Jyotirmay Eye Clinic

Dispensing of the spectacles in children is Different than in adults

Children have different facial and nasal structure hence the frames are different
Children have higher safety requirements hence the durability of frames and safety features of lenses are different
Children have different visual requirements hence their spectacle prescription guidelines are different

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

For children 3 4 years of age MiraflexTM is the best however inform the optician to fit the lenses properly as they sometimes fall off
Half rimless total rimless frames are best avoided in children u2013 lens falling off chipping is common
Plastic frames are better than metal frames in terms of retaining good fitting for long
Silicon nose restspads are useful to reduce pressure imprints on the nose
Roundoval eye wire is better than the rectangular ones as it covers the eye
Middle level bridge provide better coverage while looking up as well as down than a hightop level bridge
A temple with side springs is useful as it provides excellent fit for very long

Avoid glass material as they have a low safety profile
CR39 plastic is cheaper compared to Polycarbonate material However polycarbonate is tougher
Anti scratch coating is highly recommended for all plastic lenses
Anti reflective coating andor high index lenses are necessary for 4diopter lenses only
Bifocal lenses in children must have a large lower segment exactly as shown in the picture They are expensive more difficult to make and may need differentspecial frames so that there is a large upper as well as lower segment
Opticians often make mistakes in making bifocals in children They apply their experience regarding adults in making those glasses for children Make sure you have informed them not to do so

Less than 4 years old need flexible frames since the nasal bridge is not developed
Middle level bridge is better u2013 gives good upper and lower field coverage
Comfortable frames not restricting childrenu2019s daily activities
Rimless or half rimlees frames are best avoided

Bridge should be such that it fits on the childs nose comfortably Bridge should not be too wide or too narrow allowing the child to peep from above the frame

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

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

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

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 a larger lower segment They are expensive more difficult to make and may need differentspecial 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 a wide range of designs Progressive lenses in children should have a wide corridor to accommodate correction of long distances intermediate and reading activities comfortably
Centration plays a very important role in progressive lenses
Photogray lenses are advisable for children sensitive to light or who are on atropine drops to prevent myopia progression

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 the center of lens Such lenses should be changed
To avoid scratching of lenses it should be wiped with Soft cloth microfiber provided by the optician
When spectacle is not being used it should be kept in a frame case with the lens facing upward
Oily marks Finger smudges can be cleansed easily with the solution available at opticians

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 oilsweat drop lets from eye brow foggingsmudging the lens

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
Parallelism	The temples should be parallel to each other
Parallelism	The temples should be parallel to each other
Parallelism	The temples should be parallel to each other
Parallelism	The temples should be parallel to each other
Parallelism	The temples should be parallel to each other