Dispensing to children holds great responsibility. As Virgilia Readett explains, fitting kids is not just dispensing aids for their vision, but providing them with interventions to support their visual, academic, and social development.

WRITER Virgilia Readett

To set up the dispense and the children’s wearing experience for success, tailored and thoughtful frame selection is needed. Various factors need to be considered for an ideal frame choice.

FRAME DESIGN

Children are not small adults. Their facial features are still developing; hence different considerations are required when it comes to frame design and features.

Anatomically, children’s noses are flatter, with an underdeveloped bridge. To ensure optimal fit and positioning, children’s frames should have a lower crest, larger frontal angle, and larger splay.

Dr Alicia Thompson, Research Director at the Association of British Dispensing Opticians (ABDO), explained, “A small adult frame will have incorrect parameters for a child, often with the bridge set too high and too narrow in width. This results in a lack of contact around the bearing surface, causing the frame to slide forward until it finds some anchorage, often at the nasal bulb (regardless of side length) and the child will end up looking over the top rim of the frame.”

Fiona Anderson, a dispensing optician and the Master of the Worshipful Company of Spectacle Makers (WCSM) in the United Kingdom, said frames typically rest very low on children “as the bridge of their nose is not properly formed until around puberty”.

“Typically, a well-fitting frame will have the bridge and lugs running along the horizontal centre line to enable the frame to sit up and for the child to be able to look through the lenses rather than over them.”

Children’s frames come with a range of bridge options to meet optimal fit and comfort needs. For example, built up nose pads or adjustable silicone insert bridges on both plastic and metal frames will meet the anatomical needs of children’s flatter noses and underdeveloped bridges.

FRAME SIZE

For the intended prescription intervention to be its most effective, children need a suitable optical appliance for their current size. The width of the frame, for example, should match the width of the child’s face. If too big, the frame will be less stable in terms of fit, with unnecessary extra thickness and weight. As well, optical aberrations may be present in the lens.

Children have relatively small heads compared to adults, necessitating a shorter temple length to bend. Many children’s frames come with temple tips that can be tailored by shortening, which avoids an excessive angle down behind the root of the ear.

Dr Thompson emphasised the importance of well-fitted frames, “if the fundamental fit is incorrect, the prescription will not be as intended, or the desired intervention is not maximised at such a critical time in a child’s development”.

FRAME MATERIALS

Children are discovering and experimenting with their world and the items in it. This can mean that they tend to be rougher on themselves, others, their belongings, and the belongings of others. Glasses are no exception.

There will be accidents – whether this is due to general handling, tumbles and falls, or from other children in the playground. By proactively recommending sturdy, durable, and perhaps flexible frame materials, eye care professionals assist with the longevity of the frames. Fewer breakages mean more time for the frame to be worn on the face, and more time for the prescription intervention to be maximised.

Lana Arnold, co-founder of augie Eyewear, said all children’s frames in its range are made from acetate, “which is lightweight and available in interesting colours that appeal to kids”.

“Acetate is also great as it keeps its integrity and won’t lose its shape, unlike flexi frames. We’re loved for our silicone tip temples, these make wearing glasses more comfortable and can be adjusted by hand, by a dispenser, parent, or the wearer.”

Titanium frames are strong and lightweight – providing the benefit of comfort and resistance to breakage. However, they may not be suitable for very young children and babies due to the risk of injury from the dense hard surface and points.

LENS CONSIDERATION

Durability, safety, and comfort are not only considerations to make during frame selection, but in lens selection also. The ideal lens material for children’s spectacles must be suitable for their prescription requirements, while being impact resistant, thin, and light to ensure comfort, and have ultraviolet (UV) radiation protection.

Every child is different, but if we consider the general day-to-day activities of the average child, the argument for impact resistant lenses is strong. Of all the spectacle lens materials available in the current market, polycarbonate and Trivex lenses offer the highest level of impact resistance. Both materials meet the UV400 standards for UV protection without needing additional UV coatings.

While not the highest level of impact resistance, CR-39 still boasts good impact resistance and, with a UV coating, will meet the standards for UV400.

High-index plastics provide options to reduce thickness, and therefore weight, due to their high refractive index (density). High-index plastic categories have a higher impact resistance than CR-39.

Options are numerous for children’s sun protection depending on their lifestyle, age, and prescription needs. For convenience and a proactive approach, photochromic lenses are an ideal option for children. UV filters with sun tints or polarising filters can also be used, and are ideal when dedicated indoor and outdoor pairs are being dispensed.

As with dispensing to adults, children should be treated as individuals and dispensed what is appropriate for them. This is also true for antireflective and multicoatings. Consider their age, their disposition, and the primary activities they will be involved in when wearing their glasses. For some children, it will be appropriate to omit these coatings due to the risk of damage and the maintenance required. For others the lifestyle benefits will outweigh these risks.

WORKING WITH FAMILIES FOR SUCCESS

The success of the dispense starts with the dispenser. As a species we ‘co-regulate’. The mood and approach of the dispenser will make an impact on the child as well as their parent or caregiver. If you are relaxed this will rub off on your clients.

Talking to the child throughout the process will bring them on board from the beginning – increasing their compliance to wear the glasses. Explaining in language they will understand about what will be happening next, and what you are doing as you do it, will help them feel at ease.

Throughout the dispensing process, we need to ensure we are communicating with the parent or guardian also. We need to consider and balance their preferences and concerns with those of the child’s. A discussion prior to frame selection with the parent or guardian can help to navigate competing preferences between theirs and the child. This could involve explaining the importance of finding a frame that fits well, is comfortable, and will meet the needs of the prescription.

Given the specific fitting requirement for children’s frames, the best approach is to first consider the child’s face and prescription, and then to narrow the selection, showing only the frames that will fit and be suitable. This avoids having to recommend against pairs that do not fit well – a step that can be emotionally heightened if the child has taken a liking to the frame. For these reasons it is also important to stay with the family during the frame-selection process to guide their choice of frames. Ms Anderson’s advice for optical dispensers is to “Take a really good look at the child’s face, assess their crest, projection, head and temple width, and bring a selection that will fit them. Then you can, with some confidence, let them select from this selection and you know you will do a better job as their spectacles will be fit for purpose.”

Glasses are a big deal – especially for children. The collection should be a special occasion, with adequate time for careful adjustments and explanation of care for the glasses. Children may be less likely to voice if a frame is uncomfortable – instead they may not wear them or wear them incorrectly. This step, therefore, is of utmost importance.

CONTACT LENS OPTIONS

Compliance to correct wear and for the appropriate time is of vital importance.

This can be achieved by considering contact lens options also.

Like adults, children are individuals, who will have different preferences, maturity, ability, and motivations to try contact lenses.

Daily disposable contact lenses, such as MiSight1 day (CooperVision), offer options for myopia management while providing a convenient option with low maintenance for children who want a break from their glasses.

Various daily disposable options are available for hyperopic prescriptions also, such as Acuvue Oasys 1-Day (Johnson & Johnson). For high ametropic hyperopic prescriptions, contact lenses provide a convenient option to go glasses free, while also providing a wider field of view than spectacles. This is hugely beneficial for sporting activities for kids.

The most suitable contact lens option will be individualised to the child’s needs based on their prescription, age, lifestyle, and ability to comply with handling requirements. Depending on their prescription, daily contact lenses may not be available, which may lead to the need for fortnightly or monthly lenses.

Contact lenses provide safe and effective visual correction for children, as long as they comply with lens handling instructions. This makes the contact lens teach – for both parents and the child – imperative. Regularly checking in to ensure appropriate contact lens hygiene is being maintained is also important.

IT’S ALL IN THE SET-UP

First impressions count – for children as well. We need to build strong connections with a positive experience during the frame selection, dispense, collection and during contact lenses teaches. This will aid in compliance – and compliance is key to ensure the desired impact of the prescription. Have a look at the frame and lens options for children in the following pages.

Virgilia Readett is a Senior Trainer with the Australasian College of Optical Dispensing (ACOD). She holds a Certificate IV in Training and Assessment, a Certificate IV in Optical Dispensing and a Bachelor of Arts, majoring in Communications.

Ms Readett has been in optics since 2012 and has been teaching with ACOD since 2019.