L14 Paediatric Dispensing Flashcards
Things to consider
- communication
- prescription and vision
- lenses
- frames
- financial assistance - nhs voucher system
1) Communication
- effective communication makes px and carer feel at ease:
- explain procedure beforehand
- talk directly to the px
- use toys to keep child engaged
- explain condition, explain solution, answer any questions
Consider Timing
-child may be tired/bored after the test =dont make child wait -conduct necessary first -help with frame choice -second visit may be needed
Be aware of
- bullying of spec wearers
- peer/family pressure
- body image issues
- awareness of visual ‘disadvantage’
To help, you can talk to px, reassure them about appearance, reinforce benefits of wearing specs, take your time
2) Prescription and Vision
- visual development - alters with age
- refractive error - may not need rx - can grow out of it
- strabismus = eye doesnt point in the direction its supposed to
- amblyopia
- accommodative dysfunction
3) Lens Selection
- consider:
- safety
- vision
- cost
- weight
- blank size
- thickness
CR39
- good choice
- more durable than polycarbonate
- plastic - good from a safety pov
- covered by nhs vouchers
Trivex
- lightest for a high rx
- more impact resistance - good for safety
- extra cost
Glass
- bad choice
- not good for a child due to safety issues
Polycarbonate
- bad choice
- scratches easily
- visual properties
1.6/1.74 Plastic
- can be expensive
- cosmetically - frame size is smaller for a child, so lens sticks out more
4) Lens Materials - coatings
- hard coatings - most practices include as standard
- anti reflection coating - depends on whether child notices it
- uv coating
- tint
- child probably wont benefit from photochromic and polarising
Lens materials - glazing
- choosing minimum size uncut helps
- can alter the edges eg glaze to knife edge
- pre calculations
5) Lens Measurements - tips
- keep the childs attention
- be at eye level
- keep their attention
- praise them
How to measure PD
- pupil centre to pupil centre
- inner limbus to outer limbus
- inner canthus to outer canthus
- for a sleeping baby, estimate centre of corneal bulge to centre of corneal bulge
1/16th Rule
- you will read wide by 1/16th mm for every mm your PD is wider than your px
- so if your pd is 64 and your px pd is 56, youll over estimate by 0.5mm
Measurements for strabismus
- cover the good eye with occluder, so eye can take up fixation
6) Frame selection tips
- frame fit is v important - if frame doesnt fit, can the correct adjustments be made
- narrow down selection by size
- discuss with px and carer
- stock up to date brands
- try and let the child have final choice and allow them to try them on and get used to them in their own time
Frames for Babies
- soft plastic
- lenses should be flatter
- flexible
- moulded
- no hinges/screws
Specialist frames
- spring joints
- soft on skin/non irritant
- grip on back/strap
- adjustable length to bend
- soft nose pads
- variant bridge sizes
Frame types for infants and toddlers
- soft plastic frames ideal for comfort
- metal may be less suitable for comfort and fit, but may allow more adjustments
Frame types for older children
- more brittle plastics tend to break
- metal frames more robust and can be reshaped when damaged
Frame Side options
curl sides:
- can be fitted to any metal frame
- silicon covering
- rest along back of ear
- cost effective
- provides good fitting option for younger children = but ONLY if it fits well
Bridge options for infants and toddlers
- underdeveloped nasal structure and bridge should conform to childs nose
- moulded bridge
- saddle bridge
- strap bridge - absorbs impact and needs less frequent adjustment
Bridge options for older children
- metal frames allow pads to be changed
- can still have strap bridge
- consider spread of weight
Frame measurements for sides
- length to bend
- downward angle of drop
- curl side
Frame measurements for bridge
- splay angle
- frontal angle
- bridge projection
Fitting
- make sure they fit
- children often dont complain about poorly fitting/uncomfortable glasses, they just dont wear them
- are they happy with appearance of specs
- make sure they can see through glasses - objects to view are often higher than the child
NHS VOUCHERS
- gos 3 yellow form
- children under age 16, or 16,17 or 18 and in full time education
- specs can cost more than voucher value , so may need to charge px extra
NHS - small glasses supplement
applies only to:
- specs for a child under 7 years of age
- spectacle frame with boxed centre of no more than 55mm
- custom made or stock spectacle frame which requires ‘extensive adaptation’ to ensure an accurate fit
Repairs and Replacements (Gos 4)
- possible for children under 16
- used to: -repair or replace before next app, but not applicable to spare pair
