The patient sits before you with a new Rx in hand. Imagine saying these words, “Let me help you build the best lens wardrobe, more than just that one pair of lenses that you try to use for almost everything.”
How many pair of lenses is this? For what activity would they use them? Will the patient agree? What should you choose first? All good questions and with the lenses and technologies available at your fingertips, you can make lenses for all the times of the day that require special lenses for every activity, active specials.
Do your patients need more than clear lenses? Think blinding, early morning reflections off wet asphalt on the morning drive to work. Try finishing the lawn with a lawn edger on a hot and overcast Saturday morning without protective lenses. Or, keep those eyes from tearing while riding downhill at speed on your bike on a bright afternoon. Each requires a different lens to do the job best, to achieve the best results or the ultimate in performance.
A good way to think about it is that visual activity is only a matter of time i.e., a particular time in everyone’s day, lens time. For example, it’s light amber lenses time, (about 7:20 am), overcast on the golf course and under pressure for this drive on the first tee. I know that at about dark brown (or 12:45 pm) I’ll be heading to the clubhouse after a very satisfying 18 holes. OK, we know that the patients would prefer that their first pair of lenses does everything and that their insurance plan paid for them also, but that’s not possible – too bad. Here’s how to make it real.
Consider providing a four-place case (available from Hard Case), and use it to ensure that the patient has the right lenses, those with the best functionality for every special activity (in the right frames of course). It’s as if you became a construction worker, working from a lens plan to build all the eyewear that is indicated.
- Step 1: Uncover the activity (sport, hobby, action).
- Step 2: Define the functionality wanted. Then it’s possible to suggest the wardrobe of Active, Special and Functional lenses, perfect for the patient you’re helping.
Uncover the activity and the functionality required – ask a series of questions like:
- What are your favorite sports activities in which you participate – are particular things difficult to do?
- If you drive to and from work, is vision comfortable during those times?
- Do anything dangerous to your eyes, hobbies, at work, in your free time?
- Participate in any spectator sports – what are typical conditions, weather, and visual requirements?
- Tell me about your typical day – during the week, after work, on weekends – do your lenses work as well at all those times?
- What were the best lenses that you ever had – the worst and why?
These questions discover many things about the patient. It tells you visual activity; it also defines for the patient the areas in which they can identify a vision need (function, comfort, protection) and makes it easier for you to list their options and describe the benefits. Remember, patients buy benefits. Lens benefits answer visual activity needs.
Consider the following table of examples. Start a table like this one in your office, adding to it after each kind of patient. It’s a bit like Amazon.com that recommends books based on the one that you just bought. A table like this can be used when talking to another patient that has the same needs or wants as others that have been fit. While never complete (there are too many occupations and sports to list all the special functionality required) it is a start that provides cues and can make you an expert recommending an active, specials, lens wardrobe.
Defining Function – Protection
Impact is easily understood and provided for using polycarbonate or Trivex lenses. However, if the task requires that the sunglasses are also safety rated as meeting the ANSI Z87.1 standard, then the lenses and the frame must meet that standard.
Ultra-violet has also been shown to cause cataracts, premature aging of the skin and skin cancers so it is reasonably well understood by ECPs that active eyewear be 100% UVA and UVB absorptive. All of the following are 100% UV absorbing; polycarbonate, all high index greater than 1.59, all polarized and photochromics except standard plastic (absorbs 85-90% UV) but even plastic can be dyed to be 100% UV absorptive. Contact manufacturers and your lab for the lenses that can meet your patient’s standards.
High-energy visible light wavelengths, to about 450nm, has more recently been implicated in the incidence of macula degeneration. Like UV radiation is accumulated in the crystalline lens, blue light seems to worsen the oxidative damage that has occurred in the retina over the years; it is particularly toxic to the aging retina. Aged retinas, or those prone to AMD, may not be able to repair even low-grade damage caused by visible or blue light so a number of researchers also believe it is important to protect younger eyes that lack the yellowing of the crystalline lens.
Blue light, the shorter wavelengths to about 480nm, are scattered by particles in the air like smog, dust and fog. Removing these wavelengths improves contrast and can improve the effective recognition and vision of individuals. Use colors like yellow, amber, brown and green to reduce blue and improve contrast.
Lens color and function can be determined in part by the transmission curve of the lens. In this example of a transmission curve for gray and brown polarized lenses, they also absorb all the UV and most of the high-energy visible and blue wavelengths. These lenses are protective and can increase contrast. Ask your vendors for explanations of how their filter lenses work.
Man or Woman?
Unlike other products, lenses for action sports seem to be more task-specific and involve personal preference. So gender doesn’t seem to matter. It depends on sport, hobby, need and personality. So, choose the right fitting frame, discuss lens options and build that wardrobe. How do you start? Perhaps a couple of case histories helps.
Filling the Case – For a Man
With a new mid to high minus prescription and a +2.25 add, this 54-year-old male works at a desk managing the supply side of an outdoor gear distribution company, located on the Oregon coast. He spends about 5 hours in front of multiple monitors while on the job, the rest walking to and from the warehouse and uses a small handheld PDA. He gets to work by motorcycle and on weekend’s trucks his off-road dirt bike up to 100 miles away to compete in motor cross events. He’s pretty good too.
He’s tired of switching glasses for all the tasks he has since his eyes “got so bad”. He needs new lenses for general purpose since his add has increased +0.50D. He also says, “do you have any glasses that can provide a seal so dust and dirt can’t get behind the lenses?” Also, he’s been wearing Gray 3 tinted lenses and things don’t seem to be as sharp as they used to. “What do you suggest”, he asks.
For his general-purpose glasses, he’s been wearing progressives and with this new add power, he will probably notice that the intermediate and near is somewhat narrower if we keep the same lens design. If Varilux Physio, we’ll suggest that he upgrade to the next lens evolution of that lens from the same lens company, Varilux Physio 360 – that should improve the viewing area. The same would be true for Zeiss GT2 to Zeiss Individual, SOLAOne to SOLAOne HD, Shamir Creation to Shamir Autograph II – you get the idea. Since he does so much in front of the monitors, we’d be better to suggest a computer lens since that will really increase his mid-range and near performance. Consider Essilor Computer Lens if some distance vision is also required or SOLA Access for large mid-range and near. For sustained work at mid-range and near, there’s nothing like wearing a lens designed to function for the real task needed.
For riding to/from work a wrap frame is best for coverage but the request for a “seal” from the elements brings the Wiley X “Cavity Seal” frame line to mind. The removable conformable insert provides the tight touch required for high speed riding. Since the frame, like others are Rx-able, many of the Rx styles, colors and coatings can be added for our man’s needs and wants. In fact, these glasses can be worn with and without the cavity seal so they are versatile for riding or recreation. Also review the frames that allow interchangeable lenses so that for motor cross, lenses can be swapped when they get too badly damaged for continued high performance.
While we said that there is little difference between the solutions for men and women in lenses, if this patient were a woman, we might need to find the same frame but is a smaller size – and they exist. This makes lens fitting and delivery easier.
Filling the Case – For a Woman
Now a 32 year old woman, +0.75 sphere Rx, +1.50 add, tells you that she wears contacts for recreational and competitive skeet shooting, it is required to have Safety sunglasses to compete and play on an amateur indoor adult soccer team. She takes her contacts out at home so wants an OK pair of glasses. She’ll use them when shopping, lazy days, etc. so they shouldn’t be too utilitarian but not over the top also.
She wants to know whether there is a better color than yellow for skeet competition but can she wear the same glasses for soccer? Given her budget, if she gets a pair of skeet lenses, is there a high performance way to avoid having to buy another pair of sunglasses? Oh, what does she do when working – she’s a sales rep, in and out of the car all day, drives between accounts so wants best driving lenses possible. She’s been using 225 readers – doesn’t like the way they look and they’re pretty inconvenient, but cheap. So, how can we get her needs sorted out? By the way, this took almost a half hour to learn so we’ve got to get started describing our best recommendations let alone agree on the best frame choices.
Start with the skeet and soccer eyewear – the other glasses are a given and these are the ones where there is real interest.
Amber lenses, yellow and vermillion filters are recommended; they are best suited for shooting on overcast days. The color gives objects more contrast against a cloudy grey sky. Grey or other dark colored lenses are most appropriate for shooting when there is harsh sunlight or glare present. As you might have guessed, the darker tint of the lenses greatly improves visibility – squinting because of the sun just before pulling the trigger doesn’t fare well for your results. Clear lenses are typically used for indoor shooting, but some people find that a view unaltered by color gives them better results. Interchangeable lenses are good in case the weather conditions change. For contacts provide planos, for Rx all of these options are available including progressives though SV may be more appropriate so the entire lens field is clear.
Since contacts are the norm, a pair of plano polarized progressive sunglasses for driving, gray or brown is indicated – take her outside to determine her preferred color. For convenience and best functionality, recommend that her progressives are photochromic so they satisfy the need for sun and clear prescription eyewear. Oh, and for indoor soccer where she may be slammed against the boards, a really aggressive looking pair of wrap glasses, clear lenses with a strap ensures safety and her ability to dive into the fray with eyes protected.
One can’t do it all and that’s good in our case. A functional wardrobe of active and special eyewear will make any patient happier. So, when they hand you that new prescription, or are in for a repair or adjustment, start a dialogue about how they are doing with their glasses. Seek out needs. Ask about anything that makes them unhappy about their eyewear. That provides an opportunity to describe lens material, design and treatment benefits arsenal to fix the problem. They’re on their way to the best lens wardrobe.
by Mark Mattison-Shupnick, ABOM