Children and soft contact lenses
A couple of months ago, my friend and colleague Mark Bullimore published an excellent paper in Optometry and Vision Science in which he critically analysed how safe it was to fit children with soft contact lenses. Since about the turn of the century there has been less reluctance shown to fit children with contact lenses. While this change was probably driven initially by the introduction of disposable soft contact lenses, more recently other factors have been important such as the increased interest in myopia control and the improved self-esteem and quality of life enjoyed by children wearing contact lenses.
To determine the relative safety of soft contact lens wear in children, Mark looked at a number of large prospective studies representing many thousands of hours of soft contact lens wear in children aged from 8 to 19 and compared the incidence of corneal infiltrative events (CIEs) in children to that in adults. Note that microbial keratitis is classed as a CIE, however it usually only accounts for around 5% of all CIEs. The results showed that the incidence of CIEs in children is no higher than in adults and in the youngest age range of 8 to 11 years it was actually markedly lower.
It is interesting to speculate why soft contact lens wear is just as safe – if not even safer – in children. In his paper, Mark comments that the lower rate of adverse events in the 8 to 11 group is a result of patient behaviour rather than biological factors, and greater parental supervision may also help to mitigate risks. I think the latter comment is especially pertinent. While children (especially teenage boys!!) can sometimes be a little vague and unreliable, it is the parents who will usually ensure that their children present regularly for after-care appointments and also do the right thing with regard to contact lens maintenance and handling. Compare this to the all too common scenario that we unfortunately encounter in practice where the adult contact lens patient only presents after a four or five year absence – often sadly with irreversible damage to the eye – because they can’t see very well or their eye is extremely sore.