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What I have learned

“If glasses fit really well, they just become part of you”

Optometrist at Aves Optometrists, Polly Dulley, and mother of four-year-old Bella, Katherine Brockhouse, discuss the importance of finding frames that fit comfortably to ensure compliance

13 Aug 2018 by Andrew McClean

What did you have to consider for Bella when finding the right pair of spectacles?

Polly Dulley (PD): It was Bella’s (pictured) first pair of spectacles and she’s fairly long-sighted. Katherine brought her in because she’d noticed one eye was turning in and she was developing an accommodative squint. When I corrected the long-sighted part of the prescription, it straightened the eyes up, so as long as Bella wears the glasses, she doesn’t have a squint. It was really important to find something that fitted her very well and that she’d be comfortable and happy wearing.

Bella is only four-years-old so, in terms of the fit, the size and the shape is really important. Having something where she’s looking very close to the optical centre of the lens and having a round, oval shape is really good, particularly for plus lenses. If the top of the frame is too flat, children tend to look over the top of it.

The bridge fit is critical because at four years old, they generally have a very flat bridge and their nose hasn’t developed fully. If you wear glasses all the time, you’ve got to be able to forget that they are there. If glasses fit really well, they just become part of you whereas if you are constantly having to push them up and not getting the best vision then they’re not going to achieve their goal and the patient will be less interested in wearing them.

What concerns were raised and how did you handle them?

PD: With most new spectacles wearers, parents are mainly concerned about whether their child will keep them on. Even if the parent wears glasses, they’ll worry about that. If the glasses fit really well, the child will be comfortable wearing them. Also, if I’m putting a child in glasses, there needs to be a strong reason for doing so.

I wouldn’t put a child with a low prescription into glasses; I need to be able to justify that it will make a real difference to their ability to see and for their visual function. If that’s the case, children appreciate that very quickly. I reassure them that the prescription will make a difference and as a result the child will want to wear them.

Did you have to adapt or change your method to ensure the patient found the right pair of spectacles?

PD: Children tend to fall into two camps; children either really want to wear glasses or they really don’t. If they don’t, there needs to be lots of positive reinforcement and getting mum and dad onside. Giving the parents an explanation about why it’s important is critical. If you get that compliance from the parents, they’ll be able to encourage their child to wear them. There is a bit more psychology involved with fitting children than adults as you’re involving the whole family.

What are the most common questions that get asked when fitting children with spectacles?

PD: From the parents, it’s ‘How am I going to keep them on?’ particularly if I’m fitting under-twos with glasses. Also, you have to be really clear that while you’re helping their child to see better, that it’s not going to cure it and you are simply treating the problem. Children are more interested in details such as ‘do I need to sleep in them?’ To a child, those points are really important, so it’s good to spend some time getting them to be confident as a spectacle wearer.

"There is a bit more psychology involved with fitting children than adults as you’re involving the whole family"

What are the key points that you make sure the patient and the parent go away with to ensure success with wearing spectacles?

PD: I make it really clear why it’s important to wear the glasses and for what tasks. I talk to them about how to look after them and to take them off with two hands rather than tugging at them with one hand, for example. 

Generally, I talk to them about how much better life is going to be now that they can see really well with the glasses. For parents, we tell them that we expect them to be back for adjustments and repairs. They must never feel concerned about coming back because we’re there to maintain the glasses for their child.

What are your top tips for fitting children’s frames?

PD: Take a positive attitude and be really confident about why you are prescribing glasses. Be professional about how you dispense the glasses – don’t be swayed by parents who have an idea about a fashion statement they want the glasses to make. Often parents are not aware of the NHS help that is available, so it’s good to let them know what they are entitled to.

Why did you decide to take Bella for a sight test?

Katherine Brockhouse (KB): I’d noticed that one of Bella’s eyes had started wandering in. I kept an eye on it and then when we went on holiday, I noticed it happening a lot. I took her to the optometrist and they said that she had a squint and is also long-sighted, so she needed glasses. I wanted a second opinion and to speak to a specialist. A family friend made a recommendation to see Polly, so I took Bella along to get it checked out. 

Why did you decide on spectacles?

KB: The squint runs in our family but it had skipped me, so I wanted to see how it could be corrected. Polly explained that it’s something Bella is always going to have and that she will need to wear glasses for life. I didn’t want to leave it and think later on that I could have done something for my daughter and then find out it’s too late. Polly fitted some new lenses and we are going back every three months just to keep an eye on how it is developing as Bella’s only four years old and her eyes are still changing.

"It's easy to ignore and think that kids just do silly things with their eyes, but that squint could get worse. I really think it's important to get children's sight tested and to check their eye health"

What concerns did you and your child have about wearing spectacles?

KB: Four is a young age to start wearing glasses and I wasn’t sure if she would keep them on her face. Luckily, she’s kept them on and it hasn’t been an issue. I notice so many kids wearing glasses now that I’m aware of it as well.

How did the practitioner help you and your child find the right pair?

KB: Polly helped to get the right fitting glasses and some prescription sunglasses. She explained that a good fit will ensure Bella isn’t always looking over the glasses.

What factors did you consider when selecting frames?

KB: I didn’t want Bella to have plastic, baby glasses. If that was me, I’d want a cool pair of glasses rather than ones that don’t really suit her.

How has this experience changed your outlook on children’s eye health?

KB: It’s easy to ignore and think that kids just do silly things with their eyes, but that squint could get worse. I really think it’s important to get children’s sight tested and to check their eye health. 

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