While refractive surgery continues to attract some of the adult contact lens market, a larger percentage of new contact lens patients are school-age youngsters and teens. Years ago many practitioners tended to wait until children were in their mid-to-late teens before fitting them with contact lenses. The choices available today?especially daily and biweekly disposables?have made contacts safer and more practical for younger children.

Contacts for Infants and Young Children

For many years contact lenses have been considered the superior option for infants who have congenital cataract surgery since glasses are impractical for infants and amblyopia will set in rapidly if the visual pathways are not stimulated at a very early age. Choices in contact lens, however, are limited. Vigilance on the part of the parents is required?they must learn to clean and handle the lenses, constantly ensure that the lenses are in the eyes, keep spare lenses on hand for immediate replacement, and learn to recognize and seek immediate medical care for adverse reactions.

Toddlers and pre-schoolers can be good contact lens candidates. Young children with high refractive errors and thick glasses may be teased by playmates and develop a negative self-image. Children with strabismus may become uncooperative with their patching regimen due to the teasing of other children, the discomfort of the patch in warm weather, or an allergic reaction to the adhesive.

The School-age Market

Many school-age children are highly motivated to wear contacts. In addition to those with high refractive errors, children who are active in sports, gymnastics, dancing, and performing arts generally want contacts. These kids are old enough to care for their contacts, but must understand that contact lenses are medical devices that can cause serious complications if not cared for properly.

It's important to observe the personal hygiene of children and teens that want contacts. Children who don't meet the standards for cleanliness should be given a chance to shape up and rescheduled in a few weeks. Kids who pay part or all of the cost of their lenses are more aware of their value and are more likely to take good care of their contacts.

Role of the Parents

In order for kids to be successful with their lenses, it's essential that parents understand the need for compliance and to make sure that the child or teen maintains good personal and lens hygiene. It's also important for the parents to sit in on the care instructions so they can learn to recognize the signs and symptoms of adverse reactions: pain, redness, discharge, swelling, and unusual sensitivity to light. They should periodically inspect their children's lenses for damage or deposits and check the case for cleanliness.

Parents with aphakic infants or very young children wearing contacts must also monitor their eyes for lens loss and understand that failure to wear a lens for even a few days might result in significant loss of vision.

Today's kids should be able to have a lifetime of successful contact lens wear if we stress the importance of personal cleanliness; proper compliance with the care regimen, and replacement and wearing schedule; regular follow-up visits; and immediate treatment for emergencies.