November 01, 2009
3 min read

Prescribe contacts for vision correction, lifestyle needs, not self-esteem

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Brian Chou, OD, FAAO
Brian Chou

The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) Study evaluated 484 nearsighted children ages 8 to 11 over the course of 3 years. The study sought to determine if contact lens wear affected self-perception. The results found no significant difference in global self-worth between contact lens and spectacle wearers – except among girls who at baseline reported low levels of satisfaction with spectacles.

The results raise the question: Should we aggressively prescribe contact lenses for girls that dislike glasses to elevate their self-esteem?

Although raising self-esteem is rooted with noble intentions, research done by Jean M. Twenge, PhD, suggests that doing so can backfire. In fact, according to Twenge’s 2006 best-selling book, Generation Me, society’s mission of raising self-esteem in children is a notable factor driving depression, anxiety and cynicism.

How can that be? Since the 1970s, the self-esteem movement popular among parents and teachers taught children to “be yourself,” “believe in yourself” and “to love yourself before you love someone else.” Today’s young people feel special, and it is not hard to wonder why.

In little league, everyone on the team gets a trophy just for participating. Preschoolers commonly sing to the tune of “Frere Jacques” the lyrics, “I am special, I am special. Look at me.” Parents let their girls dress up in princess outfits, encouraging them to take the center of attention. More teachers are using purple ink instead of the harsher red ink to grade papers, in the name of promoting self-confidence.

Unrealistic expectations

Heaping praise without merit is not without consequences. A study published in 2008 by Twenge and Campbell found that U.S. teens are far more likely than those in the 1970s to believe they will make outstanding spouses, parents and workers. The results support the notion that the self-esteem movement may have gone too far. Namely, we have a generation of young people with expectations inconsistent with reality.

For example, in 1975, 24% of American high school students believed that they would earn a graduate degree. Today, 50% of high school students believe the same thing. However, in actuality just 9% of students both now and then will accomplish or accomplished this goal.

When lofty expectations – like having a high paying job upon graduating, owning a mansion and being famous – run afoul with the reality that not everyone can achieve such things, the byproduct is depression, anxiety and cynicism.

As an example, the number of people treated for depression has more than tripled from 1987 to 1997, going from 1.8 million to 6.3 million. Worse, depression is affecting those at younger ages. To be sure, the increasing levels of depression cannot be entirely attributed to the self-esteem movement. However, it awakens us to how children should receive appropriate feedback rather than being set up for disappointment through endless, unearned praise.

Prescribing for self-esteem

This discussion brings us back to the original question: Should we prescribe contact lenses for the purpose of increasing self-esteem? To that, I say absolutely not. High self-esteem will not make a child better at sports or academics, nor more socially accepted or physically attractive.

As an example, Twenge and Campbell reported in The Narcissism Epidemic: Living in the Age of Entitlement, “In a recent study, 39% of American eighth-graders were confident of their math skills, compared to only 6% of Korean eight-graders.” However the Koreans, “… far exceeded the U.S. students’ actual performance on tests.” In other words, although we are not number one, we are number one in believing we are number one. Now, that is over-confidence.

Twenge has described emphasizing high self-esteem like putting the cart before the horse. As it turns out, high self-esteem is a derivative of doing well in sports and school, social acceptance and being physically attractive – not the other way around.

Hence, do not prescribe contact lenses for the wrong reason of increasing self-esteem. We should prescribe contacts for children because in addition to correcting vision, it can help with their athletics, scholastics, social acceptance and physical appearance.

For more information:

  • Brian Chou, OD, FAAO, is an industry consultant and private practitioner in San Diego. He is the co-developer of, the online contact lens reference for eye care professionals. Dr. Chou can be reached at Carmel Mountain Vision Care, 9320 Carmel Mountain Road, Suite E, San Diego, CA 92129; (858) 484-1500; fax: (858) 484-9143; e-mail:; Web site:


  • Rifkin W, Lester D, Olfson M, et al. Changes in the treatment of depression in the United States: 1987-1997. JAMA. 2002;287:1803-1804.
  • Twenge JM. The age of anxiety? Birth cohort change in anxiety and neuroticism, 1952-1993. Journal of Personality and Social Psychology. 2000;79:1007-1021.
  • Twenge JM. Generation Me. New York: Free Press. 2006.
  • Twenge JM, Campbell WK. Increases in positive self-views among high school students: Birth-cohort changes in anticipated performance, self-satisfaction, self-liking and self-competence. Psychol Sci. 2008;19(11):1082-1086.
  • Twenge JM, Campbell WK. The Narcissism Epidemic: Living in the Age of Entitlement. New York: Free Press. 2009.
  • Walline JJ, Jones LA, Sinnott L, et al. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci. 2009;86(3):222-232.