Infants and children with serious vision problems can occasionally be helped to see well with contact lenses, says a pediatric contact lens specialist.
Although commonly prescribed for nearsighted teens and adults, contact lenses can also be the means to better vision for infants and children with crossed-eye or lazy eyes(strabismus), problems seeing out of an eye (amblyopia), congenital cataracts and some other vision conditions, says Bruce Moore, O.D., who teaches at the New England College of Optometry.
Prescribing contact lenses for these children is not an exact science. They often have multiple vision problems that require a creative approach to solve. To help parents realize what is possible, Dr. Moore described how he, with the involvement of the parents, helped five young patients. His report was featured in the Journal of the American Optometric Association .
Some need contact lenses
Dr. Moore's youngest patient, a 5-week-old infant, had a congenital cataract and a lazy eye, a typical combination. With a cataract, the lens inside the eye, which is used for focusing, is clouded. As a result, vision development in that eye is blocked. This lack of development is called a lazy eye.
When a cataract is surgically removed today, it is usually replaced with a lens implant. This does not work, however, for children younger than 2 because their eyes are growing rapidly. Contact lenses are the preferred choice when a lens implant can't be used because they provide better and more natural vision than "cataract glasses," which are thick, heavy and cause some distortion in vision. With older children, contacts are often used in combination with a lens implant, because the implant improves only distance vision.
For this infant, Dr. Moore prescribed daily-wear soft contact lenses. He also initiated a patching program to treat the lazy eye. This involves patching the good eye for periods of time to force the lazy eye to function. When the child was old enough to pull the patch off, Dr. Moore prescribed an opaque contact lens as a substitute for the patch.
Some need custom-designed lenses
Sometimes custom-designed contact lenses are needed to meet a child's vision needs. Such lenses were a major part of the treatment Dr. Moore prescribed for a 5-year-old with severe nearsightedness and astigmatism. Her vision also was vastly different in each eye; as a result, she had developed a lazy eye condition. A crossed-eye condition was also starting. The specially designed contact lenses, along with an eye-patching program to treat the lazy eye, helped the child achieve good vision.
Dr. Moore also used a custom-designed contact lens for a 9-year-old who developed a cataract and suffered eye disfigurement as the result of an automobile accident. It was a modified version of the tinted soft contact lenses used by adults to change eye color. With it, her eye appears normal and her vision is good. The fixed pupil size (center) of the lens also solved a problem the child was experiencing with too much light entering her damaged eye.
Some need extended-wear lenses
Extended-wear soft contact lenses were Dr. Moore's choice for a 6-month-old baby with Down syndrome, who had cataracts removed from both eyes. Although heart surgery delayed her cataract surgery, the contact lenses prevented severe vision loss.
Dr. Moore prescribed bifocal contact lenses for a 10-year-old child who had, since age 2, been wearing bifocal glasses for severe farsightedness, severe astigmatism and a crossed-eye condition related to them. She wanted contact lenses for appearance reasons but needed the bifocal lens to maintain good vision and straight eyes.
For their part, parents must clean the lenses; insert and remove them; and watch for and report to the optometrist any problems that might occur. In some cases, the contact lens care and other treatment prescribed requires a significant time commitment over many years, Dr. Moore said. But the parents' ultimate reward is that their child will not be hampered in school or in life by a severe vision impairment that, in some cases, would be classified as legal blindness.