How can you tell what a child's glasses prescription should be if the child is too young to tell you how well they see?

This is an excellent question.  Infants aren’t likely to sit up in the exam chair, look through the big glasses and answer questions like, “Which is clearer, number one or number two?”  But there is a very reliable way to determine if a child needs glasses.

Once the pupil is dilated and the eye relaxed, the examiner uses a special lighted instrument to look deep into the eye.  We are able to watch how well the eye focuses the light beam we are shining into it.  If the eye is focusing correctly, that light beam will have a distinct appearance.  If the eye is not focusing correctly and in need of glasses, the beam will look differently.  Additionally, far-sighted eyes reflect the beam differently than nearsighted eyes.  The greater the need for glasses, the more different the beam will look.  We then use a series of lenses to help the eye focus the beam correctly.  Once we see a properly focused light beam through the lenses we use, we can then generate a precise prescription for a child’s glasses.

My child will not keep the glasses on.  What can I do?

Children may be resistant to glasses wear at first.  There can be several reasons for this.  First, it is important to ensure the glasses fit properly.  Make sure the nose pieces and ear pieces seem comfortable and are not too tight.  If you are unsure whether the fit is correct or not, the optical shop where you purchased the glasses should be happy to assist you and adjust the glasses if necessary.  It is normal to need frequent adjustments.

If fit and comfort are not issues, your child may be rejecting the glasses because their eyes need to adjust to seeing well through them.  This is because a child’s eyes have often strained very hard for a long time in an effort to see as clearly as possible without glasses.  The eyes do not immediately realize they can relax their strain and get even better vision through the glasses.  It may take up to 72 hours of uninterrupted glasses wear during waking hours for the eyes to relax enough for your child to get the full benefit of the glasses.  Until then, your child’s vision will be especially blurry while wearing their glasses.

Many times children will be much more compliant if they can be confident the glasses will stay in place or not come off easily.  A glasses strap or a curved earpiece may help.  You optical shop can assist you in choosing a strap right for your child’s glasses.  The curved earpiece, called a “cabled temple,” is usually integrated into the frame when it is purchased.  They are normally not added later, but check with your optical shop to see if it may be possible.

An option for parents who are having a particularly hard time keeping the glasses on their child involves an eye drop.  We can prescribe, or administer in our office, a drop which will relax the strain the eye has locked itself into as described above.  This makes the glasses of immediate benefit to your child’s vision.  The effect lasts about 3 days, giving you uninterrupted good vision through the glasses.  With clear vision assured by glasses wear, behavior then becomes your biggest issue.

Only in the most rare and drastic cases do we suggest using medically designed arm restraints as a time-out tool.  This does not make the process any easier and the attention the parent must to give the child during this process increases.  It is very rarely used, but can be helpful especially with children of diminished mental capacity.

Parents have frequently commented that the struggle to have a child wear their glasses can be constant and fairly intense for about 3 or 4 days, but once the child realizes you are not giving them a choice, that they must wear them, parents often tell us their children begin to love wearing their glasses.  It is not uncommon, even with the most resistant strong-willed children, for parents to report that, with several days of hard work, their son or daughter will not take the glasses off.  They fall asleep in them and want them as soon as they wake up.  So be encouraged.  If you persevere, you may join the many parents just like you who have found success.  Their child’s eyes are healthy and seeing well and their hard work has helped end an unpleasant struggle.

What if my child says he can see just as well or even better without their glasses on?

This is very possible, especially if glasses wear is new to your child or their wearing of the glasses has been inconsistent.  The eye-straining condition previously described could cause children who are inconsistent with full-time glasses wear to find their eyes adapting back to the strained condition they had prior to getting glasses.  Once the eye is excessively strained in this way, vision will not be as clear through the glasses without breaking this cycle with a period of constant wear.  Wearing their glasses consistently is the only proper way to address their eye problem.

It is true that an out-grown prescription may indeed result in decreased vision to the point your child may see better without their glasses.   Better does not necessarily mean “good enough.”  Please check with our office before determining whether it is safe to discontinue glasses wear or whether it is an indication your child needs further evaluation.  It is very possible for what seems like an obvious decision, made in a reasonable way to result in long-term damage to a child’s visual potential.  We are happy to hear from you with any questions you might have.  Please feel free to call.  It’s much better to stay on the safe side.

But if my child sees clearly without glasses, doesn’t that mean they don’t need them?

The answer is most likely no, they do need them.  As strange as it may sound, improved vision is often not the most dramatic benefit of glasses wear for young children.  Your child may be wearing glasses to keep their eyes straight.  For a full explanation of this condition, please see the article in our patient education section titled, “How Can Glasses Make My Children’s Eyes Straight?”

What Should I Bring?

1. Click here to download the Pediatric Eye Specialists signature authorization page, fill it out prior to your appointment to save time.

2. If you or your child has a pair of glasses, please bring them to the appointment, even if they are broken, scratched or old.