Could corrective contact lenses for children improve eye health in UAE?

A technique used to reduce the number of people with poor eyesight by giving children corrective contact lenses has caused a rift between UAE eye experts.

Orthokeratology, often referred to as ortho-k, involves the use of specially fitted contact lenses to temporarily reshape the cornea to improve vision.

Although the treatment has been used for more than two decades elsewhere, it is rarely prescribed in the UAE.

The lenses are often prescribed to address myopia – short-sightedness – in which the patient can see close objects clearly but objects farther away appear blurred.

Ortho-k lenses are typically worn at night during sleep and have a similar corrective purpose as orthodontic braces worn by teenagers to realign crooked teeth.

Daniel Crown, an optometrist at Moorfields Eye Hospital in Abu Dhabi, said more children should be offered the lenses to prevent eye problems worsening in adulthood.

But Dr Julia Semprna Matarredona, an ophthalmologist who treats up to 30 children a week for myopia at Barraquer Eye Hospital, Dubai, believes glasses would be a better option due to concerns over children rubbing their eyes and causing infections.

Tackling long-term eye problems

“These lenses are relatively new for children as they were designed for adults,” said Mr Crown, who moved to the UAE from the UK in August.

“Children under 18 who are short-sighted will tend to have their condition progress rapidly.

“It is a dilemma – if the numbers increase too much it will also increase the number of eye pathologies in the future and they will end up with other eye problems.

“The international thinking is 'how can we slow this down', and these contact lenses are one option as they help to slow down the progression while at the same time improving a child’s vision.”

How do they work?

The lens works by sitting on top of the cornea to create a void between the lens and the cornea itself.

The front layer of cells in the cornea are continuously replenishing. While wearing a lens, an artificially moulded shape is created in front of the cornea, so when the lens is removed that shape remains in place, allowing it to alter how light is focused in the back of the eye.

That usually results in fully corrected vision for the day ahead but the lens must be worn every night for the treatment to be effective.

Mr Crown has been working with children in the UK with these lenses for 10 years but since moving to the UAE realised the because they were rarely prescribed, it was potentially an area for growth.

Opticians measure short and long-sightedness on a plus and minus scale, whereby the greater the number falls in either direction, the more extreme the condition.

For example, a child judged to need a prescription of minus 1 would have a mild case of myopia, with a reading of minus 5 being more serious.

“When I came here I realised few people knew about this or prescribed them to children,” he said.

“Since then we have prescribed them to quite a number of children to improve their eyesight.

“For example, if a child is six years old and is diagnosed with a prescription of minus 0.5, by the time they are 17 or so they would typically be on a prescription of minus 7 or minus 8.

“Contact lenses reduce this by about 45 per cent on average.”

The lenses typically cost about Dh3,200 ($871) for a 12-month supply but are not currently covered by health insurance.

Mr Crown has prescribed the lenses to children as young as six and while suitability is assessed on a case-to-case basis, he said most youngsters are helped by good results.

School pupil benefits

One of those is 15-year-old Khaled Arbabi who attends the British School Al Khubairat in Abu Dhabi and began wearing the lenses 12 months ago.

In that time his eyesight has improved from a prescription of minus 4 to almost perfect vision and he no longer requires glasses.

“Initially, I could barely read without my glasses,” he said.

“I wanted to switch to contact lenses as I play a lot of football. Wearing glasses, I couldn’t really go for any headers or scan the pitch properly.

“These lenses have really helped. My eyesight now is perfect, 20-20 vision and they have stopped my eyes from getting any worse.

“It has made me a better footballer as I can see more of the pitch when I’m playing and I’m more confident at school.”

Infection risk

According to the World Health Organisation (WHO), about 30 per cent of the global population is short-sighted.

By 2050, about half the population is expected to have the condition, the WHO said.

In the US, the Centres for Disease Control and Prevention report found up to 11 million 12 year olds could improve their eyesight and avoid long-term issues with early diagnosis and corrective treatments.

Despite the potential for vast eyesight improvements, some specialists said ortho-k lenses were not widely prescribed due to infection concerns.

“In young children, this is not something I would recommend as the risk of infection is very high,” said Dr Matarredona.

“Children are usually not particularly hygienic and tend to rub their eyes, particularly at night.

“It is only a temporary treatment, when you stop using the contact lens the cornea will remain the same shape and size. This not a cure for myopia, just a treatment to control it like glasses, which are generally safer for children.”