My son had a catarac removed about 8 weeks ago. He's six years old and the doctor said he will need a bifocal.What type of lenses has anyone fit successfully? I was thinking a progressive or round 25? I have always liked Zeiss lenses but have never fit them for a kid. I have heard to raise the fitting cross 3 mm higher for children with progressives? Any input would be appreciated.thanks James
Progressives would be my lens of choice. Dealing with a child dictates Polycarbonate.
This limits the field a little but of the higher quality lenses the Zeiss is a good choice. I would also consider the Shamir Genesis or if the "B" measurement is small, their Piccolo lens. Anti-Reflective should go along with this to offer the most natural vision. As far as fitting height, just to the upper portion of the pupil.
I used to do a lot of kids in progressives. I used LineFree and Varilux (always poly). I spotted them center pupil or slightly above (depending on how tall the child was). I had NO rejects. That has been a few years and I never used ARC on them, however, with CRIZAL and comparable coatings now available ,I think it's a good idea.
Carol D
I think Carol D is dead on!
Naturals, Varilux, or any soft progressive works well. Fit high. Good AR really keeps poly clear. To me the
trick is a quality fit. Take your time and fit them like a glove. Flex frames fitted well from the start work best.
As a rule, I don't give kids an AR coating, on the grounds that there's absolutely no way they will be able to refrain from touching the lenses. God knows they manage to mank up ordinary lenses
Did anyone else see the episode of South Park where Cartman had to wear glasses, and the doc stapled them to his head? It was the way things should be. :)
One thing that came to my mind in reading these posts was that a child who has had cataract surgery wears a bifocal for quite different reasons that a child with an intact phakia. The latter is usually to keep the child from over compensating at near or other fusion problems. The former is not different than any other cataract patient who has absolutly no accomodative ability due to the aphakia or pseudophakia and must wear at least a 2.50 add.
Therefore the fitting "rules" might me altered on that basis. Most likely higher is better because the patient is absolutely at a loss close without the added plus power.
If progressives are used for general wear, I would suggest an intermediate combined with near pair for study and computer.
Sir James,
Why your son was not implanted with intra-ocular lens,he would(and might not)required glasses for close work.
Also because progressives have limited field of vision you think that would help him??
Sara
There is also a pretty detailed discussion about the use of progressive lenses for children in the Ophthalmic Optics Forum.
Best regards,
Darryl
Habari, Mama Sara! Habari ya Kazi?
I lived and worked out of Nairobi from 1983 to 1989. You can e-mail me if you like.
Now to your response. Here, as best I understand, they do not use IOL's until the child has reached a certain age of maturity - usually 12 to 14. So the child either wears a very strong plus lens in his glasses, 14D to 24D, or wears a contact lens.
Obviously, no progressives are available in the high plus powers so a Flat-top bifocal would work.
If the child is wearing contact lenses, then the progressive might work for general duty, however I feel that since the add power would need to be between 2.5D to 3D, thus producing a quite narrow channel, a second pair of "in house" or "at home" glasses would be more appropriate. In this case Zeiss RD might work well or a 1.5 D bifocal combined with his intermediate RX.
There is a lot we don't know about this story,(one eye or both? Cataract is result of trauma? Other wise physically healthy and mobile?) so we are all kind of guessing.
Kwahari ya kwanana !
Homer,
Nimefurai sana ku ongia kiswahili.Wewe mzungu,muhundi au mafrika?.
Asante sana,kweheri
Sara
Sara, Meme mzungu. Now you have completely taxed my Kiswahili to the limit so we'll have to do the rest of this in English. Poli Sana!
Anyway, many greetings from our home here in the Rocky Mountains of Colorado, USA!
Haven't had much occasion to use the kidogo, kidogo Swahili I know in the last few years. It was a great time for us there. Our oldest two children graduated from Rift Valley Academy and our youngest attended the International School of Nairobi.
And now you, Sara, are you a Kenyan? Mafrika? Where do you work? Do you know Dr. Mark Wood?
Any comments on my posted response to the original question - child / bifocals?
Asante sana for the note.
Kweheri,
Homer
Homer,
OK we go for english,but practise kiswahili sometimes.What a small world,I never expected somebody who has been to Nairobi I will meet on optiboard.
I think Dr.Wood has moved to Tanzania and works for CCBRT there.He is a great ophthalmologist.
I am mix bred,my dad is an east indian and my mom is half cast(mix of arab+african)from Mombasa.
Tell me Homer if you don't mind please-where were you working in Nairobi.What is your profession in eye care industries.
It gives me immense pleasure to meet you here.
Thanks for your information on tread.It was very helpful.
Asante Sana na Kweheri
Sara
I have joined Special Eyes in west lands,Nairobi.
[This message has been edited by Sara (edited 03-11-2001).]
Sara:
I don't mean to interupt your posts to Homer. I just wanted to say it is good to have you posting here on OptiBoard. You, Shabbir, Maria, John and others from abroad are a good part of the Board. You all help us keep open minds and understand what goes on in our field in different countries. We should never stop learning and having you all here just helps broaden our classroom.
Jo,
Yes,different brains from different parts of the world and from different school of taughts makes this optiboard interesting and great place to visit.
Sara
Sorry Jo, Sara and I got carried away with some personal stuff. Anyway, thanks for getin' in there and your appropriate comments.
Homer, thanks for all the input. He did have an implant put in at Riley childrens hospital in Indianapolis.We are trying to get him to use the eye that had the catarac by patching the good eye. They say he's had the catarac for about 2-3 years.He was always very mobile and is very active in all sports. The Dr. script was for about +150 with a +300 add right lens only and +50 sv left lens. I went with poly and Zeiss Top with AR. He will have many pairs of glasses but I'm not going to get him any until we see the Dr. again next month. Sport goggles are going to be a must. can he do with just SV in these.What a bout a pair of SV for his rough play outside? And he is a big time swimmer so I can see RX goggles in the near future. thanks gotta go. James
James: Thanks for the in put.
Now that we know he has one eye with "normal vision" and an implant, that changes the story a little.
He may always have some trouble getting them to work together but we do know at least he can do mid-range and close work with the "normal" eye. Just like an ambylopic, he will depend on the good eye and tend to ignore the other "picture" because of the time of disuse and because it will be trouble to "find the right spot" with the pseudophakic eye.
As his close work increses, I still would suggest an RD for in the house just to get a good field and get the plus he so quickly needs in that eye.
Just ideas, you know the whole story.
Thanks for the good post - it was good for us all.
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