Paediatric Dispensing

Question 1

Things to consider

Answer 1

• communication
• prescription and vision
• lenses
• frames
• financial assistance - nhs voucher system

Question 2

1) Communication

Answer 2

• 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

Question 3

Consider Timing

Answer 3

-child may be tired/bored after the test 
=dont make child wait
-conduct necessary first 
-help with frame choice 
-second visit may be needed

Question 4

Be aware of

Answer 4

• 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

Question 5

2) Prescription and Vision

Answer 5

• 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

Question 6

3) Lens Selection

Answer 6

• consider:
• safety
• vision
• cost
• weight
• blank size
• thickness

Question 7

CR39

Answer 7

• good choice
• more durable than polycarbonate
• plastic - good from a safety pov
• covered by nhs vouchers

Question 8

Trivex

Answer 8

• lightest for a high rx
• more impact resistance - good for safety
• extra cost

Question 9

Glass

Answer 9

• bad choice

- not good for a child due to safety issues

Question 10

Polycarbonate

Answer 10

• bad choice
• scratches easily
• visual properties

Question 11

1.6/1.74 Plastic

Answer 11

• can be expensive

- cosmetically - frame size is smaller for a child, so lens sticks out more

Question 12

4) Lens Materials - coatings

Answer 12

• 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

Question 13

Lens materials - glazing

Answer 13

• choosing minimum size uncut helps
• can alter the edges eg glaze to knife edge
• pre calculations

Question 14

5) Lens Measurements - tips

Answer 14

• keep the childs attention
• be at eye level
• keep their attention
• praise them

Question 15

How to measure PD

Answer 15

• 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

Question 16

1/16th Rule

Answer 16

• 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

Question 17

Measurements for strabismus

Answer 17

• cover the good eye with occluder, so eye can take up fixation

Question 18

6) Frame selection tips

Answer 18

• 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

Question 19

Frames for Babies

Answer 19

• soft plastic
• lenses should be flatter
• flexible
• moulded
• no hinges/screws

Question 20

Specialist frames

Answer 20

• spring joints
• soft on skin/non irritant
• grip on back/strap
• adjustable length to bend
• soft nose pads
• variant bridge sizes

Question 21

Frame types for infants and toddlers

Answer 21

• soft plastic frames ideal for comfort

- metal may be less suitable for comfort and fit, but may allow more adjustments

Question 22

Frame types for older children

Answer 22

• more brittle plastics tend to break

- metal frames more robust and can be reshaped when damaged

Question 23

Frame Side options

Answer 23

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

Question 24

Bridge options for infants and toddlers

Answer 24

• underdeveloped nasal structure and bridge should conform to childs nose
• moulded bridge
• saddle bridge
• strap bridge - absorbs impact and needs less frequent adjustment

Question 25

Bridge options for older children

Answer 25

• metal frames allow pads to be changed
• can still have strap bridge
• consider spread of weight

Question 26

Frame measurements for sides

Answer 26

• length to bend
• downward angle of drop
• curl side

Question 27

Frame measurements for bridge

Answer 27

• splay angle
• frontal angle
• bridge projection

Question 28

Fitting

Answer 28

• 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

Question 29

NHS VOUCHERS

Answer 29

• 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

Question 30

NHS - small glasses supplement

Answer 30

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

Question 31

Repairs and Replacements (Gos 4)

Answer 31

• possible for children under 16

- used to: -repair or replace before next app, but not applicable to spare pair