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The Care and Feeding of Parents, Now That Their Child Needs Glasses

By Mark Mattison-Shupnick, ABOM, and Keith M. Cross, ABOC

Release Date: September 1, 2013

Expiration Date: September 1, 2014

Learning Objectives:

Upon completion of this course, the participant should be able to:

  1. Understand the role of the parent as the gatekeeper to children's eyecare.
  2. Learn the importance of educating the parent on critical lens attributes for children.
  3. Understand the initial biases and expectations of parents about their children's eyewear, and the role of the optician in the eyewear buying process.
  4. Learn techniques to present eyewear care and compliance instructions to parents and children.

Faculty/Editorial Board:

Mark Mattison-ShupnickMark Mattison-Shupnick, ABOM, is director of education for Jobson Medical Information LLC.






Keith M. CrossKeith M. Cross, ABOC, is director, Rx Technologies, PPG Industries; vice-chairman of The Vision Council Lens Technical Committee and serves on the ANSI Z80.1 and the ANSI Z80.3 committees.





Credit Statement:

This course is approved for one (1) hour of CE credit by the American Board of Opticianry (ABO). Course SWJHI527.

THIS COURSE IS SUPPORTED BY AN EDUCATIONAL GRANT FROM PPG INDUSTRIES


Ever wonder who's more nervous—the child who's getting their first pair of glasses, or the patient's parent? It turns out that when faced with a new eyewear prescription for their child, parents often have concerns that they don't necessarily know how to express. After all, most consumers know little about eyewear other than there are lots of styles, lenses are a mystery and they're not sure what they should cost. Add to this apprehension over having to protect such an important investment, and it's easy to see how overwhelming the situation can become.

To better understand the concerns of parents and how they're being addressed by eyecare professionals (ECPs), PPG Industries commisioned a survey of 500 U.S. adults in March 2012. The goal of the research was to learn how to better engage with today's parents to promote a child's vision as well as understand parent's expectations.

The results of the PPG survey showed that parents do feel that eyecare professionals could play a greater role in two major ways. First, ECPs should educate parents and their children on lens options that provide better solutions for the way that children use their glasses. Second, there is an essential need for children to better understand how to care for their eyewear.

EYEWEAR ATTRIBUTES—PARENTAL OPINION

We all know that kids' eyewear needs are different from those of adults, but parents' perspectives often influence how well those needs are met. In this and the following sections, we'll compare the results of the survey and the ways that an ECP can deliver a variety of options and solutions for every child and his/her parents.

Parents were asked to pick what was most important to them when deciding on a lens material for their child's eyeglasses. About half felt that a combination of lens attributes (clearest vision, thinness, light weight, impact resistance and UV protection) was the most important. The remaining three attributes were about equally important, i.e., 13 percent said they would always choose the lens that offers the best vision, while 15 percent said price was their primary concern, and 16 percent picked impact resistance, protection and durability (Fig. 1).

When asked about the importance of technology, 75 percent agreed it is important to them that their child's eyeglasses are made with the most advanced lens technology, while 86 percent of respondents said it is important to them that their vision care insurance plan covers the most advanced lens technologies for their child's eyeglasses (Fig. 2).

EYEWEAR ATTRIBUTES—PROFESSIONAL OPINION

At a professional roundtable event hosted by PPG and partner Hoya Vision Care North America, experienced eyecare professionals weighed in on the factors that they believe should be parental considerations. As it relates to frames, they recommend frames that kept their adjustment are well-constructed and feature spring hinges. For lenses, they recommend lenses that perform well across a spectrum of features, not simply offering impact resistant lenses and ending the education and recommendation process there.

If eyecare professionals don't take the time to explain to the parent about what qualities to look for in frames, lens material and lens design, in their eyes these products are just commodities. Unless ECPs take the time to talk about the difference in the lenses that come out of our practices, all lenses are equal in the parent's eyes. But once they understand the importance of children-designed frames and the right lenses, parents are empowered to make a decision that is based on more than just price and insurance coverage.

To ensure compliance with wearing the eyeglasses, there has to be a balance between parental and child preferences. For example, a parent who chooses a bright red or blue frame should not be surprised when the child does not want or like to wear their glasses. It may simply be the color. But clearly the decision should not be solely left up to the child either. It is important to engage both parties—the parent and the child—in order to help realize a visual solution that works well.

Children will also be reluctant or refuse to wear their glasses if they're experiencing distortion and/or discomfort. Lenses should be safe, clear and comfortable to wear.

Safe—Safety encompasses protection from impact, scratches and ultraviolet radiation. While all lenses are considered as “medical devices” and must meet standards for impact resistance as required by the U.S. Food and Drug Administration (FDA 21CFR801.410, commonly referred to as “the drop-ball test”), children require lenses that significantly exceed the FDA standard. For many practices, they have added Trivex material lenses as an alternative to polycarbonate for impact, absorption and clear prescription properties. The roundtable participants pointed out that in addition to safety and extreme impact resistance, lenses must be 100 percent UV-absorptive. In addition, lens finishing (i.e., beveling) requires that the lens be held firmly in a child's frame. If the bevel gets rounded, for example by hand polishing after edging, the ability for the bevel to hold firmly is diminished. As a result, be sure that your lab produces crisp edges for the best lens retention.

Clear—Corrected vision delivered with the utmost clarity is always the goal. With children, this is even more critical because during their first 12 years, visual learning accounts for 80 percent of the learning process. Visual clarity of a lens begins with the material's fundamental ability to effectively align the spectrum of light waves that pass through it. Abbe value is an indicator of the amount of dispersion or chromatic aberration of a lens material—the higher the Abbe value, the lower the chromatic aberration and clearer the vision for the wearer (all other factors being equal). Trivex material has an Abbe value of 43-45 (depending on lens manufacturer). But clear vision does not stop at Abbe value. Lens designs and anti-reflective coatings also contribute to clearer, edge-to-edge vision. Combining digitally-enhanced lenses with the best AR coatings and high Abbe materials help to provide lenses with minimal distortion, especially in higher prescriptions. No parent would ever want to sacrifice their child's vision, so this presents an opportunity to discuss the value versus cost of eyewear, encouraging them to provide the best vision with their children's eyewear.

Comfortable—Comfort is a frame and lens combination. Frame bridge design must match the child's nose bridge shape. For adjustable nosepads, rounded and silicone pads are recommended so they don't dig into the skin. For a saddle bridge, the nosepads are splayed more so they better fit the flatter and wider surface area of the nose bridge, especially for smaller children.

Lens comfort is also related to final lens weight, which is a function of refractive index, specific gravity, lens size (frame eye size) and lens processing thickness. Trivex material provides a good balance of these factors with a refractive index of 1.53, a specific gravity of 1.11 g/cm3, and the ability to process Trivex lenses to thin centers. In fact, Trivex material has the lowest specific gravity of all prescription lens materials (Trivex material, 1.11g/cm3). In addition to frame fit and lens weight, photochromics provide the comfort and convenience of adjusting from clear indoors to dark outdoors. Trivex material is available in Transitions and other photochromic lenses.

THE FIRST PRESCRIPTION

For parents who aren't already aware of the important role of vision correction, discuss the link between their children wearing their glasses (compliance) and the benefits that are being delivered. While education on eyewear care is a critical part of the discussion for new eyeglass wearers, it has to be done in a positive way in order to resonate with kids and avoid creating more pressure on parents than necessary. Focus on the benefits of wearing versus dwelling on the negatives. Every child knows a classmate who already wears glasses. In fact, there are always styles and colors that can be acceptable to parent and child so that wearing takes place.

For example, if you are working with a child who participates in sports, explain to the child how their glasses will help protect their vision and can improve their performance on the field. Or if the child is more interested in books and schoolwork, explain how their glasses will help them focus and learn more on all that there is to discover in the world.

New information supports the concept of “School Readiness Begins at Birth.” Many parents are already thinking about what they can do to give their child an advantage at birth. If improving a child's vision is projected to help them in the classroom in the future, parents are more receptive to the discussion even if their child has previously not complained of vision problems.

A vision history of the child is a good place to start. Finding out if the child is struggling in school or finding out what they do (hobbies) and then making the connection for the parents defines what you prescribe/recommend. Children are much more accepting of glasses today, almost looking forward to wearing glasses, especially when they see other kids and celebrities with cool sunglasses or trendy looks.

EYEGLASSES—CARE AND CLEANING

In addition to exploring the right decisions for children's eyewear, the study asked parents, “In your opinion, does your child understand the importance of taking proper care of his or her eyeglasses?” After all, eyeglasses can be a substantial investment, and habits for how well they're cared for start young. This research confirmed several areas where eyecare professionals could play a greater role in parent education, including care for eyewear.

Despite 78 percent of respondents saying they think their children understand the importance of taking care of their eyeglasses, the majority of parents have noticed issues suggesting the opposite.

COMMON CARE ISSUES MENTIONED

More than half of the parents surveyed said that their kids dropped, mishandled or improperly cleaned their eyeglasses or didn't use a case.

Not keeping glasses on or getting them scratched or dirty gets in the way of good visual information. If kids can't see well through their glasses, they think glasses aren't working.

Not using the right case, keeping glasses in a soft case at the bottom of a backpack or no case at all will place frames out of adjustment and make wearing less comfortable. What should parents do?

Unfortunately, only 41 percent of respondents said they were very satisfied with the amount of education their eyecare professional provided to their child on the proper way to care for their eyeglasses, suggesting that more than half felt their eyecare professionals could have done more.

In addition to being taught the proper way to care for eyeglasses, parents should also understand the options available for making lenses more durable, like scratch-resistant lenses and AR coatings. Combined, they prevent scratches and dirt buildup.

TIPS FOR MORE EFFECTIVE CARE

Add a short lens care discussion as part of the exam process, then re-do it at the end of the dispensing process. Ask patients to echo back instructions, adding in humor for kids. In your office, highlight the importance of the doctor speaking directly to kids, especially when they are getting their first pair of glasses. Develop a script that doctors, techs and opticians know for consistency in communications.

Use a personalized care bag (like at the dentist) that includes advice, a bottle of spray cleaner, towelettes in individually sealed packets and a schedule for cleaning (e.g., every morning just after brushing their teeth).

Encourage children to return with eyewear periodically (for instance, every six months) to check on how well their eyewear is performing. Is it being cared for, and if not does it need to be readjusted? Even if frames don't need to be readjusted and the eyewear is performing well, a visit such as this may reinforce compliance with care instructions. Be sure to tell patients to come back for frame adjustments whenever needed. A well-adjusted pair of glasses also lasts longer. For new prescriptions, have them come back in about eight weeks to readjust the glasses, as learning to use them and understanding what's comfortable may take a little time.

CONCLUSION

To promote children's eye health, it is essential to engage their parents. Parents are the gatekeepers to their children's eyecare, controlling how often and whether children visit their eye doctor. Providing information to parents on the latest lens options for children—such as Trivex lenses with anti-reflective coatings—and encouraging proper care of their children's eyewear will create comfort and confidence for the buying process. With frames that fit well and remain in adjustment, and lenses that are safe, clear and comfortable to wear, the glasses will deliver exactly what the doctor intended.

Healthy habits start young, so proper education of parents—and therefore their children—can influence how well a child sees for a lifetime.