Kids in Contact Lenses

About 4 million children under age 18 wear contact lenses.¹ As a practitioner who does numerous contact lens fittings for children every year, I am commonly asked by parents and other colleagues, “What is the right age for kids to start wearing contact lenses?”

Physically, a child’s eye is able to tolerate a contact lens virtually from birth. My general rule of thumb for regular contact lens fittings is to wait until children are slightly older and mature enough to take care of their lenses themselves. In our practice, we have found this age to be around 12 years, though the decision is made on a patient-by-patient basis for medically necessary contact lenses, where kids can be fit as young as a few weeks old.

HOW TO CHOOSE THE RIGHT LENS

When choosing a contact lens for a child, I like to follow a checklist:

• The patient’s refractive error,
• The contact lens material, and
• The preferred replacement schedule for the patient.

Contact lenses commonly used in children are soft lenses made of silicone hydrogel material. Rigid gas permeable lenses can also be used when it is difficult to find the right fit with a soft lens type. Hybrid lenses are not used often in kids, though some practices use them for specialty fittings.

Contact lenses also vary based on replacement schedule: daily disposable, 2 week replacement, 1 month replacement, and quarterly replacement. Kids may not be very hygienic, so I prefer daily disposables, which offer less risk of infection. On the downside, daily disposable lenses are more expensive and the lenses are thinner, which sometimes makes it harder initially for kids to get used to handling them.

WHY CONTACT LENSES?

Contact lenses may be appropriate for children for several reasons, varying from medical necessity to cosmetic purposes.² There are three main reasons why I fit children for contacts.

Reason No. 1

Contacts are often easier for children in sports and activities. Children who are involved in sports or activities such as soccer, tennis, basketball, karate, dance, or gymnastics can benefit from wearing contacts. Sports glasses or safety glasses can sometimes fog up and affect a player’s vision and performance. For this reason, many kids do not wear their glasses during sports, which increases the risk for sports-related injury because of poor reaction time. Contact lenses are beneficial in these circumstances and help eliminate problems such as fogging of the glasses. They also improve overall central and peripheral vision, reaction time, and contrast sensitivity.

Reason No. 2

I fit a lot of kids with medically necessary contact lenses, whether aphakic lenses after cataract surgery (Figure), tinted lenses for conditions such as iris colobomas or achromatopsia, or other reasons to control nearsightedness. Kids with conditions such as keratoconus can also benefit from specialty contact lenses.

Reason No. 3

Wearing contact lenses can build a child’s self-esteem and confidence, especially in the teen years. Even today, many kids are verbally or physically bullied for wearing glasses. Wearing contacts can boost children’s self-image and give them more confidence in the classroom and during athletic activities. Children don’t like to wear glasses because they are worried about how they look in them. In a study,³ 484 kids ages 8 to 11 years were given either glasses or contact lenses to wear for a period of 3 years. At the end of the study, the investigators scored the children’s self-perception of their physical appearance, athletic competence, and social acceptance. The score for the children wearing contact lenses was higher than that for the children wearing glasses.^3,4

Bonus Reason

In the past year, I have noticed one additional reason for contact lens fittings in young children. That is, the inconvenience caused by glasses fogging due to mask wear during the pandemic. Switching to contact lenses is one solution to this problem.

MYOPIA CONTROL AND MANAGEMENT

Myopia control and management also became a hot topic during the pandemic, while kids were learning virtually and using their computers or tablets all day. Recent studies show that wearing contact lenses can help control nearsightedness. In 2019, the FDA approved MiSight 1 day (CooperVision) daily disposable soft contact lenses for myopia management in children ages 8 to 12 years. Many practices have since incorporated this lens in their myopia control programs.

APHAKIC CONTACTS

The incidence rate for cataracts in children is one in 4,000 to 10,000,⁵ with variation from country to country. There are many causes of cataracts in children. The most common cause is a genetic abnormality, either in the lens itself or throughout the whole body. Cataracts can also be caused by injury, inflammation in the eye, or steroids taken by mouth or topically. Once a cataract is removed, children as young as a few weeks old can be fit with medically necessary contact lenses to improve their visual development and to avoid amblyopia.

Aphakic cataract glasses are quite thick, but they can still give good vision. Still, these spectacles may be difficult for the child to wear and for the practitioner to fit properly. This is especially true in infants or when only one eye is aphakic.

As alternatives to glasses, I use SilSoft contact lenses (Bausch + Lomb) or rigid gas permeable lenses for my aphakic patients. These can be custom-made based on their refractive error and the curve and size of their corneas.

FOLLOW CLOSELY

Contact lenses for kids can have distinct advantages, but they come with definite risks. Contact lens prescriptions should be updated every year, and yearly follow-up examinations are recommended for routine or regular contact lenses or as advised by your eye care specialist.