KEYS TO AN IDEAL OPTICAL EXPERIENCE FOR KIDS
By Fleur Nelson, RDO, ABOC, RSL
Release Date: July 1, 2017
Expiration Date: August 1, 2018
- Understand the importance of creating an ideal optical environment and experience for children.
- Select the appropriate frame, lens material and lens enhancement for kids depending on their prescription and individual needs.
- Recognize the importance of parental education, especially with regard to UV protection and when to recommend lightreactive lenses or blue light attenuating lens products based on their children's lifestyle.
- Differentiate between dispensing glasses to children and adults.
The view of the world through a child's eye is much different than that of an adult, both literally and figuratively. With that in mind, imagine how a child perceives an exam room or a dispensary, especially if it is their first experience visiting an optical practice. This course will create awareness around the importance of providing a welcoming environment for children's eye exams, the selection of kid's frames, lens materials and lens enhancements, as well as provide tips on how to dispense glasses to children.
This course is approved for one (1) hour of CE credit by the American Board of Opticianry (ABO). General Knowledge Course SWJHI011.
Fleur Nelson, RDO, ABOC, RSLD, is a board-certified optician and owns and operates Optique de Fleur Opticians and Kidspex in San Rafael, Calif. Nelson has been a Registered Dispensing Optician and a Registered Spectacle Lens Dispenser for more than 30 years throughout the San Francisco Bay Area.
This course is supported by an educational grant from VSP.
Eighty percent of a child’s learning is through their sense of sight, which emphasizes just how critical it is to identify any issues with their vision at an early age. According to the American Optometric Association (AOA), children should receive their first eye exam at 6 months of age, receive additional exams at the age of 3, the age of 5 or 6, and before they enter kindergarten or first grade. Research has shown that 5 to 10 percent of preschool children and 25 percent of grade school aged children have vision problems. (“Making the Grade,” The Vision Council, www.thevisioncouncil.org/ topic/problems-conditions/kids)
Unfortunately, there are times when a child’s first vision screening occurs at school. It’s important to note a school’s vision screening doesn’t account for near vision, so a comprehensive eye exam is also necessary. That school screening may be the first indication of a child’s vision problem and may prompt a visit to an eyecare professional’s office.
CREATE AN IDEAL OPTICAL ENVIRONMENT AND EXPERIENCE FOR CHILDREN
A doctor’s office can be an intimidating place for children, especially an environment that doesn’t appeal to their interests. Imagine the anticipation or possible anxiety a child may feel about a visit to an optical practice. They may have had a previous bad experience, or it could be an entirely new experience to them. In either case, the more comfortable the child feels, the more likely they will be willing to participate in and be engaged throughout the entire appointment. With a child’s cooperation and participation, the pre-test and exam may be more efficient, accurate, easier on the staff and doctor, and ultimately provide the child with the very best examination results.
An optical practice should appear warm and inviting for kids from the moment they enter the door. For example, the waiting room should be equipped with interactive toys and books so children feel comfortable while waiting to be seen by an eyecare professional. An enthusiastic welcome and personal introduction from the staff to the child and parent provides a starting point to build trust for that child.
Communication with both the child and their parent is important throughout the entire visit. Listening to concerns and observations of the parent in the pre-exam is crucial with younger patients. Speak directly to the child and make eye contact. Making eye contact with the child helps keep them engaged in the visit and makes them feel you value their contribution to the pretest and examination. The doctor can’t always rely on the child’s verbal communication, especially in cases where the child is very young. For example, during the pre-test, explain that the questions being asked will help the doctor determine what to look at closer or focus on in the exam room. And while walking the child to the exam room, explain what types of devices and tools the child will see and experience with the doctor.
The age of the patient will determine the type of exam your practice will perform. If the child is very young, depending upon the pediatric exam method your office uses, they’ll likely be looking at a series of photos, letters or shapes. Carefully explain all steps in advance to help ease any unnecessary apprehension. Furthermore, reassure the child by explaining that you’ll be waiting for them once the doctor has completed his or her exam. Building rapport and continued trust is critical for a successful appointment and future visits to your office.
If the child is not cooperating, he or she may be tired, hungry or upset. It is suggested to reschedule the appointment to another time or date. If the visit proceeds when the child is having difficulty, feels pressured or even worse, is forced to complete the visit, follow-up appointments may also likely suffer.
PARENTAL EDUCATION AND INVOLVEMENT, FRAME SELECTION
Patient education is critical to the success of any visit to an optical practice. When your patient is a child, educating the parent is especially important when it comes to frame and lens selection, at-home care for glasses and follow-up visits.
There are many reasons that children are prescribed glasses. Children are either nearsighted, where they have difficulty seeing at a distance, or they are farsighted, where they have difficulty seeing up close and/or are astigmatic. Children can be prescribed to wear glasses either full-time or part-time, which will make a difference in which frames, lenses and lens enhancement should be recommended.
Opticians are generally viewed as the consultant, educator and advisor when it comes to selecting the frame, lens and lens enhancement. Many factors contribute to the recommendation an optician would make to the child and parent; patient prescription, full-time or part-time wear and patient lifestyle. In order to make the most educated recommendation, the child’s activities and hobbies should be thoroughly discussed.
Questions to ask the child and parent include just some of the following: Does the child play sports, read books, use digital devices or spend a lot of time outdoors? If the child is school aged, does the child sit in the front of the classroom or the back? Answers from these questions will help guide the optician to make the best recommendations for the patient.
A child that is of school age or older should lead the initial frame selection process, with the parent’s assistance.
When a child chooses their frame, likes how it looks and fits on their face, they’ll ultimately wear and take better care of their glasses. If the parent doesn’t allow their child to participate in the frame selection process, glasses tend to end up “lost” or “broken.”
Ideally the child, with the parent’s help, would select several different frames with the help of the optician (best if it’s no more than 4 to 6 frames). Once there are several choices from everyone involved, display all the frames in front of the child. Ask the child to try on all the frames in front of a small mirror for a close-up view and a large mirror for a full view. Any frames that don’t fit the child properly should be eliminated. If there are multiple frame choices remaining, the optician should provide the parent and child pros and cons to each. The final frame selection can be challenging if the child and parent don’t agree. The optician can always offer other color and frame material suggestions. Ultimately, the child should be excited about the final selection so they’ll proudly wear and care for their glasses.
Thankfully, there are many good frame manufacturers that make children’s frames in all colors, shapes and sizes. With so many kids’ frames to choose from, there’s a frame that will fit, be practical, durable and “cool” for every child and liked by their parent.
FRAME MATERIAL SELECTION
Eyeglass frames come in many different materials. The most common children’s frames are plastic (acetate, nylon and TR-90) or metal (monel, titanium, aluminum and stainless steel). Most children’s frames, both plastic and metal, have spring hinges on the temples, which reduce breakage by allowing the temples to bend outward when glasses are taken off, increasing overall durability.
Plastic frames are lightweight, comfortable and provide the widest variety of colors and designs. There are many types of plastics that range from hard (requires heat to shape) to very bendable (flexible but returns to manufactured shape when deformed). For very young children, especially infants, bendable nylon frames are the ideal choice. Most are made from a hypoallergenic material, contain no metal pieces and have an elastic band that wraps around the infant or young child’s head. These plastic frames stay put and are generally safer for a young child to wear. Zyl (acetate) is the most common plastic used for frames because it is cost-effective, available in fabulous colors and used for creative layering of multiple colors. Nylon is strong, resistant to hot and cold, and is the best choice for a sports frame. TR-90 is a thermoplastic material that is durable, lightweight, somewhat flexible and impact resistant.
Metal frames have attributes that may be more desirable for some children. Materials such as titanium are more durable than most plastics, hypoallergenic, lightweight and can withstand harsher treatment. Flexon is a unique titanium-based hypoallergenic material that is also called “memory metal” because it is bendable, 25 percent lighter weight than other metal and will always retain its original shape. Some metal frames may be better suited for an active child who may be a little rough on their frames. Similar to titanium is stainless steel, which is strong, still lightweight and cost-effective.
DETERMINING FRAME FIT
There’s much to consider when fitting anyone with a new pair of eyeglasses. The optician will be the best equipped to determine which frame fits the child best. Avoid a frame that the child will grow into, so the frame selected shouldn’t be too big or too wide. The same is true about not too small, and the frame width shouldn’t be touching the child’s face.
Bridge fit is also very important to ensure that the glasses don’t slide down the child’s nose, and there should be no gap in a saddle bridge at the top of the child’s nose when trying on plastic frames.
Nosepads on metal frames and some plastic frames can be a good alternative for children with a flat or wide nose. If a child has been prescribed multifocal lenses, choosing a frame with nosepads can be extremely beneficial as they can be adjusted much easier to accommodate the fitting height. The nosepads should fit comfortably against the nose with no gaps. Lens positioning is vital when fitting a child for multifocal lenses. It’s best when the child’s eyes are centered in the frame both horizontally and vertically.
The temples of the frame should be straight from the hinge to the ear and should not bow out. When a temple bows, that indicates the frame is too narrow. The length of the temple is also important when selecting a child’s frame. The temple can sometimes be too long for a child and extend below the ear indicating the frame is too big.
Ultimately, comfort and fit will result with less “playing around” with his or her glasses and thus reduce the chance of breakage. If the parent expresses concern about the frame investment, discuss both the value of the frame’s quality from a durability perspective and the manufacturer’s warranty. Typically most eyewear manufacturers offer a warranty on their frames, and that suggests increased value since the manufacturer stands behind their product. Like an adult’s products, an investment in better quality pays off in the long run.
LENS SELECTION AND LENS ENHANCEMENTS
The best lenses for children’s glasses are polycarbonate (poly) or Trivex material because they produce an excellent combination of thinness, lightness, protection and impact resistance. Most parents already understand the importance of protecting their children’s skin from harmful UV rays from the sun by using sunscreen. However, most are not aware of protecting their child’s eyes from the same UV light. Poly and Trivex are 100 percent ultra-violet (UV) protective for children’s eyes. Both lens materials provide protection from all the UVA and UVB rays from the sun that might pass through the lens. With lens material decided, discuss lens enhancements such as anti-reflective coatings or light-reactive lenses. The child’s activities and hobbies will determine the right lens enhancement.
Everyday light—indoor and outdoor, natural and manmade—reflect off lenses. This reflection can make it difficult to see clearly. Since 80 percent of how children learn is visual, AR lenses are the right choice.
Light-reactive lenses, also called photochromics, help reduce glare when stepping outside into the bright sunlight or when cloudy. The most popular color choice remains gray. Gray lenses alter colors through the lens least. For example, photochromic SunSync lightreactive lenses get dark when exposed to the sun’s ultraviolet rays and change back to clear indoors when UV is not present. SunSync light-reactive lenses are the ideal choice for a child that is frequently indoors and outdoors, fulfills the preference for sun lenses outdoors and clear in the classroom with the convenience of a single pair of glasses.
New to many classrooms are digital devices that emit blue light. LED (light-emitting diode) screens such as tablets, computers and handheld devices are common in schools today. If these devices are not in the child’s classroom, you can likely count on them being in their home. According to a recent “Digital Devices and the Family” survey conducted in 2016 by Vision Service Plan, the average American 2-year-old has an average of 30 hours per week of screen time, and a 13-year-old has an average of 70 hours per week of screen time. By 17 years old, an average American teen will have spent one-third of their life on a digital device.
Both the amount and intensity of blue light exposure has increased. According to The Vision Council, “Digital eye strain is the physical discomfort felt by many individuals after two or more hours in front of a digital screen.” Digital devices can cause eye strain, and blue light attenuating lens products, such as TechShield Blue, can help alleviate the symptoms of digital eye strain for children. While parents will question the additional costs of these enhancements, a discussion about digital eye strain can give them the information they need to make an informed decision. Of course, quality anti-reflective coatings are warranted for defects and satisfaction from the manufacturer or the laboratory.
SECOND PAIR POTENTIAL
As with most patients, a second pair is highly recommended in the event the first pair is damaged or lost. This is especially important for children. The second pair can also be more than just a backup, it can serve and support the multiple activities of children. Kids are extremely active, whether it is in school, sports, clubs or simply playing outside. Glasses great for classrooms aren’t likely ideal for soccer or baseball practice.
There are several ways to approach the second pair sale. The approach will differ based on the individual lifestyle and needs of the child. This is where the questions asked earlier in the visit come in handy. If a child only needs glasses to read, recommend a second pair, one for the classroom and one for home. However, if the child needs to wear glasses all the time and plays sports, there is the opportunity for two completely different types of frames, lenses and lens enhancements.
Everyday glasses, such as those for the classroom, are not typically as durable as a pair of eyeglasses intended for a sports application and can even cause injury to the eyes, face, nose and sides of the head if a child is hit with a ball, equipment or even by another player. Eye injuries can be prevented with the use of protective sport eyewear. Prescription sports glasses are available for football, soccer, basketball, lacrosse, rugby and tennis, and even for swimming. Lens enhancements such as light-reactive lenses, anti-reflective, anti-fog and polarization will improve vision during any sport and ultimately enhance visual performance.
DISPENSING TO CHILDREN
With today’s busy schedules, parents sometimes prefer to pick up glasses without their child present. This is not recommended for many reasons—prescription accuracy, frame fit and adjustment, explanation of at-home care for glasses and much more. Dispensing glasses to children takes a little more care and time, and if it is their first pair of glasses, it may be a very emotional, life-changing experience.
Ideally the child should sit directly across from the optician, and if the child is very young, possibly a parent’s lap would be best. It is much easier to adjust the frame when the child is still, so the more comfortable the better. Adjusting the glasses is similar to that of an adult; make sure the temples are not too tight or pulling the child’s ear forward. Warm a plastic frame to make adjustments to the temple if needed and adjust the nosepads, typically splayed out to rest flush on their nose. If the glasses are at all uncomfortable, the child will not likely wear them.
Include the child in the dispensing process by asking how the glasses feel with each adjustment. Once the glasses are adjusted, have the child stand up, look down, shake their head side to side and then look up at you to check if the glasses are in the same place the glasses started. If not, make further adjustments. If you are dispensing a multifocal lens, verify the fitting height is placed as the doctor recommended.
Demonstrate to the child and parent the steps to care for the child’s glasses. Cleaning and at-home care includes the proper way to take on and off glasses. Teach the best way to clean the lenses using a lens cleaner and cloth, and caution against paper products since they may scratch the lenses. Last but not least, show the child how to gently place the glasses upside down on the table with the frame’s top and bridge and temples resting on the table’s surface.
To make the experience even more exciting for the child, carry a large variety of fun eyeglass cases, cleaning cloths and accessories. Kids love little toys and giveaways to take home. A “prize chest” always creates a fun ending! The goal is to make the entire optical environment, from beginning to end, an exciting and enjoyable experience. The hope is that the child and parent will look forward to getting their exam and new glasses every year from your optical practice.