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The perfect fit?

Dr Mark Bullimore tells OT  that an optometrist’s smallest patients are often their most compliant wearers – and can reap long-term eye health benefits

29 May 2019 by Selina Powell

Dr Mark Bullimore’s advice when it comes to fitting children with contact lenses is simple: treat them like a small adult.

“If they are able to handle contact lenses, with or without supervision, there is no reason not to start them early on,” he shared.

“We’ve been fitting teenagers with contact lenses for years. It is really just moving the starting age back five years and putting them in contact lenses that not only have a visual, but a long-term therapeutic benefit,” Dr Bullimore highlighted.

The University of Houston College of Optometry adjunct professor assessed the safety of contact lenses in children through a research paper published in Optometry and Vision Science in 2017.

He concluded that the incidence of corneal infiltrative events was no higher in children than in adults and suggested that the incidence may be “markedly lower” in the eight to 11 age range.

Dr Bullimore told OT that this difference is likely to be present for behavioural reasons.

“You see the risk of adverse events associated with contact lenses increase as risky behaviour increases,” he said.

“Children are one of the safest groups for contact lens wear because they are pretty good at following instructions. Once they become rebellious teenagers or out-of-control college students, that is when the wheels come off,” Dr Bullimore highlighted.

“They are not so good at taking care of themselves when left to their own devices,” he added.

“Children are one of the safest groups for contact lens wear because they are pretty good at following instructions. Once they become rebellious teenagers or out-of-control college students, that is when the wheels come off”

Mitigating risks

The risks associated with contact lenses, in both adults and children, vary depending on what type of contact lens is used, Dr Bullimore shared.

Daily disposable contact lenses have a reduced risk profile because there is no need for a case, which needs to be handled, reused and cleaned.

“If you take that out of the equation then you have a very safe modality. If I were seeing patients and fitting soft lenses in kids or adults, I would be steering them towards that modality,” he said.

Reuseable contact lenses that require a case and contact lens solution entail a slightly higher degree of risk, while sleeping in lenses is also linked to a heightened risk of complications.

In terms of the benefits of contact lenses, Dr Bullimore highlights the boost to self-esteem that can result from contact lens wear in children and the freedom to participate in activities where spectacles may not be suitable.

Contact lenses on desk

Tackling myopia

Myopia control is also a key advantage of fitting contact lenses in children.

Limiting myopia progression means that children will have better refractive surgery outcomes if they decide to undertake the procedure when they are older, Dr Bullimore shared.

Myopia control reduces a person’s level of disability when not wearing glasses, he added.

“I am a -2 dioptre myope so I can navigate around a house and a hotel room in the dark without my glasses. If I were a higher myope, that would be more challenging,” Dr Bullimore elaborated.

One of the most important aspects of myopia control is the potential to reduce long-term complications from high levels of short-sightedness.

High myopes have an elevated risk of developing cataracts, glaucoma, retinal detachments and myopic maculopathy, Dr Bullimore said.

“In public health terms, if we can do something fairly simple through an early intervention and reduce someone’s risk of potentially blinding eye disease later in life that is a good thing,” he observed.

“That is why many of us believe that the benefits of contact lenses outweigh the risks,” Dr Bullimore said.

Dr Bullimore observed that a shift in mindset is needed in some practitioners so that they consider contact lenses as an option for children.

“People have perhaps not been convinced in their training that contact lenses are appropriate in young kids. They get set in their ways,” he said.

“We are becoming more of a public health profession and if people can become convinced of the long-term visual health benefits of myopia control then hopefully things will shift,” Dr Bullimore added.

He emphasised his view that the increased interest in fitting children with contact lenses is being driven by the “myopia epidemic.”

“It is early days, but it is an exciting field to be in. I think we are very much at the front of the wave,” Dr Bullimore said.

Image credit: John Holcroft

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