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A Focus on Kids' Eye Health

By Mark Mattison-Shupnick, ABOM

Release Date: July 2011

Expiration Date: August 31, 2012

Learning Objectives:

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

  1. Understand the importance of kids’ eye health.
  2. Learn the business potential for adding kids’ eyewear to an office.
  3. Know the special lens and frame dynamics of toddlers to tweens eyewear.

Faculty/Editorial Board:

Mark Mattison-Shupnick Mark Mattison-Shupnick, ABOM, FNAO is currently director of education and training, program development for Jobson Information Services LLC, has more than 35 years of experience as an optician, was senior staff member of SOLA International and is a frequent lecturer and trainer.

Credit Statement:

This course is approved for one (1) hour of CE credit by the American Board of Opticianry (ABO). Course STJMI090-2


"A 20 year delay…" in the cumulative effects of UV and high energy visible (blue light) "…would practically eliminate these diseases as significant causes of visual impairment in the United States." This is still a pretty profound statement even though I first read it a while ago in the paper by RW Young MD, titled Sunlight and Age‐Related Eye Disease published in the Journal of the National Medical Association (1992, 84:353‐358). It suggests that if we do the best job we can to significantly reduce the effects of UV in kids and make their parents aware, we can help those kids as adults. Wow!

Kids Have Complex Needs

But, kids are, of course, more complex than that. The issue is that children 18 years and younger have a variety of unique eyewear and eyecare needs; UV is just a part.

Kids live an active lifestyle, much of it outdoors and therefore are exposed to the effects of UV. While the cornea absorbs ultraviolet light in the lower ranges, prior to age five, there are not enough chromophores that protectively absorb UV in the lens of a child. As a result, it does not filter ultraviolet radiation with the efficiency of an adult eye. According to several studies, the average child receives approximately three times the annual UV dose of the average adult and up to 80% of lifetime exposure before age 20. Long‐term exposure to UV rays can result in major eye diseases such as cancer, cataracts, and macular degeneration. So, make sure clear and sun lenses block 100% of UV rays. Outdoors toddlers to tweens require sunwear.

A Plan
Align yourself and your office for kids; develop a plan.

  • Understand the products needed (frames and lenses) and place orders
  • Prepare staff and self with the education required
  • Contact suppliers for merchandising materials
  • Launch with goals and metrics in place at a staff meeting
  • School all in the Managed Vision Care benefits of kid’s eyewear
  • Answer questions as they present themselves daily, to all concerned

 

Kids are rough on their eyewear. They wear and enjoy them but don't usually think about how to care for them or protect them from damage. The result is scratches sooner and usually deeper than an adult. That requires better scratch coatings and often more frequent replacement.

The clearest vision, promotes learning. Suggest no‐glare (anti‐reflective, AR) lenses for kids. Given the terrific scratch resistance and durability of today's AR, there's no reason to avoid AR.

Kids also may have more frequent prescription changes required by medical or refractive conditions. There may be patching for strabismus, toddlers with a higher refractive error make take a number of Rx changes to get to the right correction. Regardless, be prepared to see some kids more often.

Fitting is a specialty too. In toddlers, the fit on the nose is most critical and frame choice differentiates the practiced optician from the ordinary. In tweens, the optician is balancing personal wants of this young individual with parents' influence and shapes and sizes that also look right. In both, the choice of lens material requires impact protective properties while balancing design for the best vision and lightness for lenses that stay in place.

Finally, kids mean multiple pairs; it's a necessity because they're kids. I often start a conversation with a parent about the choice of two frames ‐ so there is a pair of glasses in reserve for the days that an Rx is changing or when those mangled frame and lenses are being replaced.

According to…

The US Census, there are about 75 million kids in the population under 18. In fact, in 5‐year increments (see the graph), there are about 20 million in each group. That means that there is an opportunity out there for the enterprising optical office.
The American Public Health Association, "About 1 in 20 preschoolers have eye or vision problems that they can't describe so go undetected."
A June AOA PR release, "Most Americans know the importance of UV blocking sunscreen to protect their skin from aging and diseases. Unfortunately, according to the recent American Eye‐Q® survey, funded by the American Optometric Association (AOA), only 32 percent of Americans understand the same is true when it comes to protecting their eyes from aging and diseases."
The American Academy of Ophthalmology, "More than 100,000 people sustain eye injuries each year and more than half of those injured are children."
Everydayhealth.com, "Research has found that only one in three kids ages 6 to 16 has had a comprehensive eye exam within the past year. And one study estimates that 90 percent of school‐age children who need prescription glasses do not have them."


Image from from Digitalness blog, Amy Saunders, Oct 2010

The American Optometric Association (AOA), "Infants should have their first comprehensive eye exam at 6 months of age. Children then should have additional eye exams at age 3, and just before they enter the first grade — at about age 5 or 6. It is important to know that a vision screening by a child's pediatrician or at his or her preschool is not the same as a comprehensive eye and vision examination by an optometrist. Vision screenings are a limited process and can't be used to diagnose an eye or vision problem, but rather may indicate a potential need for further evaluation. They may miss as many as 60% of children with vision problems.

So, no matter how you slice it, kids can be an important part of a practice – they most certainly have the need for comprehensive eye exams and eyecare products. Ask yourself ‐ are or should "kids" be part of your demographic? If yes, follow these steps.

Get Mom on Board

Kids are the access to "mom" and mom brings even more to the practice. First, they are typically the decision makers in the home, especially about healthcare. So, that means that a child well cared for in your office will probably get mom to bring dad, friends and others in as new patients. In fact, according to the Management and Business Academy (Jobson MBA), the gross revenue, per patient, in an average practice is about $300. That means that a child seen that also brings in parents that become regular patients in the practice, can add $6000‐9000 of revenue over the life of that child (over 18 years, using a 2.2 year eyewear repurchase cycle).

To appeal to mom, meet her needs by understanding the variety of conditions that can affect her kid's eyes. Work with the doctor to know how to best fill the prescription and treatments that may also be prescribed. Then, provide the right environment and selection to also make this young patient excited and trusting. Be able to connect so that mom feels comfort and trust in your recommendations.

Checklist
  1. Develop a preventative plan for the kids in your practice.
  2. Ensure that all lenses dispensed are 100% UV absorptive.
  3. Promote early eye exams.
  4. Recommend quality sunglasses for every kid.
  5. Get mom on board.


Learning and Good Vision Are Connected

It's estimated that 80% of what children learn their first 12 years comes through their eyes. Yet, according to Prevent Blindness America, "Vision problems affect one in 20 preschoolers and one in four school‐age children." It is important to recognize that good vision is a must. When children cannot see well, their school performance suffers. Since many vision problems begin at an early age, it is very important that children receive comprehensive eye exams beginning as early as six months of age.

Good vision is more than 20/20 distance acuity. Experts agree that children need to be able to use both eyes so that they work as a team for binocular vision. Both eyes should be able to track together and return to the place that they were reading when they look from reading to distance and back again. If the child is having difficulty, an exam is in order and for some, vision training may also be suggested.

Focus on Kid's Eye Health

Be knowledgeable of the more important conditions that can affect children's vision and the spectacle lens treatments that would be recommended or prescribed. Vision problems can affect a baby's and young child's ability to develop the hand‐eye coordination required daily and the ability to navigate their environment with good depth perception.

Amblyopia ‐ Amblyopia, also known as lazy eye, is a vision development disorder in which an eye fails to achieve normal visual acuity, even when the eye appears normal or with prescription spectacles or contact lenses. Amblyopia begins during infancy and early childhood. Vision development may be affected if one eye has a significantly different refractive error than the other or when strabismus is present where one eye is turned significantly. Usually only one eye is affected. But in some cases, reduced visual acuity can occur in both eyes. Treatment – Eye exams early in life. If lazy eye is detected and promptly treated, reduced vision can be avoided. If left untreated, lazy eye can cause severe visual disability in the affected eye, including legal blindness. (Adapted from allaboutvision.com)

Photokeratitis – A sunburned cornea (photokeratitis) is typically the result of the UVB radiation portion of UV, like the intense UV reflected off snow. All surfaces reflect UV to some degree but snow reflections are the most severe. For example, green grass only reflects about 1‐2%, sand and asphalt 8‐12%, the windows in cities and slanted windshields can reflect as much as 20% of the UV like water, especially when the whole sky effect over open water can be as much as 20% but, a snowfield reflect 85%. Treatment – 100% UV absorbing sunwear with excellent size and coverage of the eye and the surrounding skin; wrap around sunglasses are best.

Strabismus – A turned eye, also known as "squint" is due to a muscle imbalance. A lack of alignment prevents binocularity and can cause the brain to suppress the vision from that eye because of double vision. Treatment – Usually managed by both an optometrist and ophthalmologist, the muscle imbalance may be corrected surgically for cosmetics and then using vision training, the eyes can be taught to work together. Lenses with prisms may also be used to realign the images seen by both eyes to prevent double vision.

Congenital cataract ‐ is a clouding of the crystalline lens present at birth. There is no one specific cause and will affect the vision development. Treatment – This usually requires cataract removal surgery, with an intraocular lens (IOL) implanted. Vision training usually includes patching the good eye to force the child to use the weaker eye to prevent amblyopia. A variety of colored and patterned patches for the child to choose from and the expertise to train parents in their attachment and use is key.

Refractive error – While as common as in adults, many kids that need correction go undetected. TreatmentEarly exams are required to identify any error that needs correcting. In cases where high‐powered prescriptions are required, results can be life changing for the child (and the optician). The first time I placed a pair of ‐23D glasses on a four year old changed the way that I thought about kids and eyewear. That smile and the torrent of conversation had me looking for every kid that really needed a pair of eyeglasses.

Early eye exams identify the vision skills required for learning. They are:
  • Near vision acuity
  • Distance vision acuity
  • Binocular (two eyes) coordination
  • Eye movement skills
  • Focusing skills
  • Peripheral awareness
  • Hand‐eye coordination

That means that it is a requirement that we provide kids, the best eyewear solution possible. Since so much of their vision development, education and adult health is dependent on the right eyewear sooner, learn everything about kids eyewear and deliver the best you can.

Compliance ‐ Delivering What They Will Wear

Getting kids to wear their glasses is often harder than expected and can lead to frustration for parent and a dilemma for the dispenser. That's why the right choice of frame and lens, in a kid‐tuned environment, is key to success. Consider ordering a copy of "Will My Child Actually Wear These Glasses?" by Kathryn Dabbs Schramm, a pediatric optician. This excellent resource discusses the parent's point of view from the experience of a pediatric optician. Visit willmychildactuallyweartheseglasses.com.

From Pediatric Frames: Balance Child and Parental Preferences on the Review of Optometric Business website, the author, Katie Walford says, "When children need eyewear, the best result occurs when you assess the child's needs and tastes and then those of their parents. Finding a balance between the two will provide the optimal selection.

Offer a frame the child likes best. If a child is excited about the frame they selected, they have a greater chance of wearing their eyewear consistently. For that reason, the optician should first show the features of the frame the child seems most drawn to. Once the child has that frame on their face or in their hand, gauge the parent's response. (reviewob.com)

Lenses

Lenses should be durable and no‐glare. Excess glare from white boards, computers and bright lights in the classroom can add another obstacle to efficient learning. So, no glare lenses are recommended. Their durability today is better than even the scratch resistant lenses of just a few years ago. Materials must be impact protective and 100% UV absorptive. Therefore, consider polycarbonate or Trivex lenses. Both absorb 100% UV while they are significantly impact resistant even as AR lenses. For high plus and minus lenses, when frame size is also larger, consider AR 1.67 high index lenses. When premium AR is an added it includes an impact primer (confirm with your lab) for improved impact resistance, lenses are 100% UV absorptive and the overall lenses can be made thinner and lighter. In higher prescriptions, thinner edges in plus or centers in minus lenses get thicker faster so 1.67 lenses have good overall thickness for impact resistance.

Deliver kid's clear eyewear with the convenience and protection of photochromics. It removes the reminders to change to sunwear that kids can forget and most importantly, kids can show off the way that they work – it adds to their reasons for wearing.

Sunlens color selection is important – too dark and it might cause a dilated pupil allowing the entry of UV from the top and side. So, 70% dark lenses in gray or brown are correct. They ensure a small pupil and most brown lenses also are effective absorbing high energy visible blue light suggested as a contributor to age related macula degeneration. Speaking of side entry UV, wrap sunglasses do the best job for kids.

Lastly, for those lenses above 10D, reduce frame size, decentration and increase index when possible. Another way to reduce lens thickness is to lenticulate the lens using freeform techniques. Consider this +16 sphere, +2.50 add flat top lens (Fig x). The lens was made by turning the plano base FT28 around so the flat top segment surface becomes the lens back. A blended lenticular was cut on the front. The bowl size was made for a 38mm frame (the 28mm segment is almost the size of the power bowl). Quest Optical Lab in Tampa FL produces these lenses for other labs for special needs (see questopticallab.com).

Lens Packages

Consider bundling the right lens materials and treatments together. After all, a clear set of recommendations with the proper explanation, at a kid's package price meets the way that most consumers (and moms) buy products today. Make sure that parents understand that plastic lenses, due to their lesser UV absorption as well as reduced impact strength, are not considerations for kids. Offer AR, polycarbonate or Trivex, and photochromic lenses as a package.

Simplify your story with a Best, Better and Good offering with Best and Better being a two pair package – why? Two pair completely meets the needs for both sun and clear or clear with a back up. In both cases, the "other first pair" (not second pair) includes your office's normal multiple pair discounts common in most offices (usually 20‐30% of the bundled pricing). The basis for this pricing is the Good package that includes protective No‐Glare lenses. Say, "Our office combines the right lens properties to best protect your child's eyes. This provides the clearest distance and reading vision in eyewear that's the most impact and UV protective."

 

Frames

Offer Durability (Adapted from reviewob.com)
Parents often will invest more in their children's frames than they would in their own, but they also expect a product that will withstand rough treatment. Favorites with both parents and children are memory metal frames. The frames are resilient and children usually find it cool that they can twist and turn their glasses. These frames also have attractive 1 or 2 years warranties for parents. A more expensive frame with a good warranty increases its value as replacement costs, for broken frames, can be of concern. This helps parents relax about their way that their kids wear their glasses. For durability in sports, suggest that their daily glasses be replaced with sports specific eyewear.


Image courtesy Baby Banz

Fitting (Adapted from the CE course Children Need Sunglasses, see 2020mag.com/CE)
Age determines fitting characteristics and frame choice considerations. Of primary concern is the fit of the bridge within each aged group.

Infant/Toddler ‐ A baby's bridge has very little depth and can appear almost flat. Yet, this tiny structure must support the weight of the glasses. To do so comfortably, the bridge must conform exactly to the shape of the child's nose. The correct bridge will distribute the weight of the glasses evenly over the sides and top of the child's nose while avoiding contact with the supra orbital bone and not resting heavily on the cheeks. Sunglasses must be of sufficient size to limit UV exposure through the upper eyewire or from the sides. While the eye should center vertically in the frame, it should be large enough through the "A" measurement to allow approximately one years growth.

Preschool, 3 through 6 years ‐ Can be quite independent and want to make all the decisions, decisions based solely on color. Availability will limit choices, but only appropriate colors should be shown. The correct bridge fit will still be the primary fitting concern, one that will distribute the weight evenly over the sides and top of the child's nose. The frame should be sized to allow at least one years growth and be at least as wide as the widest part of the face.

School age, 7 through 9 years ‐ By school age, children's opinions are beginning to be based more on their peers and far less on their parents. Colors that were once in demand now may be firmly rejected. Whenever possible, non‐gender‐specific colors should be shown to insure wearing compliance for the longest time. As the child matures, it becomes increasing important to conform to their peers and older children. Brand name recognition and their influence are escalating for this age group.

Tweens, 10 through 14 years ‐ Tweens generally have fully developed facial features, fully developed visual systems and fully developed attitudes and opinions. These children want to wear what older teens are wearing. Today's tweens want brand names and their parents have more expendable income than any previous generation. They are more open to frame colors based on individual coloring, like cool colors for youth with blue undertones and warm colors for those with golden undertones.
From the age of 10 years on, the shape of the child's nose takes on far greater cosmetic importance. In the younger age groups, the primary concern is finding a sunglass frame that fits the child's bridge correctly. But, for tweens, it is the appearance of the frame's bridge that may determine whether or not the child uses the sunglasses.

Temple Length
Temples are another story – unless you carry enough inventory of kid's designed frames, many temples will be too long. Serious about selling kid's eyewear? Without enough inventory, mom won't think that you are, so work with your vendors to ensure enough styles, colors and sizes to show you're committed.

Too long temple ends (temple tips or zyl) can be shaped around the ear, more like a comfort cable ‐ if the ear can tolerate it. This ensures a snug fit but be sure that it doesn't irritate. Shorten metal temples – straighten the temple end, remove the temple tip, cut the core, file burrs off the cut end, soften the end of the temple tip with heat and push the temple tip back onto the core wire – all the way until the core end is at the end of the temple.

Managed Vision Care
Know the varieties of benefits that cover kid’s eyewear. It makes a difference. Most plans cover an annual exam and polycarbonate lenses. Recently, EyeMed introduced a new, unique KidsEyes benefit that offers two funded eye exams within a single benefit year; an additional covered pair of eyeglasses if the child’s
vision changes during a benefit year; a 40 percent discount on additional pairs of glasses, including replacements of broken or lost glasses; and a 20 percent discount on sports-related eyewear and plano sunglasses. The program funds polycarbonate and photochromic lenses as well as contact-lens professional services.

This change was prompted by the recognition that access to more frequent eye exams, when kid’s eyes are changing, is logical. The plan covers optimal lens materials to encourage younger people to keep their vision clear and in focus, and to use good health habits including safely, UV protection and proper contact lens usage.

 

Duty to Warn/Inform

Kids can play rough and the chance of potential eye injury is increased so when selling eyewear, presenting the most impact protective lenses is your responsibility. Why? The FDA only requires a basic impact resistance in lenses and makes no special requirements for kids. From a product liability point of view, parents purchasing eyewear must be informed about the best choices that would protect their children's eyes.

While a parent can choose a lesser impact material (like plastic because of cost), the fact that they have had described the choices of plastic, high index, polycarbonate and Trivex means that the dispenser has done their job. Most offices ask the parent, not purchasing the most impact resistant lenses to initial the patient file that they have been informed of their choices and the attributes of each, but choose not to purchase.

For most offices today, plastic lenses aren't even offered but rather only polycarbonate and/or Trivex. This is because the cost of polycarbonate is the same as plastic lenses. Therefore, pricing to the patient for the impact and UV protective advantages of polycarbonate, no longer costs more.

Marketing and Merchandising

Want a kids business? That requires merchandising plan that targets kids in your practice. Need to know how many kids are in your database? Mine your Practice management software data. Sort by age, then by parent/vision plan. Send a message by email about getting ready for school with the newest lens packages to meet all kid's needs for eyewear. Take the elements of that communication from this CE course.

Consider the following merchandising plan:

  1. Take pictures of your kid's frames and displays from your dispensary. Talk to your suppliers for digital images.
  2. Develop an email that includes information about kid's eye health facts, reasons to have an exam and all the things that you do for kids. Include frame photos and those of your dispensary.
  3. Talk with your web developer to add a Kid's Eye Health tab that describes potential issues and the treatments and solutions offered by your office.
  4. Talk to your major suppliers for brochures for counters and reception, DVDs for that flat screen, counter cards and point of purchase (POP) for counter and shelf displays.
  5. Use co‐op funds to create and mail a recall postcard reminding parents.
  6. Begin a discussion of kid's eye health on your Facebook page. Add kids images (with parent's permissions) from your office.
  7. Consider an end‐of‐summer (before school) kids eyewear trunk show.


Making the Promise

In conclusion, get kid transformed today with a checklist.

  1. Develop a plan
  2. Review and incorporate national association recommendations into your plan.
  3. Adopt actions and products that ensure compliance.
  4. Know the conditions, problems and treatments specific to kid's vision.
  5. Get mom on board.
  6. Include no‐glare, photochromic high impact lenses as your core lens package.
  7. Become a frame‐fitting expert – the bridge and temple lengths are key.
  8. Build a merchandising plan that identifies your office as kid "expert".
  9. Create a kid friendly environment.

Now take that lollipop out of your mouth and go help that kid that looks so unsure about their first pair of glasses.


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