disfigurement with custom designs.
The appropriate age and reason for contact lens fitting should be determined on an individual basis, with input from the child, parent, and practitioner. As outlined above, there are many indications for contact lens wear in a child, and the overall improvement in quality of life afterwards is priceless. The old adage does hold true when it comes to optometrists and contact lenses: children are our future!