15 - prescribing glasses for kids and amblyopia treatment

What type of frames should you prescribe for an infant or toddler?

frame with no hinges that come with strap

what adjustments are useful for sunglasses for children?

1. magnetized sunclips

2. temples that can be switched with bands

What adjustment can be made to a frame for toddlers and preschool aged kids? What is the advantage?

cable temples:

-more difficult to take off

-stay on during rough play

What type of frames should be picked for a school aged kid?

1. durable frame → flexible material, spring hinges

2. something that the kids likes, over the parents choice

What should you never do when getting glasses for a child?

give them a larger frame so that the child can "grow into it"

When can kids start wearing adult frames?

around age 10

do kids need anti-reflective coating?

NO → gets dirty and not necessary because not doing activities with glare like driving

what are the risks of prescribing glasses for kids who are playing sports?

1. frame could break

2. nose-pad could get jammed into eye

What should you prescribe for a glasses wearing kid who plays sports?

prescribe sports goggles or consider contact lenses

What lenses should be used for kids?

polycarbonate or trivex → not optional

What type of lens should be used for a kid that needs a multifocal for first time?

flat top (unless older child who has been in multifocal for awhile)

Where should you fit the seg height for a kid with a multifocal?

higher than an adult bisect the pupil → position forces them to use bifocal power

write on Rx!!

what do you notice with wear for a kid with a multifocal?

see the child posture to use the seg when looking at near

which RE do kids more easily adapt to glasses with?

myopes!

hyperopes have trouble adapting because are cyclopleged when prescribed

How should you set the expectations for a child needing glasses?

explain magnification and anisometropia

For kids who absolutely need glasses but refuse, what are some techniques to get them to wear them?

1. cycloplege (if hyperopic)

2. put their glasses on when they are sleeping

3. swim floaties over elbow

reward system for older kids

what are some methods of occlusion?

1. cloth patch attached to frame

2. adhesive patch to stick on skin

3. Bangerter filters

4. 1% atropine

what are ways to keep cloth patch on glasses secure?

cut a slit on nasal side and temporal side to prevent peeking area

what can you recommend parents do if adhesive patch irritates skin?

press patch on own skin before sticking over child's eye to lessen adhesive

what can be used to prevent red irritated skin from adhesive patches?

1. moisturizers

2. whipped Vaseline

what are the advantages of Bangerter filters?

1. less cosmetically noticeable

2. removable

3. different filters create different amounts of blur

why does Bangerter filters only work with children who correctly use their glasses?

does not obscure peripheral vision

how to apply Bangerter filter to glasses?

cut to fit lens

stick on glasses with water

what must you confirm with Bangerter filters?

filter over good eye is WORSE than the vision with the amblyopic eye

what can you use for amblyopia treatment if child refuses to use glasses?

atropine

when does atropine work for amblyopia treatment?

will only blur a child at distance if they are hyperope without full cycloplegic correction

what must you confirm with atropine for amblyopia treatment?

vision with cycloplegia in good eye is WORSE than vision in amblyopic eye