Contact lens ABCs for pediatric patients

How contact lenses can be a vision saver for children

Baby being fitted for a contact lens Source: The Vision Center at Childrens Hospital Los Angeles

Many young children may begin to assist in their own home contact lens regimen

Infants as young as 1 month can benefit from contact lens use, according to Natalia Uribe, O.D., director, contact lens program, The Vision Center at Childrens Hospital Los Angeles. Normally children arrive at the center because either a pediatrician or the parents noticed that something is happening with the eye. The children often have conditions such as congenital cataracts, corneal scars, or keratoconus.
“In most cases we see children with congenital cataracts and we need to do the interventions at an early age,” Dr. Uribe said. “There are some cases where babies are going to surgery two or three weeks after they are born; we then start treating them at about 1 month of age.”
Proper development of the visual system hangs in the balance with these children. “The contact lens in these kids is going to be part of their visual rehabilitation,” Dr. Uribe said. “When the lens is removed because it is cloudy, we have to replace the power of that lens with a contact lens. We have to give them the opportunity to see and develop vision with that eye.”

The only feasible answer

Unfortunately, there are often no other reasonable options in these children. “Some doctors are trying to implant intraocular lenses in babies but the problem is that for the first two years, the prescription in babies changes so much because the eye is growing,” Dr. Uribe said. “If they put that intraocular lens in then they are going to need to change it frequently; there are huge changes in prescription during the first year.”
Likewise, spectacles are usually not the answer for such patients. “Often the problem with glasses in these kids is that they have one eye with one problem but the other is developing perfectly,” Dr. Uribe said. “In that case the thickness of the lenses is going to be so dissimilar and the brain is going to see two different images—it’s not going to be able to fuse them to create one and give stereopsis.” In such cases, the child will often use the normal eye and ultimately become amblyopic. If a contact lens is used, however, the images are almost the same. “With a contact lens the brain is going to work to integrate all of the images and develop the vision in the right way,” Dr. Uribe said.

Practical concerns

Some of the biggest issues with these young patients often arise early on after the child’s family takes the contact lens home. In many cases, while the parents are supportive, they have their own trepidations. “They are afraid to handle the lens, or to take it out, or of what will happen if the lens gets lost,” Dr. Uribe said. “There are parents who are very committed to the rehabilitation of that eye, but normally it’s not easy because kids hold their attention for less than two minutes and you have to be really fast.” Parents worry about how they’re going to insert the lens on a daily basis. “In some cases parents are afraid because they know that if they restrain them, kids are going to cry and move around,” Dr. Uribe said. “So you have to be pretty accurate and pretty fast when you’re doing this.”
To help forestall any worries about potential lens loss, Dr. Uribe urges parents to have an extra lens on hand. “We always recommend that because in some cases, the child rubs the eye and, inadvertently, pulls the contact lens out,” she said. As children get older they can begin to help with the daily contact lens routine. “In some cases they learn first how to take the lens out,” Dr. Uribe said. “Then at around 3.5 or 4 years old they are able to cover one eye and tell Mom that the lens is still in there.” Older children can begin to help with the insertion process. “We have some kids who are around age 7 or 8 who have been wearing contact lenses for awhile, so they begin to help Mom and Dad,” Dr. Uribe said.
Such help not withstanding, she finds that the child’s success in using the contact lens often rests with the commitment of the parents and in building a strong alliance with the doctors. “This requires teamwork with the parents to continually put in the contact lenses and with myself and the others at the vision center who are involved in the care of the child,” Dr. Uribe said. “If the parents aren’t doing things the right way then the prognosis is going to be poor.”
Overall, Dr. Uribe finds that one of the most rewarding parts of the pediatric contact lens program comes when results are finally seen. “When kids are 2.5 or 3, then we can take visual acuity and start to get real numbers. It’s amazing when we are able to check and find that they have developed good vision,” she said.

Editors’ note: Dr. Uribe has no financial interests related to her comments.

Contact information

Uribe: 323-361-2347, muribe@chla.usc.edu