CR Labs
The role of the optical dispenser in paediatric dispensing is crucial, both for the child’s vision and for setting them up for future success and growth.
By taking accurate measurements, ensuring the best lens and frame fit possible, and by making appropriate adjustments, we can be confident in our dispense. If we fail in any of these areas, we can cause more harm to the child.
Dispensing for children is like dispensing for a team. If you view it as such, you can build a rapport with not only the child, but the family too.
It is our job to create a welcoming and open atmosphere that can be engaging and educating, including for the parent or caregiver. It is through communicating and educating parents – allowing them to become aware of certain topics they may not be aware of – that we can help them, so they can fully support the child.
It’s important to know that not many parents are aware their child may need glasses, especially if they don’t wear specs themselves. This means bringing a child into an optometrist and realising the extent of their child’s refractive error can sometimes be emotional. Often guilt surfaces for parents as they were unaware that their child couldn’t see as clearly as they had assumed.
It’s a new journey for all and without the correct help it can have a massive impact on the child’s comfort, facial growth, and vision at a crucial time of their life for their development and education.
Overall, there’s no better feeling as a dispenser than watching a young child put on their first pair of glasses and staring at their parent’s face. It doesn’t happen all the time, but when it does, it is magic.
TIMELY ADVICE
Although the optometrist does discuss the prescription and what it will be used for, as an optical dispenser, part of the duty of care is to give our customers the best possible advice. We may need to reinforce the messages of the optometrist, remembering this experience is often new to the family in front of us. You will need to convey what the correction is for, the testing distance, and any important communication that should accompany the refractive error. This will allow a smoother adjustment for the child, especially if they have high ametropia. This requirement can be challenging if the prescription is outsourced.
Parents need to be aware that it is incredibly important for some conditions, such as amblyopia, to be acted upon in a timely manner as there is a limited window to get the child to use the eye that’s beginning to lose function before irreversible functional loss or damage occurs.
ADVISING ON FRAME SELECTION
Although considerations for high ametropia and frame style are the same for children and adults in terms of determining where the thickness lies, it’s important to understand the face structure and additional needs of a child.
Generally, children are very active; having a poor fitting frame for these young children can affect their vision and comfort. If their spectacles are slipping constantly, it’s annoying. They’re not looking through their optical centre (OC), and the action of pushing up the frames can cause dirty lenses, again affecting their vision. The discomfort may cause them to dislike wearing glasses.
When it comes to choosing a frame for a baby or child, it’s not merely scaling an adult frame down to a smaller size. A child’s head can be up to one fifth of their body. Also, young children have not yet developed their bridge; it’s not until around six to eight years that the bridge/ nose tends to lift and become higher although this can vary depending on multiple factors, including ethnicity of the child. As a result, most children require a larger splayed bridge or a bridge with a lower crest. If the bridge is too narrow or the nasal design is deep; this can cause red marks, pinching, slipping and even cause damage to sinuses. Sometimes, a metal frame with nose pads can be a great option as it’s more universal in fitting comfortably on a nose and can be adjusted.
Although there are trendy, smart frame styles available, when fitting a child, remember that they tend to spend a lot of their time looking up, so having a lens sitting higher is ideal. This ensures their eyes are aligned with the OC or horizontal centre line (HCL). Otherwise, if the frames are sitting below eyebrow line, they may only be using a quarter of the lens and not looking through the OC, meaning they’re not getting their best vision from their lenses.
MEASUREMENTS
Children’s faces don’t necessarily develop symmetrically. This makes monocular pupil distance (PDs) incredibly important and always preferred, especially when considering amblyopia or strabismus.
Although it can be hard to measure PDs, especially in a child with special needs, it’s crucial to take these measurements correctly. This ensures the child receives their correct prescription and avoids creating other issues such as inducing prism. If high ametropia or amblyopia is present, the child will more than likely have an outside prescription and pupil distance to accompany this, but it’s best practice to also measure these pupils against what has been provided.
If unable to use a pupilometer, for example with very small children where it is simply not an option, measuring inner canthus on one eye to outer canthus on the other will suffice. Sometimes using a toy to distract the child can be useful in directing them where to look. Getting down to their level will reduce parallax errors.
LENS CHOICES
Trivex or polycarbonate lenses are preferred materials for children as they are highly impact resistant. They are also lighter and more comfortable, depending on the degree of amblyopia in the prescription, especially in comparison to Columbia Resin 39 (CR-39).
Equally important, trivex and polycarbonate lenses have UV protection, which is an important consideration as studies have shown that 50-80% of UV damage occurs before the age of 18.1 This UV damage can be from simply not having protection from any form of glasses but also because a child’s crystalline lens is more transparent, therefore allowing more short wavelengths of light to reach the retina.1 Parents may not consider UV damage to the eyes when discussing glasses, so it is important to arm them with the knowledge so they can make an educated decision.
Photochromic lenses, while reducing the amount of UV hitting the eye, also assist children with light sensitivities, headaches, or glare discomfort. They can also save the cost of sunglasses, and ensure the child doesn’t need to swap glasses throughout the day.
Antireflective coatings are strongly recommended as they allow light to travel through the lens at a faster rate. This significantly reduces surface reflection, optimising clarity for the child as they are not distracted by the surface reflection on the lenses. This can have a significant impact in the early years of school and the child’s level of confidence.
CREATING A SAFE SPACE
While I have focussed on the importance of communicating with parents, it is vital to include the child and give them your attention. Use age-appropriate language, encourage them to share their point of view, and actively listen to them. Get down to their level to maintain eye contact and be mindful of your body language.
Overall, your aim is to create a safe space so that both the child and the parent feel comfortable asking questions. Take your time with the family and explain your reasonings.
Rather than saying ‘I don’t like that frame’, explain why. Demonstrate what a good fit looks like and the consequences of choosing something you know will annoy the child.
Children are often not able to articulate what they feel, or what they see. Although some children may immediately see visual benefit from putting on glasses, many do not. Some may be emotional and overwhelmed. For some, it can take a while for the brain to ‘settle’ so they feel comfortable with their glasses.
Advise parents at the time of the dispense and pick-up that some love their glasses straight away, but others will want to take them off, and their child may become upset. Managing expectations and educating parents in a professional manner is vital to setting the child up for success.
Take the time, when the glasses are collected, to show the child and their parents how to take them on and off, and how to put them down so they can avoid scratches. Let them know that the glasses may need to be adjusted from time to time, particularly if the child has a growth spurt, to ensure they are sitting correctly and providing the child with optimal vision.
It’s incredibly important that the child is comfortable and happy with their glasses as it will promote compliance, which in turn will allow them to flourish in their education, development, and self-esteem.
Parents want to do the right thing by their children; as their child’s optical dispenser, you can really be there to support them in this.
Louise Walker is an optical dispenser, working for the Australasian College of Optical Dispensing (ACOD). She has worked in the optical industry since early 2014, completing her qualifications as an optical dispenser through ACOD, and becoming an in-store trainer and supervisor, before joining the team at ACOD in 2023.
Ms Walker acknowledges the following sources: ‘The Science and Art of Paediatric Dispensing’, a webinar by Fiona E. Anderson; President of International Opticians Association, presented on 4 April 2022; and Wilson, D.A. and Daras, S., Practical Optical Dispensing, 3rd edition, Open Training and Education Network, 2014.
Reference
- Webinar ‘Effective myopia management’ presented by Ulli Hentschel; National Training and development manager at Hoya. Available at: odamembers.com.au/webinar-library [last accessed 29 Nov 2023].
Frames for Your Littlest Patients
Nano Baby
Nano Baby frames are designed so children aged 0–4 years can enjoy their first glasses without worries. Flexible, non-toxic, adjustable, adaptable, and ergonomic: these are just some of the many features of Nano Baby.
Each frame is supplied with two headbands for optimal security and fit.
Contact: Aviva and Mann Optical (AUS) 1300 850 882
Active Frames
Active Frames by CentroStyle are suitable for children aged between 0–14 years. For early childhood, Active Soft frames are designed for children aged 0–3, and are made of lightweight, soft, safe materials, often without metal parts, to allow freedom of movement while keeping the correct optical centre. For this reason, each frame is supplied with a cord.
Contact: Aviva and Mann Optical (AUS) 1300 850 882
Police Junior
Police Junior offers two frames designed for young children, with style and functional benefits calibrated to the young audience. The ultra-light and resistant frame features bright tones in the rubber end tips and nose pads for a comfortable and stable fit. Unisex shapes are available in a range of colours.
Contact: De Rigo (AUS) 02 9428 1500
Instyle Kids
Comfort and affordability are top considerations when choosing frames for young and active patients. Opticare offers different frame options that are specifically designed for children. Opticare champions the durability of its Instyle Kids collections.
Visit Opticare: https://bit.ly/3ejzkL0.
augie Eyewear
It’s easy to see why augie makes kids feel so happy to wear their glasses. With a range of amazing colours in simple styles that are sure to fit well, augie has all styles covered to let kids express who they are. For ages four and over.
Contact: augie Eyewear (AUS) 1300 391 440
Milo & Me
Milo & Me makes eyewear cool. With vibrant colours in durable lightweight frames that stand up to a kid’s rough and tumble world, they’re for cool kids.
Contact: Hilco Vision Australia (AUS) 1800 217 651
Planet Pop
Planet Pop is an eco-friendly brand, decreasing human impact on our environment by creating eyewear from bio-based materials derived from renewable, BPA-free plant-based resources.
The collection boasts unisex and simple designs, coupled with fun and playfulness at the heart of the brand, including O=MEGA23 Children’s frame of the year, Minke.
Contact: Little 4 Eyes (AUS) 03 9448 8932
Lipo Kids
Lipo Kids eyewear is designed for myopia control lenses to help address increasing myopia concerns.
With an expanded field of view, adjustable temples, and nose pads, Lipo Kids frames provide the perfect, comfortable fit for children.
Lipo Kids recently joined ZEISS in launching MyoCare myopia control lenses in Australia and New Zealand.
Visit: ryanadda.com
Beamers
Prevent UV-related eye disease in our kids by protecting their eyes with a quality pair of kids’ sunglasses, the same way we protect their skin with maximum protection sunblock.
All Beamers sunglasses have Optoshield technology for maximum UV protection so babies, toddlers, big kids, and adults are safe from the harsh rays of the sun. Beamers have a wraparound frame design to prevent unfiltered side light from entering the eye and lens coatings that prevent unfiltered light reflecting back into the eye.
Visit: beamers.com.au
Stepper Kids
Stepper Kids frames are designed and manufactured using empirical research into children’s developing facial features. Stepper Eyewear has worked closely with one of the world’s leading authorities of paediatric eyecare, Dr Alicia Thomson, to create frames that significantly advance and improve children’s eye care.
Stepper’s Alpha Fit range has four fit variants, identified as 0–4, 4–6, 6–8, and 8–10. Further customisation of frame parts to match the frame more precisely to the wearer are also possible.
Contact: Optique Line (AUS) 03 9853 0796
Paediatric Lenses
Rodenstock MyCon
The peripheral defocus areas in Rodenstock’s MyCon myopia control lenses are placed to the sides of the lens, where they slow the progression of myopia the most, leaving the main vision zones of the lens undisturbed for sharp vision.
An independent clinical study, examining myopia progression in Caucasian children over a period of five years, has shown that myopia control lenses based on the same principles as MyCon lenses are effective in reducing the progression of myopia.1
Whether a child is slightly or highly myopic, Rodenstock MyCon lenses help prevent further myopia progression. Available in index 1.5, 1.6, 1.67, and 1.74, MyCon lenses are both thinner and sleeker than many other myopia lenses on the market and well suited to high prescriptions. Also available tinted and with all Rodenstock coatings.
Contact: Rodenstock (AUS) 02 9748 0988
Reference
1. Tarutta E.P., Proskurina O.V., Tarasova N.A., et al., (2019) Long-term results of perifocal defocus spectacle lens correction in children with progressive myopia. Vestn Oftalmol.2019;135(5):46–53.
Opticare
Opticare’s innovative MyoEase and MyOnic lenses address the urgent need for myopia control. These lenses employ peripheral retinal defocus while maintaining sharp central vision for distance correction. MyoEase incorporates high-precision microtransparent pinholes in the mid-peripheral area, effectively slowing axial elongation. MyOnic
features a 10mm central single vision zone with a mid-peripheral positive defocus ring for easy adaptation during ocular movements.
These lenses are available in various materials and coatings, suitable for myopia up to -16.00D (MyoEase) and up to -20.00D (MyOnic), providing effective myopia management for young patients.
Contact: Opticare (AUS) 1800 251 852
Australis Kids Design
Australis Kids Design is a solution for daily use for children with accommodative convergence. In the past, when a child required visual aid for both distance and near zones, they either received a pair of bifocal lenses, or progressive lenses that were developed for presbyopic adults. Through extensive research, CR Labs has developed
a revolutionary progressive lens, specifically designed for children.
While adults stay in a more stable position and only move their eyes to look to the side, up or down, children are more active and move their heads around to look at objects in different positions and distances. Australis Kids Design is an ergonomic progressive lens design, created with our children’s unique behavioural norms in mind.
Visit: crsurfacing.com.au
MiyoSmart
The award-winning1 MiyoSmart spectacle lenses have been shown to slow myopia progression by 60% in children aged eight to 13.2 The findings of the six-year, long-term follow-up study proved the MiyoSmart spectacle lens myopia
control effect is sustained over time for children wearing the lens, with an average cumulative myopia progression less than 1.00D and axial elongation 0.6mm over six years in children that wore MiyoSmart for the duration of the study.3
It also confirmed that patients who stop wearing the MiyoSmart spectacle lens show no rebound effects.3
MiyoSmart solutions are now available in clear and sun options, to suit every child’s needs.
Contact: Hoya Account Manager
References
1. Winners of the exhibition’s grand prix. Inventions Geneva. N.D. Available at: inventions-geneva.ch/en/winners/ [accessed 20 Feb 2023]; Winners 2020. SILMO Paris. 2020. Available at: en.silmoparis.com/SILMO-d-OR/SILMO-d-Or-Awards/2020-Winners# [accessed 20 Feb 2023]; Winners Best Lens Design 2023. O=MEGA23, Melbourne. odma.com.au/odma-general-news/odma-2023awards-for-excellence-winners.
2. Lam, C.S.Y., et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104(3):363–8.
3. Lam, C.S.Y., et al. Long-term myopia control effect and safety in children wearing DIMS spectacle lenses for 6
years. Sci Rep. 2023;13(1):5475.
Essilor Stellest
Essilor Stellest lenses demonstrated significant myopia control in a two-year clinic trial. After this, extending the study for another two years gave results that demonstrated Essilor Stellest remained effective in the third and fourth year of wear, and that myopia control is sustained in older children (11–15years) over a four-year period.1
Contact: Essilor Account Manager
Reference
1. Li, X., Huang, Y., Bao, J., et al., Myopia control efficacy of spectacle lenses with aspherical lenslets: Results of a 3-year follow-up study. Am J Ophthalmol. 2023 Sep;253:160–168. DOI: 10.1016/j.ajo.2023.03.030. Epub 2023 Apr 10. PMID: 37040846.
MiSight 1 day
MiSight 1 day from CooperVision remains the only contact lens with United States Food and Drug Administration approval for slowing the progression of childhood myopia.
Now available in higher prescriptions, the range covers -0.25D to -10.00D (0.50D steps after -6.00D), allowing even more children to benefit from myopia management.
MiSight 1 day contact lenses are backed by the longest-running soft contact lens study among children.1 This extraordinary study also confirmed the overwhelming preference children have for contact lenses, giving optometrists the evidence to support their decision making and parental conversations.
Contact: CooperVision Account Manager
Reference
1. Chamberlain, P., Bradley, A., Young, G., et al.,. Long-term effect of dual-focus contact lenses on myopia progression
in children: A 6-year multicenter clinical trial. Optometry and Vision Science 99(3):p 204-212, March 2022. | DOI:
10.1097/OPX.0000000000001873.
NaturalVue by CLCA
NaturalVue (etafilcon A) Multifocal 1Day contact lenses are indicated for the correction of myopia, presbyopia, and myopia progression control.
The lens is a centre distance, extended depth of focus (EDOF) design, with +6D to +8D of relative plus power in the periphery. The high amount of rapid continuous plus power in the design creates the EDOF channel and defocus zones.
The design is easily adapted by the brain without sacrificing vision quality. For presbyopes, the lens delivers spectacle-level visual acuity and better stereoacuity. For myopes, the lens provides excellent vision and is proven effective in reducing myopia progression.
Contact: CLCA Account Manager
EyeSpace
The goal at EyeSpace is to make rigid contact lenses easy. Contact the EyeSpace team to book in a training session on Forge orthokeratology, or find out about EyeSpace Bespoke – daily wear right contact lenses with complete customisation to aid in the management of myopia.
Visit: www.eye.space
