I just read the May 2023 edition and loved the article from Siu-Yin Shing regarding the dispensing of children’s glasses. Thanks for putting this in – we orthoptists and hospital practitioners deal with poorly fitting children’s frames on a daily basis.

A couple of points I’d like to add: I loved the bit about ‘the angles of the under-developed bridge are also much larger and the width of the bearing surface wider compared to the adult form’. So many times I have to add silicone ear-locks to the arms in order for the glasses to sit correctly and the child not look over the spectacles. Also, cycloplegic refraction is a must for all children under eight for accuracy due to their short fixation pattern and attention. So by all means check non-cyclo first but then back up with a dilated exam – only then will you uncover any latent hypermetropia.

Tomato glasses are excellent for those children with trisomy 21 due to their adapted bridges, while Specs4us are designed specifically for this group of patients.

Also Māori and Pacific Islanders have much broader skulls than Caucasians and will need larger frames sooner, which will often require additional funding from the Enable NZ grant.

As to May’s Eye on Ophthalmology column on how Covid-19 affects the eye, I can clinically vouch for cranial nerve palsies post- and during infection, as I saw three in our region.

Sally-Anne Herring is a UK-trained orthoptist with more than 30 years’ experience in paediatrics and neuro-ophthalmology who now works in Hawke’s Bay.

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