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Prescribe vision correction only after educating patients
Contact Lenses and Eyewear
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To improve efficiency, most clinicians delegate eye wear selection responsibilities to their staff members. However, before transferring patients to the optician, optometrists should make specific recommendations on vision correction options.
“The most important aspect of prescribing any type of eye wear is educating patients that eye wear is a medical device for the correction of their refractive error,” Brian Rosenblatt, OD, owner of Rosenblatt Family Eye Care Associates in Raritan, N.J., said in an interview with Primary Care Optometry News. “A lot goes into the design and the prescription of a medical device such as spectacle eye wear. Patients are not sold; they are educated. Then it makes the selling of the products much easier.”
“The most important thing we do as doctors is the consultant part, whereby we give recommendations to patients about what is best for them and why it is good for them,” Peter G. Shaw-McMinn, OD, in private practice in Sun City and Riverside, Calif., said in an interview “This is far more important than gathering data.”
Dr. Rosenblatt discussed the importance of the transfer of the patient to the optician. “After reviewing my findings with the patient, I present him or her with a treatment plan, whether it is for an ocular disease state or refractive error,” he said. “I then introduce the patient to a member of our optical staff, presenting all pertinent findings in the presence of the patient. I review my refractive error treatment plan with both of them, thereby enhancing the continuity of care.
“I might say something like, ‘Chris, Mary is a hyperopic presbyope who spends her work day using a computer,’” Dr. Rosenblatt continued. “‘I have prescribed a Definity [Essilor, Dallas] progressive-addition lens with an AR coat to enhance the comfort and cosmetics of her eye wear. I would also like you to review the options available to her in prescription sun wear.’”
Antireflective coating
Dr. Rosenblatt noted that a practitioner should consider the patient’s vocation, preferences, facial type and prescription when advocating particular features of spectacles. “If I had it my way, every pair of spectacle lenses would automatically come with antireflective (AR) coating,” he said. “There are only a few circumstances where AR coating may not be appropriate, such as a contractor working in an environment not conducive to the integrity of the AR-coated lenses.”
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Dr. Shaw-McMinn, who is also an assistant professor at Southern California College of Optometry in Fullerton, agreed. “Practically every lens now should have AR coating,” he said.
“I never use the words ‘think’ or ‘recommend,’” Dr. Rosenblatt said. “I use the word ‘prescribe.’ For example, ‘I am prescribing for you this particular treatment on your eye wear.’ I also explain why a particular treatment is important. For AR, the explanation is simple: ‘We believe the AR is in your best interest because it reduces the incoming glare and enhances the cosmetic appearance of the lenses.’”
For patients working in an office setting with fluorescent lighting, the light emits “a very white hue that increases ambient and spectacle-induced glare,” Dr. Rosenblatt said. Irritating glare from computer screens and glossy paper types can also be alleviated with AR lenses.
All AR spectacles are also edge polished. “We find this to be advantageous to the patient cosmetically,” Dr. Rosenblatt said.
Although scratch-resistant coating is built into AR lenses, “we explain to the patient that as a nice benefit of us preparing the eye wear with an AR coating, a factory-approved hard coat within it reduces the possibility of scratching the lens,” Dr. Rosenblatt said. “We never tell a patient that a coating is scratch-proof.”
A double-sided hard coat is strongly advised for a young child, someone working in a landscaping or contracting environment and someone who uses safety eye wear. “Exposure to certain contaminants or airborne particles can scratch eye wear,” Dr. Rosenblatt said.
Sun wear recommendations
Dr. Rosenblatt believes that polarization is the best approach to sun wear. “With sun wear, we also prescribe an anti-glare coat on the ocular surface,” he said.
Photochromic lenses are prescribed to patients who either do not want two separate pairs of glasses (clear lens and sun lens) or cannot financially afford two spectacles. In addition, contemporary eye wear often has a magnetic or some other type of detachable sun lens, he said.
Transitions Optical (Pinellas Park, Fla.) sponsored a study on photochromic lenses, “Enhancements to quality of vision with photochromic lenses and antireflective coating,” by Kenneth Scherick, OD, a private practitioner and a clinical instructor in the Department of Ophthalmology at New York University College of Medicine. These two popular lens enhancements were found to provide overall satisfaction among 121 patients, 18 years of age and older, randomized to one of four groups. The Transitions lenses successfully adapted to different lighting conditions and offered convenience. Adding AR coating to the lens further enhanced visual quality.
UV protection
It has been well documented that ultraviolet (UV) light and visible light cause damage to the eyes, according to Dr. Shaw-McMinn. “Consequently, virtually every lens we prescribe should have UV protection.
“About 80% of the light that reaches our retina does so before the age of 18,” he continued. “Children have large pupils and are often outdoors all day long, but they rarely have any protection. These patients can really benefit from transitional lenses that change in sunlight. Polarized lenses are also better than they have ever been. You can now order polarized lenses in just about any material and design. We forget that a lot of the damage to our eyes from cataracts and macular degeneration is caused by the sun.”
Progressive multifocal lenses
Dr. Shaw-McMinn also noted that new variable focus designs for computer users are much more comfortable. “I use them myself,” he said. “It makes a big difference.”
Dr. Rosenblatt said he rarely prescribes a computer-specific single vision lens, because once the patient leaves his or her desk, the eye wear is no longer practical. “As a result, we do a tremendous amount of work in the progressive multifocal type of eye wear,” he said.
Either short corridor or wide/intermediate zone progressive-multifocal design lenses are prescribed. “That pair of spectacles becomes multipurpose,” he said.
Moreover, new high-index lenses of 1.74 are catering to the growing number of patients who desire cosmetic benefits from spectacle wear. “It is like the cell phone phenomenon,” Dr. Shaw-McMinn said. “People want the thinnest cell phone they can get. Glasses are no different. People want thin, attractive glasses. Overall, this is a good time to be an optometrist prescribing glasses. Once we properly educate patients, they will be willing to spend the money to protect their eyes because vision is so important.”
For more information:
- Brian Rosenblatt, OD, can be reached at 80 East Somerset St., Raritan, NJ 90069; (908) 725-3331; fax: (908) 725-3237; e-mail: brian.rfea@verizon.net.
- Peter G. Shaw-McMinn, OD, can be reached at 17675 Van Buren Blvd., Riverside, CA 92504; (951) 672-4971; fax: (951) 780-4807; e-mail: shawmc@cox.net. Drs. Rosenblatt and Shaw-McMinn have no direct financial interest in the products mentioned in this article, nor are they paid consultants for any companies mentioned.