Contact lenses for children and teens: when and how

"Is she old enough for contact lenses?" is one of the first questions I get from a parent of a teenager who has just declared, usually mid-appointment, that glasses are ruining their life. I understand the question completely. I also think it is the wrong one.

There is no age printed anywhere in the medical literature at which a child crosses over into contact lens readiness. There is a routine, followed every single day without being reminded, and that routine is what actually decides whether contact lenses are safe for a particular child. So the conversation I have with a fourteen year old is about what happens at the bathroom sink at eleven at night, not about her birthday.

How old does my child need to be for contact lenses?

There is no specific age, and I mean that literally rather than diplomatically. The safety review I lean on most for this question looked at wearers from seven to nineteen years old and did not attach a minimum age to its findings at all. What it looked at instead was behaviour: whether the routine of cleaning, storing and replacing lenses was actually followed. A responsible ten-year-old who never misses a step is a better candidate than a fifteen-year-old who cannot be trusted to take lenses out before falling asleep on the sofa. Age is a proxy for responsibility, and a fairly poor one at that.

Are contact lenses actually safe for children?

The published data is more reassuring than most parents expect. A review pooling results across several prospective studies, covering roughly 1,800 patient years of soft contact lens wear in seven to nineteen year olds, found no case of sight-threatening corneal infection in any of them. The rate of milder inflammatory reactions in children was no higher than the rate seen in adults, and in the youngest children studied, it may have been lower still. That does not mean risk is zero. It means the risk, when the routine is followed, is genuinely low, and lower than the word "infection" tends to make a worried parent imagine.

Milder eye irritation, short of a true infection, is more common but still not frequent. In the large prospective studies pooled in that same review, the rate of these milder events in eight to fourteen year olds ran up to 136 for every 10,000 years of wear, which is under one and a half in a hundred wearers a year. Looking at it by age band, the same body of research found roughly 97 such events per 10,000 years of wear in eight to twelve year olds, rising to around 335 per 10,000 years of wear in thirteen to seventeen year olds. Older teenagers had more events than younger children, not fewer, which runs against the instinct that a child needs to reach a certain age before lenses are sensible.

Safety in that data, though, was measured in children who were following a proper routine as part of a study. What decides whether your own child gets anywhere near those numbers is not the lens type or the clinic that fitted them. It is what happens at home, every evening, without anyone watching.

What is the one habit that matters more than age?

Never topping up old solution. This single habit, more than any other, separates safe contact lens wear from risky contact lens wear, and it is the easiest one to let slide when a teenager is tired or in a hurry. Fresh solution goes in the case every single time, the leftover solution from last night is poured away rather than reused, and the case itself is replaced roughly every three months, or sooner if your child's eye doctor says otherwise. Lenses should be rubbed and rinsed exactly as instructed, not simply dropped into the case and hoped for the best.

Clean, dry hands before handling a lens matter just as much as the solution itself. If a child cannot manage this reliably on a school night, on a sleepover, and on the mornings everyone is running late, that is the honest answer to whether they are ready, whatever their age says.

Can she swim in her contact lenses?

No, not in a pool, a lake, the sea or a hot tub, and not "just this once" either. Water of any kind carries bacteria and other organisms that soft lenses can trap directly against the surface of the eye, which is exactly the setup an eye infection needs. If your child swims regularly, contact lenses that come out before getting in the water, with glasses or goggles as the backup, is the simple rule worth setting from day one rather than negotiating each time. A splash from a garden hose or a sudden downpour on the walk home is far lower risk than deliberately swimming in lenses, but the same principle applies: water and lenses do not mix, and the safest habit is simply never to let them meet on purpose.

He fell asleep in his lenses once. Is that dangerous?

It raises the risk for that stretch of hours more than almost anything else does. A large population based study in Australia, following adult contact lens wearers for a year, found the annual rate of sight-threatening infection was around ten times higher in people who slept in soft lenses than in people who wore the same type of lens only during the day. That study was in adults, in Australia, and I would not read its exact number across to a Malaysian teenager. What does carry across is the authors' own conclusion, which is that overnight use of any contact lens carries more risk than daytime use.

One accidental night is not a certainty of harm, and panicking over it helps nobody. What matters afterwards is watching for redness, pain, unusual light sensitivity or blurring over the following day or two, and treating any of those as a reason to be seen rather than something to wait out.

His eye is red this morning. Lens out, or lens in?

Out, immediately, every time, and it does not go back in afterwards. Redness, pain, discharge, unusual sensitivity to light, blurred vision or a gritty or burning feeling are all signals to remove the lens straight away and get in touch with an eye care professional the same day. A wearer, particularly a young one, genuinely cannot judge from how something feels whether it is a mild irritation or the start of something serious, and that is not a failure of judgement on their part. It is simply not possible to tell from the inside. Keep the lens in its case rather than throwing it away; it can occasionally help work out what went wrong.

One more rule belongs here, because it surprises almost every parent the first time they hear it: never rinse a lens with tap water, bottled water, distilled water or a homemade saline solution, under any circumstance, including an emergency. These carry an organism that causes a corneal infection which is genuinely difficult to treat once it takes hold. Only proper contact lens solution should ever touch a lens, which is exactly why a spare bottle belongs in a school bag as much as at home.

None of this is meant to talk you out of contact lenses. For the right child, they are a well studied, reasonably safe way to manage a prescription, and many teenagers reaching for contacts have been wearing glasses for years already, sometimes for a prescription that has been climbing steadily as part of the same rise in childhood short-sightedness we see across the region. The decision to move from glasses to lenses is one worth making together with your child's own eye doctor, at a proper eye check rather than at a counter, so fit, prescription and readiness are all confirmed at once, not guessed at separately.

What I ask parents to hold onto is simpler than any of the numbers above. Contact lenses are not a reward for reaching an age, and they are not a risk to be avoided altogether either. They are a daily routine that either happens properly or does not, every evening, without exception, and a child who can be trusted with that routine is ready, whatever is written on their birth certificate.

Common questions

References

1. U.S. Food and Drug Administration · Contact Lens Risks · www.fda.gov
2. Bullimore MA, The Safety of Soft Contact Lenses in Children, Optometry and Vision Science, 2017 · pmc.ncbi.nlm.nih.gov
3. Stapleton F et al, The Incidence of Contact Lens-Related Microbial Keratitis in Australia, Ophthalmology, 2008 · pubmed.ncbi.nlm.nih.gov
4. AAPOS · Accommodative Esotropia · aapos.org

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.