little four eyes

One of my biggest worries when Zoe got her glasses was how she would do with her glasses when she was at daycare.  While they’ve always been wonderful with Zoe, I was sure that they would not be interested in spending all day fighting with her to get her to keep her glasses on.  When we first got Zoe’s glasses, I asked my source for glasses advice (the lady at the glasses shop) if she had any advice for me to pass along to her daycare providers.  The woman just told me that her teachers would have to figure something out.  That was the one time I got completely unhelpful advice from that shop.  I also hoped that since I was home with her the first week she had her glasses, that she’d be a spectacle-wearing pro when she went back to daycare.  Alas, it was not to be.  There were days, those first weeks, when they weren’t able to get her to wear her glasses, and we’d find them sitting in her cubby when we picked her up at the end of the day.  Luckily, she started wearing them reliably within a few weeks, so that part didn’t last long.  Still, knowing that she and her glasses were out of my control added stress to an already stressful time.

Whether or not your child is in daycare, there will be times when they’re being watched by someone who is likely less familiar with young kids in glasses than you are.  Here’s a few tips:

Information for your child care provider about your child’s glasses:

• 

  Should kids go without glasses when playing sports? It’s often safer for them to be wearing their glasses so they can see during those activities.  (Check with your child’s doctor, or think about getting sports goggles if you’re concerned about safety)

  When should your child be wearing his or her glasses?  Or maybe it would be easier to tell them when the glasses are allowed to come off (for example: nap, bath time, face washing).

• What do you want them to do when your child takes off their glasses?   This includes what to do with the glasses during nap time, or other times when your child should not be wearing glasses, but also, how should they handle your child not wanting to wear their glasses.
• Make sure they understand how vital wearing glasses is to your child’s visual development.  Since a lot of farsighted kids can function very well with glasses, it’s easy for someone to think they don’t need their glasses.
• Make sure they know how to help your child take off and put on glasses (using both hands).
• Ask them to keep an eye out for dirty lenses and make sure they know how to clean the glasses without scratching the lenses.
• Are there any activities your child should not be doing because of their vision?  Or any activities that might be particularly difficult?  Make sure they know about it and talk with them about ways to help your child during those activities.
• If your child patches, how long should they patch, when, and what should they do with the patch when your child is done?  In this case, you should also keep them up to date on how well your child can see when patching.  There may be some activities that are too frustrating, especially in the beginning with patching.
• If your child wears contacts, you should provide similar information about when and how they should be removed.
• Are there any things having to do with your child’s vision that you want them to watch out for (for example: eyes not straight, squinting, looking over the glasses)?
• Make sure they have contact information for your child’s eye doctor, and under what circumstances should they be contacted.
• If something does happen to the glasses (or contacts), what do you want them to do with the wreckage.

Things to provide (or to make sure your child care provider knows where they are):

• Glasses case.
• Glasses cleaning cloth and cleaning spray.
• Prescription sunglasses or clip on sunglasses if necessary.  Same with sports or swimming goggles if they’ll be needed.
• Extra patches, if they’re patching.
• Contact cases and solution if they wear contacts.

Am I missing anything?  (Update:  Thanks for the great suggestions!  I’ve been adding them to the list as I get a chance)

Update:  Thank you for all the great responses.  I got some great suggestions and I’ve updated this in response. 

As I was reading through the comments on my last post (asking for favorite comments about your child in glasses), it got me thinking about the good things to say to young kids in glasses, and to their parents.  And that, of course, led to me thinking about the things not to say.  Now, I’m sure there’s going to be some disagreement on some of these things.  Different people (kids and parents alike) are sensitive to different types of comments, what one person finds funny might really upset someone else.  Still, I expect there’s some general guidelines we could pull together.  All the examples below are comments that we’ve gotten personally, or ones I’ve heard about through this blog and the facebook group.

Oh, and there’s nothing wrong with saying nothing about the glasses.  It can be really hard when a child is first starting to wear glasses, even when they’re too young to care what anyone thinks.  A lot of times parents get them to wear their glasses by distracting them with an interesting trip out and about.  Having someone point out the glasses may remind the child that the glasses are there, leading to more struggles to keep them on.  But I’ve come to the realization that sometimes, you see this little one in glasses and you just have to say something.

So let’s start with what not to say:

• 

  Yes, they're real...and with them, my vision is spectacular!

  “Are those real?”
  No, they’re just imaginary.  It’s such a silly question, and yet it’s one of the most common questions that parents of a young child in glasses get.  Yes, our children look very cute in them, but believe us when we say that we would not spend the money and effort to get our child to wear these if they weren’t needed.

• “What’s wrong with your child?”  or “What’s wrong with her eyes?“
  While it’s totally reasonable to wonder why a child is wearing glasses, asking what’s “wrong” with them is really hurtful.  It’s a pretty good bet that they’re wearing glasses because their vision needs correcting (though they could be protective if the child is blind in one eye).  You could ask why the child needs glasses, without using the term “wrong”  if it’s something that you really want to know.
• Any nonsense about glasses hurting the child’s vision, or questioning whether the eye doctor got things wrong.
  Again, no one puts glasses on our children without good reason.  The glasses are there to help our child’s vision develop correctly.
• “Poor baby!”
  Glasses can be difficult, and bad vision is nothing to sneeze at, but the glasses are correcting our children’s vision.  They’re helping them to see, they don’t need pity.
• Just pointing or staring or making mocking gestures about the glasses.
  It’s just rude.  Don’t do it.  I’m sure you were raised better than that.
• He looks so cute in those glasses!
  This seems like a nice thing to say, and yes, it’s true, our kids do look cute in their glasses, but it makes it sound like they wouldn’t look cute without their glasses, and that’s simply not true.
• She looks so smart in those glasses!
  Again, this sounds like our children don’t look smart without glasses.  And besides, glasses have a magical ability to help our kids see better, but they don’t have any ability to change our child’s intelligence (not that our kids would need it).

Things to say

• Comment on something other than the glasses
  One of the fears I’ve often heard from parents is that people will always focus on their child’s glasses, and not on them.  And that fear isn’t unfounded, the majority of comments that I hear from strangers about Zoe are related to her glasses.  So buck the trend: compliment the child’s beautiful eyes, or their smile, or their quick wit, or how fast they run, or how well behaved they are.  We’d love it.
• Comment on a specific aspect of the glasses.
  Rather than simply saying a child looks cute in glasses, you could talk about how the color of the glasses brings out our child’s eyes, or that their shape really compliments his face, or that the glasses really match her personality.  If the child is old enough, you could ask if they picked out the glasses and tell them what a good job they did with that.

If you do comment on the glasses, don’t be surprised if the child is really shy or upset by it.  Zoe is normally a talkative kid, but she often clams up when she gets comments on her glasses.

Questions

We all get a lot of questions about our children’s glasses, probably the younger the child, the more questions we hear.  A parent of a young child in glasses gets pretty good at answering questions about how they knew their child needed glasses, how on earth you get a child to wear glasses, or how they can test a pre-verbal baby’s vision.  Please ask, especially if you have a young child yourself, because good vision is extremely important, and if we can help someone catch a vision problem early, then that’s a great thing.

Missy Adams created this tutorial of how she manipulates her son’s Miraflex glasses to keep them from folding down his ears.  She originally posted it on the Little Four Eyes facebook group, and I wanted to post it here as well, so it’s easy to find again.  And by special request, I’ve also made this in to a pdf that you can download and print.  Many thanks to Missy for sharing this! – Ann Z

1. This is what his Miraflex frames look like before I manipulate them.
2. I fold them first with arm pieces slightly lower than the center of the lens.
3. I pinch the joint on each side.
4. I bend the arm piece in at about where his ear is going to be.
5. This is what they look like right before I put them on his head. They don’t fold his ears down this way. He leaves them alone.

Updated: I’ve added Vision Therapy as a choice, but it’s not showing up yet.  It should show up shortly.  Sorry for that, I knew there was something I was forgetting when I hit publish.

One of our readers, Heather, asked if I’d do a poll about how many children with accommodative esotropia end up patching.  I’m expanding the poll just a bit to include other treatment options.

If your child has accommodative esotropia (partial or full), let us know what treatments you’ve done.

Zoe in her third pair of glasses (from Peeps Eyewear), and me in my second pair (from Cafe).

(Ok, not everything, that’s an exaggeration, but it sounds better than the title “Some things I know about glasses…”).  I was recently at the eye doctors for my normal eye check up.  I’d decided that I was finally going to get myself a second pair of glasses.  I could say that it’s because I want a back up just in case something happens to one pair, but I’d be lying.  I’ve found myself jealous recently of Zoe’s 3 pairs of glasses, and the fact that she gets to choose which pair she’s going each morning.  After I chose my frames, I was talking with the optician about my lens choices, when he stopped for a moment and observed that I really seemed to know a lot about glasses.  It made me chuckle, but indeed, I do know a whole lot more about glasses now.  I’ve had glasses since I was 10, but it wasn’t until we embarked on this journey with Zoe that I really learned much about glasses.

Some other things I’ve learned since Zoe got her glasses:

1. I’d never bothered to figure out what those numbers on the prescription mean.  Now I can tell people way more about what they mean than anyone probably wants to know.  Funny thing, though.  I have Zoe’s prescription memorized, but not mine.
2. I used to wipe my lenses with whatever cloth or tissue was nearby.  I know better now.
3. I also used to take my glasses on and off with one hand.  That was until we took Zoe’s glasses in for adjustment because the ear pieces were bending out, and we were both told to use both hands.
4. Speaking of adjustments, I’m no longer afraid to go in to get my glasses adjusted if they bother me.

Of course, there are a few things I still haven’t gotten through my thick skull:

1. I still forget to take off my glasses when I’m putting on a shirt with a tight-fitting neck, leaving me to struggle helplessly with the shirt half over my face, stuck on my frames.
2. That “on your face or in their case” rule that I posted recently?  I’m really, really bad at it.  The worst part being that if I don’t have my glasses on, my vision is bad enough that I can’t see my glasses.  Another great reason to have 2 pair!

A study was published this past September that looked at the safety and accuracy of glasses ordered online – including children’s glasses:  “Safety and compliance of prescription spectacles ordered by the public via the Internet,” by Karl Citek, published in Optometry, vol. 82, iss. 9 , pgs 549-555, Sept. 2011   The full text of the article is available here.

The study found that nearly half of the glasses ordered were either the wrong prescription, the wrong lens style, or the lenses failed impact testing.

It’s important to note that this study looked only at online retailers where you can buy both the frames and prescription lenses online.  Cases where the frames are purchased online, but have the lenses filled by a local optical shop would not have the problems identified in this study.

Overall, the study found that nearly half of all glasses they ordered online had a problem, either with the prescription being wrong, the lens type (single vision vs bi-focal) being wrong, or with the lenses not passing impact resistance testing – and that problem existed regardless of the cost of those glasses online.  Probably the most disturbing finding of the study was that in 25% of the glasses for children, the lenses failed impact testing.  Given how active kids can be, it’s extremely important for our children’s glasses to not shatter on impact.  The study did find that all of the polycarbonate lenses that were ordered did pass the impact resistance testing.  Some of the children’s glasses also had incorrect prescriptions.

A couple of interesting pieces from that study include the fact that the rate of problems with prescription errors was similar to the error rate at traditional optical labs, it’s just that when you order glasses through a traditional optical shop, there are additional checkpoints, and nearly all the problems have been caught and correct before the glasses even make it to the shop. The article also mentioned that some of the researchers had difficulties placing the orders correctly with some of the vendors, this despite the fact that the researchers were quite knowledgeable about eyewear.  So if you’ve felt confused by some of those sites, you’re not alone.

So given this study, I would be much more hesitant to purchase glasses online for Zoe, and I would not recommend it for a primary pair glasses.  If you do order glasses online, you can – and should! – take the glasses in to your eye doctor.  He or she can verify that the prescription is correct.  In fact, you should do that with glasses that you purchase from a traditional optical shop, too.  Your eye doctor will not be able to test the impact resistance of the lenses, though (well, at least not without breaking the lenses). I would only order polycarbonate lenses online, since the material is extremely strong and is unlikely to shatter on impact.  Also, make sure that you understand the return policy for the glasses you purchase, so that if there is a problem, you know how to return the glasses.

Thanks to the EyeWorks facebook page, which is where I first heard of this study.

A special place for Zoe's glasses.

Do you have any rules for glasses at your house?  I’ve come up with a few ideas, the first one even rhymes (I can’t take credit for that one, though, I’ve heard it a lot of times):

1. Glasses on your face, or in their case, on in the special glasses place.
2. When putting on or taking off your glasses, use both hands.
3. If your glasses are dirty, give them to an adult to clean.
   • As Zoe has gotten older and more responsible, she cleans her glasses herself, so the new rule is that she uses a special glasses cleaning cloth.
4. Tell a parent if your glasses are hurting or slipping down your face.

Rules for the adults in the house:

1. Always ask before taking Zoe’s glasses off.
2. Use both hands to take off her glasses, or put them on.
3. Put the glasses in their place or case when they’re off her face.  (Fun rhyme, but I’m really bad at this).

Rules for other kids

1. The glasses are off limits for playing, stealing, hiding, etc.  No exceptions!
2. If the glasses fall off while playing, everyone stops until they’re back on her face.

by, Rebecca of Mommy, Ever After

Something happened, recently;

In fact, many somethings.

My baby daughter became a kid;

She started to go to school;

She got recognized for her glasses.

Back in the early days, when her diagnoses, and spectacles, were so new,

my greatest fear was that she’d be judged.

I worried that she would be ridiculed

and prayed that she would not be marginalized.

I hoped that people would be able to look beyond the tiny, wire frames that sat upon her nose,

and not see a girl who was bespectacled,

but instead, a girl who was being spectacular.

I hoped. I wished. I waited.

And then, she grew up.

She started preschool.

She met children.

She made new friends.

And, by coincidence, we found out that another girl in her class had the very same name.

I wrestled with the idea of how to tackle the name situation, as I am in the role of both mother and teacher,

and with the girls being so young, I wanted to avoid as much confusion as possible.

Should I call by daughter by her full name, although she’s used to going by the abbreviation?

Should I tack on the first initial to their last name?

But, before I could come up with the right answer,

it was handed to me;

handed to me by two, tiny, sticky, toddler hands.

A little boy in the class, for whom my daughter has the utmost affection, began to ask for her on his drive to school in the morning.

His mother shared with me that as they would pull into the parking lot, he would ask for his teachers, the puppets, and my daughter.

And he would say her name, and then, to be absolutely clear, he would modify it, by saying,

“With glasses.”

His mother told me this with a smile.

Her son loved my daughter. His friend. His friend with glasses.

And when I heard this, I was overcome with great emotion.

For all those many days and weeks and months, I had felt so worried that my daughter would not be seen for who she was

for what she could do,

and here it was: The affirmation of my fears. My kid was the little girl who was known for having glasses, and even given a nickname, as such.

And as soon as her words hit me,

I felt

absolutely

nothing

but

love.

I thought it was precious.

I felt grateful.

I felt proud.

Because for me, her glasses are just one of the many things that maker her special. And they make her special to her new friend. And they have absolutely nothing to do with why he loves her.

He loves her because she shares his obsession with animals. He loves her because they do puppet shows for one another. He loves her because they sit quietly together, in the corner, and read books. And he loves her enough to have a nickname for her. And it is true. She’s with glasses,

but she’s also with so much more.

It’s long bothered me that some of the terms or phrases related to children’s vision are  inaccurate and sometimes even mean very different things, which leads to all sorts of confusion.  Here are the ones that I can think of, though I’m sure I’m missing others:

Squint

The one that trips me up the most is the word “squint.”  Until we started our journey with Zoe’s strabismus, I always thought squint meant having your eyes mostly closed, like you do when you’re in bright sunlight.  Turns out that squint is also a synonym for strabismus and having your eyes not in alignment.  This can lead to all sorts of misunderstandings when people talk about their child having a squint, or squinting to see something.  For instance, before realizing there were two definitions, at one of Zoe’s eye appointments, I tried bringing up the fact that Zoe squints one eye in the sun, that is, she closes one eye most of the way, leaving the other open.  Zoe’s ophthalomologist thought I meant that Zoe was crossing an eye whenever she was outside.  I now try to avoid this word altogether.

Zoe exhibiting two different "squints": eyes not aligned (left), and looking through eyes mostly closed (right)

Lazy Eye

The phrase “lazy eye” is similar in that it can mean different things to different people.  I think most people in the eye care industry consider lazy eye to be a common phrase for amblyopia – when one or both eyes doesn’t see clearly even if it has no defects, or even if any refractive error is corrected with glasses or lenses.  Never mind that “lazy eye” doesn’t really accurately reflect what’s happening with amblyopia, since it has nothing to do with an eye being “lazy” and everything to do with the brain not paying attention to the visual input of the eye.  But beyond that complaint, a lot of people hear “lazy eye” and equate it with strabismus, since you see one eye focusing on an object and the other eye looking elsewhere (being lazy?).  And I’ve heard other people refer to ptosis (drooping of the upper eyelid) as a lazy eye, again, presumably because the droopy eye looks “lazier”.   Further confusing things is the fact that both of those conditions can lead to lazy eye or amblyopia, but they’re not the same thing, and the treatments can be very different.

patching for amblyopia

Strengthening the weak eye

Related to treating lazy eye is the phrase that I find myself using a lot: “strengthening the weak eye”.  When a child patches the amblyopic eye, we often explain that they’re doing it to strengthen that eye.   In reality, though, we’re trying to get the brain to recognize the visual input from that eye, the eye itself isn’t being strengthened.  It’s misleading in a couple of ways.  First, when people hear “strengthen” they often think muscles, and I wonder if that adds to the confusion of thinking that lazy eye has to do with eye muscles and strabismus.  It can also lead to the misunderstanding that patching might make it so that the eye won’t need any correction any more if the patching is successful.  While patching can improve the visual acuity, if that eye needs glasses to see clearly, patching won’t fix that.

and on a much lighter note

Finally, on a lighter note, a reason to know the correct terminology for parts of glasses was posted over at Not Always Right (a blog about working with customers who aren’t always right).  I’d recommend using the term “temples” or “ear pieces” when talking about that part of glasses, not “legs”.

For the crafty minded, or those looking for some crafts to work on with their kids, here’s some glasses-related crafts…

• Make a glasses case: Amomofelly pinned this link to instructions for making a simple glasses case that can be decorated however you or your child chooses.
• Turn old glasses frames into picture frames: I found these instructions a long time ago. I think it’s an interesting I idea, though with kids’ glasses, the pictures would be so small.
• Patches: There’s a ton of instructions for making your own patches to go over your child’s glasses, and the great thing is that they can be decorated to fit your child’s personality and likes. The big thing to be sure of is that the patch provides complete occlusion, and your child can’t peek. Here’s a couple tutorials, you can also google for eye patch tutorials or eye patch patterns:
• Using craft foam – pattern developed by Amomofelly and posted here a year ago.
• Using felt – from Lucykate Crafts

Anyone made any of these and want to share a picture?  Or have any other glasses-related crafts to share?