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By Carole Burns, OD
 Eye disease increases exponentially with age. Conditions
common to patients over age 65 include dry
eye, cataracts and macular degeneration.
Starting in 2011, eyecare professionals are going to see
a sharp and steady rise in the incidence of eye disease
among baby boomers, the leading edge of whom turn
65 this year. According to agingstatistics.gov, in 2030,
the older population is projected to be twice as large as
in 2000, growing from 35 million to 71.5 million.
Eye doctors routinely treat these patients medically, but
often overlook their optical needs. In order to treat all of
the patient’s needs, eyecare practitioners have an obligation
to understand the conditions of aging and to
prescribe lenses which protect and maximize eyesight.
Treating Dry Eye
Dry eye is found more frequently in females and increases
with age, affecting up to 20 percent of the aging
population. Current understanding about dry eye
has increased significantly. The new understanding has
led to a renaming of the condition: ocular surface disease
(OSD).
A case presentation for patients with OSD should address
three areas: medical treatment, environmental
management and optical prescription. This three-part,
global treatment plan provides the best care for the patient.
Consider the case of Mr. Jones, a 68-yearold
gentleman suffering with OSD. Mr.
Jones has moderate ocular surface disease.
He is experiencing blurred vision, burning,
itchy and stinging eyes. He is light sensitive
and his eyes tear. The excessive tearing
is worse in sunlight. He is being managed
medically. In addition to his medical management,
Mr. Jones should be given the
following environmental and optical care.
Below is an example of a case consultation
with this patient.
“Mr. Jones, when people read, they tend to
stare at the page. This causes a decrease
in your blink rate. I noticed you have an
e-reader. When reading, you need to occasionally
think about blinking. I want you
to look up and blink every time you move
the screen, then look down and continue
reading.
“In the winter, the dry heat makes your
symptoms worse. It’s important to have a
humidifier to help keep your eyes comfortable.
“To help you see better and feel better, I’m
prescribing indoor glasses and outdoor
glasses for you.
“Your sight outside is worsened by the
scatter of light and by glare. You will need
a brown outdoor tint to decrease the scatter. You may
have heard on TV how blueblockers help you to see,
this is because blue light scatters and it is blocked by
brown filters. In addition to the brown tint, you must
have polarized lenses to decrease the glare. Glare can
become so severe that it may decrease your reaction
time while driving—polarized lenses make all the difference.
I want you to be sure your outdoor lenses wrap
around your face, this helps keep the wind from causing
more dryness.
“Mr. Jones, for your indoor eyewear you need to give
yourself every advantage to improve your sight, so I am
going to prescribe glasses with a light amber tint. I’m
also going to prescribe a specific type of lens that will
allow you to see well at distance and near, these lenses
help by eliminating what we call ‘higher order aberrations.’
“Your indoor lenses need to be glare-free. Glare-free
lenses allow more light into your eyes so it will also reduce
halos around car headlights while driving at night.
I’m going to prescribe the glare-free lenses for both
your indoor and outdoor glasses.”
Treating Patients with Cataracts
According to the Centers for Disease Control, an estimated
20.5 million Americans over 40 have cataracts. This number is estimated to increase to 30.1 million by
2020.
Cataracts are a condition of aging and will affect each
one of us. This insidious condition can be tolerated for
quite a while by some but will eventually require surgery.
A case presentation for patients with cataracts should
not concentrate on the eventual surgery, but should
concentrate on treatment for the here and now. Since
cataracts progress slowly, discussing environmental
management and optical prescription are crucial.
Mrs. Green, a 59-year-old female has cataracts which
are best corrected to 20/20 each eye. Mrs. Green is experiencing
glare and blurred vision, especially at night.
Car headlights seem like halos. She states that she is
constantly feeling as if her glasses need to be cleaned,
however cleaning never helps. Glare testing shows only
a mild decrease in acuity. A case presentation follows.
“Mrs. Green, beginning cataracts are annoying, however
we have many options that will help you. Cataracts decrease
theamount of light which enters your eye. This
means that to improve your sight, you must increase
the amount of light. When reading, be sure to have a
lamp positioned directly on your reading material. Halogen
bulbs will light the room and help you to read.
“In addition, you will need both outdoor and indoor
eyewear. You are experiencing the most common concern
of patients with developing cataracts—glare. Your
outdoor eyewear will need to be an amber shade, if you
go with gray or another dark shade of lenses, you will
be unhappy as everything will appear too dark. Your
sunwear must be polarized, and there should be a glare
coating on the front and back surface of the lenses.
These two features—the polarization and the glare-free
coatings—will decrease the glare, and the ultraviolet
protection will stop the sunlight from hastening the
cataract development. You should always wear these
protective sun lenses when outdoors, even on cloudy
days.
“Your indoor eyewear often seems dirty because less
light is getting through the cataract and into your eyes.
Putting an anti-glare coating on your indoor eyewear
will allow 10 percent more light to enter your eye, helping
you to see better. Glare-free lenses also reduce halos
around car headlights while driving at night. In addition
to the glare-free lenses, I am also going to prescribe a
specific type of lens that will allow you to see well at
distance and near. These lenses help by eliminating
what we call ‘higher order aberrations.’”
Treating Patients with Macular Degeneration
Age-related macular degeneration, often called AMD
or ARMD, is the leading cause of vision loss and even
blindness among Americans age 65 and older. A new
case of macular degeneration is diagnosed every three
minutes in the U.S. It occurs in about 10 percent of people
over the age of 50, and about 33 percent of people
over 75.
AMD is most common in Caucasians of European decent
and is more prevalent in women. Every year 1.2
million people with macular degeneration lose part of
their central vision, and 200,000 suffer complete loss
of central vision in one or both eyes. Prevent Blindness
America and NEI warn that the number of Americans
with age-related eye disease will likely double within
the next three decades.
The consequences of macular degeneration are serious,
not only for its victims and their quality of life but
also for Medicare and other government services presently
unprepared for the macro-level effects of AMD, at
which experts warn will reach “epidemic proportions.”
AMD causes daily tasks that are part of central vision,
such as driving and reading, to become difficult to perform.
AMD is a disease affecting the central part of the
retina and is the leading cause of vision loss in the developed
world.
It has been shown that visible blue light may cause the
highest risk for development or progression of AMD.
Implantation of lenses during cataract surgery that do
not filter blue light have been shown to increase the
risk for development or progression of AMD.
Consider Mr. Smith, a 69-year-old retired business man
who likes to spend time outdoors. He has no complaints
about his vision. During testing you see macular
drusen, photo document the macular areas and then
show Mr. Smith the photos to discuss the clinical signs
of macular degeneration.
“Mr. Smith, these yellowish dots are called macular drusen.
These dots are not currently affecting your vision.
However there are studies which show that blue light
may make your macular degeneration progress which
may cause permanent vision loss. To reduce your risk, I
am prescribing outdoor and indoor eyewear.”
The Benefits of Outdoor and Indoor Lenses
Be sure to point out the following benefits of outdoor
lenses to Mr. Smith:
1. Protection against blue light
2. Protection against UV light
3. No glare lenses
4. Wrap sunglasses
5. High-definition lenses
6. Lenses that let you see at all distances
Describe these benefits to him by first noting that outdoor
eyewear must protect against blue light, since
prolonged exposure to blue light may cause macular
degeneration to progress. Explain that his lenses will
contain a 30 percent transmission amber tint. This tint
filters out the harmful blue rays and, therefore, protects
his eyes.
Then tell Mr. Smith, “To eliminate glare, your sunwear
must be polarized and have a glare-free coating on the
back surface. One study has shown that harmful glare
contributes to 30 percent of left-hand turn accidents.”
When discussing the benefits of wrap sunglasses, point
out to Mr. Smith that his sunlenses must wrap and sit
very close to his face. This ensures that ultraviolet light
does not damage the eye and the structures that surround
the eye including his eyelids, sclera and conjunctiva.
Because he will need impact resistant lenses, his
glasses will also have ultraviolet protection built into
the lenses. These lenses are lightweight, thin as well as
protective.
Transitions Offers Bilingual Diagnosis Guide
for Age-Related Diseases
Transitions Optical offers a bilingual diagnosis
guide which provides a comprehensive overview
of several age-related diseases, including
cataracts, AMD and glaucoma. The company
also offers six disease cards that are intended to
heighten patients’ understanding and help ease
their anxiety during an eye disease diagnosis.
Each includes a section on vision wear considerations
to help maximize and protect vision,
such as photochromics and anti-reflective coatings
to protect against UV and counter light
sensitivity and contrast issues.
Take-home PDFs of the various diseases, in English
and Spanish, are available for download under
the Marketing Tools/Multicultural section at
transitions.com/pro. In addition,the white paper
“The Eye Disease Diagnosis: Addressing Communication
Challenges,” is available on the site
under the Education/Clinical Papers tab and
may be of particular interest to eyecare professionals
with an older patient base. |
You should also note, “To see the clearest, the best lenses
today are aberration-free lenses. That’s why I am prescribing
these high-definition lenses for you.
“Additionally, clearest vision is obtained with a lens that
lets you see at all distances. We call these lenses progressive,
and we will put you in the newest technology.
“Your indoor lenses will be high definition also to improve
your sight. Your lenses must be glare-free and
made of an impact resistant material called Trivex. This
will not only protect your eyes in case of an accident as
it is shatter resistant, but it is also safer as it comes with
ultraviolet protection built into the lens.”
Notice in all three examples, it is assumed each patient
must have at least two pairs of eyewear. In addition,
many of these patients may also require computer
lenses or specific lenses for reading, especially if some
vision is already lost.
When prescribing what the patient needs, it is helpful
to have a prescription pad pre-printed with all the
features necessary for best sight which is handed to
the patient as you are discussing their treatment plan.
These pre-printed prescription pads give reality and let
the patient know this prescription is just as important
as every other medical prescription.
Dr. Burns is CEO and senior partner of a nine-doctor,
three-location private practice and is co-editor of ReviewofOptometricBusiness.
com, a new, online practice
management magazine. She has been named the visiting
Benedict practice management professor for the
University of Houston in 2011. She lives in Westerville,
Ohio.
Source: 20/20 Magazine.
Published here under license and reprinted with permission of
Jobson Medical Information.
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