Dr Vineet Shrivastava
B.E.M.S., D.O., (FOOREC)
FCLC (Gold Medalist)
Consultant Optometrist &
Educator Banswara, Rajasthan
Dispensing spectacles for children, especially those below the age of 10 years, can be quite a challenging task for any optician. One needs to be more alert and aware in such cases as these are the most difficult age groups to comfortably fit eyeglasses; the ears and nose of children are soft and rapidly changing. Also, youngsters are typically careless in the way they handle their spectacles, thus sturdy and reliable frames need to be suggested.
Dispensing glasses for children is an art involving mechanical, physiological, and management skills. In other words, it is a highly skilled and complex task that requires a significant degree of patience on the practitioner’s part to achieve the desired results.
While dispensing glasses to children, special attention must be given to the following factors:
♦ Proper frame selection
♦ Taking accurate interpupillary distance
♦ Common problems associated with dispensing glasses for children
♦ Solving common problems encountered while fitting eyewear to children
♦ Assuring compliance with wearing and caring instructions
PROPER FRAME SELECTION
When selecting proper frames for children, the dispenser needs to satisfy two people – the child and the parents. There must be some steps in the mind of the dispenser while selecting a frame for children. Read the steps below:
⇒ The first thing to do is to assure the parents that there is no stigma to youngsters wearing glasses since the modern style has made spectacles an “in” thing.
⇒ The new wearer must be allowed to handle several frames to get the “feel” of them and also to help move past the fear of having to wear them.
⇒ Ask the child about their favourite colour and try to select a suitable frame that complements their individual style, eye colour, complexion, and hair colouring.
⇒ Of course, parents would like to get into the process but it is important to make the effort to convince them that children enjoy their glasses much more when they have a hand in the decision. Also, the optician will definitely be involved every step of the way so that the child does not choose a frame that is unbecoming or ill-fitting.
⇒ Avoid particularly large sizes. There is no rationale for making glasses too large since they lead to excessive and unnecessary weight only. Also, it is better to not stress about very small-sized frames as they will not fit properly and will tend to slide forward.
⇒ Avoid extra narrow shapes for children.
⇒ A good check for determining a proper bridge is essential. A Keyhole bridge is a better choice in almost any case except the infants whose frames come in sizes of 34 to 40 mm as their nasal bridges are flat and almost non-existent. These young children should be fitted with thick plastic saddle bridges or metal frames with adjustable strap bridges to keep the frame off the cheeks.
ACCURATE INTERPUPILLARY DISTANCE MEASUREMENT
Unless sophisticated equipment like a pupillometer is used, taking pupillary distance manually on children can be very frustrating because children’s eyes wander all over the place. To maintain proper fixation while taking manual PD on these patients, several interesting devices that delight the children can be used. Moreover, after the PD is measured, the respective device can even be shown to the child.
PROBLEMS ASSOCIATED WITH DISPENSING GLASSES FOR CHILDREN
A basic concept for fitting and adjusting eyewear is to distribute the frame’s weight over the greatest bearing surface, thus keeping the pressure points to a minimum. Essentially the bridge of the nose has to carry the frame’s weight while the temples stabilise the frame and prevent it from sliding forward. Besides, a continuously sliding-down spectacle leads to poor visual performance due to changes in vertex and the introduction of an unwanted prism.
SOLVING PROBLE MS WHILE FITTING EYEWEAR TO CHILDREN
Every effort should be made to correct the irritated areas behind the ears as well. The side bend should gently wrap behind the ears. If plastic temples are too long and it is not possible to cut them, try non-slipping silicone temple tips. Spring-hinged temples may also be tried, besides Curl tips to solve the dilemma of the frame sliding down.
LENS TIPS FOR CHILDREN
The following lenses should be recommended to parents to provide utmost conformance with accepted safety standards for children’s eyewear:
1. Ultraviolet protection – A proper use of UV protective sunglasses will help prevent the development of cataracts and even allergic conjunctivitis.
2. CR 39 – The shatterproof, lightweight, and anti-scratch properties of CR 39 lenses make them suitable for children’s eyewear.
3. High-index lens – Always recommend high-index lenses for strong minus power. The edge of a concave lens gets thinner in the case of high-index lenses, as compared to crown lenses.
4. Aspherical lens – In case of a high plus prescription aspheric lens can be a good choice since they make the lens look flatter. When prescribed in conjunction with high–index material, aspheric lenses can reduce the lens thickness by 40%, thereby reducing the weight of the lens substantially.
5. Polycarbonate lens – Polycarbonate lens is virtually unbreakable and also lighter in weight than either CR 39 or glasses. Prescription can be ground much thinner with poly lenses.
Compliance is an important part of successfully dispensing glasses for children. In addition to being uncomfortable or unsightly, the eyewear may even have an undesirable optical effect. Accordingly, the dispenser should take the time to teach parents and children how to wear and care for their eyeglasses.
The instructions should stress on the following points:
♦ Teach children to clean their lenses at least once a day by gently blowing on the lenses to remove dust or grit. Then wash them with soapy water and dry them with a soft, cotton, clean cloth.
♦ While keeping glasses on a hard surface, be sure they are placed face up to prevent scratches. Better keep the spectacle in a spectacle case when not in use.
♦ If the spectacle has plastic movable pads, the pads should be cleaned with soap using an old toothbrush.
♦ When putting on or taking off eyeglasses, the child should be taught to use both hands so that the frame’s alignment is not disturbed.
Dispensing is indeed an integral yet tricky process, especially in the case of children where patience, manners, and gentleness are much required.
Dispensing varies from customer to customer but accuracy must be maintained in all cases. In special cases like anisometropia, amblyopia, strabismus, keratoconus, uniocular, high refractive errors of aphakia etc., all the measures must be taken keeping in mind the patient’s comfort.
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