CHILDREN & CONTACT LENSES
Doctors’ Attitudes & Practices in Fitting Children in Contacts
The Children & Contact Lenses study was conducted by
the American Optometric Association (AOA) Research
and Information Center in conjunction with the Sports
Vision Section and Contact Lens and Cornea Sections
of AOA, with support from VISTAKON®, Division of
Johnson & Johnson Vision Care, Inc.
The purpose of the survey was to gauge current trends
in prescribing contact lenses to children ranging in age
from 8 to 17, and to understand factors that influence
an optometrist’s decision to fit a child in contact lenses.
Current contact lens patients by age
8-9 a child
Appropriate age to
to soft contact
Nearly all (97%) optometrists surveyed currently fit contact
lens patients under the age of 18. Children up to the age
of 17 account for about 41% of respondents’ total contact
lens patient population. On average, optometrists say that
about 59% of their contact lens patients are 18 years of
age and older and report less than 1% of their contact
lens patients are younger than eight-years-old, less than
2% are 8-9 years old, 7% are between 10-12, 13% are
13-14 year olds, and 19% of contact lens patients are
between 15 and 17 years old.
More than half (51%) of optometrists feel it is appropriate to introduce children to soft contact lenses
between the ages of 10 and 12 years old, while nearly one in four (23%) feel 13-14 years old is a
suitable age for a child to begin wearing contact lenses. One in ten doctors surveyed think it is proper
to introduce 8-9 year olds (12%) or children younger than 8 (11%) to soft contact lenses. Figure 1
below visually displays the age which optometrists say is the appropriate age to introduce a child to
soft contact lenses.
Influence of gender
The majority (74%) of optometrists surveyed say that
gender does not influence their decision to fit a child in
contact lenses, while one in four (26%) say they are more
likely to fit younger children when they are girls.
Appropriate Age to Introduce Soft Contact Lenses
Support provided by VISTAKON®, Division of
Johnson & Johnson Vision Care, Inc.
Optometrists’ approach to vision correction
Two out of three (67%) doctors surveyed fit children under the age of 8 in glasses
only. At ages 8-9 (51%) and 10-12 (71%), optometrists most often fit children in
glasses as the primary method of vision correction and prescribe contact lenses
as a secondary correction. As children get older, optometrists begin to change
their approach to vision correction with one in five (20%) prescribing contact
lenses as the principal form of vision correction for 10-12 year olds, half (49%)
prescribing contact lenses first for 13-14 year olds and two-thirds (66%) recommending contact lenses as the main form of vision correction for 15-17 year olds.
See figure 2 below.
Optometrist’s Approach to Vision Correction in Children
GLASSES AS PRIMARY,
Changes in fitting criteria for children
A key purpose of this survey was to determine if, in the last year, optometrists have changed contact
lens fitting criteria in children and what has caused such changes. Doctors were asked to indicate if
they are more likely to fit, less likely to fit, or if they have not changed their fitting criteria for children
over the last year. For each of the age groups presented, more than three-fourths of doctors say
they have not changed their contact lens fitting criteria for children. More doctors indicated their
contact lens fitting criteria has changed for 10-12 year olds than any other age group, with 21% of
respondents more likely to fit children in this age group with contact lenses versus a year ago. Table
1 details how contact lens fitting criteria has changed in the last year for each age group.
Criteria has not
Younger than 8
8 - 9 years old
10 - 12 years old
13 - 14 years old
15 - 17 years old
Three in ten (30%) doctors who are “more likely to fit”
children with contact lenses attribute their change in
fitting behavior to daily disposable lenses; 23% of doctors
cite “improved contact lens materials”; 19% say they are
more likely to fit children with contact lenses because of
requests from the child and/or parent, and 10% say that
“recent research/studies” on the subject and children’s
participation in activities/sports have influenced their
decision to fit more children in contacts. Figure 3 shows
top reasons provided by doctors who are more likely to fit
children with contact lenses.
While only a small percentage of doctors say they are less
likely to fit contact lenses in children, those that provided
an explanation of why attribute their change to the poor
hygiene and maturity levels seen in younger children.
Why Optometrists Are More Willing to Fit Contact Lenses in Children
ACTIVITIES / SPORTS
CHILD AND / OR
Nearly all (96%) respondents point out
that a child’s interest and motivation
to wear contact lenses is the most
important factor to consider in fitting a
child with contacts. Also very important
to doctors are a child’s maturity level
(93%), the child’s ability to take care
of contact lenses by themselves (89%),
and the child’s personal hygiene habits
(89%). Participation in sports (84%),
the child’s prescription requirement
(77%), and the impact of contact lens
wear on a child’s self-esteem (71%)
round out the top seven factors seen as
most important to optometrists.
The least important factors that doctors consider when choosing to fit a
child with contact lenses are patient
gender (74%) and the annualized
cost of contact lenses (68%). Table 2
(below) illustrates each of the factors
measured in order of their importance
BETTER / SAFER
Factors that influence
contact lens fitting for
Properties that influence doctors’ decisions
in fitting children in contact lenses
Doctors ranked various contact lens properties that they consider when
fitting a child in contact lenses. One-hundred percent of respondents
cite the visual acuity (i.e., clearness of vision) achieved with a contact
lens as important, and virtually all respondents rate ease of handling
(99%), oxygen permeability (99%), comfort (98%), and replacement
schedule (96%) as properties that influence their decision to fit a child
in contact lenses. While not rated as high as the other properties,
three-fourths (75%), say contact lenses that offer ultraviolet protection
influence their decision to prescribe contacts for children. See Table 3.
Contact Lens Properties
Factors Influencing Contact
Child’s interest / motivation to wear
Child’s maturity level
Child’s personal hygiene habits
Child’s ability to take care of
contact lenses by him / herself
Participation in sports
Impact of contact lens wear on
Parental interest in having child
wear contact lenses
Frequent frame loss or damage
Ease of Handling
Frequent spectacle lens damage
Parental experience with contact
Annualized cost of contact lenses
Contact lens modalities frequently prescribed for children
Daily disposable contact lenses are the most frequently prescribed lenses for children 12 years
old and under. For children 13-14 and 15-17, doctors tend to prescribe reusable contact lenses
(i.e., two-week and monthly replacement) more often than daily disposables.
Who initiates the conversation about contact lenses
Nearly three in five (57%) respondents indicate that the parent initiates a conversation regarding
fitting the child with contact lenses in children less than nine-years-old. Doctors say that the percentage of parents initiating the contact lens conversation falls as the age of the child increases.
At ages 10-12, children and doctors begin to start the contact lens discussion more often than
before and by ages 13-14, either the child or the doctor generally initiates the conversation.
Why parents want contact lenses for their children
Two out of five (39%) optometrists say that parents requesting their child be fit in contact lenses
do so because the child refuses to wear his or her glasses; 36% say parents note that the child’s
current vision correction interferes with sports, and 16% say parents want their child in contact
lenses because the current form of vision correction interferes with daily activities.
Seven in ten (71%) doctors say overnight wear of contact lenses is not appropriate for children
under the age of 18.
Cosmetic (non-therapeutic) contact lenses
Nearly three-fourths (73%) of doctors believe that cosmetic (non-therapeutic) contact lenses are
appropriate for children under the age of 18. Of these respondents, seven in ten (69%) say they
would fit children ages 15-17; 40% say they would fit children ages 13-14, and 16% say they
would fit 10 to 12-year-olds in these lenses. (Multiple responses were allowed for this question)
ABOUT THE SURVEY
Survey Method and Sample
A random stratified, sampling of 4,004 American
Optometric Association practicing optometrists was
mailed a survey on July 6, 2010. Optometrists invited
to participate in the study were asked to complete and
return the survey using the self-mailer to the AOA no
later than August 2, 2010. Two reminders to complete
the survey were posted in AOA First Look on July 23rd
and again on July 30th. 576 surveys were returned for
a response rate of 14.4% and an error level of 4%
at the 95% confidence interval. Responses were
received from all AOA affiliates with the exception of
the District of Columbia. Survey results were analyzed
using SAS Statistical Software and correlation analysis
was conducted using Chi-Squared and Cramer’s V.
Differences in prescribing patterns were not found
when correlation analyses were conducted on practice
location and the number of years the optometrist has
been in practice.
Nearly eight in ten (78%) respondents are currently practicing in major metropolitan areas, 14% are practicing in micropolitan areas (population more than 10,000 but less than 50,000) and 8% are practicing in
rural areas. About two-thirds (63%) of respondents are male and 37% are female. Geographically - 31%
of respondents are located in the Midwest, 17% in the Northeast, 29% in the South and 23% in the West.
Three in ten (29%) respondents are solo practitioners; 28% are employed in a non-retail; 28% are group
practitioners; 14% are employed in a retail setting, and 1% are in other practice settings. The majority of
responses (39%) received were from optometrists who have been in practice for more than 25 years, 30%
of responding optometrists have been in practice 11 to 24 years, 13% have been practicing for 6 to 10
years and 18% have been in practice 5 years or less.
© American Optometric Association. All Rights Reserved
Several limitations of this study should be noted: (1) Survey participants were invited to complete a paper
survey which was distributed by the United States Post Office. Incorrect addresses or delays experienced
in delivering the survey may have excluded selected doctors from participating in, or receiving the survey.
(2) Member optometrists who chose to participate in the survey were self-selected which may mean that
the survey attracted responses from optometrists with strong opinions about fitting children in contact
lenses. (3) The response rate is only 14.4%; results of this study may not be generalizable to the entire
population of AOA member optometrists.