paediatric dispensing Flashcards
why is it important to effectively communicate?
- effective communication will make the patient and carer feel at ease
how to effectively communicate ?
- explain the procedure beforehand
- talk directly to the patient
- use toys to keep the child engaged
- explain condition - explain solution - answer question
what are things to consider with children ?
- child may be tired/bored after the test
- don’t make child wait
- conduct necessary first
- help with frame choice
- second visit
how to communicate with children under the age if one ?
- communicate verbally and non verbally
- verbal- coos, gurgles and grunts
- non-verbal- facial expressions, crying, body movement
- respond to sing-song voice and exaggerated facial expressions
how to communicate with 12-36 months ?
- communicate verbal and non-verbal
- verbal - one or two sentences
- non-verbal - gestures and grunts, positive and negative emotional expressions
- explanations should be in short sentences, in the order that actions occur
how to communicate with three to six years?
- begin to use sentences
- can ask about past experiences
what are some problems you may experience with children ?
- may not want this strange device on their head
- don’t understand tat with spectacles they can see
- want to know what spectacles taste like
how to communicate with 6 to 12 years?
- ask more questions and wants more information
- discuss strategies and solutions
- explain the reasons why we do something
how to communicate with 12 to 18 years?
- interested in self and relationships
- conscious of what others think of them
- be sensitive and avoid impatience or diagreement
what are things to be aware with older children and how to solve them ?
- bullying of spectacle wearers- talk to px
- peer/family pressure- reassure them about appearance
- body image issues- reinforce benefits of wearing spectacles
- awareness of visual disadvantage- take your time
what are some of the reasons that require children to wear glasses ?
. visual development . refractive error . strabismus . amblyopia . accommodative dysfunction
what is the VA required for each age ?
- birth to 3/12 months - VA= 6/300-6/60
- 6 to 12 monts - VA= 6/36-6/18
- 1 to 2 years - VA= 6/18-6/9
- 3 years - VA = 6/9-6/6
- 5 years - VA = 6/6-6/5
what to consider when picking lenses?
- safety
- vision
- cost
- weight
- blank size
- thickness
what are things to consider for lens materials for children ?
- hard coating- always recommended - comes as standard with cR39- increases durability of lens
- anti-reflection coating- less often dispensed to children as they may not realise their potential benefits- don’t sit in front computer for long time
- more suitable for teenagers
- UV coating
- tint- can be useful for children when they go on holiday
- photochromic- not very suitable for children under 16
- polarised- not very suitable for children under 16
why is important pre calculating the minimum size uncut and using minimal material required should be utilised where possible for plus lenses?
- pre calculating the minimum size uncut and using minimal material required should be utilised where possible for plus lenses
- this can make difference for small frame sizes
- a standard positive uncut lens for adult will be thick and uncomfortable for children
- consider smaller blank size
- ask lab to work to knife-edge as this creates a smaller blank based on the frame size and create superior finish lens
how to take children lens measurements ?
- keep the child’s attention
- be at eye level
- keep their attention
- praise them
how to measure PD for children ?
- pupil centre to pupil centre
- inner limbus to outer limbus
- inner canthus to outer canthus
how to measure sleeping baby ?
- estimate centre of corneal bulge to the centre of corneal bulge
what happens when your PD is wider than px?
- you will read wide by 1/16th mm for every mm your Pd is wider than your PX
- if your PD is 64 and px PD is 56 you will overestimate by 0.5mm
how to measure PD for patients with strabismus ?
- px with strabismus their eye may not be looking ahead - may be turning in or out
- depending on the vision they have in their eye which has the strabismus we may need to make the eye which is not straight focused straight
- we can cover their good eye - the eye with worse vision will turn from its natural position to a forward facing position
what are things to consider with frame selection ?
- frame fit is very important- if frame does not fit can the correct adjustments be made
- narrow down the selection by size
- discuss with the patient and the carer
- stock up to date brands
- try and let the child have the final choice and allow them to try on
what things to consider for frames for babies ?
- soft plastic ( nylon )
- lenses should be flatter
- flexible
- moulded
- no hinges
what are some suppliers for children frames ?
- tomato frames- extendable sides
- zoobug-
- centrostyle active soft
- norville
what are some feature of specialist frames for children ?
- spring joints- for older children - people more rough with glasses
- soft on skin/non irritant
- grip on back/strap
- adjustable length to bend
- soft nose pads
- variant bridge sizes
what frame types that are ideal for infants and toddles?
- soft plastic frames ideal for comfort
- metal may be less suitable for comfort and fit, but may allow more adjustments
what frame types are ideal for older children ?
- more brittle plastics tend to break
- metal frames more robust and be reshaped when damaged
what are curl sides ?
- curl side has a metal curl with silicon covering
- rest along back of ear
- cost effective
- can be fitted onto any metal frame
- provides good fitting option for younger children
what are loop end sides ?
- allows materials to be tied to each loop and to rest at back of head
- material must be ribbon or cord
- don’t use plastic
what are bridge options for infants and toddlers ?
- bridge should conform to child’s nose
1. moulded bridge
2. saddle bridge
3. strap bridge - absorbs impact
- needs less frequent adjustment
what are some bridge options for older children ?
- metal frames allow pads to be changed
- can still have strap bridge
- consider spread of weight
what other measurements you may take ?
. side measurements
- length to bend
- downward angle of drop
- curl side
. bridge measurements
- splay angle
- frontal angle
- bridge projection
what must you do when it comes to the fitting of glasses ?
- make sure they fit
- children often don’t complain
- are they happy with the appearance of their spectacles
- make sure that they can see through their glasses
what are some sports/safety eyewear ?
swimming goggles
ski goggles
what are the NHS vouchers available for children ?
- all children under 16 the eye exam is covered by the NHS
- children 16, 17 or 18 and in full time education will have eye exam covered
- GOS 3 yellow form which contribute to the help of the price of the glasses
- amount they get towards the glasses is dependent on the prescription and is set by the NHS
- spectacles may cost more than voucher value so may need to charge the px extra
what is small glasses supplement ?
- spectacles for a child under 7 years of age
- spectacle frame with boxed centre of no more than 55 mm
- custom made or stock spectacle frame which require extensive adaptation to ensure an accurate fit
what repairs are possible for children under 16?
- possible for children under 16
- GOS 4
