1. World Congress on Refractive Error
Durban 2007
Paediatric Dispensing
David Wilson
ICEE Australia
Diagrams by:
•D Wilson
•OTEN

2. What Is Paediatric Dispensing?
• Babies to mid teens
• Young children, 4 - 11

3. What Makes Paediatric
Dispensing Different?
• More fun
• The duality of the client
• The larger difference between face and
spectacle durability
• Time

4. History of Children’s Eyewear
Until 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. History of Children’s Eyewear
but now
We have designer frames and lightweight lenses
More children are wearing spectacles
* testing younger
* more screening
Changing image of spectacles
Seen more and more as a fashion accessory
Many of their heroes wear spectacles

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. Age Differences
• Younger children (up to about 8 or 9) less likely
to want spectacles
• Teens are more likely to recognize spectacles
as an accessory
When is a child not a child?
• When he or she says so!
• Have some small sizes on your adult display

8. Frames - Technical
Young children do not have
a developed nose
Characteristics of good kids’ frames
* lower crest

9. Frames - Technical
Young children do not have
a developed nose
Characteristics of good kids’ frames
* larger frontal angle

10. Frames - Technical
Young children do not have
a developed nose
Characteristics of good kids’ frames
* larger splay

11. Frames - Technical
Young children do not have
a developed nose
Characteristics of good kids’ frames
* flatter pantoscopic tilt

12. Frames - Technical
Young children do not have
a developed nose
Characteristics of good kids’ frames
* ability to shorten sides
* spring hinges

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. 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. 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. 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. Lenses - Technical
The 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. Lenses - Polycarbonate
Refractive index: nd = 1.586
Abbe number: d = 31
Specific gravity: 1.20 gm/cubic cm

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. Lenses - Prioritizing Conflicting Needs
• Fashion versus durability
• Comfort versus durability
• Safety versus durability

21. Lenses - Prioritizing Conflicting Needs
•Take the emphasis out of durability
•Fashion- a child is more likely to wear frames
they like than a sturdy frame
•In modern frames fashion and durability are
not mutually exclusive

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. Lenses - Sport

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. 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. 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. 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. Communicating With Kids
Use humor - e.g.“What’s the cleaning cloth
for?”
“What’s your shirt for?”
Keep it light - joke with them
Speak to them at their height - for little children,
sit on the floor with the child’s parents

29. The Kids’ Corner
Have a special display designed
It should
• be colourful
• have mirrors at different heights

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. Teaching Kids
Kids are use to being taught how to clean
their teeth by dentists
Optometrists and opticians should teach how to
care for their spectacles

32. Measurements
PDs
• 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. Measurements
Centres
• as close as possible to geometric centres
• principal axis/ centre of rotation rule

34. Measurements
Bifocals
• segs set on pupil centre
• use a pre marked
dummy lens

35. Practice Building
Clients for life
Parents and friends
Extra special service now is a good
investment for the future

36. THE END