FITTING KIDS WITH correctly sized eyewear is essential for the proper development of their vision. That means not too big and not too small.
However, there are times when a larger eye size may be ideal or even necessary. Frames that have the child’s eyes centered top to bottom and left to right are considered “optimal fit,” but occasionally there are reasons why this is not the best for your patient. I’m sharing four reasons why you may need to fit your little patient with a larger eye size than conventional wisdom dictates.
Nystagmus or Wandering Eyes
Nystagmus causes the eyes to move rapidly back and forth. When a child has eyes that wander like this they need extra lens area to look through. If the frames are small and limiting, it could interrupt their vision. Also kiddos with nystagmus often have a “null point,” which is the position of the eyes that creates the least amount of jittering back and forth. When I measure a child’s pupillary distance, I take special care to look for this null point. If it’s far off to the side, causing the child to turn their head to see the clearest, I will mark it accordingly. If I see that the child often turns their head to accommodate for this point, a larger eye size frame may be required so that they are not restricted by the frame’s edge when looking around. In this case, just a few millimeters larger on the eye size can make a big difference in the field of vision.
Neck Paralysis or Head Tilt/Turn
Like nystagmus, a head turn or tilt may require a slightly larger eye size. Some children may suffer from a neck paralysis or stiffness which may make it difficult to turn their head in the direction they need or want to see. Children in wheelchairs with restricted head rests also fall into this category. Special consideration should always be given when natural head movement is restricted. Often a larger eye size frame can make a world of difference.
Safety
Glasses can be prescribed for eye protection. If a child has poor vision in one eye, the other eye needs to be fully protected. Glasses that don’t completely cover the entire eye socket area won’t provide adequate protection. Not only should the lenses be made to a special safety thickness and of polycarbonate or Trivex, but they also need to be large enough to cover the cheek bone and extend around the eyes enough to block fingers and debris.
Craniotomy and Facial Challenges
I’ve met many little children who have had surgeries on the skull and face. When their glasses are being fit, it’s important to remember we are not just fitting the eyes, but the whole head. Some kiddos may have scarring, swelling and sensitivity in areas where the glasses touch. Care should be given to these areas! Sometimes a larger eye size is needed to take the pressure off. However, you should still look for the smallest eye size that can be adjusted and molded to create the needed release of pressure. When using a larger eye size frame it may add unnecessary weight causing a problem.
In a very fashion-centered adult eyewear world, “big” glasses are all the rage right now. Some of these larger shapes can prove to be an advantage for some of your little patients if fitted properly.