Spectacles are far from a thing of the past, according to the American Optometric Association Clinical and Practice Advancement Group. However, specific recommendations from optometrists are often necessary to ensure patients reap the benefits of today's advanced eyeglass lenses.
To paraphrase Mark Twain, “reports of the demise of eyeglasses have been greatly exaggerated,” said Jeffrey L. Weaver, O.D., director of the American Optometric Association (AOA) Clinical and Practice Advancement Group. Dr. Weaver notes that spectacles might have been declared obsolete when contact lenses (CLs) were introduced and again after the development of refractive surgery. However, the eyeglass dispensary continues to account for a high percentage of the revenue in most optometric practices, according to AOA Economic Surveys. And with good reason, Dr. Weaver believes.
Over the last 2 decades, designer frames have transformed eyeglasses from mere optical appliances to fashion accessories, Dr. Weaver notes. Celebrities from politician Sarah Palin (and “Saturday Night Live” satirist Tina Fey) to talk show host Sally Jesse Raphael have made their fashion frames their trademarks (with each reportedly boosting eyeglass sales in the process). However, the growth of designer frames is not the real story, according to Dr. Weaver.
“Marked improvements in lens design and manufacturing have substantially improved the visual performance of eyeglasses compared with just a decade ago,” notes Dr. Weaver, an adjunct full professor at the University of Missouri–St. Louis College of Optometry, who has taught courses in ophthalmic optics. Those improvements have minimized or eliminated many of the problems that traditionally have prompted patients to consider vision correction alternatives. “Framemakers continue to produce frames that are more appealing and fashionable. It is only appropriate that lenses keep up with the progress,” Dr. Weaver notes. “There are many lens options today that may benefit patients; however, a great many patients are unaware of them,” he observes. Notable among those options are the following.
Tougher plastics
Improved manufacturing techniques have now made most plastic lenses practically as scratch-resistant as glass, according to Dr. Weaver. That will be welcome news to patients who may have tried plastic lenses a half dozen years ago, only to find the lenses became scratched, nicked, or full of small abrasions. Manufacturers have improved the scratch resistance of virtually all of the major plastic spectacle lens materials: CR-39, high-index plastic, polycarbonate, and Trivex®. Plastic lenses continue to have the advantage of lighter weight and superior shatter-resistance compared with glass. Glass is rarely a good option but is sometimes still requested by patients in work environments in which lenses could be subject to continual abrasion. However, whether glass or plastic is used, spectacles today, when properly cared-for, should remain scratch-free for a considerable period.
Progressive lenses
Apparently, the only thing many patients dislike more than peering through stodgy bifocals is enduring the dizzying visual sensations caused by poorly performing progressive addition lenses. “Even 10 years ago there were a significant number of nonadapters,” Dr. Weaver acknowledges. “However, today's progressives successfully provide for much greater patient satisfaction than either the progressives of a decade ago or segmented bifocals.” Significant improvements in design and manufacturing processes have reduced lens aberrations. That has minimized the “swimming” effect that traditionally has proven to be a major source of dissatisfaction among those trying progressives for the first time. In particular, Dr. Weaver credits increasingly sophisticated computer design techniques, which have now improved several generations of the progressives. Virtually all major spectacle lens makers—including Essilor, Hoya, Shamir, Sola, and Zeiss—have markedly improved the performance of their progressive lenses over the last decade, Dr. Weaver says. In many cases, re-introducing patients to the lenses may be appropriate, Dr. Weaver suggests.
Smaller lenses
As a result of lens design changes over recent years, many lenses can now be used in smaller, more fashionable frames. New bifocal designs, for example, can provide enough room for a plano area at the top of the lens and plus correction at the bottom, even when mounted in small frames. That may be particularly good news for patients who would like to keep a pair of bifocals with them but still want to look nice and do not want to carry a pair of bulky eyeglasses in their pockets.
Photochromics
Plastic photochromic lenses have also been markedly improved by advances in design and manufacturing over recent years, according to Dr. Weaver. As a result, light attenuation problems have largely been solved, he says. The lenses now both darken and lighten more quickly, become darker, and return to a color more closely approximating “clear,” he observes. Patients who tried photochromics when the lenses were first introduced in plastic material may be surprised at the improvements that have been made. Once again, re-introducing patients to the lenses may be appropriate, Dr. Weaver suggests.
Computer eyewear
Many patients may still not be aware that eyeglasses or contact lenses that are prescribed for general use may not be adequate for computer work. For years, manufacturers have offered special lens designs, lens powers, and lens tints (or coatings) that could help maximize visual abilities and comfort for computer users. Yet many patients may not realize that special lenses can be prescribed to meet the unique visual demands of computer viewing.
Wavefront eyeglasses
Introduced in 2005 by San Diego–based Ophthonix, Inc., iZon® wavefront spectacle lenses represent the most sophisticated computer lens design technology yet. Utilizing the same corneal mapping technology that is used to guide state-of-the-art laser ablation, Ophthonix provides virtually custom-tailored spectacle lenses for both single-vision and multifocal correction. Marketed with the promise of “High-Definition Vision,” the lenses are effective in reducing problems such as poor night vision, glare, halos, blurring, starburst patterns, or diplopia, according to the manufacturer. Although the lenses have been drawing perhaps the most attention as a means of correcting higher-order aberrations, they can be used for lower-order aberrations as well.
Ophthonix markets an integrated in-office system for eye care practitioners, with a Z-View® aberrometer used to develop an iPrint™ map of the patient's cornea. The iPrint™ is used to produce a pair of iZon® High Resolution Lenses. “While this technology is new and still being assessed by many practitioners, it serves to demonstrate how computer design technology can be used to provide vision improvement for the spectacle-wearing patient and how spectacle lens correction is constantly being improved along side other forms of vision correction,” Dr. Weaver observes.
In addition to improvements in lens designs and materials, coatings and treatments continue to make spectacle wearing a vastly improved experience today compared with decades past, Dr. Weaver notes. Every patient with a spectacle lens prescription should have the benefit of antireflective lenses, ultraviolet protection, and other lens treatments as appropriate, Dr. Weaver said.
AOA optometric practice surveys confirm that today, as in the past, a substantial number of patients are being prescribed eyeglasses. The surveys further indicate that an increasing number of those patients are wearing spectacles with state-of-the-art lens materials and treatments. “You will always have a certain percentage of patients who are in spectacles; patients whose corneal topography renders them inappropriate candidates for refractive surgery or whose lifestyle renders them inappropriate candidates for contact lenses,” Dr. Weaver noted. Moreover, many contact lens and laser patients remain spectacle-wearers on at least a part-time basis. The AOA Scope of Practice Survey finds that 56% of refractive surgery patients continue to obtain eyewear through their optometrists' offices. All contact lens patients should have a backup pair of spectacles, and the survey indicates many do, Dr. Weaver noted.
Dr. Weaver believes attractive, well-fitted eyeglasses are an important and often overlooked means of encouraging compliance with contact lens care regimens. “The contact lens wearer who has a pair of attractive eyeglasses that provides excellent vision will be much more to likely to remove contact lenses at the first sign of discomfort than the wearer who does not,” he says.
However, a great many patients who might benefit from spectacle wear are still are not being fitted with eyeglasses, Dr. Weaver says, and many more are not getting the spectacles necessary to maximize their vision. He believes optometrists should take a more active role in ensuring patients receive appropriate spectacle correction. Dr. Weaver believes optometrists, as opposed to dispensary staff, should take the lead role in assessing the type of eyeglass lens correction that may be appropriate and then recommending that correction to the patient. He suggests a 3-step process can help ensure that patients get any spectacle correction that may be necessary to optimize their vision.
1. Practitioner recommendations. Practitioners should consider advising patients on the potential benefits of spectacle correction in the examination room. “Patients will be more likely to act on a lens option recommended by the optometrist in the examination room than an option that is suggested for the first time by a paraoptometric in the dispensary,” Dr. Weaver notes.
2. Specific prescriptions. Practitioners should consider prescribing the specific type and brand of spectacle lens that is best suited for the patient in the same way they prescribe pharmaceutical treatments by specifying the exact drug, and in many cases the exact brand of drug, the patient should receive. This will help to ensure the patient receives the most appropriate spectacle correction and will reinforce the importance of the spectacles as a health care device necessary for good vision. Resources such as the Optical Laboratories Association (OLA) Lens Menu can help practitioners select the optimal correction for the patient (see Figure 1).
3. Lifestyle assessment. Practitioners should consider recommending appropriate spectacle correction on the basis of patient needs indicated in the patient history. “In many practices, that will mean taking better patient histories in order to better assess the vocational and avocational needs of the patient,” Dr. Weaver adds. The practitioner may wish to consider use of an expanded patient history form (see Figure 2).
Dispensary staff will still have an important role to play, Dr. Weaver emphasizes. And that requires the dispensary staff be properly trained, he adds. The AOA Paraoptometric Section's ABCs of Optical Dispensing Home Study Education Module, developed as part of the section's Home Study Education series, explains the use of lens treatments as well as frame selection and adjustments, spectacle lens materials and designs, lens treatments, lens measurements, and tips for presenting designer frames and prescription sunglasses. Together, optometrist and staff can be effective in ensuring patients receive any spectacle correction necessary, Dr. Weaver said.
“Too often eyeglasses have been effectively ‘demonized’ in advertising for other modes of vision correction,” notes John Coble, O.D., of the AOA Industry Relations Committee. “Eyeglasses remain the best form of vision correction for many patients and a highly appropriate form of supplemental or occasional correction for many others. And with the great improvements in both spectacle frames and lenses over recent years, eyeglasses certainly should no longer carry a stigma.”
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