Your stories: Bifocal Q&A

Many, many thanks to Julie for sharing what she’s learned from having her daughter in bifocals.  Julie is a part-time working mom, mother to 4-year-old Amelia, and the blogger behind  – Ann Z

Our little princess has been wearing bifocals for only a few weeks now. We had two failed strabismus surgeries, and are giving glasses a try for a nine-week test. Recently, I had a bad day filled with guilt, worry, and impatience. I picked up the phone and called the pediatric ophthalmologist’s office.

I had too many questions, and not enough answers.

Q&A: Small children and bifocals for esotropia

Disclaimer: Nothing should replace your own relationship with a trusted physician. Asking your own questions is critical in your child’s eye health journey. The answers above are paraphrased from a telephone conversation with our nurse at an Atlanta, GA pediatric eye group.

Do child bifocals require the “line”?

The line is highly recommended for young children and those getting bifocals for the first time. Unlike adult bifocals, where the reading section is below the pupil, child bifocals for esotropia therapy are split at the pupil. The line is very helpful for children to better adjust to the different segments of their lenses. Progressive(no-line) bifocals have a gradual change from the top to bottom prescription, and young children have a more difficult time understanding that there are only two areas of their lenses.

How long does it take for a small child to get used to bifocals?

It can take several weeks for a child to use bifocal lenses correctly. They have to train themselves to look through the different lens segments in differing scenarios. Sometimes this means a new tilt to their head or change in posture. We do not expect a small child to use bifocal lenses correctly within the first week, sometimes more.

Should we, as parents, do anything to help a small child adjust to bifocals?

No. Aside from making sure they physically wear them, parents should let children adjust to bifocals on their own. Often we find that the more attention you bring to the bifocal, the harder a child tries to focus, which turns the eyes in and defeats the purpose. It takes time, but children will figure out the glasses on their own. Eventually using a bifocal lens will become second nature to them.

If the glasses “work”, what should we observe?

The goal of glasses in this case (accommodative esotropia) is to train the focus. Children are naturally far-sighted, so sometimes the eye crossing is due to the poor vision of things up close. We say the child is responsive to glasses if the eye movement is lessened with the glasses vs. same tests with the glasses removed. The prescription may be tweaked if crossing remains visible with glasses. The final goal is to have NO crossing with glasses on. Crossing will still occur with the glasses off.

Can glasses make her crossing worse?

No. Parents sometimes say the crossing is worse with glasses removed, but we have no evidence that eye turning is permanently worsened because of glasses. The turning is much more noticeable because the glasses straighten the eyes while worn.

What is the long-term outlook for glasses in this situation?

If the child proves to be responsive to bifocal glasses (eyes not turning in while worn), we continue with glasses. The glasses are not expected to be permanent, because the far-sightedness corrects itself as a child ages. This physician usually begins to wean patients off of glasses around age 8. Usually between ages 8-12, the glasses can be removed (unless near-sightedness or another typical adolescent eye issue occurs).

7 responses to “Your stories: Bifocal Q&A

  1. Fantastic! My daughter turned four in August and has had bifocals for almost two months now. I think they are making a real difference… She has shown renewed interest in painting, reading, and writing. I’m interested in the point about the head tilt–do you just mean they have to learn to hold their head at the correct angle to use the right part of the lens? This post was very helpful and reassuring. I wish I’d had this info at first because I was very worried about her avoidance of the lower part of the bifocal, though now she’s adjusted and does use them. Thank you for asking all these questions and sharing the answers!


  2. Thank you, Thank you, Thank you! Our daughter has been wearing glasswes for several years and just got her first pair of bifocals this week. Your Q&A was just what my family needed.


  3. Nice to “meet” you both! So glad this was helpful. I was lucky to get a fantastic nurse who was willing to spend several minutes on the phone with me. As I’m sure you understand, I was having one of those “nervous wreck” days! Amber, re: the head tilt, you said it perfectly. My daughter had a distinct downward head tilt before the glasses; that’s how she tried to counteract the exotropia. Now she has to learn to reverse that and look through the bottom part of her lens at times.


  4. Thanks you!!! I JUST founs out a few hours thad my dd (17 months old) needs bifocals for trial…after 2 surgeries and still patching. These were the same answers the doc gave me, and thanks for sharing! Now I can share with family so they understand…Im so bad at explaining! Im nervous about when the rx comes in…but hope they can help.


  5. I randomly found this post. My daughter (now 14) began wearing bi-focals at the age of 5. No one in our family had worn glasses so imagine our anxiety on what to expect. She was a champ! She had a slight turn in one of her eyes that wasn’t corrected after patching for years. She is very athletic and continued with glasses until her 12th year. We decided on surgery to correct her “crossed eye.” The surgery was a success and a few months later was able to begin wearing contacts. The vision continues to improve and when it does and she is ready for a new script, her eye will slightly turn. It was concerning but we were told this would happen as she grew. Today, she is a smart, beautiful blue-eyed 14 year old. I have to admit I do miss the days of her tiny little bifocal glasses — she was so stinkin’ cute!


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