2. ANATOMIC CONSIDERATIONS
• Premature infants→ 49.50D
• 1 to 2 months→ 47D
• 4 years old→ 43D to 44D
• Normal neonate→ Moderately hyperopic with slight astig; premature→
• Aphakic power at 1 month→31D, age 4 →17D
• At birth~9.8mm
• By age of 1 year, reach almost adult size~11.6mm
4. PEDIATRIC CONTACT LENS SELECTION
1. SILICONE ELASTOMER
Comfort Very costly
Excellent DK (DK 340); safe for EW Hydrophobic (heavy lipid deposition)
Stays in place (low rate of loss) Limited parameters (3D steps, 3 base
Great durability and handling Cannot mask astigmatism
No dehydration of material during
No UV protection
Base Curves 7.5, 7.7, 7.9 mm
Powers +23.00D to
Optical Zone 7.00mm
Centre Thickness 0.51-0.71mm
Initial trial lens: 0.40mm-0.60mm
flatter than average K readings
Assessment using fluorescein and
cobalt blue light
Remove at once if central
Should show minimal apical
clearance and some degree of
Recheck fitting pattern after 10
and 60 minutes later.
6. 2. HYDROGEL
Comfort High cost (if custom)
Not easily displaced/dislodged Low DK
DK/t ↓ as power ↑
Wide range of parameters Corneal oedema, Neovascularization:
Tints Difficulty in handling
7. 3. RGP LENSES
Low cost, longer life span Prolonged adaptation period
Wide range of parameter Risk of dislodgement
High oxygen transmission (Dk up to
150), Low protein adherence
Need greater skill to fit
UV protection, provide best optics
(correct corneal irregularity)
Corneal abrasion from eye rubbing
8. PEDIATRIC PREFITTING EXAMINATION
Careful evaluation of patient’s lids, bulbar conjunctiva and cornea
Using an UV light of the handheld Burton lamp/handheld slit lamp with cobalt filter
illumination, fluorescein dye is applied to the corneal surface.
Although keratometry is helpful, fitting without this information can proceed. Infants and
toddlers who are aphakic have steep corneal curvatures and high plus refractive errors
Retinoscopy, with handheld trial lenses, of the pediatric eye before lens fitting (determine
starting contact lens power).
Selection of initial trial lens base curve is typically based on patient’s age.
9. Pediatric Contact Lens Selection
Parameters of initial fitting- based on age of the child
Children < 2 y/o, start lens fitting with 7.5mm base curve, 11.3mm
diameter, +32.00D lens
As the toddler matures, it is expected that the child’s corneal
curvature will flatten, aperture will enlarge, and the prescription will
require less plus power
The 7.7mm base curve lens is the starting point for children between 2
and 4 years age, whereas the 7.9 mm base curve is for the child than 4
years of age
10. Pediatric Contact Lens Fitting
• Insertion → After 15 minutes
of lens equilibrium,
fluorescein dye is instilled in
the child’s eye
• The UV lights and
magnification of the Burton
lamp aid in determining the
Silsoft lens centration,
movement, and thickness of a
post-lens tear film
Ideal fluorescein pattern
• Minimal apical clearance
• Minimal bearing in the
• Peripheral edge clearance
• Moderate nasal edge lift
• Lens movement of 1-2mm is
expected on a normal blink
No fluorescein exchange under
lens base curve
Significant edge lift
Flat-fitting has the steepest
(7.5mm) base curve,
transition to a hydrogel
(6.8mm) or RGP (5.0 mm) lens
11. Pediatric Contact Lens Insertion
When inserting , the thumb and forefinger of the dominant hand hold a
partially pinched contact lens.
The inferior 1/3 of the lens is pinched closed, yet the top 1/3 of the lens is
As the palm of the nondominat hand stabilizes the forehead, the thumb of
this hand is used to retract the upper eyelid allowing for fanned out superior
lens edge to rest on the superior bulbar conjunctiva.
As the middle finger of the lens-holding hand retracts the lower eyelid, the
inferior lens edge is allowed to unfold onto the inferior cornea
12. Pediatric Contact Lens Removal
Two-hand method using both lids to expel the lens.
Fingers from each hand should be placed at the lid margin of both the top and
Pressure should be placed on the lids so the margin presses against the globe.
The lids should then be pushed toward each other. Care should be taken not to
evert the lids.
When performed properly, the lens will be expressed from the eye.
13. PROGRESS EVALUATION
Scheduled according to age of child and complexity of the case
Infants < 6 months – seen every 2 weeks
Age: 6-12/18 months – seen monthly
Age: After 18 months- seen every 3 months
Maintained at a minimum of 6 months for minors
Spectacles must be prescribed at all times- to act as a back up during eye
infection, flu or other systemic illness that may affect the eyes
Remove lenses when swimming, playing with sand and during flight
4 y/o patient
had a h/o of
removed in 1st
year of life
Initially fit with
Silsoft CLs, At
age of 3,she
with a hydrogel
4 mths after
Silicone hydrogel trial lenses are to be ordered.
OD: pl (20/20)
OS: +15.00 (20/60)
The following lens was ordered for her OS: BCR 8.3mm, Dia:13.0mm,
RX: +20.00D. (The power was chosen to make the patient artificially
myopic to allow clear vision at near-lack of accommodation in
At f/u visit, the results of testing were:
OS: 20/100 with an over-RX of -4.00/+1.00X180; VA still 20/100
The lenses centered well. To continue patching for amblyopia.
After 3 months of amblyopia treatment, her VA with contact lens was
OS 20/40. Her over-RX was -0.50/+2.00X135 (20/30). A new lens was
ordered with the same parameters, except the power was changed
to +16.00D, The lens centers well and provides good fit.
Baldwin, W. R., Adams, A. l. and Flattau, P. (1991) Young adult myopia. In:
Refractive Anomalies: Research and Clinical Applications (T. Grosvenor and M.
C. Flom, eds). Butterworth-Heinemann, pp. 104-120.
Hom, M. M., Bruce, A. S.(2006). Manual of contact lens prescribing and
fitting. Elsevier Butterworth-Heinemann, pp. 599-601.
Duckman, R. H. (Ed.). (2006). Visual development, diagnosis, and treatment
of the pediatric patient. Lippincott Williams & Wilkins, pp. 263-265.
Bennett, E. S., & Henry, V. A. (2013). Clinical manual of contact lenses.
Lippincott Williams & Wilkins, pp. 481-493.