BLOG: The digital eyestrain opportunity

Many practice management experts believe that optometry practices can be divided into two distinct businesses: a medical clinic and a retail optical store. Both of these businesses financially support the day-to-day operations of the practice and contribute to the bottom line.

If you are a practice owner, you are acutely aware that both of these lines of business are being squeezed. On the clinic side, the sheer difficulty of insurance claim filing has raised the cost of doing business for many, on top of shrinking reimbursements. On the optical side, competition from alternate sources for spectacles and contact lenses is fierce. Just yesterday I saw a TV commercial from an optical retailer stating, “You don’t have to get your glasses where you have your eyes examined.” Ugh.

In a previous blog, I discussed the rationale behind incorporating macular pigment optical density (MPOD) testing or contrast sensitivity testing into practice along with prescribing the proper supplements to improve these measures. With proper implementation, this provides a vital and valuable service to your patients and added revenue to your clinical income. To enhance optical revenue, we have an opportunity to help the majority of our patients with a common and growing problem, digital eyestrain.

A recent report from the Vision Council discussed hours of digital device use per day by adults, including Gen Xers and Millennials:

90% spend over 2 hours per day
60% spend over 5 hours per day
30% spend over 9 hours per day

Of this group, more than 60% report symptoms of digital eyestrain, including redness, burning, itchiness, blurred vision, fatigue and headaches. However, 32% take no action to reduce these symptoms. This is likely due to a lack of awareness that, outside of reducing screen time (difficult to do in the workplace), something can be done.

Additionally, there is one other very telling number in this report, and that is that 72.5% of adults are unaware of the potential dangers of blue light. These dangers include digital eyestrain, health disorders related to sleep disturbance and cumulative retinal damage that can lead to age-related macular degeneration. Prescribing lenses that protect the eye from blue light represents an opportunity to help our patients while adding to optical revenue.

Spectacle lenses that protect against blue light fall into two categories: antireflective coatings and en masse lenses. Importantly, there are variations in the levels of protection each provides. Depending on manufacturer, the blue light AR coatings block anywhere from 10% to 20% of wavelengths between 415 nm and 455 nm.

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The problem I see with this when it comes to digital eyestrain is twofold. First, the amount of light blocked by these AR coatings may not be enough to be visually comforting when viewing digital devices for long periods of time. Second, blue light is myopically defocused (chromatic aberration), with increasing blur at shorter wavelengths. As visible light starts at 400 nm, there is a gap in protection. Additionally, depending on the manufacturer, these AR coatings can cause slight shifts in color perception.

En masse lenses have protection infused right into the matrix of the lens material. In the past, the protection was in the form of melanin. New designs are now incorporating ocular lens pigment (OLP).

In the crystalline lens, tryptophan is metabolized into 3-hydroxykynurenine, which then polymerizes into the yellow-brown colored OLP. At an early age, this process helps protect the retina from UV light. Later on, OLP protects the retina from photo-oxidation caused by blue light.

However, as you know through examining patients, yellowing of the crystalline lens does not significantly start until midlife. Fully protective levels of OLP are not achieved until after age 70, which we then know as a cataract that is removed. OLP spectacle lenses use this same process to provide full protection at any age.

Additionally, OLP lenses protect against the entire spectrum of light we are exposed to, including 100% UV (light below 400 nm). In contrast to blue-blocking coatings, OLP lenses selectively filter blue light, protecting in proportion to potential damage caused, with strongest protection starting at 400 nm and slowly decreasing. The overall effect of this is that significantly more blue light is filtered at the most damaging wavelengths than with blue light AR coatings. And because blue light is selectively filtered, natural color perception is maintained, with wearers able to pass the Farnsworth-Munsell color test.

When asked which of these lens types I recommend, my answer is both! For all-around wear, if prescribing an AR coating, why wouldn’t one be selected with some blue blocking capabilities? As well, the concept of blue light protection beautifully sets up a second pair sale. Using an en masse OLP lens coupled with a specialized computer lens design can be presented as a second, task-specific pair of eye wear. I like to refer to these as 21st century safety glasses. Our optical keeps ready-made OLP plano eye wear available for those who do not require vision correction or for use over contact lenses.

The conversation regarding the dangers of blue light may represent the biggest opportunity we have for retaining eye wear sales, including multiple pairs. We owe it to our patients to ensure they are properly educated and given solutions for the dangers they face from blue light. If in the process the financial stability of our practice were enhanced, I would call it a win-win.

References:

Loughman J, et al. Macular pigment and its contribution to visual performance and experience. J Optom. 2010;3(2):74-90.

Vision Council. Nearly 95% of Americans at risk for digital eye strain with increased device use. Available at https://www.thevisioncouncil.org/blog/nearly-95-percent-americans-risk-digital-eye-strain-increased-device-use. Posted January 7, 2015. Accessed March 3, 2015.