Glasses 101 for Children with Low Vision/Blindness

Annie Hughes
VIPS Indiana Director and Teacher of Blind/Low Vision 

When a child is blind or has very low vision, sometimes the first thing a parent or a friend or relative says is; “He needs glasses.” But whether or not glasses will improve a child’s ability to see is dependent upon the reason for the child’s low vision or blindness. For some eye conditions/diagnoses, there IS something that will help improve vision; a surgery, a medication, a visual intervention, or prescription eye glasses. But, for many serious eye conditions, there is NOT an intervention that will improve visual acuity. And in these cases, putting glasses on a child simply will not help. That is why, as a teacher of the visually impaired, one of the first things I try to do is make sure a child’s parents have an accurate diagnosis from a pediatric ophthalmologist or an optometrist so parents understand whether or not prescription glasses might help their child to use his or her vision.

Why Glasses are Often Prescribed

There are a number of reasons that eyeglasses are prescribed. By far, the most common reason is to correct a refractive error. In the case of a refractive error, glasses (or contacts) are prescribed to help the lens bend the light so it comes into focus where it should on the retina. When a child is diagnosed as near-sighted, (myopia), or far-sighted, (hyperopia), glasses can greatly improve visual acuity. Sometimes, each eye has a significantly different refractive error, (anisometropia), and each eye needs a distinctly different correction. And because we all have small imperfections in the shapes of our eyeballs, glasses can also include a correction to take our eyeball shape into account. (Astigmatism)

Another reason that an eye doctor might prescribe glasses involves alignment /eye muscle issues or Strabismus. The most common types of Strabismus are esotropia or exotropia. There are a number of things that are usually part of the protocol when an eye doctor is trying to help the child to use both of his/her eyes together. (Binocular vision) After patching the better eye, frequently, one of the steps can be to try to pull the weaker eye into alignment by prescribing specific lenses. As a teacher, I have watched a child put on glasses and eyes miraculously align, followed by taking those same glasses off and watching the eyes immediately slip out of alignment. Sometimes though, glasses are not effective, and eye muscle surgery is necessary, or glasses are used in conjunction with other strategies to foster binocular vision.

There are times when a child is prescribed glasses with clear unbreakable lenses with the only purpose being the protection of the better eye. This is usually done if the child has very little or no vision in his/her other eye and the doctor is doing everything possible to protect the child’s one working eye. Because accidents happen, especially with children and in a busy school setting, the doctor decides to put a layer of polycarbonate in front of the better eye to protect it from flying objects, (rocks, dust, balls, elbows), that could blind the child if his/her better eye sustained damage.

Another reason for glasses is when a doctor tries simple magnification in a child with extremely low vision in an effort to increase a child’s ability to perceive objects. (Fostering object perception) Along the same lines, sometimes specific prism lenses are dropped into glasses in an effort to pull more light into the eye of a child with CVI who is not responding visually to lighted targets. (Fostering light perception)

Frequently, children with very significant visual loss have more than one diagnosis. They may have a primary diagnosis, and then several secondary diagnoses that all contribute to the loss of acuity, and the glasses prescribed may only help one of the eye conditions. Also, children with significant vision loss frequently can only be provided with “best correction,” which means that in spite of the glasses, he or she does not see with the clarity of a child with normal vision. Sometimes a person sees a child wearing glasses and it can be misleading. They assume that the child can see, when in fact, they see very little. But as any parent of a youngster with visual impairment will tell you, any little bit of visual acuity that you can gain for your child is “golden” and greatly impacts functional skills and mobility.

Deciding which eye professional to use is the subject of a completely different article, but parents should always feel free: 1) to ask questions of their ophthalmologist or optometrist, 2) to get a second opinion, and 3) to talk with their child’s teacher of the visually impaired (TVI) to get more information about the implications of their child’s diagnosis and ways to make visual accommodations that might allow the child better use of the vision he/she does have.

Keeping Glasses on Your Little One

Once glasses are prescribed, the next challenge can be to keep them on a child’s face! As an adult, you may have experienced the sensation of putting on new glasses. If so, you understand that there is an adjustment period as your brain recalibrates to the new correction. The same is true for children. Knowing what the glasses are for and when they will help the most, (viewing at a distance, viewing at near-point, etc.); will go a long way in making the transition easier. If the child continues to take the glasses off, try “pairing” a favored activity with “glasses time” (meals, snack-time, favorite toys, a favorite CD or video, etc.) If the glasses come off, the favored activity stops until those glasses are replaced.

Keeping those little hands busy is a good idea, and sometimes it is necessary to create a barrier of sorts to keep the child from reaching up and pulling off his/ her glasses. Put on music, slip those glasses on, grab the child’s right arm, trap the child’s left arm under your right arm and dance! The idea is to build up a tolerance to the sensation of glasses on a child’s face over time and to gradually increase “glasses time” so the brain actually has an opportunity to adjust to the new correction.

Consistent verbal cues or physical prompts can help to teach the child to leave the glasses on and avoid pulling them off. With very young children, the rule can be, “Only Mommy or Daddy can take your glasses off or put them on.” Because prescription glasses are expensive to replace, it is important that they are put in a specific safe place when taken off. This won’t occur if the child takes them off whenever he/she feels like it.

Picking the Right Kind of Glasses

It is important that the doctor prescribes the correct type of glasses for your child’s specific needs. If your child does not sit up or stand, but lies down or rolls around to move, glasses with a comfy foam wrap-around strap that adjusts rather than standard temple earpieces are preferable. Some children’s glasses frames are unbreakable flexible plastic in a variety of colors, but they usually need a strap to keep them in place. Straps can really help as long as they are not too tight. For some children who have difficulty with glasses, sports goggles can be an answer. Whether or not your child’s glasses have nose pads depends on the shape of your child’s face. There are also non-slip pads for glasses that are put on the earpieces and can keep the glasses from moving around.

Sometimes, using a timer to signal the time when the parent will remove the glasses provides an opportunity to increase the time a child can tolerate glasses in small increments. Praise your child whenever the glasses are in place and allow your child to become aware of significant people in his life who also wear glasses. Have your child look in the mirror to see how handsome or beautiful he or she is. Teach proper care of glasses, and build “shiny glasses cleaning time” into the day (before putting them on in the morning, after meals, after naptime, etc.).

For children who need a great deal of correction, doctors sometimes do not correct to the full strength with the first pair of glasses, but instead, build up to the full strength over a period of time. The important thing is to give the child time to adjust to his/her new glasses. Most often, as the child realizes that the glasses are helping, he/she will WANT to wear them. If, after trying lots of things and giving it plenty of time, your child is still not wanting to wear his glasses, then it is time to talk with your eye care professional again to figure out what is going on. Are the glasses really helping? Is there an error with the prescription? Sometimes in a youngster with a CVI diagnosis, an optometrist will correct for a refractive error and prescribe glasses, but the CVI is so significant that the refractive error is not even functionally noticeable. Perhaps later, after the child begins to use his/her vision, the correction for the refractive error may be revisited. And some children with significant brain damage or multiple impairments have difficulty with bi-focal and progressive lenses because processing, in general, is difficult for them. Each child is unique, and if prescription glasses are a part of the visual solution, a lot of variables will need to be considered as decisions are made about the types of lenses, frames, and straps that will be best-suited to your child.