Your child's first glasses at the optical shop: frame fit, lens material and what to ask

You have the prescription slip and a free Saturday. The kedai cermin mata has a wall of frames, a dozen lens options and a child who has already picked the pink pair. The number was the eye doctor's job. Choosing the pair is where fit and lens material decide whether the glasses actually get worn and whether they are safe when they fall.

What do I take to the optical shop for my child's first glasses?

Take the prescription slip, your child, and any note from the eye doctor about the lenses. In Malaysia, opticians and optometrists must be registered with the Malaysian Optical Council under the Optical Act 1991, and the Act lets optical appliances be sold only by or under the supervision of a registered person or a medical practitioner. Ask who is dispensing your child's pair.

The slip carries the power for each eye. The optician will also measure the pupillary distance, the gap between the centres of the two pupils, so that each lens sits in front of the pupil. If your doctor wrote anything about lens type, such as impact-resistant lenses only or a particular coating, hand that over first. For a young child, bring the child along even if it is tiring. Frames are fitted to a face, not to a number.

If the glasses were just prescribed and you are still taking it in, what happens after a child is told they need glasses covers the first steps.

How should a child's frame fit?

The eye should sit in the middle of the lens, the frame should be wide enough that your child looks through the lens and not over the top, and the glasses should stay put without pinching. The American Association for Pediatric Ophthalmology and Strabismus says the frame should be comfortable with each eye centred behind the lens, and that size is very important.

Go through the parts one at a time.

• Bridge. A child's nose bridge is low and still growing. A UK hospital leaflet advises that the bridge sit fairly low on the frame so the lenses are raised to sit centrally in front of the eyes. If the glasses slide down, the bridge is often the reason.
• Width. Too narrow and your child peers over the top. Too wide and the lens drifts off the pupil, but the eyes should not touch the sides of the head either.
• Temples. The arms should follow the line of the ear. The same leaflet suggests no more than about 3 to 3.5 cm behind the ear. Toddlers often wear cable temples, the flexible hook behind the ear, and the cable should not be too tight nor the arm too short.
• Grip. A strap or silicone temple tips (ear grips) help keep glasses on a small face, and the tips can be changed as the child grows.
• Material and hinges. Plastic frames suit babies and children with small features, and many shops offer a flexible hinge that gives when the glasses are pulled. I know of no source that ranks acetate against silicone or one hinge type against another, so ask the optician to show you how the frame handles a tug before you buy.

For a toddler who keeps taking them off, glasses a toddler will keep on goes through straps, tips and routines.

Which lens material is safe for a child?

Polycarbonate. The American Association for Pediatric Ophthalmology and Strabismus says polycarbonate lenses are the only type that should be prescribed to children unless the ophthalmologist advises otherwise, because they are shatterproof. The American Academy of Ophthalmology advises non-breakable frames and polycarbonate safety lenses, at least 2 mm thick for daily wear.

Glass is the weak choice for a child. The Academy says plastic lenses are lighter than glass and safer because they are less likely to shatter. Ordinary plastic is better than glass, but polycarbonate is the highly impact-resistant one. The Academy also lists trivex, a newer plastic that meets the same safety standards as polycarbonate and distorts the picture less. Polycarbonate comes with built-in UV protection and a scratch-resistant coating.

Ask the shop to write the lens material on the receipt. Children fall, sit on glasses and get hit by balls, and a lens that breaks near the eye is the injury this choice prevents. If your child plays ball sports, ask the eye doctor about proper sports eyewear as well.

What about thin lenses, coatings and photochromic lenses?

A strong prescription makes a thick lens, and a high-index lens is a thin, light plastic made for substantial prescriptions. Polycarbonate already works well with strong prescriptions, so ask the optician which option gives a thinner lens in your child's power, and whether it is also impact resistant. Thinner is lighter on a small nose, and that helps the glasses stay on.

Coatings come next. A scratch-resistant coating helps, although the Association of British Dispensing Opticians notes no lens is fully scratch-proof. An anti-reflective coating reduces glare. For UV protection, polycarbonate has it built in, and the Academy notes some plastic lenses already block UV without an extra coating, so ask before paying for it. Photochromic lenses darken in sunlight and clear indoors. They are an option, not a need, and I have no evidence either way for children, so choose them for convenience if at all.

Blue-light coatings are the one to skip. The American Academy of Ophthalmology says there is no scientific evidence that screen light is damaging to the eyes and does not recommend blue-light glasses. Do children need blue-light glasses? gives the full picture.

What should I check when I collect the glasses?

Put them on your child and look at three things: the lenses are centred in front of the pupils, nothing pinches or leaves a red mark on the nose or behind the ears, and the glasses do not slide when your child looks down or shakes the head. Do this in the shop, before you pay.

Ask for adjustment on the spot if any of these fail. Most children settle into glasses within about two weeks, according to the American Association for Pediatric Ophthalmology and Strabismus, but a pair that hurts or slips is a fit fault, not a child fault.

Return for adjustment whenever the frame stops sitting right, as the UK hospital leaflet advises, because a child's face changes. How often to re-check the number and when a frame is outgrown is in how often a child needs new glasses, and the numbers on the slip are explained in reading your child's myopia prescription.

What should I ask the optician, and who picks the frame?

Ask five things: Are these lenses polycarbonate or another impact-resistant plastic? Is the pupillary distance measured for this frame? Does the shop adjust or repair the frame after collection, and for how long? What happens if a lens scratches or the frame breaks in the first months? Can I buy a second pair or a spare frame with the same lenses, and what does it cost? Shops differ on warranty and spares, so ask and get the answer on the receipt. I do not know of a Malaysian rule that sets either.

Your child chooses the frame. The one your child likes is the one your child wears, and a frame that is left in a bag does nothing for the eyes. Pick the rules first, then let your child choose within them: the right width, the bridge that sits low enough, arms that grip, polycarbonate lenses. A bright colour that meets the fit rules beats a plain one that gets pulled off.

The honest difficulty is that the pair your child loves is sometimes the pair that does not fit, and the shop may not say so. If it fails the checks above, say no and offer two that pass.

When should my child see the eye doctor again?

Come back sooner than the routine date if your child gets headaches, squints, holds things close, complains of blur, or refuses to wear the glasses after the first weeks even with a good fit. The optician can fix the frame. Only an eye examination tells you whether the number has changed or something else is going on.

A refusal is not stubbornness to push through. It can be a fit problem, a prescription that is not right, or a child who cannot see well enough with the glasses to want them. Keep the receipt and the slip together, book the check, and bring the glasses. How to tell if your child needs glasses lists the signs by age.

Common questions

References

1. American Association for Pediatric Ophthalmology and Strabismus · Glasses for children · aapos.org
2. American Association for Pediatric Ophthalmology and Strabismus · Glasses fitting for children · aapos.org
3. American Academy of Ophthalmology · Eyeglasses: lens materials and coatings · www.aao.org
4. American Academy of Ophthalmology · Children's eye injuries: prevention and care · www.aao.org
5. American Academy of Ophthalmology · Screen use and kids · www.aao.org
6. United Lincolnshire Hospitals NHS Trust · Children's glasses · www.ulh.nhs.uk
7. Association of British Dispensing Opticians · A guide to selecting children's glasses · www.abdo.org.uk
8. Optical Act 1991 (Act 469), reprint hosted by the World Council of Optometry · worldcouncilofoptometry.info

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.