Which is the most appropriate contact lens option? Questions to ask patients and parents.

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Contact lenses for myopia management present a fantastic option for children - offering the benefits of correcting myopia, slowing its progression and allowing children the functional freedom and increased confidence1 which comes with contact lens wear. You may have a clear understanding of the benefits, but find communication the bigger challenge. How do you introduce contact lens options as a concept in the myopia management consultation? What questions can you ask to identify suitability for contact lenses, specific to that child and family?

Considering patient and family factors

When deciding which option to recommend for myopia management, it is useful to consider optical treatments first to both correct myopia and slow its progression. When considering contact lenses, there are clinical factors involved such as astigmatism, corneal curvature and availability of options which will influence your recommendations. For an exploration of these clinical factors, check out Selecting an option: Clinical Decision Trees for Myopia Management.

These clinical factors are mostly objective, so arguably easy to manage and describe to parents and patients. Subjective factors, though - such as patient preferences and family capacity - can be less easy to explore. How can you best approach these discussions to recommend the most suitable option for your patient?

Key discussion questions

What do you like doing when you’re not at school? Are your spectacles getting in the way?

It's obvious that contact lenses open up the opportunities for children to participate in sports and hobbies compared to spectacle lens wear. Asking about sport and hobbies is important to ensure the child's vision correction suits their daily activities. From sporting activities where spectacles may not be suitable or pose a safety issue, through to pursuits like dancing or music, there are various situations where contact lenses can provide a more convenient form of vision correction as well as helping to manage myopia progression.. Water exposure is an important consideration in contact lens wear – this should be avoided as it is associated with numerous complications.2

Some sports may require special eye protection, to prevent injury to the eyes or orbit from equipment or projectiles.3 Whilst certainly possible in some cases to fit safety goggles or spectacles with prescription lenses, contact lenses present an easy solution here too. Regular spectacles cannot be assumed to provide sufficient protection, and may even be a hazard or prohibited in contact-style sports.

How are you getting on with your spectacles?

Wearing spectacles has thankfully become more popular in children and teens in recent times and in fact, sometimes young children (primarily girls!) will declare their 'need' for them as they walk through the consultation room door! It is still the case, though, that some children can suffer a knock to their confidence when prescribed spectacles. Both children and teens gain a similar confidence boost when switching from spectacle to contact lens wear, even for those who still enjoy wearing their spectacles.1 In children under 12, who are at greatest need of proactive myopia management,4 contact lens wear improves their confidence in their sport performance, their appearance and perceptions of social acceptance.5

Asking about how a child is getting on with their spectacles can cover discussion from compliance through to frustrations with wear. Another open-ended question to follow on from the latter could include ‘Tell me when your glasses annoy you?’ This can help to reveal additional opportunities to discuss the benefits of contact lenses.

Has anyone in the family worn contact lenses?

This question helps to explore parental experience and attitudes towards contact lenses. If a parent has had a negative experience in the past, or no experience, then there is a little more to explain in terms of options, benefits and healthy ways to wear contact lenses. If a parent has had a positive experience, then it's useful to discuss the type of contact lenses they've worn, wearing frequency, and how their child's lens type and wearing experience may be different. For example, children wearing contact lenses for myopia control should ideally wear them full time (at least 6 days a week for 10+ hours per day) to gain the most benefit. A survey of childhood contact lens prescribing found that 84% of children fit for myopia control wore their lenses 7 days a week, compared to only 56% of children fit for non-myopia control reasons.6

Interestingly, prior parent experience of contact lens wear does not influence whether they proceed with contact lens wear for their child.7 Hence, discussing contact lens benefits and safety is important, regardless of parental experience - in either case, understanding and addressing any parental concerns is crucial. Learn more about how to explain contact lens benefits and safety in Kids And Contact Lenses – Benefits, Safety And Getting To ‘Yes’.

Other discussion points

Did you know that most contact lens treatments for myopia have been researched in 8-12 year olds?

Parents can have perceptions of contact lenses being less safe for children than the general population,8 but in fact the opposite appears to be true in soft contact lens wear where children (8-12 years) appear to have a lower risk of complication than teens9,10 or adults.10

Long term, real-world data of daily disposable and mixed soft contact lens modalities in children have shown very high safety profiles. Firstly, six years of daily disposable hydrogel SCL wear was shown to have minimal impact on ocular physiology in children, with 99% of biomicroscopy signs being Grade 1 or lower.11 Secondly, children aged 8-16 years who fit with daily or reusable soft contact lenses, and followed for an average of almost 3 years, showed a rate of non-infectious corneal inflammatory events (eg. inflammatory keratitis, CLARE or CLPU) of 0.66% per year (or 1 in 151) and only 7.4 per 10,000 risk of microbial keratitis, or less than 1 in 1000 per year.12

It can be very helpful explaining to parents that children commonly wear contact lenses for myopia control, with much research in this area and evidence of long-term safety. This is crucially important given that earlier intervention will provide the largest absolute outcomes for reducing the final level of myopia or axial length of the eye.4 If parents are concerned about healthy contact lens wear, daily disposable contact lenses present an ideal option.9-13

Take home messages

  1. When discussing myopia controlling contact lenses with patients and parents, it is important to consider not just the objective ocular factors, but also the subjective factors of patient lifestyle and perceptions, to find the best solution.
  2. Discuss sport and activities, perceptions of wearing spectacles and ask about any parental experience with contact lenses - this ensures you can address the benefits and safety of contact lenses specific to that patient and their family.

Further reading on kids and contact lenses

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About Kate

Dr Kate Gifford is a clinical optometrist, researcher, peer educator and professional leader from Brisbane, Australia, and a co-founder of Myopia Profile.

Cassandra Haines BIO image 2019_white background

About Cassandra

Cassandra Haines is a clinical optometrist, researcher and writer with a background in policy and advocacy from Adelaide, Australia. She has a keen interest in children's vision and myopia control.

This content is brought to you thanks to an unrestricted educational grant from

 

References

  1. 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(6 Pt 1):317-321. (link)
  2. Arshad M, Carnt N, Tan J, Ekkeshis I, Stapleton F. Water Exposure and the Risk of Contact Lens-Related Disease. Cornea. 2019 Jun;38(6):791-797. (link)
  3. Dain SJ. Sports eyewear protective standards. Clin Exp Optom. 2016 Jan;99(1):4-23. (link)
  4. Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res. 2020 Nov 27:100923. doi: 10.1016/j.preteyeres.2020.100923. Epub ahead of print. (link)
  5. Walline JJ, Jones LA, Sinnott L, Chitkara M, Coffey B, Jackson JM, Manny RE, Rah MJ, Prinstein MJ; ACHIEVE Study Group. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci. 2009 Mar;86(3):222-32. (link)
  6. Efron N, Morgan PB, Woods CA, Santodomingo-Rubido J, Nichols JJ, International Contact Lens Prescribing Survey C. International survey of contact lens fitting for myopia control in children. Cont Lens Anterior Eye. 2020;43(1):4-8. (link)
  7. Jones LA, Walline JJ, Gaume A, Rah MJ, Manny RE, Berntsen DA, Chitkara M, Kim A, Quinn N, Group CS. Purchase of contact lenses and contact-lenses-related symptoms following the Contact Lenses in Pediatrics (CLIP) Study. Cont Lens Anterior Eye. 2009;32(4):157-163. (link)
  8. Zeri F, Durban JJ, Hidalgo F, Gispets J; Contact Lens Evolution Study Group (CLESG). Attitudes towards contact lenses: a comparative study of teenagers and their parents. Cont Lens Anterior Eye. 2010 Jun;33(3):119-23. (link)
  9. Bullimore MA. The Safety of Soft Contact Lenses in Children. Optom Vis Sci. 2017;94(6):638-646. (link)
  10. Wagner H, Chalmers RL, Mitchell GL, Jansen ME, Kinoshita BT, Lam DY, McMahon TT, Richdale K, Sorbara L. Risk factors for interruption to soft contact lens wear in children and young adults. Optom Vis Sci. 2011;88(8):973-980. (link)
  11. Woods J, Jones D, Jones L, Jones S, Hunt C, Chamberlain P, McNally J. Ocular health of children wearing daily disposable contact lenses over a 6-year period. Cont Lens Anterior Eye. 2021 Feb 3:S1367-0484(20)30204-6.
  12. Chalmers RL, McNally JJ, Chamberlain P, Keay L. Adverse event rates in the retrospective cohort study of safety of paediatric soft contact lens wear: the ReCSS study. Ophthalmic Physiol Opt. 2021 Jan;41(1):84-92.
  13. Stapleton F, Keay L, Edwards K, Naduvilath T, Dart JK, Brian G, Holden BA. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008 Oct;115(10):1655-62. (link)

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