1. Kids and Contacts: How Old is Too Young? Dr. Kris Kerestan Garbig krisgarbig@fuse.net

2. Generation Z Born: 1995-2014 Children… Ages 8 – 10 yrs. Preteen… Ages 11 – 12 yrs. Teen… Ages 13 – 18 yrs.

3. Generation Z Characteristics:  Technology since BIRTH!!  Extreme involvement in sports and other activities  Always on Social Media

4. 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. 576 American O.D.s participated Children & Contact Lenses AOA and Vistakon Study

5. AGE FACTORS in prescribing 97% of the O.D.s surveyed said they fit CLs on patients younger than 18 years  41% of all the CL patients in their practices are actually kids under the age of 17 years Children & Contact Lenses AOA and Vistakon Study

6. 19% were between 15-17 yrs 13% were between 13-14 yrs 7% were between 10-12 yrs 2% were between 8-9 yrs < 1% were 8 or younger Of the 41% of Kids fit in CL:

7. Children up to 17 yrs. account for 41% of all Contact Lens fits

8. 66% of Docs. 15-17 years of age 50% of Docs. 13-14 years of age 20% of Docs. 10-12 years of age What AGES are Soft Contacts FIRST introduced as Primary mode of Visual Correction ?

9. Below 8 yrs. 12% Age 8-9 yrs. 12% Age 10-12 yrs. 51% Age 13-14 yrs. 23% Ages 15-17 yrs. 3% What AGE is Appropriate to Introduce a child to Soft Contact Lenses for the FIRST time ?

10. Why are we fitting Kids in CL at Younger Ages?? 33% say due to DAILY DISPOSABLES: Why Daily Disposables? 1. Most Healthy option 2. Minimal Care/ No CL Soln’s 3. Extremely Flexible

11. Why Daily Disposables?? Healthiest option: New, Fresh, Clean CL Q day No chance for buildup of protein or CL debris Best choice for Allergy patients No protein buildup + Better wetting

12. Why Daily Disposables?? Minimal Care/No Solutions: Saves Time and Saves Money ($$) Eliminates Soln. Related Red Eyes Eliminates Soln. Related Allergies

13. Why Daily Disposables?? Extremely Flexible: Sports Dance Gymnastics Drama Swimming Other Activities

14. Aqua Comfort Plus- sphere, toric and multi. Acuvue Moist- sphere, toric, UV Acuvue Oasys Dailies Biotrue- UV, spher aberration control, high H2O Dailies Total 1- Only water gradient CL Clariti 1 day Proclear- sphere Soft Lens- sphere True Eye- sphere What Daily Disposables??

15. 20% of the U.S. market > 70% of Asian market > 50% of European market Daily Disposables

16. Why are we fitting Kids in CL at Younger Ages?? 23% say due to IMPROVED CL MATERIALS: (Silicone Hydrogel)  Extremely comfortable  Increased O2 to cornea  Ease of handling  UV protection (Important to 85% parents)

17. Acuvue Oasys 1 Day Moist True Eye Biotrue Which CL’s have UV Protection??

18. Why are we fitting Kids in CL at younger ages?? 19% say due to Parent or Child Request: - More awareness of benefit of CL for school and sports activities - Friends wearing CL

19. 10% due to Current Research 10% due to Parent Awareness: Articles in Magazines: Woman’s Day Ladies Home Journal U.S. News and World Report Info. on the Internet Why are we fitting Kids in CL at younger ages??

20. 10% say participation in sports and other activities :  Often start with PT wear Why are we fitting Kids in CL at younger ages??

21.  Interest and Motivation of the Child ( Most important factor… 96% of O.D.s)  Maturity Level ( 93% )  Personal Hygiene ( 89% )  Ability to take care of contact lenses by him/herself ( 89% )  Parental help and support Most Important Fitting Factors Considered

22.  74% of optometrists surveyed say that gender does NOT influence their decision to fit a child in contact lenses  26% say they are more likely to fit younger children when they are girls.  68% - Annualized cost of contact lenses Least Important Fitting Factors Considered

23. Most Important CL Properties to Consider  Ease of Handling  Oxygen Permeability  Comfort  Visual Acuity  Frequency of Replacement  UV protection

24. Quality of Life Study Total of 484 myopic children aged 8 - 11 years of age All children previously wore glasses

25. 50% of children continued in Glasses 50% of children fit in CL’s 93 % chose Daily Disposables 7 % chose 2 Week Disposables Quality of Life Study

26. After 3 yrs. their Vision-Related Quality of Life was assessed using an in-depth profile questionnaire of 26 questions ( Strongly disagree to Strongly agree) Increase Q of Life of 14.2 units in CL wearers Increase Q of Life of 2.1 units in Glasses wearers

27. Quality of Life Study Improved Self Esteem in Non Vision-related areas: Athletic Performance Appearance Peer Perception

28. Quality of Life Study Conclusion Freedom of movement Excellent peripheral vision Less distortion than glasses Clearer vision allows for deeper participation and understanding of materials in the classroom

29. Quality of Life Study Fitting Criteria used the 3 “Ms” 1.Maturity 2.Motivation 3.Mom

30. Practical ways to introduce CL to Kids for the first time Display office brochures to stimulate interest and conversation about CL’s Keep trials in the exam rooms as a visual reminder for you and the parent

31. Use conversation starters... “Have you ever thought about wearing contacts?” “Many people like wearing contacts for activities like sports, would you like to try them today?” BOTH Parent AND the Child Practical ways to introduce CL to Kids for the first time

32. Optometric Staff must show patience and care during the initial fitting/training Send kids home with wear/care instructions

33. Practical ways to introduce CL to Kids for the first time On-line resources from CL manufacturers Give the kids a way to communicate with the office…email or cell # that they can text

34. Elementary Age Challenges Short Attention Spans – Keep Simple Small Palpebral Fissures – Small diameter CL Developing Dexterity - Train parents I/R * Make sure an extra care kit is given for school*

35. Preteen Challenges Challenging attention spans and gets bored easily Busy sports and school schedules Increasing life responsibilities and CL care Daily Disposables

36. KISS principle: - Keep - It - Simple - Succeed Succeeding with Kids and Contact Lenses

37. Important Care Concerns Always give Extra Care Kits…Locker, Backpacks, Sports Bags Compliance Contract…Signed by the CL wearer in which they take FULL responsibility for proper wear and care Program replacement schedule in cell phone, Ipad, computer Acuminder ?

38. CLIP Study CL in Pediatrics Study Compared CL wear in Children vs. Teens 84 children between 8-12 yrs. 85 teens between 13-18 yrs. Protocol for fit, I/R training, FU appts. @ 1 week, 1 month and 3 month

39. CLIP Study CL in Pediatrics Study Three variables were measured: Eye Health Ease of Fit Quality of Life Issues

40. CLIP Study CL in Pediatrics Study EYE HEALTH Equal adaptation between Child and Teen No serious adverse effects or eye health issues

41. EASE of FIT Essentially the same By 3 months 83% of the children vs. 89% of teens found it easy to clean/care for CL By 3 months little if any parental assistance was needed CLIP Study CL in Pediatrics Study

42. QUALITY of LIFE improved in ALL areas Activities Satisfaction Appearance Peer Perceptions Overall Vision Far Vision

43. Medical use of CL’s in Children Myopia Control Aphakia Amblyopia

44. Can GP Contact Lenses Control Myopia in Children? YES Progressive Myopia …can result in a higher incidence of complications Retinal tears and detachments Glaucoma Cataracts Reduced quality of life

45. Ortho-Keratology (Ortho K) Corneal Refractive Therapy (CRT) Overnight wear allowing for corneal reshaping I nhibits the growth of the eye's axial length, which determines the degree of myopia. Studies show capability to slow down eye growth by more than 45% compared to soft lenses and glasses

46. Best Candidates 8 to 12 year olds with progressive myopia Low to mild nearsightedness (-4 diopters or less) Ortho-Keratology (Ortho K)

48. Two-year study of children aged 8–11 years old with near-sightedness between -1 to -6 D and less than 1 D cylinder Compared SV to Multifocal with +2.00 Add Soft Multifocals Study (OSU)

49. Soft Multifocal Results 29% decrease in axial length 50% decreased progression of Myopia Creates a ring of increased power in the peripheral retina which the eye interprets as a "stop signal" for further growth. Also R elaxes focus and the reading effort

50. Future of Soft Multifocals CooperVision is marketing a lens called the MiSight in Hong Kong on a trial basis, reported to be a daily disposable made of the ProClear material. The lens reduced myopic progression by 37% over 20 months

51. CIBA Vision is testing an anti-myopia silicone- hydrogel contact lens that is reported to slow myopic progression by 34% over one year and 49% if one parent was myopic. Future of Soft Multifocals

52. Contact Lenses in Aphakia After removal of Congenital Cataracts Silsoft lens (B+L) It is an extremely soft, extended wear lens made from 100 percent silicone polymer with the best oxygen permeability. Available from +7 D to +32 D

53. Anisometropia/Amblyopia Anisometropia  Minimize Aniseikonia-image size differences  Prevent the Unbalanced Lens appearance Amblyopia  Occlusion therapy after traditional patching or Atropine fail

54. Thank You for your ATTENTION!! It has been a pleasure being here with you today…any Questions???