Post cataract CL wearing 7 year old--Line or no line??

[Uncle Fester]

Looking for Optiboarders expierence/advice on a 7 year old who is a post cataract, soft CL wearing girl dreading (in tears over) the thought of a lined bifocal. O.D. who refracted says it's her choice to go lined or no line.

RX -2.OO Add +2.50 O.U.

Progressive must be poly, height 17mm.
My first thought is go for a progreesive as she'll need accomodation help her whole life but I've never fit anyone this young.
Your help is appreciated!

[Aarlan]

PROGRESSIVE!!!!!


I've fit a number of children in progressive with various ocular issues, and have had no problems. Children are more receptive of change than old folks, so if she knows what to expect, and she knows that she won't need the lines, She'll do just fine

AA

[GOS_Queen]

PROGRESSIVE!!!!!


I've fit a number of children in progressive with various ocular issues, and have had no problems. Children are more receptive of change than old folks, so if she knows what to expect, and she knows that she won't need the lines, She'll do just fine

AA

exactly! (ditto ;) )

[Judy Canty]

I agree. My 25 year old daughter has been wearing progressives since the 4th grade.

[William Stacy O.D.]

I tend to prefer lines on kids. They have different needs than adults, mainly in that their near point tasks tend to be much wider than adults. Compare any child's book to Newsweek, or Time, or any newspapers. The columnar print is fine for progressives. Kids books tend to be large print, running all the way across a full page or more. For this reason, I don't think I've EVER fit a progressive on a kid. And they handle the lines just fine. By the way, I'm now only fitting polycarb on people who's insurance covers it but won't cover trivex and they don't want to upgrade. Everyone else who needs the strength and lightness of poly gets trivex. Polycarbs days are numbered...

If you must do a prog on a kid, fit a hard style with the widest reading area you can get.

[Ed_Optician]

Go for it use a short corridor lens make sure theree is enough reading area it should work fine. I would also suggest an extra pair of just reading glasses as a back up / long term close work pair of glasses. Poly or Trivex all around of course

Ed

[fjpod]

I tend to prefer lines on kids. They have different needs than adults, mainly in that their near point tasks tend to be much wider than adults. Compare any child's book to Newsweek, or Time, or any newspapers. The columnar print is fine for progressives. Kids books tend to be large print, running all the way across a full page or more. For this reason, I don't think I've EVER fit a progressive on a kid. And they handle the lines just fine. By the way, I'm now only fitting polycarb on people who's insurance covers it but won't cover trivex and they don't want to upgrade. Everyone else who needs the strength and lightness of poly gets trivex. Polycarbs days are numbered...

If you must do a prog on a kid, fit a hard style with the widest reading area you can get.

While you make some good points about the functionality of VFLs in kids, the VFL is really for the parent who is having a stroke over the fact that their child needs "old people glasses".

I really don't see a problem giving a pseudo-aphakic child a VFL. As they have NO accomodation, they actually need it more than a 48 year old.

[Happylady]

I would go with the progressive. A standard bifocal will give her only one small distance at near where she can see clearly. A progressive will give her more range.

[GOS_Queen]

I'm kinda thinking that if she is already wearing contacts, has been thru surgery, and highly motivated to NOT wear a lined bifocal ... then she should be fine !

[William Stacy O.D.]

While you make some good points about the functionality of VFLs in kids, the VFL is really for the parent who is having a stroke over the fact that their child needs "old people glasses".

I really don't see a problem giving a pseudo-aphakic child a VFL. As they have NO accomodation, they actually need it more than a 48 year old.

The stroke may be being caused by the opthalmic practitioners' bias that is rampant about the "ugly" factor. I appreciate the intermediate distance problems, but still think the fact that the near usable area of VFLs is about half the size of a 28 mm seg is a big problem.

[eyegirl]

I say progressive.
If this was an infant or toddler then I would do lines, but a 7 year old should be able to handle progressives.

The other reason is that a lined pair does no good if it's never worn d/t the self conscious factor.

[William Stacy O.D.]

I say progressive.
If this was an infant or toddler then I would do lines, but a 7 year old should be able to handle progressives.

The other reason is that a lined pair does no good if it's never worn d/t the self conscious factor.

I've run into 7 year olds who didn't want to wear glasses, but never one who was wearing glasses who wouldn't wear them because of a bifocal line.

If she's "in tears" over lines, it's because some adult (a parent or her eye person) said something about them being "ugly". Unfortunate. She certainly didn't get that "old person" comment from one of her peers.

Sure, she can "handle" progressives, but her near point performance will not be as good because the optics are way worse. If it were my kid, she'd get the best optics (a lined bifocal).

[sharonseyes]

I say if the child already has issues with lined bifocals ,wheather her parents or another adult put that image in her head is not they way to go. There is a nice Prog. Varilux makes called the Liberty. This lens should give your patient enough reading and mid rage.

[William Stacy O.D.]

I say if the child already has issues with lined bifocals ,wheather her parents or another adult put that image in her head is not they way to go. There is a nice Prog. Varilux makes called the Liberty. This lens should give your patient enough reading and mid rage.

To me it's like taking your kid to the orthodontist and opting for the transparent braces instead of those "ugly wire things" despite the fact that the ugly ones will work twice as good as the transparent ones.

It could even be argued that it's a form of child abuse to deprive a child of the best medical devices because of looks.

[sharonseyes]

Remember the psycology, if it looks bad it is bad. If it looks good it must be good. I do agree lined Bifocals would be best if this was a non thinking being. But she already has a bad impression of lined bifocals. Let her believe these no lines are best and she will think that they help her see better.

[Framebender]

a Round 22. I believe it is now available in poly transition. Could be worth a shot.

I hope you're all having fun and making money!!

[drk]

Progressives!

[eyegirl]

I've run into 7 year olds who didn't want to wear glasses, but never one who was wearing glasses who wouldn't wear them because of a bifocal line.

If she's "in tears" over lines, it's because some adult (a parent or her eye person) said something about them being "ugly". Unfortunate. She certainly didn't get that "old person" comment from one of her peers.

Sure, she can "handle" progressives, but her near point performance will not be as good because the optics are way worse. If it were my kid, she'd get the best optics (a lined bifocal).

Working in a ped's practice, I see parents instill fear or self consciousness into their children a lot. It's sad but true. I've seen parents try to persuade the doctors to fit contacts on their 5 year old b/c THEY (the parents) didn't like the way the glasses looked.

I completely agree with you with regards to the lined bifocal performing the best optics.

I think their has to be a balance in choice when deciding between what's optically best, and what is psychologically accepted by the patient. With choosing progressives, you may get the patient to be more cooperative with wearing them.

[Andrew Weiss]

Uncle Fester started this thread, but I'm the optician who's actually working with this young girl. My thanks to you all for your thoughful responses and suggestions.

This kid has no lens implants, wears CLs, +20 and +22. She will most likely be wearing glasses for the rest of her life. My experience of her mother is that she is tremendously supportive of what her child wants to do with the glasses. She did not steer the discussion I had with the kid about what type of lens to use in one direction or the other. In the end, the kid opted for progressives -- a good choice for the long-term, I think.

Some of her decision was based on the progression zone in the progressive lens, the fact that she would have a more precise power available for computer viewing and games. She didn't articulate any strong feelings about wearing a line, just a preference not to. She selected a zyl frame -- clearly, she has no qualms about being seen as an eyeglass-wearer -- a ClearVision OP zyl in a lovely sky-blue.

So I'm putting her in a Rodenstock XS, we have just about enough room for it. And we'll see how she adapts. If there's a problem, I'll suggest shifting her over to a FT. But even here, I will most likely follow the kid's lead and preferences. She is smart, level-headed and clear. A great 7-year-old.

Would I do the same with another child coming in with a similar problem? I don't know. With this kid, it was easy to just listen, learn, educate, and then enter into a kind of joint decision-making with her. Another kid most likely will be different. For now, I'll stay away from the generalizations and just work with what's given to me.

Thanks again to you all.

[Robert Martellaro]

I would also suggest an extra pair glasses as a backup

If you make the spare with a lined bifocal (using Framebender's recommendation of a round seg) the kid will get a chance to evaluate both designs. I would also make another pair as a backup to the contacts. These will have to be bifocals due to the +15 diopters or so of distance power.

[chip anderson]

The kid needs contact lenses. Single vision rigid with readers or lined bifocals.

With Spectacles he will have ring scotomas, 22+/- over magnification, curved doorways, only about 35 degrees periperal vision, etc. Patient is not too young for same.

Chip

Spectacles only to find contact lenses with.

Now I am confused is the patient a +2.00 & -2.00 or a +22? If the latter the above definitely applies. If the former what's the problem if no fusion, or strabismus problems exist?

[Andrew Weiss]

Chip, I think you misunderstood my post. The child is wearing contact lenses, +20 in one eye and +22 in the other. She wears the glasses over the CLs.

[QDO1]

My first thought is a progressive, with a second pair of occupational progressives. one covers the general running arround kids things, and the other covers school, playstations and study etc...


you probrably ought to do some decent sunspectacles

you ought to have a backup distance vision (full RX) for emergencies

[chip anderson]

Chip's still confused do we have two patient's here one at -2.00 with +2.50 add or one with a +20.00 & +22.00 who still needs -2.00 with +2.50 add? Can't see a whole lot of point in putting one with -2.00 +2.50 add in contacts at seven.

Motivation increases proportionally with distance correction and hormone level.

Chip

[QDO1]

Motivation increases proportionally with distance correction and hormone level.

Chip

patients on HRT come to mind LOL