Issue #21 – Tips for Buying Kids’ Eyewear

Tips for Buying Kids’ Eyewear

If you’re a parent of a child with Down syndrome in search of the right pair of eyeglasses for your child (him/her), you probably know that walking into an optical store can be confusing. There is no shortage of children’s eyeglass frames. The problem is: how do you figure out which ones: a) your child will be willing to wear; and b) will last longer than the ride home?

To begin with, most Down syndrome children who need eyeglasses are either nearsighted or farsighted. Some parents will be instructed to take their children’s eyeglasses off for schoolwork, while others need to have them on every waking moment. Sometimes the eye doctor will make specific recommendations about suitable eyeglass frames; but more often that decision is left up to you, your child’s facial features and the optical dispenser who fits the glasses.

Here are a few items to consider to make your trip to M. S. Optical an enjoyable experience and to ensure that you get children’s glasses that will endure.

1. Fashion
Whether they are full- or part-time eyeglass wearers, most parents of children with Down syndrome get at least a little critic about their child’s eyewear, especially the first time they wear them. So it’s very important that they avoid frames that make them look outdated. You also should consider steering away from frames that clearly are objectionable, too expensive or inappropriate.
Just keep in mind that the real object is to get your child to wear the glasses. Extra features like transition lenses with tints that darken outdoors, which help protect the health of the eyes, may make child to want to wear glasses at all times indoors and outdoors.

2. Plastic or Metal?
Children’s frames are made of either plastic or metal and many have styles that intentionally mimic frames designed for adults. Kids often are attracted to these styles because they look more grown-up. It’s not unusual for kids to ask for glasses that look just like their mother’s or father’s pair.

In the past, plastic frames were a better choice for Down syndrome children because they were considered more durable, less likely to be bent or broken, lighter in weight and less expensive. But now, manufacturers are making metal frames that incorporate these features as well. Metal composition varies, so ask us which one is best for your child, based on experience with different alloys.
Ask for hypoallergenic materials if your child has shown sensitivity to certain substances. For example, some people are allergic to frame alloys that contain nickel.

3. Proper Bridge Fit
One of the toughest parts about choosing suitable frames for Down syndrome children is that their noses are not fully developed, so they don’t have a bridge to prevent plastic frames from sliding down. Metal frames, however, usually are made with adjustable nose pads, so they fit everyone’s bridge.
Most manufacturers recognize this difficulty with plastic frames and make their bridges to fit Down syndrome children with small noses.
Each frame must be evaluated individually to make sure it fits the bridge. If any gaps exist between the bridge of the frame and the bridge of the nose, the weight of the lenses can cause the glasses to slide, no matter how well the frame seems to fit before the lenses are made.
It’s important that the glasses stay in place; otherwise kids tend to look over the top of the lenses instead of pushing their glasses back up where they belong. Our staff is usually the best judges of whether a frame fits properly.

4. Spring Hinges
A nice feature to look for is temples with spring hinges. These special hinges allow the temples to flex outward, away from the frames, without causing any damage. Although they sometimes cost a bit more, spring hinges can be a worthwhile investment for children’s eyewear.
Children with Down syndrome are not always careful when they put on and take off their glasses, and spring hinges can help prevent the need for frequent adjustments and costly repairs. They also come in handy if the child falls asleep with the glasses on or just has a rough day at play. Spring hinges are strongly recommended for Down syndrome children, who sometimes get carried away playing with their new glasses.

5. Warranties
Many optical manufacturers offer a warranty plan that will replace eyewear for a small fee in case of damage to the frames. Warrantees are important especially if your child is a toddler or a first-time wearer.

6. Backup Pair
Because Down syndrome children can be tough on their eyewear, it’s always a good idea to purchase a second, or backup, pair of eyeglasses for them. This is especially true if your child has a strong prescription and cannot function without his or her glasses.
Ask us if special discounts apply for second pairs – they often do if the backup pair is purchased at the same time as the primary pair. If your child’s prescription has not changed significantly, keep his or her previous eyeglasses in a safe place for use as a spare.
If your child wears glasses full time (including outdoors), photochromic lenses or prescription sunglasses also should be considered to decrease glare, increase visual comfort and provide 100 percent protection from the sun’s harmful UV rays.
To reduce costs, ask us if the lenses in your child’s previous glasses can be tinted to transform them into sunglasses. If the prescription is essentially the same as your child’s current glasses, this is a viable option to purchasing a new pair of prescription sunglasses.

MICHAEL KAPLOWITZ, M.D.
3014 ARLINGTON AVE.
RIVERDALE, NY 10463
(718) 796-1494

1. Biographical Statement
After graduating from the Albert Einstein College of Medicine, Michael Kaplowitz, MD completed his psychiatry internship and residency and a fellowship in Consultation-Liaison Psychiatry all at Hillside Hospital – Long Island Jewish Medical Center. He is certified by the American Board of Psychiatry and Neurology in both General Adult and Geriatric Psychiatry. He was a faculty member in the psychiatry residency training program at Flushing Hospital (Queens, NY) for ten years, teaching courses on psychiatric diagnosis, psychopharmacology, and interviewing techniques. His academic and clinical activities center around central nervous system (CNS) disorders, specifically mental retardation, dementia, head trauma, and seizure disorders. He is a consultant to seven organizations for Jewish developmentally disabled / mentally retarded adults, each of which sponsors group homes for such individuals. He is the Director of Behavioral Health at the Blanche Kahn Medical Center in Brooklyn, NY since 2004 and maintains a private practice.
2. “Reflections on the Practice of Psychiatry”
When behavioral or psychiatric symptoms develop in mentally retarded, intellectually disabled, autistic or other developmentally disabled individuals, medications should not be considered the first option in addressing the problem. Behavior plans, creative non-pharmacologic interventions and, when possible, psychotherapy should be considered before medications. If, after a fair trial, these fail to produce the desired results and the individual’s level of functioning deteriorates because of the difficult behaviors, or if the individual’s well-being or that of others around him/her is threatened on an ongoing basis because of the difficult behaviors, we consider using medications to help the individual regain control of his/her impulses and ability to function more appropriately.
A “general principle” of practicing medicine is to “Above all, do no harm” (primum non nocere). Prior to initiating treatment for any psychiatric purpose, the doctor is obligated to learn as much as possible about the individual to be treated by obtaining a good history of his/her life, activities, and past medical history. We request current blood tests to assess if a person’s body is performing normally and can safely tolerate recommended medications. We test for electrolyte levels (sodium, potassium, calcium, etc.), blood counts, thyroid, liver and kidney function and any other tests a particular individual may need. Liver and kidney function, for example, are important to know because almost all psychiatric medications are metabolized (broken down into a usable form, or from a usable form into a waste product) by the liver and are excreted (eliminated from the body) by the kidney. If either the liver or kidney is not working normally, the medication might not work, or worse, may cause the patient to suffer the effects of drug toxicity.
It is also important for the doctor to know all medications a person used in the past and what effects resulted. Current medications and dosages, including those prescribed by other doctors, vitamins, supplements and over-the-counter medications need to be identified. On April 26, 2011, the Wall Street Journal reported that for a long time it had not been understood why the SSRI anti-depressants (Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro) helped many people but seemed useless for others. In studying this question, researchers discovered that many of those who received no benefit from the SSRIs were also taking NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin or Motrin/Advil, for various reasons. By a mechanism not yet understood, the NSAIDs effectively block the anti-depressant effect of the SSRIs.
The brains of intellectually disabled and autistic individuals are usually more sensitive to the effects of psychotropic medications and to the possibility of side-effects and drug-drug interactions, than the general population. This is why the dosages of psychotropic medications used in treating such individuals are generally lower than dosages used in treating the general population. In addition to using the fewest number of unique medications, it is wise to start a new medication at a very low dose, and assess after 1-2 weeks if it is tolerated or produced side-effects. Only then can the dose be advanced, if needed.
The issues listed above are just of few of the many concerns a doctor must have before considering prescribing a medication, and which he/she must continue to monitor for, as long as the patient is using the medication. The pharmacologic approach we employ is meant to maximize an individual’s potential, to help him/her gain control over difficult impulses and minimize agitation, aggression, and self-abusive behaviors commonly seen in the intellectually disabled population. We also believe that when our clients exhibit symptoms of agitation and aggression, mood disorders (depression or bipolar disorder), anxiety disorders (panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, etc.) or psychotic disorders, the quality of their lives can be enhanced if we treat the problems that are causing them to suffer. In this way, the dedicated and careful doctor fulfills his/her mission to “Above all, do no harm”, to ease the sufferings of the patients and to enhance their lives by helping them to fulfill their potential.

Michael Kaplowitz, M.D.
Director of Behavioral Health
Blanche Kahn Medical Center