The Use of Therapeutic Contact Lenses in Pediatric Patients with Low Vision

Kelly E. Lusk, Ph.D. Terry Schwartz, M.D. Cincinnati Childrens Vision Rehabilitation Program (CCVRP)

Points of contact
- An overview of therapeutic contact lenses? - Literature review
- Contact lens use in children - Therapeutic CL use in persons with low vision - Therapeutic CL use in children with low vision

- Discussion
- Contact lenses with other low vision rehab options

- Future directions with the pediatric population

What is low vision?

A person with low vision is a person who has measurable vision but has difficulty accomplishing or cannot accomplish visual tasks, even with prescribed corrective lenses, but can enhance his or her ability to accomplish these tasks with the use of compensatory visual strategies, low vision devices, and environmental modifications (Corn & Lusk, 2010, p. 4-5). Low vision devices include optical, non-optical, and electronic devices.

What are therapeutic contact lenses?

A therapeutic CL is a lens that can be prescribed to some patients with low vision to further enhance visual functioning

Characteristics of Therapeutic Contact Lenses

Can be hard or soft lenses May have a prescription for a refractive error May be clear, tinted, or opaque

Why are therapeutic CLs prescribed?

Light control Cosmetic purposes Pathologies (e.g., keratoconus) Patients with high refractive error As a part of a more complex lens prescription Therapeutic contact lenses in conjunction with other low vision rehabilitation options, such as near and distance magnification.

Literature Review and Discussion

Contact lens use in children Therapeutic CL use in persons with low vision Therapeutic CL use in children with low vision
Relative lack of studies specifically on pediatric population Relative lack of studies looking at additional low vision rehab options/interdisciplinary models

Why are these important? Where do we go from here?

Future Directions
Large scale study (or studies) of children with low vision
Light-controlling contact lenses with and possibly without further vision rehabilitation options
Albinism, Achromatopsia, Aniridia, Cone Dystrophies

Age to prescribe (evaluations and follow-up) Improvement in functional outcomes (visual performance, comfort, social acceptance, ECC areas, etc.) Longitudinal data to support findings, continued use

References
Efron, N., Morgan, P. B., Woods, C. A., & The International Contact Lens Prescribing Survey Consortium. (2011). Survey of contact lens prescribing to infants, children, and teenagers. Optometry and Vision Science, 88, 461-468. Jones, L. A., Walline, J. J., Gaume, A., Rah, M. J., Manny, R. E., Berntsen, D. A., Chitkara, M., Kim, A., & Quinn, N. (2009). Contact Lens and Anterior Eye, 32, 157-163. Kruijt, B., Franssen, L., Prick, L., van Vliet, J., & van den Berg, T. (2011). Ocular straylight in albinism. Optometry and Vision Science, 88, E585-E592.

References, continued
Park, W. L., & Sunness, J. S. (2004). Red contact lenses for alleviation of photophobia in patients with cone disorders. American Journal of Ophthalmology, 137, 774-775. Rajak, S. N., Currie, A. D. M., Dubois, V. J. P., Morris, M., & Vickers, S. (2006). Tinted contact lenses as an alternative management for photophobia in stationary cone dystrophies in children. Journal of AAPOS, 10, 336-339. Stevenson, G., & Gardner, L. (2010). Progressive cone dystrophy, nystagmus, and contact lenses. Contact Lens and Anterior Eye, 33, 228-230.

References, continued
Walline, J. J., Jones, L. A., Chitkara, M., Coffey, B., Jackson, J. M., Manny, R. E., Rah, M. J., Prinstein, M. J., Zadnik, K., & The ACHIEVE Study Group. (2006). The adolescent and child health initiative to encourage vision empowerment (ACHIEVE) study design and baseline data. Optometry and Vision Science, 83, 37-45. Walline, J. J., Jones, L. A., Rah, M. J., Manny, R. E., Berntsen, D. A., Chitkara, M., Gaume, A., Kim, A., Quinn, N., & The CLIP Study Group. (2007). Contact lenses in pediatrics (CLIP) study: Chair time and ocular health. Optometry and Vision Science, 84, 896-902.

References, continued
Walline, J. J., Long, S., & Zadnik, K. (2004). Daily disposable contact lens wear in myopic children. Optometry and Vision Science, 81, 254-258.

Questions?

Thank you!
kelly.lusk@cchmc.org