Paediatric Dispensing

David WilsonICEE Australia

Diagrams by:•D Wilson•OTEN

World Congress on Refractive ErrorDurban 2007

What Is Paediatric Dispensing?

• Babies to mid teens

• Young children, 4 - 11

What Makes Paediatric Dispensing Different?

• More fun

• The duality of the client

• The larger difference between face

and spectacle durability

• Time

Until around 1990s children were rarely given much thought Opticians had little to offer

* frames were black or brown (or pink), two tone or full colour

* lenses were toughened glassSpectacles were still largely considered as medical

appliances (for children)Children were treated as miniature adults

Possession of adults

History of Children’s Eyewear

but nowWe have designer frames and lightweight lensesMore children are wearing spectacles

* testing younger* more screening

Changing image of spectaclesSeen more and more as a fashion accessoryMany of their heroes wear spectacles

History of Children’s Eyewear

But• Children are no longer content to wear

what their parents tell them

• More demanding and brand conscious

History of Children’s Eyewear

Age Differences

• Younger children (up to about 8 or 9) less likely to want spectacles

• Teens are more likely to recognize spectacles as an accessory

When is a child not a child?

• When he or she says so!

• Have some small sizes on your adult display

Frames - Technical

Young children do not have a developed nose

Characteristics of good kids’ frames * lower crest

Frames - Technical

Young children do not have a developed nose

Characteristics of good kids’ frames * larger frontal angle

Young children do not have a developed nose

Characteristics of good kids’ frames * larger splay

Frames - Technical

Young children do not have a developed nose

Characteristics of good kids’ frames* flatter pantoscopic tilt

Frames - Technical

Young children do not have a developed nose

Characteristics of good kids’ frames

* ability to shorten sides

* spring hinges

Frames - Technical

• Over 95% of frames dispensed to children are metals• Make sure that the frames have no sharp edges

and fit the above requirements• Titanium is an ideal

material for kids

Frames - Metal Majority

Face shape theory

• Soft curves for square faces

• Angular shapes for round faces

• Short face - shallow frameColour matching

Overriding consideration - be guided by the child

Frames - Fashion

Match width• avoid the desire to supply frames that

• they can “grow into”Too wide means

• easily knocked off• optical considerations such as aberrations

and thickness• kids will reject oversized frames

Frames - Fashion

• Kids normally know what they like and are very honest

• They rarely have preconceived ideas about their image

“We’re going to try everything on that fits you”

• Use terms like that looks cool or cute (relate language to age) and be honest

• Ask them “does this go in the good pile or the bad pile?”

Frames - Selection

The ideal lens should be

11 Impact resistant

22 Light and comfortable

33 Able to cut out ultra violet

44 Relatively thin

55 Relatively durable

Lenses - Technical

Refractive index: nd = 1.586

Abbe number: d = 31

Specific gravity: 1.20 gm/cubic cm

Lenses - Polycarbonate

• Able to withstand a speeding bullet

• Able to fall from tall buildings with a single

bounce

• More powerful than a locomotive

• Almost kid proof

Lenses - Impact Resistance

• Fashion versus durability

• Comfort versus durability

• Safety versus durability

Lenses - Prioritizing Conflicting Needs

•Take the emphasis out of durability

•Fashion- a child is more likely to wear frames

they like than a sturdy frame

•In modern frames fashion and durability are

not mutually exclusive

Lenses - Prioritizing Conflicting Needs

• Comfort - children will not wear frames that

are uncomfortable

• Again modern frames are also comfortable

• Safety - a critical issue

What is more important, eyes or spectacles?

Lenses - Prioritizing Conflicting Needs

Lenses - Sport

• Scratched lenses lose their impact resistance

• Lenses should be changed regularly

British standard BS6625 has two grades for children’s frames

• Grade B metal for younger children are not expected to last more than one year

Lenses - How Long Should Spectacles Last?

“Can’t consent to the practitioner’s

negligence” OLA

“Is CR39 too fragile for children?”

The Optician (England)

Lenses - Duty to Warn (duty to inform)

• Try to judge whether the parents are dominant

If they are use phrases like

“You need to like the frame but mum and dad need to like it too, they have to look at you”

• Have a quiet word with the dominant parent and point out the need for children to be involved

• If the parents are OK speak to the child

Treading the Fine Line

Kids like rules e.g. “Use two hands and lift up over your ears”

Use rhymes e.g. “When they’re not on your face they live in their case”

Use questions e.g. “Why don’t you put your glasses down on their lenses?”

Communicating With Kids

Use humor - e.g.“What’s the cleaning cloth

for?”

“What’s your shirt for?”

Keep it light - joke with them

Speak to them at their height - for little children,

sit on the floor with the child’s parents

Communicating With Kids

Have a special display designedIt should • be colourful• have mirrors at different heights

The Kids’ Corner

• Sit next to the child with the parent behind the child, looking into the mirror with the child

• Have the toy box a little to the side (to amuse siblings)

• Give small gifts (balloons, small soft toys etc.)

The Kids’ Corner

Kids are use to being taught how to clean

their teeth by dentists

Optometrists and opticians should teach how to

care for their spectacles

Teaching Kids

PDs• older children - pupillometer• younger children - PD rule• very young children

(or strabismus cases) PD rule (inner to outer canthus)

• involve the child in the task

Measurements

Centres• as close as possible to geometric centres• principal axis/ centre of rotation rule

Measurements

Bifocals

• segs set on pupil centre

• use a pre marked dummy lens

Measurements

Clients for life

Parents and friends

Extra special service now is a good

investment for the future

Practice Building

THE END