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Spectacles for Children

Dispensing of the spectacles in children is Different than in the adults.

 

  1. Children have different facial and nasal structure hence the frames are different.
  2. Children have higher safety requirement hence the durability of frames and safety features of lenses are different.
  3. Children have different visual requirement hence their spectacle prescription guidelines are different.

 

Bad spectacles – examples

 

Spectacle in children

Examples of poor spectacle frames and lenses in children. (a) Temple non -parallelism, (b) Loss of four-point touch, (c) Short temple length, (d) Lens scratches, (e) Lens pits and scratches, (f) Lens chipping, (g) Poor overall fit, (h) Not good nose bridge and (i) Poor mastoid bend.

 

 

Ideal features of a child’s spectacle:

 General Principles

  1. When selecting frames for children, safety should be the first concern followed by the fitting requirement and then the looks.
  2. Frame should able to hold the spectacle lenses in required position well.
  3. Frame with correct vertical height should be chosen so as to cover the eye and peripheral orbit of child completely.
  4. The material should be corrosion free.
  5. Of-course, it should have good acceptance by the child than the good cosmetic appearance as decided by the parents.
  6. Well fitted lens (larger lens size than the eye wire) to prevent popping out of lens from spectacle
  7. Flexible temples.

 

Dispensing spectacle in children is different from dispensing spectacle in Adults in many ways

  1. Frame criteria
  • Less than 4 years children need flexible frames since nasal bridge is not developed.
  • Middle level bridge is better – gives good upper and lower field coverage.
  • Comfortable frames not restricting children’s daily activities.
  • Rimless or half rimlees frames are best avoided.

 

  1. Frame Material:
  • For children less than 4 years, Soft malleable plastic, flexible with adjustable elastic band are advisable.
  • Plastic frames are advisable for children, to prevent possible injury from metal frames and also to prevent Corrosion.
  • Plastic frames are also more durable.

 

  1. Bridge:
  • Bridge should be such that it fits on child’s nose comfortably. Bridge should not too wide or too narrow allowing child to peep from above frame.

 

  1. Temple:
  • Temple of any frame selected should follow the mastoid region smoothly, so that it holds the frame front in position. Temple should not be too tight or loose, since it may get uncomfortable for children. Same holds true for Adults as well.

Lens Criteria:

 

  1. Lens Material
  • For children it should be Fibre lens (Also known as Colombia resin 39 / CR-39)
  • Polycarbonate lenses can also be used. They are more expensive and tougher, hence advised in patients who are one eyed.
  • Strictly NO to glass lenses.

 

  1. Lens Centration:
  • Lens centration should coincide with the pupil centration

 

  1. Lens selection:
  • Anti reflective coating and /or High index lenses are necessary for greater than 4 dioptre lenses only.
  • Bifocal lenses (Executive bifocal) in children should have larger lower segment. They are expensive, more difficult to make and may need different/special frames so that there is a large upper as well as lower segment.
  • Progressive lenses when prescribed in children should be selected carefully due to wide range of designs. Progressive lenses in children should have wide corridor to accommodate correction of long distances, intermediate and reading activities comfortably.
  • Centration plays a very important role in progressive lenses.
  • Phototgray lenses are advisable for children sensitive to light or who are on atropine drops to prevent myopia progression.

 

  1. Lens care:
  • Although most of the fibre lenses come with scratch resistant coating, they cannot be completely scratch proof.
  • Position and amount of scratches, lens pit or chipped off lenses matters since they can result in blurred vision if present at center of lens. Such lenses should be changed.
  • To avoid scratching of lenses, it should be wiped with Soft cloth (microfiber) provided by optician.
  • When spectacle is not being used, it should be kept in frame case, with lens facing upward.
  • Oily marks, Finger smudges can be cleansed easily with the solution available at opticians.

Summary – The IDEAL pediatric spectacle

THE SPECTACLE DISPENSING FOR CHILDREN AT JYOTIRMAY EYE CLINIC FOLLOW THE GIVEN CRITERIA TO PROVIDE IDEAL SPECTACLE TO EVERY CHILD

Criteria for ideal spectacle frame and spectacle lens in children by Dr Mihir KothariKothari M, Darji KB, Bhagat P. Quality of spectacles in school going children in urban India. Indian J Ophthalmol 2014;62:258-9
Spectacle frame criteria
Four point touch test All four points on the spectacle frame (two points from each side of eye wire and one each from temple) should touch the flat surface simultaneously when placed as shown in Figure 1b
Eye wire Should cover both the eyes completely all around permitting the patient to view from the spectacle in various ocular positions and head positions without coming in contact of periocular skin
Nose pads They should sit symmetrically on the lateral side of the nose bridge and it should be angled in a manner that prevent repeated slippage or excessively close placement of spectacle lens resulting in eyelash brushing the lens or repeated oil/sweat drop-lets from eye brow fogging/smudging the lens
Temple
Parallelism The temples should be parallel to each other
Pressure There should be mild, uniform and symmetric pressure of the temples on the forehead without causing serious imprinting on the skin. A metallic component of the temple should not come in contact of skin
Length The temple should not project more than 2 mm out beyond the mastoid bone
Spectacle lens criteria
Centration error in millimeters (mm) The optical center should be within 2 mm of visual axis
Power error in D ≤0.25D
Axis error in degrees ≤5°
Surface quality The surface should have to fractures/pitting/scratches in the center of the lens

TV Watching Guidelines for children click here

To get the spectacle prescribing guidelines for children  CLICK HERE

 

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Last updated 8th May, 2017
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Dr Mihir Kothari

Director, Jyotirmay eye clinic

drmihirkothari@jyotirmay.com