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A youngster in your chair means talking with two patients about glasses
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HIGHLAND, CALIF. - Dispensing a safe, quality pair of eyeglasses and frames to children means discussing all options with the child and parent, offering a wide selection of frames and then tailoring the glasses to meet the child's needs.
"You don't treat children any differently than adult patients," said Pamela J. Miller, OD, JD, in private practice here. "You do have a moral and ethical responsibility to try to protect children a little more, but you end up with two patients - child and parent - and you must keep both in mind when you dispense glasses."
While taking the patient's history, Dr. Miller learns what activities the child is involved in that may affect her recommendations when it comes to eye wear. Regardless of what she learns about the child's activities, there is one aspect that does not change in her practice - all children are prescribed polycarbonate lenses.
Children need polycarbonate
"It's polycarbonate for a child unless the parent says he or she doesn't want polycarbonate," she said. "If the parent says no, that's documented in my files. The only exception I would consider is a pair of reading glasses."
Selling the safety of polycarbonate lenses to parents is fairly easy, Dr. Miller said, but she finds that most "really respond to the [manufacturer's] 2-year warranty on scratches or other problems."
She emphasizes the advantages of polycarbonate to her patients. "When I present polycarbonate, I say this lens is thinner, lighter, keeps out virtually all ultraviolet light and is substantially safer than any other lens material," Dr. Miller said.
The optometrist's job, she said, is to let the child and parent know "why you think this material is most suitable for them." Dr. Miller said there is no age at which she no longer recommends polycarbonate or any lens material, but noted that until a child reaches the age of 18 and is legally considered an adult, optometrists must be aware of their liability when dispensing lenses.
"You need informed consent from the parent. If you know the child plays a sport and you do not make a recommendation reflecting that, you open yourself up to liability," she said.
Thomas P. Fefer, head of the Center for Dynamic Training in Santa Barbara, Calif., echoes Dr. Miller's stance on polycarbonate lenses for children. "I make a flat-out recommendation that all children should wear polycarbonate," Mr. Fefer said.
He also recommends that optometrists take advantage of programs from Prevent Blindness America, the Better Vision Institute and Vision Council of America that offer information on dispensing eyeglasses to children, the advantages of polycarbonate and how to prevent eye injuries.
"The downside is that polycarbonate scratches more easily than other lens materials, and, in some cases, that's a major objection," Mr. Fefer said. "We answer this objection with the assurance that polycarbonate lenses are fully warranted against scratching for 2 years. This becomes a moot point because the majority of children will be dispensed new frames and lenses before this warranty even expires."
Ask about sports
Learning if a child plays sports and what sports are played is fairly easy, Dr. Miller said. "Children react immediately. If you ask them what they do outside of school, they'll tell you right away they're a catcher for little league or an ice skater or a soccer player," she said.
Children who play sports not only need polycarbonate lenses, Dr. Miller said, but they need frames tailored to their sport. For example, she might recommend RecSpecs for children who play baseball or softball, and ScubaSpecs or swimming goggles for children involved in swimming or water sports. Children who play golf may be candidates for contact lenses.
But if a parent is reluctant to buy a separate pair of sports glasses for a child, her job then is to recommend frames that are durable. "Usually, sports frames are made of some form of plastic or have a nylon component so they have rubber padding, bend more easily and provide greater resistance to breakage," she said.
According to Mr. Fefer, advances in today's metal frames have all but eliminated the need for parents to choose between plastic and metal frames for a child. "There used to be a myth that plastic frames were the only ones safe for children," he said. "That is no longer true. We want a frame that's strong and well made, whether the frame is metal or plastic."
Areas to inspect closely, he said, are the bridge, end piece and hinge, nose pads and nose pad arms. "Make sure the welding is proper and strong," Mr. Fefer said, "because these areas get the most abuse during the rough and tumble life of a child."
Dr. Miller also emphasizes to parents that there must be a lens in the sports frame. "A frame of and by itself does not offer appropriate safety and protection," she said. "It's important when discussing sports frames with parent that you make certain there is a lens in the frame."
Offer children, parents choices
Optometrists who want to dispense lenses and frames to children should consider several factors, Mr. Fefer said, such as frame selection, designating an area for children and promoting this aspect of the practice.
"From a dispenser's point of view, you need a variety of frames to meet the sizing requirements for children. If you're serious about pediatrics, devote about 25% of your frame board space to children. That's not an unreasonable amount," Mr. Fefer said.
Dispensers should also look for frame companies that offer more than one frame size in a particular style in order to have more than one or two temple length options for children. "Many children do not have long temples, so having several frame sizes will help you fit the child properly," he added.
Other frame features that enhance safety for children, he said, include a spring hinge, a split hinge and a comfort cable temple, also referred to as a coil temple.
"As a rule of thumb, a child's frame should have a spring hinge. These can preserve a frame's adjustment and might even prevent some kinds of breakage because the temple gives a little bit on the spring," Mr. Fefer said. A split hinge, he noted, is a bonus on a child's frame because if one screw becomes loose or falls out, the hinge is constructed in such a way that the other screw will hold the eye wire rim shut.
A comfort cable temple, which has a soft coil that wraps around the child's ear instead of coming straight back, offers another safety feature because it helps glasses stay in place.
Children need UV protection
Another area not overlooked by Dr. Miller or Mr. Fefer is the issue of ultraviolet (UV) protection in children's eyeglasses. Both agree that UV protection is an important component of dispensing glasses to children.
"I feel strongly about UV protection for children," Mr. Fefer said. "It's clear that UV damage to the eye is cumulative over the lifetime of a person, so the earlier we can filter UV from the lens of the eye, the more protection we afford a child."
Polycarbonate material already offers UV protection, he said, but if a parent chooses to go with a CR-39 lens, he will recommend that a coating be added to the lens to give the child complete UV protection.
Mr. Fefer also advocates sunglasses for children who, on average, spend more time outdoors than adults and need protection from exposure to bright sunlight. "If children wear good sunglasses, they're also getting protection from any impact to the eye," he said.
Dr. Miller said if a child is involved in an outdoor sport, UV protection is important. "I often use the phrase `as you know' with my patients in explaining that UV light is harmful and that a child may be at greater risk," she said. "It's important to give parents a reason for what you're recommending, especially if they want to spend extra money above what a managed care plan will cover."
League rules may differ
One twist to dispensing glasses to children who play sports, Dr. Miller said, is trying to work within the limits of league rules or a coach's rules that may actually prohibit protective eye wear.
"League rules differ, and some will require individuals to wear appropriate eye protection, but few have this rule in writing," Dr. Miller said. "In our area, I have a problem with the sport of water polo, which disallows individuals from wearing goggles."
As difficult as this may be to believe, she said, coaches won't allow players - often high school students - to wear goggles because "in their words, they could be used to injure another player when playing water polo."
Dr. Miller said, "I find it very frustrating when you find a sport in which, through ignorance I believe and not maliciousness, the coach or league says that you will not wear protective eye wear."
Despite the support of parents who would prefer their children wear eye protection, Dr. Miller said, there is little recourse for parents or children.
"Most parents won't say that their child simply won't play that sport, and they decide to live with the rule," she said. "Most of the time, we're talking about high school sports, where's it's competitive, and the child is confident, so it's not easy for a parent to say no."
For Your Information:- Pamela J. Miller, OD, JD, can be contacted at 6836 Palm Ave., Highland, CA 92346-2513; (909) 862-4053.
- Thomas P. Fefer, can be contacted at 6110 Manzanillo Dr., Santa Barbara, CA 93117; phone/fax: (805) 967-8897. Neither Dr. Miller or Mr. Fefer has a direct financial interest in any of the products mentioned in this article, nor is either a paid consultant for any company mentioned.
- Prevent Blindness America can be contacted at 500 E. Remington Rd., Schaumburg, IL 60173; (708) 843-2020; fax: (708) 843-8458.
- Vision Council of America can be contacted at 1655 North Ft. Myer Dr., Ste. 200, Arlington, VA 22209; (703) 243-1508; fax: (703) 243-1537. Better Vision Institute can be contacted through the Vision Council of America.