Kids and bifocals

**Mizikal** · 11-05-2014, 03:17 PM

I recently had a mother in with a toddler in a bifocal lens. The RX was somehwere around +16.00 and the child was in a blended bifocal. I have had no real experience with these. I have read a little bit about them and I know my doctors never want me to put a child in them. The parent was insistant on them saying that is what she has always been told that is what she needed and that she didn't want people to see her daughters bifocal. I explained why we us a lined bifocal and about how much easier it will be for her daughter to us. The only reason the doctor wanted her to get new glasses was to get her out of those bifocals. Now I am second guessing my self. Am I wrong to put kids in a ft 28 ? What would the benefits be to the blended bifocal aside from looks?

**Hayde** · 11-05-2014, 03:33 PM

I'm with you, Miz. Depending on the diagnosis, the kid's seg needs to bisect the pupil or come darn close to it. I don't see how a blended bifocal helps such a patient at all--the dead zone is dead ahead in their frontal gaze or else the seg is pushed low enough to defeat the purpose.

**Uncle Fester** · 11-05-2014, 03:35 PM

Need more information.

Sounds like premature cataracts in the kid required crystaline lens removal (congenital cataracts).

Is it?

**Mizikal** · 11-05-2014, 03:48 PM

Originally Posted by Uncle Fester

Need more information.

Sounds like premature cataracts required crystaline lens removal.

Is it?

I don't know for sure without looking at the chart but I assume so.

**Uncle Fester** · 11-05-2014, 04:01 PM

So if I read the post right the MD wants segmented bifocals. This I assume is to eliminate the blur zone and allow the near vision to develop.

I don't think bisecting the pupil is required. But fit it high for best optics.

I'd verify this with the MD and tell the mom your hands are tied and in the best interest of her child she should do as recommended and if she refuses you cannot in good conscience change the rx and doctor's requirements. (And then with your best puppy dog eyes ask her "don't you want what's best for your babies eyesight"?)

What about contacts? That seems to be the usual recommendation even for toddlers.

btw- How old is the kid?

**Mizikal** · 11-05-2014, 04:57 PM

Just had a talk with the doctor I guess they were severly misinformed at her last dr's office and what they were told about the glasses is just the tip of the iceberg.

**Judy Canty** · 11-05-2014, 06:25 PM

At age 2, my son was only a +6.75 -.75/+1.50 add. I kept him in a FT35 to have control over the OC in the seg. Doc wanted an exec, until I explained how horrible it was. Placed the seg to bisect the pupil, because even with cable temples and a comfort bridge, they would slide down his tiny little nose and be so low that they were nearly useless.

**Paul Smith LDO** · 11-05-2014, 07:20 PM

Originally Posted by Mizikal

I recently had a mother in with a toddler in a bifocal lens. The RX was somehwere around +16.00 and the child was in a blended bifocal. I have had no real experience with these. I have read a little bit about them and I know my doctors never want me to put a child in them. The parent was insistant on them saying that is what she has always been told that is what she needed and that she didn't want people to see her daughters bifocal. I explained why we us a lined bifocal and about how much easier it will be for her daughter to us. The only reason the doctor wanted her to get new glasses was to get her out of those bifocals. Now I am second guessing my self. Am I wrong to put kids in a ft 28 ? What would the benefits be to the blended bifocal aside from looks?

The blended bi focal could also be a result of the previous dispensers lab choice. The aesthetic of the blended lenticular bifocal along with having to cut and edge it vs a lenticular FT.

**Jubilee** · 11-05-2014, 08:08 PM

To balance with cosmetics.. I have used round segs, and with the current round of backside round segs (Duo, etc) you could still make something less noticeable, but better cosmetically.

**Jubilee** · 11-05-2014, 08:09 PM

http://www.eyecarebusiness.com/artic...rticleid=50162

On a side note.. I did find this older article that might have given someone the thought of using it.

**obxeyeguy** · 11-05-2014, 10:34 PM

Originally Posted by Mizikal

I recently had a mother in with a toddler in a bifocal lens. The RX was somehwere around +16.00 and the child was in a blended bifocal. I have had no real experience with these. I have read a little bit about them and I know my doctors never want me to put a child in them. The parent was insistant on them saying that is what she has always been told that is what she needed and that she didn't want people to see her daughters bifocal. I explained why we us a lined bifocal and about how much easier it will be for her daughter to us. The only reason the doctor wanted her to get new glasses was to get her out of those bifocals. Now I am second guessing my self. Am I wrong to put kids in a ft 28 ? What would the benefits be to the blended bifocal aside from looks?

Please stop trying to reinvent the wheel, fit the child with flat tops or round segs( preferred with this much plus), fit them high as recommended. This Kid has a distance problem and a near accommodation problem, give them what they need. Cosmetics is not what they need, either is an intermediate distance to see the dash and/ or the computer. No age given on this toddler, but most young ones are naturally plus power at distance, just not a +16, and most of what the bifocal provides is for muscle development. My opinion only, any talk at all of cosmetics over optics in a toddlers eyewear is wrong, period. Do what we do best, at least most of us, make the kid see, and do what the Doc wants power wise.

**mervinek** · 11-06-2014, 08:23 AM

I have fit an older child with progressives with no problems, but we are talking middle school and older. A toddler definitely should be in FT. I agree...fit a little higher due to slippage.

**Uncle Fester** · 11-06-2014, 11:32 AM

Please note this is not a convergence issue for muscle weakness. The kid is missing the lenses of their eyes due to congenital cataracts.

I'll bet the doc wants to wait for an implant until the child is older and the eye more developed probably to get a more accurate implant power. Meanwhile we're looking at bifocal lenses.

At least that what it looks like to me so far.

**obxeyeguy** · 11-06-2014, 12:20 PM

Originally Posted by Uncle Fester

Please note this is not a convergence issue for muscle weakness. The kid is missing the lenses of their eyes due to congenital cataracts.

I'll bet the doc wants to wait for an implant until the child is older and the eye more developed probably to get a more accurate implant power. Meanwhile we're looking at bifocal lenses.

At least that what it looks like to me so far.

Didn't see that in the origional post, and I don't assume anything.