Many children who have had retinoblastoma will also wear glasses to correct their sight. Alicia Thompson, Director of Education, Research and Professional Development at ABDO (the Association of British Dispensing Opticians*) explains the importance of a good fit for children’s glasses, and what to look for.
A child’s face is not the same as a small adult.
Currently, most spectacle frames are not designed for children, they are just small adult designs. The designs are fashionable, and children often want to wear these frames which is positive, their friends approve, and parents like the ‘mini-me’ look. However, let’s consider the impact of a child wearing a small adult frame…
A young child has a very low, flat and wide bridge of the nose which leaves us very little to sit a pair of spectacles on.
If we fit a small adult frame with a bridge in a typically high position, it will invariably slide down the nose until it stops at the first point of resistance – usually the end of the nose where the nostrils are.
Added to the slipping problem, a child spends a great deal of time looking upwards in this adult-designed world so will therefore end up looking over the top of their spectacles.
And how annoying for anyone to keep having to push the frame up your nose!
Looking over the top or through the wrong part of the lens means the child cannot see clearly and visual learning is vital for development. This may mean they cannot see the teacher or whiteboard in a classroom environment, or they don’t see the ‘look’ that parents can give silently when behaviour may need reflection and correction!
We have spectacle lens technology that can do wonderful things such as correct vision, attempt to slow progression of short-sightedness and even intervene in the developing visual pathway. This is all great news for our child’s future vision but we must ensure the positioning of these lenses is both correct and stable to ensure the benefits of this technology are received. Sunglasses for children are also very important to protect against UV and if these frames also do not fit well, the harmful rays will still reach the eyes.
FIT – what to look for
Spectacles should make suitable contact with the face so that the weight of the spectacles is distributed appropriately and therefore is comfortable, stable and safe for the child.
The green frame above has been designed using ‘small adult’ parameters, there is little contact with the bridge and already the frame is sliding down the nose. The lens shape is rectangular which makes it easier for the child to look over the top. The width of the frame is also too wide – there are gaps alongside the head.
The blue frame on the right is better by design – the pupils are sitting more centrally as the bridge of the frame is positioned lower than the green frame. The rounder lens shape means this child has more lens to look through when gazing upwards, rather than looking over the rim. The width is better with some gentle contact on the head before the sides bend at the ear.
Ideally, a well-fitting frame would:
- Sit on the face with the child’s pupil positioned centrally in the lens.
- Sit as close to the eyes as possible – this gives a wider field of view and more accurate correction.
- Make good contact with the nose around the bridge area, or soft nose pads sitting flat against the skin to distribute the weight.
- Achieve the correct tension on the head – no large gaps or indentations being left on the side of the head.
- A gentle bend of the side behind the ear, tucked slightly into the head and the end tip is not too long.
- The angle of the frame front does not allow contact with the child’s cheeks.
- If an elasticated strap band is used with young children, ensure it is not too tight so that the child can blink easily without their lashes touching the lenses.
Dispensing opticians train for three years and are rigorously assessed to dispense and fit children’s spectacles effectively. Children are protected by regulation, and this means the practitioner who dispenses the child, or oversees the dispense must be registered with the General Optical Council.
My research on children’s facial dimensions is now feeding into frame designs so we should see more appropriate frames and an improvement overall in the fit, comfort and stability allowing our children’s vision to be the very best it can be.
Alicia Thompson BSc (Hons) PhD FBDO R (Hons) SLD SMC (Tech)
I began my career in optics 35 years ago and I feel really privileged to say that I have never stopped learning since surfacing my first lens as an optical technician. I then went on to become a dispensing optician, registering in 1994 and managing a successful practice. My interest in teaching took me to Aston University as clinic manager for over ten years where I also qualified as an examiner for the ABDO. Having an interest in ophthalmic lenses, I went on to complete the L7 course in Spectacle Lens Design in 2006.
In 2008, I was appointed as Director of Professional Exams for ABDO and since 2022 Director of Education, Research and Professional Development which is my current role.
I was fortunate to be given the opportunity of joining the first cohort with Canterbury Christ Church University to obtain my degree in 2010 which has now allowed me to pursue my interest in research. In 2021, I completed a part-time PhD at Aston University looking into paediatric facial anthropometry in relation to spectacle frame design. My ultimate aim is to improve the fit of spectacles for all children by assisting the frame manufacturers with a sensible set of parameters and design features. I still practice in my specialist paediatric dispensing clinic in Birmingham and run workshops for educational purposes.
In addition, I also serve on many committees such as Education Committee and Expert Advisory Group for the General Optical Council, ABDO Research and Clinical Committee Chair, Academic Committee and British Standards for Spectacles.
I have been honoured to be invited to speak at many conferences and educational events worldwide.
*Dispensing opticians measure for glasses or contact lenses and help people choose lenses and frames.