As a general rule, we avoid polycarbonate when we can. We have encountered occasional problems with "cracking and splintering", which so far we have not had with Trivex. We would generally only use poly when the lens design is not available in another appropriate material, and we also want the combination of thin, light, and impact resistant.Originally Posted by opticalwoman
We only very occasionally get scripts for bifocals for kids, and when we do so, it usually comes from a paediatric ophthalmologist, usually for accommodative esotropes, and only rarely from another optom. In almost 20 years, I could probably count the number of bifocals I have prescribed for kids on one hand. We did get an ophthal's script for a high set executive for a little girl (@ 5 years old, hyperopic esotrope) a few months back. We dispensed them as cr39 45FTs. A much, much better result!We have never had a script for a child in an Exec. In my 8 years I've only had 5 children total in any type of bifocal or progressive..........
I'd agree 100%. I've never filled one from an OD.
Ophthalmic Optician, Society to Advance Opticianry
Odd, because almost all the Rx's and glasses we have seen on children from O.D.s were for bifocals. Although this seems to be more the preference for O.D.'s dispenseing in-house. See a lot of young people (very late teens to mid-20's) wearing bifocals form O.D.'s). The ones in Australia and wherever John's is must not dispense so have no motivation (theory, I think it's called) for bifocals Rx's.
Chip
Most kids (pre-teens) wearing specs here would be single vision plus. There are a lot of kids wearing low plus "readers" where the symtomatology is very "vague". A recent study here ( sorry I don't have the references) by a local ophthalmologist concluded that the majority of these low plus specs were "unnecessary" (and up to a point I may agree with him). Although I work with an optical dispenser, I don't derive any financial gain from frame and lens sales, but I do want what I think is best for the patient. If that happens to be specs, then I'll prescribe them. Prescribing for kids can be somewhat emotive, so I tend to take a conservative, cautious approach. Parents are often dubious about the need for specs for their child, and need to be involved. Often that will involve more than one visit (it's amazing how symptoms can miraculously disappear by the 2nd visit). I would virtually never prescribe specs for anyone under the age of 12 without having cyclopleged them first. I take the viewpoint, that whenever possible, I would choose the course of action for the child as if it were my own.
Are you guys the only show in town, or are there a lot of other offices around? In our town, a suburb of Dallas, there are 18 optometrist offices. Maybe that is why we don't see very many. Also there is a retail office just down from the pediatric opthamologist office that does nothing but children's eyewear, and that is where the doctor's usually send the children they see in their offices.
We have an office policies and procedures form that everyone has to sign before we see them for an exam or help them with an outside RX. It states specifically that we decide the best material for the patient based on the prescription and type of frame purchased. If they choose to do poly because that is what the MD wrote on the script, we do not warranty the lenses in anyway, not as a non adapt, not for scratches. This way we have the parents signature on hand giving up permission to deviate from the script.
No, but one of our offices specializes in kids, and we get a ton of referals from the MDs in the area. Plus, we have a 2 year unconditional warranty on all the kid's stuff. There's a WM a block away, and a handful of ODs that buy from the big guys, but we stock over 200 kids frames, so in that respect, I guess we are the only show in town.
Ophthalmic Optician, Society to Advance Opticianry
we agree
If WalMart is the only place to get it, then I don't need it...
We have something in common, I haven't stepped foot in one in 8 years, what about you???
It's been about 11 year ago. I was on my way out to Ca. and got a hotel in Little Rock Ark. I forgot to pack Tums, and at 3:00 AM went to WM to get some. They were having a mini pep rally for the stock people, and I thought I was sleep walking or something. That was the last time I was ever in one.
Ophthalmic Optician, Society to Advance Opticianry
I fill all kids RXs with poly.There is no law in PEI that I have to do it,but when little Johnny gets a soccer ball in the face I know his lenses are going to protect him to some degree.
Alan
I agree with everything you said. But I don't agree with the ophthalmologist.
I think BFs and low plus Rxs for kids are underprescribed and here is why. BTW Chip, our price for BF is such that our profit margin is the same for a FT or a SV, so profit is not the motive.
A BF doesn't neccessarily mean that the kid has a reduction in accomadative ability. But what do you do with the kid that "needs" a +2.00 distance correction. They really don't need that for daily needs because of their ability to accomadate. They won't like their specs because they won't see better, and they won't wear them. So let's get a chief complaint
Provider: "Do you get headaches?"
Pt: No.
Provider: "Do you like to read?"
Pt: Well, not really
Mom pipes up: "He can't sit still and read for more than 15 minutes. His older sister likes to read for hours, but he never liked it"
Provider: "Is he having any trouble in school?"
Mom: "Well . . ."
By the time the child gets to high school, the hyperopia may have resolved or he will complain of headaches. But the problem is this; throughout grade school the kid failed to develop a love for reading, the ability to concentrate, lowered self-confidence because he always made lower grades than his sister, and even a dislike for school. This manifests in lower test scores, less chance to finish or even start college, lowered earnings and less choices throughout life.
This is the reason that myopes are more intelligent than hyperopes, in general. It doesn't have anything to do basic cognitive ability, but what their (uncorrected) vision allows them to do comfortably when they are young. LOVE OF READING = HIGHER INTELLIGENCE.
I know exactly what I would do if it were my kids. Two of my own wear +1.00s. I want to give them every opportunity to succeed.
And I know prescribing these low hyperopes it isn't a slam-dunk like myopes. We hear this all the time from patients that have been to another doctor. "Little Johnny was prescribed glasses by that other doctor. But Johnny said that they never helped and now that he is 15 the doctor said he doesn't need them anymore. I think that doctor just tried to sell us glasses."
Provider: "Does Johnny do well in school?"
Mom: "Well . . ."
Signed,
a hyperopic BF wearer since age 19 and wished it were much earlier
I know, me neither. I was just having a little scarcastic fun with Chip.We have never had a script for a child in an Exec.
If so, which states?? Any way to find out or get it in writing that kids need to have poly??
I have filled a lot of Rx's for about 5 pediatric OMD's, none would allow any bifocal design except an exec, (some exceptions for FT45 &35) but all insisted that the bifocal be placed high enough to split the pupil.
Does this phlosophy not exist in your world?
Chip
I see countless rx's with a recommendation of plastic from od's trying to save a patient money and opticians explaining why the patient needs poly,especially at under 18. the only time i like to sell plastic is for an reading rx as a second pair of glasses.
That philosphy is not universal. I don't see it much. But one "local" pediatric OMD has a picture printed on the Rx pad that shows the line bisecting the pupil. A FT35 will work more than adequately in anything less than a 49 eye.
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