Bifocals for kids

[chip anderson]

Sara: I have always concidered an optician's job to be to provide whatever services best serve the needs of the patient. If this is not the most profitable option for me, or not the most cosmetic option for the patient, so be it.

I may die poor, naked and alone. But I will feel that I was a good Optician, Ocularist, Contact Lens Technician (and I spell them all with capitals). No one will ever accuse me of being a salesman (which I concider to be another term for liar).

Keep your money, maybe you can buy your way in.

Chip

[Sara]

Jo & Uncle Chip,
I appreciate your concern & will emulate your examples.Thanks for putting me on right track.
Sara

[Sara]

Uncle Chip
What does Ocularist mean? Its my first time to come across this word.
Sara

[chip anderson]

Sara: Ocularist: Expensive sounding word for an artificial eye maker.

Hope you are not too mad.

[Joann Raytar]

Originally posted by chip anderson:
Ocularist: Expensive sounding word for an artificial eye maker.

Chip:

Through your experiences, what are the top reasons, injury or disease, why you're services as an ocularist are needed?

[chip anderson]

While we see everything from gunshot wounds to strange diseases. In the very, very young I would say retinitus blastoma, In medium age children scissors, in young men in the lower echelons of society (these two other guys was in a fight). In the somewhat higher age/incomes diabetes. Used to see an awful lot of "It started out as a cataract." but I started getting bad feelings about some surgeons and stopped asking years ago.

Have only seen one in 42 years that started out as a contact lens infection (pt. also got treated with cortizone too long).


Chip

Sorry I forgot to mention bottle rockets, aways good for a few eyes each year.

[This message has been edited by chip anderson (edited 03-06-2001).]

[Joann Raytar]

Chip:

A couple of nights ago there was a news special on about a young child being fit for an artificial eye. The detail to the prosthetic was amazing. The eye looked very natural as far as color and anatomical detail. What goes into making an artificial eye and about how long does it take you?

[Carol D]

Pedseye

I measured most of the kids at center pupil or very slightly above. At the time I was getting $250.00 for a pair of poly progressive lenses. Generally, the easiest way to sell them was to show the parents a pair of cute frames with a FT35 already mounted in them and then show them a pair made with progressive. I left the decision up to them. I never had a child non-adapt, but of course, I always told the parent that if the child could not adjust to them I would remake them in FT 35 at no additional charge.
I think parents liked the way I dealt with the kids. If the child wanted to sit or lay on the floor then I would sit or lay on the floor too. I always got down to their level to take measurements and framestyle. It made parent and child more comfortable. Oh yeah, one other thing,the mirrors on my dispensing tables were plastic. They got moved and knocked around alot.

Carol D.

[chip anderson]

Jo: I think I have the record on fitting young patient's the earliest I started was 23 hours. Have done a couple at 98 years. As to making one (short version) I take a mould of the socket, make a plaster cast of this, then a wax model to attain socket/lid fill. Make a mold of that with pupillary center pegged. Paint an Iris, mold white plastic around that, strip off some of the white plastic, apply veins (red nylon fibers) and match the color of the sclera. Then I apply a layer of clear plastic, and smooth an polish. Working time 4 to 12 hours with some notable exceptions each way.

Long version is too long for this forum.

Chip

[Joann Raytar]

Thanks for the reply Chip. I never knew what went into making prosthetic eyes. I guess that is where you get your knack for paying attention to details in other areas of optics. After watching that news special, you guys to some terrific work.

[Diane]

In this Opticians view, I believe that if we need to fit a child with a bifocal, for the various reasons sited here, a good Optician will evaluate each and every child (patient). Then and only then determine whether a lined bifocal would be best or if the child is beginning to get a little older, and would benefit from a PAL. Sometimes we fail to remember that if a child is made fun of, then he/she will not wear the glasses, so what use are they then. Identify the visual and emotional needs of the child and do what is best for each of them. If a PAL is determined to be the option, then a style with a short corridor is best. I believe that we hold these very important patient's lives in our hands, and we have a great responsibility to them.

Diane

[chip anderson]

If our "selection" results in failing to correct a childhood strabismus or amblyopia for "the poor child's psychology" we fail.
We are in the vision correction business not mental care.

Children are teased more for crossed or cocked eyes, than glasses and this can last forever.

Chip

[Jocelyn]

I am hoping that although this thread is old, someone will be able to reply to me in a short amount of time. I am not in your profession at all but am just a mother looking for answers. I took my 8 year old to the Optometrist for a check the other day and he has been diagnosed as being near-sighted. The Optometrist also did some tests on his focusing ability and said that he would benefit some wearing bi-focals as his right eye is a lot stronger than his left and it may help him to have both eyes working together for close-up work too. I will give you his prescription:-0.75 Right eye, -1.25 Left. She has also written that if he gets bi-focals, Add: +1.75R and +1.75L. She said something about research indicating that there is a lesser rate of decline in vision amongst those who wore bi-focals. They were not her exact words and I think she is echoing some of what I've seen on this thread. Not being up on all the terminology though, I haven't been able to see a definitive view which would help our situation. Any advice would be welcome.

[drk]

I am hoping that although this thread is old, someone will be able to reply to me in a short amount of time. I am not in your profession at all but am just a mother looking for answers. I took my 8 year old to the Optometrist for a check the other day and he has been diagnosed as being near-sighted. The Optometrist also did some tests on his focusing ability and said that he would benefit some wearing bi-focals as his right eye is a lot stronger than his left and it may help him to have both eyes working together for close-up work too. I will give you his prescription:-0.75 Right eye, -1.25 Left. She has also written that if he gets bi-focals, Add: +1.75R and +1.75L. She said something about research indicating that there is a lesser rate of decline in vision amongst those who wore bi-focals. They were not her exact words and I think she is echoing some of what I've seen on this thread. Not being up on all the terminology though, I haven't been able to see a definitive view which would help our situation. Any advice would be welcome.

We here have a rule that we shouldn't second guess a "non-cyber" Dr.'s opinion.

It is a fact, though, that the evidence for accommodation as a component of myopia progression is controversial, as the body of studies do not strongly indicate one way or another.

I note, though, that that is only a secondary reason for the bifocal prescription. The primary reason seems to be for accommodative insufficiency, and this is a completely mainstream treatment for such a diagnosis.

Suffice it to say that there is no indication that your Dr. is doing anything risky or controversial.

I hope this helps.

[Jocelyn]

I'm sorry I didn't realise that you had that rule about not contradicting a non-cyber Dr - even though it makes sense. I guess I'm the one leaning toward getting the bi-focals whereas my husband thinks that the prescription for his distance correction should be enough and we'll wait and see. The Optometrist was not emphatic that my son should also have bi-focals but said they would probably help. I guess I'm wondering if we should err to that side rather than just getting the distance ones and waiting to see if his vision then gets worse and requires bi-focals later.

[Alvaro Cordova]

Sorry guys, I had to get that one off my chest. What started out an annoying exchange with an insurance company ended up being a multiple tear jerker.

PS - To put my own mind at ease. If Jimmy does not learn to adjust to the lenses at his age, what other treatments may help correct his lazy eye.

There are various types of patches and drops (last resort before going to surgery (if muscle imbalance is the culprit for the eye turn)) that are used on the good eye.

Sometimes when I write a post, I'm finding that my writing resembles Scheme, a programming langauge that has ungodly amounts of parenthesis.

;;; Hello World in Scheme

(define helloworld
(lambda ()
(display "Hello World")
(newline)))

[eyeboy]

I am hoping that although this thread is old, someone will be able to reply to me in a short amount of time. I am not in your profession at all but am just a mother looking for answers. I took my 8 year old to the Optometrist for a check the other day and he has been diagnosed as being near-sighted. The Optometrist also did some tests on his focusing ability and said that he would benefit some wearing bi-focals as his right eye is a lot stronger than his left and it may help him to have both eyes working together for close-up work too. I will give you his prescription:-0.75 Right eye, -1.25 Left. She has also written that if he gets bi-focals, Add: +1.75R and +1.75L. She said something about research indicating that there is a lesser rate of decline in vision amongst those who wore bi-focals. They were not her exact words and I think she is echoing some of what I've seen on this thread. Not being up on all the terminology though, I haven't been able to see a definitive view which would help our situation. Any advice would be welcome.

Could you talk a little bit more about the original symptoms?

[eyeboy]

I should also add that I never prescribe bifocals for kids except in say near vision strabismus such as convergence excess. In my experience most near problems for kids can be sorted out with regular review and possibly exercises. In this case it doesn't appear clear as to why this child was prescribed bifocals, was it their first visit?, had they complained of near vision problems?

In an 8 year old I would be worried about messing with binocular control by giving bifocals. Intrestingly I have read that in myopes with esophoria for near myopia could be reduced by 20% using a +1.50 add, this is a small subgroup of myopes, (Pickwell's Binocular Vision, pg111). Even so personally I would still be careful unless I felt the myopia was 'galloping away' and they are esophoric for near.

Incidently I am am new to this site, and it is absolutely fantastic. I wish something like this was around when I was studying years ago!!!!

[QDO1]

As a lowly Dispensing Optician I only ask Ophthalmic Opticians, MD's or whoever else prescribes Bifocals to kids one thing... dont start a war with the other local professionals (via the parants). Bifocals for kids are quite emotive.

If you prescribe bifs. for kids dont tell the parants how useless other (non-prescribing) practitioners are

If you are not a bifocal for kids prescribing practitioner, dont slag off the prescribing ones (via the parants)

I have twice worked in a district with a bifocal prescribing practitioner, and been at the brunt end of this practice of dissagreement between professionals. Once betwenn two long term locums in the same practice! The rub is that the kid gets upset, parant very upset, and the proffesion looks stupid and inconsistant. The dispensers desk also sports a box of tissues

[eyeboy]

As a lowly Dispensing Optician I only ask Ophthalmic Opticians, MD's or whoever else prescribes Bifocals to kids one thing... dont start a war with the other local professionals (via the parants). Bifocals for kids are quite emotive.

If you prescribe bifs. for kids dont tell the parants how useless other (non-prescribing) practitioners

If you are not a bifocal for kids prescribing practitioner, dont slag off the prescribing ones (via the parants)

I have twice worked in a district with a bifocal prescribing practitioner, and been at the brunt end of this practice of dissagreement between professionals. Once betwenn two long lterm ocums in the same practice! The rub is that the kid gets upset, parant very upset, and the proffesion looks stupid and inconsistant. The dispensers desk also sports a box of tissues

I'm not entireley sure if this was directed towards my reply, but I feel I should at least defend my last post.
I actually did say I would dispense bifocals in certain cases and actually sited recent research which showed that Myopia could be controlled in a small sub group of Myopes.
I do not agree with your point of view about disagreeing with other practioners. The evidence for prescribing bifocals in all cases for reducing myopia in children is vague. If an optician has anecdotal evidence proving that they can reduce the myopia with bifocals is this ethical? They would have to show that it is statistically significant over a population of screened individuals. With any form of such research it would have to be put before an ethics comittee. This would be even more important, with the test population comprising of children and where there is a risk of causing a problem with the motor control for near. Personally with any new advances in optics I think professionals should fully review the research before applying the 'advance' to a patient.
I have met opticians who have not performed any further education in years, who still apply old fashioned methods and perform inadequate examinations to the detriment of the patient and our profession. Should I disagree with these practioners? Yes! Should I slag them off? No! The public has the right to a second opinion and in this case the parent was obviously concerned about the treatment carried out to subscribe to this thread. In fairness I was interested in the symptoms in more detail. From what she said though it did seem strange to put a child into bifocals. I also thought it sounded a bit like the childs first visit. As a dispensing optician would you have been comfortable prescribing bifocals in this instant?

[chip anderson]

This all goes back to the question of trust. The question of whether the precriber can be trusted or not. If the precriber has no financial interest in the filling of the Rx then one can assume the Rx is based on his genuine belief that his theories and exams are based in fact. However since bifocals can also be prescribed to increase profits if the precriber has a financial interest in the filling of the Rx his motives come into question. And no, the amount of education one has bears no resemblence to personal integrity.


Chip

[QDO1]

I'm not entireley sure if this was directed towards my reply, but I feel I should at least defend my last post.
I actually did say I would dispense bifocals in certain cases and actually sited recent research which showed that Myopia could be controlled in a small sub group of Myopes.
I do not agree with your point of view about disagreeing with other practioners. The evidence for prescribing bifocals in all cases for reducing myopia in children is vague. If an optician has anecdotal evidence proving that they can reduce the myopia with bifocals is this ethical? They would have to show that it is statistically significant over a population of screened individuals. With any form of such research it would have to be put before an ethics comittee. This would be even more important, with the test population comprising of children and where there is a risk of causing a problem with the motor control for near. Personally with any new advances in optics I think professionals should fully review the research before applying the 'advance' to a patient.
I have met opticians who have not performed any further education in years, who still apply old fashioned methods and perform inadequate examinations to the detriment of the patient and our profession. Should I disagree with these practioners? Yes! Should I slag them off? No! The public has the right to a second opinion and in this case the parent was obviously concerned about the treatment carried out to subscribe to this thread. In fairness I was interested in the symptoms in more detail. From what she said though it did seem strange to put a child into bifocals. I also thought it sounded a bit like the childs first visit. As a dispensing optician would you have been comfortable prescribing bifocals in this instant?

No the post was not directed at you.

My post merely commented that pediatric optometry, and dispensing, can be very emotive, and as the dispenser, I am often the person somoothing out the issues raised by Optometrists, (and holding the box of tissues).

I am 100% happy to dispense anything a OO or MD asks me to

Within a small town (or practice) there are a lot of different ideas about how to deal with chidrens vision, and often the parant ends up ping ponging between different practitioners with thier different methods of approach to childrens Optometry. I feel practitioners have a responsibility to ensure that the child comes first and not thier ego. If that means that the practitioner has to spend an extra hour explaining to the parants the philosophy of thier desision, then so be it. If that means a second practitioner disagrees, then a smidgen of diplomacy (which is often not evident) would go a long way

[chip anderson]

One must remember that I think in the UK (and most of Europe) and Optician is what we call an Optometrist.. In the US, Optometrists are writers of prescription who usually dispense or have a dispensary. In the US Opticians dispense spectacles and can sell nothing without an Rx.

In the US an optician may have some leeway as to what type of bifocal and a few other options on the spectacles may be used, but actual power, SV or bifocal is not an option of the Optician.

Also until about 1965 or so Ophthalmologists for the most part, practiced medicine, surgery and examinations. Most did not have ownership interest in the dispensary. This has changed since that period, and I fear will never change again unless spectacles should become for the most extent unprofitable.


Chip

[QDO1]

One must remember that I think in the UK (and most of Europe) and Optician is what we call an Optometrist.. In the US, Optometrists are writers of prescription who usually dispense or have a dispensary. In the US Opticians dispense spectacles and can sell nothing without an Rx.

In the US an optician may have some leeway as to what type of bifocal and a few other options on the spectacles may be used, but actual power, SV or bifocal is not an option of the Optician.

Also until about 1965 or so Ophthalmologists for the most part, practiced medicine, surgery and examinations. Most did not have ownership interest in the dispensary. This has changed since that period, and I fear will never change again unless spectacles should become for the most extent unprofitable.


Chip

You are right. Despite changing all the names of the professionals, and deregulating a few years ago the basic structure of the optical profession in the UK is as follows

OMP = Eye surgeon = Allowed to refract
OO = Optometrist / Ophthalmic Optician = Allowed to refract + fit contact lenses +performs a complete Eye examination including ocular health, and will refer if any problems
DO = Optician = Dispensing Optician = Not allowed to refract or fit contact lenses
CLDO = Contact Lens Optician = Dispensing Optician who fits conttact lenses (only allowed to refract in terms of contact lenses)
(Q)DO = (Qualified) Dispensing Optician

Incidentally there is a new breed (anyone can call themselves a dispensing optician, so long as they do not use the word qualified :angry: )

Qualified Dispensing Opticians are an increasingly rare breed over here


This set up tends to mean the folowing:

• OMP's work in hospitals, and tend not to bother refracting
• OO's work in practice, but mainly refract in a testing room all day and tend not to dispense, and refer patients with a medical problem to their GP who then refers to an OPM /Opthalmologist
• DO's tend to be the practice manager, and deal with all of the dispensing
• Unqualified dispensers tend to do most of the dispensing in the UK ans work mainly for multiples

In terms of prescribing a bifocal for a child.. an Opthamlologist / OMP or OO would prescribe the bifocal, a dispenser would then Dispense, produce, fit and deal with the parant. Because often the DO is nowhere near the OMP/Opthalmologist, the OMP/Opthalmologist is generally never that aware of the issues they cause to the parant / child / practice. In terms of a OO prescribing a bifocal, well they have it comming at them from all angles - a higher opinion is available from OMP/Opthalmologist's, other opinions are offered by other OO's, and then the Dispensing Optician is Having a go at them about the amount of Kleenex they are using!

In my observation, the best system over here is where the child goes to the hospital, and all the dispensing is done in house, using the hospital's OMP/OO/DO team who work in unison

Back to the original question:

I have an OD in my area who puts almost all kids into bifocals. She told one parent that by putting the kid (-4.50 ou) into a bifocal (+1.00) that it would slow down her change in
the distance RX. (My terminology seems to still be asleep - can't think of the correct terms!!) Seems a little strange to me, but I thought I'd see what you guys think of this and if it is really some form of vision therapy. By the way, I see more Dr. changes on refractions from this OD than any other for adult RXs.

Rhonda seems to have the same problem as me. That is that she is not the prescriber (of the bifocals), but is picking up the questions and queries from the patients parants. That is why I say that if you do prescribe bifocals for children, then a lot more time is needed in councelling the patient and parant. In that way, if there is a problem, the patient and parant will tend to go back to the original practitioner, and not the one over the road to the next practitione, who may have a different opinion about pediatric refraction and dispensing methodology

[QDO1]

I have an OD in my area who puts almost all kids into bifocals

Does any one know the % of Kids with a relevant RX / need for dispensing bifs?