David willson paediatric dispensing


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David willson paediatric dispensing

  1. 1. World Congress on Refractive Error Durban 2007 Paediatric Dispensing David Wilson ICEE AustraliaDiagrams by:•D Wilson•OTEN
  2. 2. What Is Paediatric Dispensing? • Babies to mid teens • Young children, 4 - 11
  3. 3. What Makes Paediatric Dispensing Different?• More fun• The duality of the client• The larger difference between face and spectacle durability• Time
  4. 4. History of Children’s EyewearUntil 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 glass Spectacles were still largely considered as medical appliances (for children) Children were treated as miniature adults Possession of adults
  5. 5. History of Children’s Eyewearbut now We have designer frames and lightweight lenses More children are wearing spectacles * testing younger * more screeningChanging image of spectacles Seen more and more as a fashion accessory Many of their heroes wear spectacles
  6. 6. History of Children’s Eyewear But • Children are no longer content to wear what their parents tell them • More demanding and brand conscious
  7. 7. Age Differences• Younger children (up to about 8 or 9) less likely to want spectacles• Teens are more likely to recognize spectacles as an accessoryWhen is a child not a child?• When he or she says so!• Have some small sizes on your adult display
  8. 8. Frames - Technical Young children do not have a developed noseCharacteristics of good kids’ frames * lower crest
  9. 9. Frames - Technical Young children do not have a developed noseCharacteristics of good kids’ frames * larger frontal angle
  10. 10. Frames - Technical Young children do not have a developed noseCharacteristics of good kids’ frames * larger splay
  11. 11. Frames - Technical Young children do not have a developed noseCharacteristics of good kids’ frames * flatter pantoscopic tilt
  12. 12. Frames - Technical Young children do not have a developed noseCharacteristics of good kids’ frames * ability to shorten sides * spring hinges
  13. 13. Frames - Metal Majority• 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
  14. 14. Frames - Fashion Face shape theory • Soft curves for square faces• Angular shapes for round faces • Short face - shallow frame Colour matching Overriding consideration - be guided by the child
  15. 15. 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
  16. 16. Frames - Selection• 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?”
  17. 17. Lenses - TechnicalThe ideal lens should be 1 Impact resistant 2 Light and comfortable 3 Able to cut out ultra violet 4 Relatively thin 5 Relatively durable
  18. 18. Lenses - PolycarbonateRefractive index: nd = 1.586Abbe number: d = 31Specific gravity: 1.20 gm/cubic cm
  19. 19. Lenses - Impact Resistance• Able to withstand a speeding bullet• Able to fall from tall buildings with a single bounce• More powerful than a locomotive• Almost kid proof
  20. 20. Lenses - Prioritizing Conflicting Needs • Fashion versus durability • Comfort versus durability • Safety versus durability
  21. 21. Lenses - Prioritizing Conflicting Needs•Take the emphasis out of durability•Fashion- a child is more likely to wear framesthey like than a sturdy frame•In modern frames fashion and durability arenot mutually exclusive
  22. 22. 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?
  23. 23. Lenses - Sport
  24. 24. Lenses - How Long Should Spectacles Last?• 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
  25. 25. Lenses - Duty to Warn (duty to inform) “Can’t consent to the practitioner’s negligence” OLA “Is CR39 too fragile for children?” The Optician (England)
  26. 26. Treading the Fine Line• 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
  27. 27. Communicating With Kids 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?”
  28. 28. Communicating With Kids Use humor - e.g.“What’s the cleaning cloth for?” “What’s your shirt for?” Keep it light - joke with themSpeak to them at their height - for little children, sit on the floor with the child’s parents
  29. 29. The Kids’ CornerHave a special display designedIt should• be colourful• have mirrors at different heights
  30. 30. 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.)
  31. 31. Teaching Kids Kids are use to being taught how to clean their teeth by dentistsOptometrists and opticians should teach how to care for their spectacles
  32. 32. MeasurementsPDs• 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
  33. 33. MeasurementsCentres• as close as possible to geometric centres• principal axis/ centre of rotation rule
  34. 34. MeasurementsBifocals• segs set on pupil centre• use a pre marked dummy lens
  35. 35. Practice BuildingClients for life Parents and friends Extra special service now is a good investment for the future
  36. 36. THE END