david willson paediatric dispensing
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Paediatric Dispensing
David WilsonICEE Australia
Diagrams by:•D Wilson•OTEN
World Congress on Refractive ErrorDurban 2007
What Is Paediatric Dispensing?
• Babies to mid teens
• Young children, 4 - 11
What Makes Paediatric Dispensing Different?
• More fun
• The duality of the client
• The larger difference between face
and spectacle durability
• Time
Until around 1990s children were rarely given much thought Opticians had little to offer
* frames were black or brown (or pink), two tone or full colour
* lenses were toughened glassSpectacles were still largely considered as medical
appliances (for children)Children were treated as miniature adults
Possession of adults
History of Children’s Eyewear
but nowWe have designer frames and lightweight lensesMore children are wearing spectacles
* testing younger* more screening
Changing image of spectaclesSeen more and more as a fashion accessoryMany of their heroes wear spectacles
History of Children’s Eyewear
But• Children are no longer content to wear
what their parents tell them
• More demanding and brand conscious
History of Children’s Eyewear
Age Differences
• Younger children (up to about 8 or 9) less likely to want spectacles
• Teens are more likely to recognize spectacles as an accessory
When is a child not a child?
• When he or she says so!
• Have some small sizes on your adult display
Frames - Technical
Young children do not have a developed nose
Characteristics of good kids’ frames * lower crest
Frames - Technical
Young children do not have a developed nose
Characteristics of good kids’ frames * larger frontal angle
Young children do not have a developed nose
Characteristics of good kids’ frames * larger splay
Frames - Technical
Young children do not have a developed nose
Characteristics of good kids’ frames* flatter pantoscopic tilt
Frames - Technical
Young children do not have a developed nose
Characteristics of good kids’ frames
* ability to shorten sides
* spring hinges
Frames - Technical
• Over 95% of frames dispensed to children are metals• Make sure that the frames have no sharp edges
and fit the above requirements• Titanium is an ideal
material for kids
Frames - Metal Majority
Face shape theory
• Soft curves for square faces
• Angular shapes for round faces
• Short face - shallow frameColour matching
Overriding consideration - be guided by the child
Frames - Fashion
Match width• avoid the desire to supply frames that
• they can “grow into”Too wide means
• easily knocked off• optical considerations such as aberrations
and thickness• kids will reject oversized frames
Frames - Fashion
• Kids normally know what they like and are very honest
• They rarely have preconceived ideas about their image
“We’re going to try everything on that fits you”
• Use terms like that looks cool or cute (relate language to age) and be honest
• Ask them “does this go in the good pile or the bad pile?”
Frames - Selection
The ideal lens should be
11 Impact resistant
22 Light and comfortable
33 Able to cut out ultra violet
44 Relatively thin
55 Relatively durable
Lenses - Technical
Refractive index: nd = 1.586
Abbe number: d = 31
Specific gravity: 1.20 gm/cubic cm
Lenses - Polycarbonate
• Able to withstand a speeding bullet
• Able to fall from tall buildings with a single
bounce
• More powerful than a locomotive
• Almost kid proof
Lenses - Impact Resistance
• Fashion versus durability
• Comfort versus durability
• Safety versus durability
Lenses - Prioritizing Conflicting Needs
•Take the emphasis out of durability
•Fashion- a child is more likely to wear frames
they like than a sturdy frame
•In modern frames fashion and durability are
not mutually exclusive
Lenses - Prioritizing Conflicting Needs
• Comfort - children will not wear frames that
are uncomfortable
• Again modern frames are also comfortable
• Safety - a critical issue
What is more important, eyes or spectacles?
Lenses - Prioritizing Conflicting Needs
Lenses - Sport
• Scratched lenses lose their impact resistance
• Lenses should be changed regularly
British standard BS6625 has two grades for children’s frames
• Grade B metal for younger children are not expected to last more than one year
Lenses - How Long Should Spectacles Last?
“Can’t consent to the practitioner’s
negligence” OLA
“Is CR39 too fragile for children?”
The Optician (England)
Lenses - Duty to Warn (duty to inform)
• Try to judge whether the parents are dominant
If they are use phrases like
“You need to like the frame but mum and dad need to like it too, they have to look at you”
• Have a quiet word with the dominant parent and point out the need for children to be involved
• If the parents are OK speak to the child
Treading the Fine Line
Kids like rules e.g. “Use two hands and lift up over your ears”
Use rhymes e.g. “When they’re not on your face they live in their case”
Use questions e.g. “Why don’t you put your glasses down on their lenses?”
Communicating With Kids
Use humor - e.g.“What’s the cleaning cloth
for?”
“What’s your shirt for?”
Keep it light - joke with them
Speak to them at their height - for little children,
sit on the floor with the child’s parents
Communicating With Kids
Have a special display designedIt should • be colourful• have mirrors at different heights
The Kids’ Corner
• Sit next to the child with the parent behind the child, looking into the mirror with the child
• Have the toy box a little to the side (to amuse siblings)
• Give small gifts (balloons, small soft toys etc.)
The Kids’ Corner
Kids are use to being taught how to clean
their teeth by dentists
Optometrists and opticians should teach how to
care for their spectacles
Teaching Kids
PDs• older children - pupillometer• younger children - PD rule• very young children
(or strabismus cases) PD rule (inner to outer canthus)
• involve the child in the task
Measurements
Centres• as close as possible to geometric centres• principal axis/ centre of rotation rule
Measurements
Bifocals
• segs set on pupil centre
• use a pre marked dummy lens
Measurements
Clients for life
Parents and friends
Extra special service now is a good
investment for the future
Practice Building
THE END
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