Can Children wear Silicone Hydrogel Contact Lenses?

Contact lenses offer a convenient form of vision correction while also providing substantial cosmetic appeal. The present range of silicone hydrogel contact lenses accommodates almost all visual correction parameters and also offers significant ocular health benefits compared to hydrogel and other lens materials. Since their introduction in 1999(1), there has been a growing market trend to prescribe silicone hydrogel contact lenses due to their increased oxygen transmissibility and concomitant reduction in hypoxia compared to conventional contact lenses. Materials of this type are available as a frequent replacement modality (daily, fortnightly or monthly disposables) and the reduced hypoxia associated with these materials allows children to wear them successfully through their teenage years(2) and through their adult life with reduced physiological complications related to hypoxia.

However, there is an enduring disincentive to prescribe lenses to children and adolescents which includes concerns expressed by parents and practitioners relating to the child's ocular hygiene practices and the fitting of adult contact lens to children's eyes. It has been suggested that children are not capable of performing the strict hygiene regimens required for successful contact lens use and that standard "adult sized" contact lenses do not fit the smaller younger eye(3)

From the age at which children begin school, the need for vision correction becomes more evident and this time of first correction is an opportunity for children to become familiar with wearing contact lenses. Not only can contact lenses offer convenience throughout the day, they can also increase overall quality of life and self-esteem. In fact, when wearing contact lenses compared to spectacles, children feel happier about participating in activities and they feel more satisfied about their appearance(4).

Prescribing spectacles is believed by many practitioners to be quick, requiring less consultation chair time. In fact, consultation time for a child's contact lens fitting does not take any longer(5) than fitting an adult. In addition, for the wearer, practitioners often overlook that spectacles also require a cleaning and care regimen. Thus, many people tend to fall into the trap of believing that caring for contact lenses is more difficult than spectacles. Long-term research of children wearing contact lenses from the age of 8 years has shown that the children are capable of caring for their contact lenses.(6-7) These studies have also shown that children can wear lenses designed for adults, at least for soft hydrogel lenses.

In relation to the ill-fitting of adult lenses to children's eyes, the Sydney myopia study(8) found that corneal curvature was very similar between children of 6 and 12 years of age. In addition, the average adult corneal diameter of 12 mm is fully developed by the age of 4.(9) These similar anterior ocular characteristics in children and adults substantiate the contention that standard soft contact lenses can be successfully fitted to a child's eye. Commercially available silicone hydrogel lenses should be considered as a choice for contact lens wear with children. As reported recently,(11,12) soft and silicone hydrogel contact lenses with anti-myopia features may actually slow myopia progression rates. So far, preliminary results from experimental phases are promising.

To enable flexibility and the convenience of no lens wear during the day, orthokeratology is gaining substantial popularity as a correction for childhood myopia. Although there is evidence to support orthokeratology's control of myopia progression,(10) the associated discomfort and documented increased risks in overnight wear must be considered before fitting a child in these lenses.

The currently held (mis)conceptions relating to a child's lack of ability to care for contact lenses, and the idea that adult lenses do not fit children adequately suggest a need for increased education of both the practitioner and the parents. Children can be fitted with contact lenses, and with careful instruction, children are capable of caring for their lenses, if regular ongoing education is provided. The benefits of increased self-esteem and convenience for sporting activities with contact lens wear highlight that children should be offered contact lenses as a viable option to correct their refractive errors. Children should be fitted with frequent replacement lenses and practitioners must ensure regular contact lens follow-up appointments to promote safe contact lens wear.

References

1. Woods CA, Morgan PB. Use of silicone hydrogel contact lenses by Australian optometrists. Clin Exp Optom 2004; 87: 19-23.
   
   
2. Sankaridurg P. Contact lenses for tweens. Silicone Hydrogels Website March 2004.
   
   
3. Burger D. The untapped use of silicone hydrogels. Silicone Hydrogels Website March 2006.
   
   
4. Walline JJ, Gaume A, Jones LA, Rah MJ, Manny RE, Berntsen DA, Chitkara M, Kim A, Quinn N. Benefits of contact lens wear for children and teens. Eye Contact Lens 2007; 33: 317-321.
   
   
5. Walline JJ, Jones LA, Rah MJ, Manny RE, Berntsen DA, Chitkara M, Gaume A, Kim A, Quinn N. Contact Lenses in Pediatrics (CLIP) Study: chair time and ocular health. Optom Vis Sci 2007; 84: 896-902.
   
   
6. Walline JJ, Jones LA, Chitkara M, Coffey B, Jackson JM, Manny RE, Rah MJ, Prinstein MJ, Zadnik K. The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) study design and baseline data. Optom Vis Sci 2006; 83: 37-45.
   
   
7. Soni PS, Horner DG, Jimenez L, Ross J, Rounds J. Will young children comply and follow instructions to successfully wear soft contact lenses? CLAO J 1995; 21: 86-92.
   
   
8. Ip JM, Huynh SC, Kifley A, Rose KA, Morgan IG, Varma R, Mitchell P. Variation of the contribution from axial length and other oculometric parameters to refraction by age and ethnicity. Invest Ophthalmol Vis Sci 2007; 48: 4846-4853.
   
   
9. Tucker SM, Enzenauer RW, Levin AV, Morin JD, Hellmann J. Corneal diameter, axial length, and intraocular pressure in premature infants. Ophthalmology 1992; 99: 1296-1300.
   
   
10. Cho P, Cheung SW, Edwards M. The longitudinal orthokeratology research in children (LORIC) in Hong Kong: a pilot study on refractive changes and myopic control. Curr Eye Res 2005; 30: 71-80.
    
    
11. Holden B, Sankaridurg P, Lazon P, et a. Reduction in the rate of progress of myopia with a contact lens designed to reduce relative peripheral hyperopia. ARVO E abstract 2010: 2220.
    
    
12. Phillips J, Anstice N. Myopic Retinal Defocus With a Simultaneous Clear Retinal Image Slows Childhood Myopia Progression. ARVO E abstract 2010.