children and lined bifocals

[chaoticneutral]

After reviewing System for ophthalmic dispensing by brooks and boorish I came across the section for children and lined bifocals. It states "To assure that the near addition is being used, the bifocal should be measured and placed so that the seg line bisects the pupil." It then goes on to say that "Children adapt quickly and are not bothered by the high seg placement." Ive measured quite a few children between the age of 5 and 10 but never put the seg quite so high. Have I been doing this wrong for years? I can't imagine that would be comfortable - even if children can adapt quickly. It may give them neck strain trying to see clearly over the seg. how do you measure kids for lined bi-focals?

[ioptical72]

I have always measured a child for lined bifocals by bisecting the pupil. Unless previous patient and there were complications or doctor specifies it placed elsewhere. In my experience they do adapt much better than adults and I do believe it is to help with neck strain and alignment.

[COMEINPEACE]

depending on what you are trying to do with the bifocal,they are set high to force accommodation
and i am a huge fan of the lined bifocal as opposed to progs, when attempting this

[fjpod]

depending on what you are trying to do with the bifocal,they are set high to force accommodation
and i am a huge fan of the lined bifocal as opposed to progs, when attempting this

...to "force" accommodation, or to "relieve" it??

[CCGREEN]

And...........most children do not have a bridge! So set that seg HIGH! By the time the glasses have slid down their nose a bit the seg is still up high enough to be usable. If you are using a plastic frame make sure you are using one with a bridge placed real low on the frame to try and accommodate their lack of a bridge. Or best......use a really good quality frame with nose pads so that you can get those glasses up in place where they belong and the seg it up where it is usable.

[Randal Cheek]

Has anyone else used the new Shamir Duo on children? It seems like a better option optically because there is no image jump with the add segment. It behaves like a st-28 otherwise. It also looks nicer without a line: http://www.shamirlens.com/index.php?...duo&Itemid=469

[golfnut]

Has anyone else used the new Shamir Duo on children? It seems like a better option optically because there is no image jump with the add segment. It behaves like a st-28 otherwise. It also looks nicer without a line: http://www.shamirlens.com/index.php?...duo&Itemid=469

I haven't had the chance yet but was definitely going to give it a try. Seems like a very viable replacement.

[Robert Martellaro]

depending on what you are trying to do with the bifocal,they are set high to force accommodation
and i am a huge fan of the lined bifocal as opposed to progs, when attempting this

...to "force" accommodation, or to "relieve" it??

Relieve of course. We do want to force the child to look through it (near add for near) though, hence the high position. Also make sure there's plenty of lens height above the pupil so that the child is looking through the distance correction, and not over the top of the lenses. A rounder more p3 shape works best, especially with the very young.

[fjpod]

Relieve of course. We do want to force the child to look through it (near add for near) though, hence the high position. Also make sure there's plenty of lens height above the pupil so that the child is looking through the distance correction, and not over the top of the lenses. A rounder more p3 shape works best, especially with the very young.

I agree of course, but that's not what he said. I was trying to get him to clarify his statement.

[COMEINPEACE]

BY penalizing the 'good' eye sir

[Java99]

Having been a child forced to wear a seg that bisected the pupil, I can say it was not a big deal to get used to and it did work. I always measure kids this way, hate using PALs for this, but when that's what the doc orders, that's what the kid gets.

[Michael I. Davis]

I also wore a lined bifocal as a child. Set high was not a problem. Now in my early dotage, I find that I like my progressives set higher than normal.

[drk]

There are two general categories of add use for pediatrics:
1. Strabismics, where you absolutely have to keep the eyes aligned or they may really suffer.
2. Accommodative disorders, where the child may get reduced visual efficiency.

Clearly, strabismics should have segmented multifocals with high placement that they'd have a hard time avoiding. With accommodative patients, progressive adds are just fine.

How do you know? This isn't airtight, but strabs will have adds like +2.50 and up, and accommodative patients' adds will be about +1.00.