PEDIATRIC DISPENSING

AUTHOR
David Wilson: Brien Holden Vision Institute (BHVI), Sydney, Australia

PEER REVIEWER
Mo Jalie: Visiting Professor: University of Ulster, Varilux University in Paris

THIS CHAPTER WILL INCLUDE A REVIEW OF:

 Uniqueness of Pediatric Dispensing

 History of Children’s Eyewear
 Frame
 Lenses
 Measurements

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UNIQUENESS OF PAEDIATRIC DISPENSING

There are several aspects of dispensing children that make the experience unique. These include the following:

 It can be fun dealing with children.

 The duality of the client; where you are essentially dealing with two clients who are often in conflict about what
they want. That is, the child and his/her parents.

 The tendency of children to be rough in their handling of spectacles.

 The need for greater chair time.

HISTORY OF CHILDREN’S EYEWEAR

Until around the 1990s, children were rarely given much thought where dispensing was
concerned. Opticians had little to offer.
 Frames were black or brown (or pink), 2-tone or full colour.
 Lenses were toughened glass.
PAST
Children’s spectacles were considered to be nothing more than a medical appliance and
there was little consideration given for appearance.
Children were treated as miniature adults. They were required to do as they were told or at
least, that is how parents saw the relationship between the optician and the child.

While children, in the past, were often resistant to wearing spectacles because they felt
different from their peers, today, it is more socially acceptable due to the increase in the
number of children who are wearing spectacles. There are now designer frames and
PRESENT lightweight lenses designed specifically for children. There is more screening at schools and
there is more testing available from a younger age.
The image of spectacles has changed, with them being seen more and more as a fashion
accessory. In addition, many child heroes make wearing spectacles trendier.

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FRAME

Young children do not have a developed nose.

Characteristics of a good child’s frame include:
1. A lower crest: The crest is the dotted line shown in Figure 29.1A.
2. Larger frontal angle: The frontal angle, sometimes known as, the “nasal” angle is the
slope shown by the dotted line in Figure 29.1B.
3. Larger splay: The splay can be seen from above and is shown by the dotted line in
Figure 29.1C.
4. Flatter pantoscopic tilt: the degree to which the side of the frame is tilted with respect
to the lens is flatter in a child’s frame (Figure 29.1D).

TECHNICAL
CONSIDERATIONS

Figure 29.1A: Lowered crest Figure 29.1B: Large frontal angle

Figure 29.1C: Large splay Figure 29.1D: Flatter Pantoscopic tilt

5. The ability to shorten sides.

6. Spring hinges to allow for children taking their spectacles off with one hand and general
hard wear.
Over 95% of frames dispensed to children are metal. It should be ensured that the frames
METAL MAJORITY have no sharp edges and fit the above requirements. Titanium is an ideal material for
children as it is strong, durable and holds its adjustment well.
The same cosmetic principles that are applied to dispensing adults can also be applied to
FASHION
the dispensing of children.
Square faces: Soft curves
Round faces: Angular shapes
FACE SHAPE Short face: Shallow frame
THEORY Colour matching: Consider skin colour
The over-riding consideration is to be guided by the child. They will only wear spectacles
they are happy with.
Avoid the desire to supply frames they can “grow into”.
Too wide means that:
 they are easily knocked off
MATCH WIDTH
 optical quality is compromised e.g. aberrations are increased
 lens thickness is increased
Children will reject oversized frames just as they are likely to reject oversized clothes.

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LENSES

The ideal lens should be:

1. Impact resistant
2. Light and comfortable
TECHNICAL
3. Ultra violet resistant
4. Relatively thin
5. Relatively durable

The ideal materials for children are:

Polycarbonate
Refractive index: nd = 1.586
Abbe number: nd = 31

IMPACT Specific gravity: 1.20 g/cm3

RESISTANCE

Trivex
Refractive index: nd = 1.530
Abbe number: nd = 45
Specific gravity: 1.11 g/cm3

 Should not fit too tight as this reduces impact resistance.

 Ensure back safety chamfer does not have sharp edges (Figure 29.2).

FITTING
REQUIREMENTS
POLYCARBONATE
AND TRIVEX

Figure 29.2: Wideback safety chamfer

Parents are often concerned with durability, however there are more important concerns with
spectacles for children. Safety being one and cosmesis another, a child is much more likely
PRIORITIZING to wear a frame because they like it than because of its sturdy characteristics.
CONFLICTING
NEEDS When selecting a frame for a child, emphasis should be given to the more critical concerns,
notably what will ensure the child wears the spectacles and what will ensure safety is
maintained.

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LENSES (cont.)

“Polycarbonate lenses should be considered the lens of first choice if the client is a child,
toddler or active teenager”. Opticians Association of America
National Society to Prevent Blindness warns that glass and ordinary plastic lenses do not
SPORT provide enough protection for children involved in active sports.
Polycarbonate “sports specs” – are advised for all children involved in sports such as
basketball, squash etc.
Note: Trivex was not available at the time of these quotes.

Children’s spectacles should be changed regularly. Scratches will reduce impact resistance
LASTING DURATION and impair vision.
OF SPECTACLES British standard BS6625 has two grades for children’s frames; grade A and grade B.
Grade B metal for younger children are not expected to last more than one year.

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MEASUREMENTS

 For older children use a pupillometer.

 For younger children use a PD rule.
 For very young children or for
PDS strabismus cases use a PD rule
measuring from the inner to the outer
canthus (Figure 29.3).
 Involve the child in the task.
Figure 29.3: PD measurement
Centres should be as close as possible to the geometric centres, using the principal
axis/centre of rotation rule (Figure 29.4A). That is, dropping the optical centre 1 mm below
the pupil centre for every 2 degrees of pantoscopic tilt (Figure 29.4B).

CENTRES

Figure 29.4A: Coinciding the optical
centres with the geometrical centres
 Segs set on pupil centre.
 Use a pre marked lens insert.
Figure 29.4B: Dropping optical centre
1 mm below pupil centre for every 2º of
pantoscopic tilt

BIFOCALS

Figure 29.5: Markings around pupil centre

SUMMARY

Children are less compliant than adults when it comes to spectacle wear. It is vital that children wear spectacles that
have been prescribed for them so that they avoid long-term visual problems and/or hindrance to their development.
Paediatric dispensing therefore, requires special consideration.

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