Contact Lenses in Kids

Share

Tweet

Share

Share

Email

sponsored content

August 1, 2023

As Johnson & Johnson Vision expands its portfolio of myopia management treatments, the international vision care leader is working to educate eye care professionals and other health care practitioners about the benefits of myopia management and the different treatment options available.

Review of Myopia Management’s Editor-in-Chief John Sailer recently interviewed Monica Jong, BOptom, PhD, Johnson & Johnson Vision’s Global Director of Myopia Professional Education, along with Kate Gifford, PhD, BAppSc(Optom)Hons, GCOT, FBCLA, FCCLSA, FIACLE, FAAO, co-founder and director of Myopia Profile, about their teams’ efforts to educate on the use of contact lenses in children and why they are a great option.

John Sailer, Editor-in-Chief, Review of Myopia Management: Of all the treatment options available to eye care practitioners to manage myopia in children, we would like to focus our discussion today on contact lenses. So, please tell us, Dr. Jong and Dr. Gifford, why are contact lenses for myopia management a good treatment method?

Monica Jong, BOptom, PhD: With myopia we know that every diopter matters in terms of the risk of ocular complications and vision impairment down the track.¹ We should therefore be offering myopia management to every child with myopia. Many clinical trials show that OrthoK and various soft contact lenses designed to manage myopia work to limit myopia in children of different ethnicities in various parts of the world such as the U.S., China, Australia, and parts of Europe, ranging from the age of 6 to 18 years.^2,3 The sheer number of great studies in OrthoK and soft contact lenses should give us confidence as we recommend and prescribe these treatments.² Additionally, trusted independent professional organizations like the International Myopia Institute systematically assess the evidence and have recommended that we should be offering personalized myopia management to children.⁴

Kate Gifford, PhD, BAppSc(Optom)Hons, GCOT, FBCLA, FCCLSA, FIACLE, FAAO: I think it’s also important to think about the benefits of contact lenses for kids in general. We now know from research that for children and teenagers wearing contact lenses, it can improve their confidence, their self-perception, and their ability to participate in activities of daily living and sports.⁵ It can improve their vision-related quality of life. So, even before we think about all of the benefits of correcting and managing myopia, we have benefits in kids wearing contact lenses just in terms of these functional and psychological factors. Ultimately, the way I look at it is that children with myopia need either spectacles or contact lenses to correct their vision. However, since contact lenses can both correct vision and manage myopia, in addition to conferring the additional benefits of improved quality of life, sports participation, self-perception, and confidence in kids, it just absolutely makes sense to look at these as a first line option.

John Sailer, Editor-in-Chief, Review of Myopia Management: As a follow up to that, Dr. Gifford, would you mind telling us a little bit about the different types of contact lenses available for myopia management?

Dr. Gifford: Absolutely. Both OrthoK and soft contact lenses are fantastic options. If you are fortunate to have both options available to you in your practice, it’s worth considering the features of each to determine which may be suitable to your patients. With OrthoK, one of the most notable benefits is that there’s no daytime wear of contact lenses. Since OrthoK is worn overnight, children can take part in water activities without risking water and lens contamination. Also, parents are able to oversee the entire process of handling and wear because this only happens at home. 

When it comes to daily disposable soft contact lenses, they are simpler to care for because there’s no lens cleaning required. Fitting daily disposables is relatively simpler, as OrthoK does require a little bit more expertise and equipment, such as a need for a corneal topographer, for optimized fitting. Patient compliance is normally very good with daily disposables, and when it comes to safety and adverse events, we know that daily disposable soft contact lenses are the safest way to wear contact lenses with the lowest rate of adverse events compared to reusable soft contact lenses or compared to OrthoK.^6,7 Knowing that each option has unique features and benefits enables us to tailor our treatment and management towards each patient’s activities, lifestyle, family situation, as well as clinical information such as prescription. In this way, we can select the best contact lens option for each patient.

Dr. Jong: I would like to also add that more research is emerging that shows that when kids wear their optical treatments for a longer duration, the level of myopia treatment efficacy also increases.⁴ So, if you have a treatment option that kids really enjoy and is tailored to their lifestyle,  they’re much more likely to wear it more often, which may increase the treatment benefits. That’s something that clinicians should consider as well. 

John Sailer, Editor-in-Chief, Review of Myopia Management: What are some of the barriers for children in wearing contact lenses? Do they find them difficult to handle and wear?

Dr. Gifford: Some of the main barriers of contact lens wear for children are actually in the minds of parents and of practitioners. There can be perceptions by parents that contact lenses aren’t safe for children, when in fact the evidence indicates that children aged 8 to 12 years may be safer wearing soft contact lenses than teens or adults with a lower incidence of adverse events.⁸ This is perhaps due to supervision and compliance factors. 

Research also tells us that children can handle soft contact lenses. We might be concerned that they’re unable to do it, but while of course there can be outliers, and those are perhaps the cases we most remember in practice, on average, 95% of children learn to handle their lenses at their first visit.⁹ And children aged 8 to 12 only appear to take 10 minutes longer to learn handling their lenses than teens aged 13 to 17 years.¹⁰  It’s also been shown that children can quickly improve on their lens application time.^10,11  The key message here is that if we do see handling as a barrier to children wearing soft contact lens, the evidence absolutely points to the fact that children can actually handle their lenses well and will improve quite quickly in their ability to apply and remove them.

John Sailer, Editor-in-Chief, Review of Myopia Management: Following up on the safety aspect, Dr. Jong, are they safe for children to wear?

Dr. Jong: We do encounter medical professionals as well as the general public who feel that contact lenses could be unsafe because we do hear the stories of people who didn’t wear their lenses as advised, or they didn’t observe hygiene when they handled their lenses. It’s therefore important that we use our knowledge and skills to educate and remind our patients about the importance of hygiene and compliance factors such as washing hands prior to handling lenses, as well as advocating for regular replacement of lenses, cases, and solutions to limit contamination. Ensuring the basics of hygiene compliance is critical for safety.¹²

Ultimately, we want to avoid any sight-threatening complications such as microbial keratitis. Mark Bullimore once reported that in 10,000 patient years of soft contact lens wear in kids, only three cases of microbial keratitis were observed.¹³ Recently, he published a study on pediatric OrthoK wear and found that there were approximately five microbial keratitis cases per 10,000 patient years of wear for OrthoK.¹⁴ These findings show very low rates of infection and suggest that children can safely wear contact lenses. However, eye care practitioners will always play a key role in advocating for safe contact lens use especially through regular reviews and reinforcing correct contact lens handling procedures. 

John Sailer, Editor-in-Chief, Review of Myopia Management: And can you both share some tips for fitting contact lenses in kids? 

Dr. Gifford: It’s important to consider parents’ willingness to be part of the contact lens management or treatment plan. If they are not initially on board, continued discussion and education may enable them to understand the true picture of the safety and benefits of contact lenses for kids. Communication of the benefits and safety is so important towards that understanding. 

Additionally, if you’re considering what to prescribe, think about what’s available to you, what’s going to best suit that child’s refraction and perhaps their ocular health, and then think about what’s going to suit their lifestyle. We’ve talked about the different benefits of orthokeratology versus soft contact lenses. Finally, depending on the family, on the child, on their particular activities, and their particular clinical picture, you’ll be able to determine which option is likely to suit them best for their life.

Dr. Jong: Thanks, Dr. Gifford. You’ve summarized a lot of the things that I also agree with. 

For teaching children lens handling, insertion and removal, using easy-to-understand language and clear steps to explain the whole process is going to be important. You don’t necessarily have to do that yourself as a practitioner; you can train and delegate training to your staff when needed. Also, Myopia Profile has a lot of wonderful insertion and removal videos on their site, and Johnson & Johnson also has produced insertion and removal videos specifically for children as well. Practices can utilize these resources and do not need to go through the trouble of creating their own patient support resources.

Having materials on hand that are suitable specifically for children to understand also makes sense. 

John Sailer, Editor-in-Chief, Review of Myopia Management: Thank you for all that great information, Dr. Gifford and Dr. Jong. I understand your teams have actually partnered to develop an infographic about contact lens wear in children. Can you tell us about that?

Dr. Gifford: Yes, definitely. The contact lenses infographic was the brainchild of Dr. Monica Jong, myself, Dr. Kate Gifford, and Dr. Paul Gifford. What we’ve designed this to do is address questions that a parent or an eye care professional may have about contact lens wear in children. It’s designed to be visually appealing and colorful with easy-to-follow information on everything we’ve discussed today for clinical communication. 

We’ve also ensured it can be printed in numerous formats, so it can be printed as a booklet to use in the examination room or even a poster to be put in the practice waiting room or the dispensary. It’s supported by numerous scientific references and designed to distill the science into clinically actionable items. Johnson & Johnson Vision is known for leading with science, and Myopia Profile is known for translating science into practice. Our collaboration on this infographic brings these values together to support eye care professionals to confidently fit and manage more kids with contact lenses.

Dr. Jong: Thank you, Dr. Gifford. The contact lens infographics are just one of the great resources that we have made available that puts all the evidence and information in one place at the fingertips of doctors. 

However, Johnson & Johnson also understands that the whole myopia management conversation doesn’t just end between the optometrist and the patient and the parent. We realize that it involves medical practitioners, such as pediatricians. That is why Johnson & Johnson Vision launched this contact lens pediatric-centered infographic at the AAPOS pediatric ophthalmology meeting in March 2023 in New York City. It’s important to also share the role of contact lenses and OrthoK with pediatric ophthalmologists who are seeing children and make them aware of myopia and the potential benefits of contact lenses and OrthoK, in addition to traditional forms of correction or myopia management. 

Johnson & Johnson Vision is now embarking on the path to further engage with pediatricians and ophthalmologists because we recognize that it’s all part of the solution to change the trajectory of myopia. We’ve piloted a pediatric referral program for myopia management and are currently testing it, and we really hope to expand and grow the awareness of myopia as a chronic disease further over time with an evidence-based approach. It really is about partnering with professional associations in optometry, ophthalmology, and working with other groups such as Myopia Profile and research institutes around the world.

For more information, and to download the infographic, see the Myopia Profile Contact Lenses for Kids download page.

 

References

1. Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci. 2019 Jun;96(6):463-465. doi: 10.1097/OPX.0000000000001367. PMID: 31116165.
2. Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res. 2021 Jul;83:100923. doi: 10.1016/j.preteyeres.2020.100923. Epub 2020 Nov 27. PMID: 33253901.
3. Bullimore MA, Brennan NA. Efficacy in Myopia Control: Does Race Matter? Optom Vis Sci. 2023 Jan 1;100(1):5-8. doi: 10.1097/OPX.0000000000001977. Epub 2022 Dec 13. PMID: 36705709. 
4. Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, Michaud L, Mulder J, Orr JB, Rose KA, Saunders KJ, Seidel D, Tideman JWL, Sankaridurg P. IMI – Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M184-M203. doi: 10.1167/iovs.18-25977. PMID: 30817832.
5. Lipson MJ, Boland B, McAlinden C. Vision-related quality of life with myopia management: A review. Cont Lens Anterior Eye. 2022 Jun;45(3):101538. doi: 10.1016/j.clae.2021.101538. Epub 2021 Nov 18. PMID: 34802915.
6. Bullimore MA, Sinnott LT, Jones-Jordan LA. The risk of microbial keratitis with overnight corneal reshaping lenses. Optom Vis Sci 2013;90:937-944.
7. Stapleton F, Keay L, Edwards K et al. The Incidence of Contact Lens Related Microbial Keratitis in Australia. Ophthalmol 2008;115:1655-1662.
8. Bullimore MA. The Safety of Soft Contact Lenses in Children. Optom Vis Sci. 2017 Jun;94(6):638-646. doi: 10.1097/OPX.0000000000001078. PMID: 28514244; PMCID: PMC5457812.
9. Paquette L, Jones DA, Sears M, Nandakumar K, Woods CA. Contact lens fitting and training in a child and youth population. Cont Lens Anterior Eye. 2015 Dec;38(6):419-23.
10. Walline JJ, Jones LA, Rah MJ, Manny RE, Berntsen DA, Chitkara M, Gaume A, Kim A, Quinn N; CLIP STUDY GROUP. Contact Lenses in Pediatrics (CLIP) Study: chair time and ocular health. Optom Vis Sci. 2007 Sep;84(9):896-902. doi: 10.1097/OPX.0b013e3181559c3c. PMID: 17873776.
11. Mathews JR, Hodson GD, Crist WB, LaRoche GR. Teaching young children to use contact lenses. J Appl Behav Anal. 1992 Spring;25(1):229-35. doi: 10.1901/jaba.1992.25-229. PMID: 1582968; PMCID: PMC1279669.
12. Weissman BA, Mondino BJ. Risk factors for contact lens associated microbial keratitis. Cont Lens Anterior Eye. 2002 Mar;25(1):3-9. doi: 10.1016/s1367-0484(01)00002-9. PMID: 16303475.
13. Bullimore MA, Richdale K. Incidence of Corneal Adverse Events in Children Wearing Soft Contact Lenses. Eye Contact Lens. 2023 May 1;49(5):204-211. doi: 10.1097/ICL.0000000000000976. Epub 2023 Mar 6. PMID: 36877990.
14. Bullimore MA, Mirsayafov DS, Khurai AR, Kononov LB, Asatrian SP, Shmakov AN, Richdale K, Gorev VV. Pediatric Microbial Keratitis With Overnight Orthokeratology in Russia. Eye Contact Lens. 2021 Jul 1;47(7):420-425. doi: 10.1097/ICL.0000000000000801. PMID: 34050085.

 

PP2023OTH5220