Posts Tagged ‘seniors’

Kellogg Researcher Helping Eye Care Providers Better Assess Driving in Older Adults

September 13th, 2011

Drivers over age 65 are the fastest-growing segment of the driving population, and their eye care providers—ophthalmologists and optometrists—are playing an increasingly important role in assessing their ability to drive safely.

David C. Musch, Ph.D., M.P.H.

Kellogg researcher David C. Musch, Ph.D., M.P.H., recently led a multidisciplinary University of Michigan (U-M) study team, which was supported by a grant from M-CASTL, a unit of the U-M Transportation Research Institute, who surveyed how 500 vision care providers in Michigan assess the driving capabilities of their senior patients.

Dr. Musch and his team found that the majority of eye care providers feel it’s their responsibility to ask senior patients about driving, and most do it routinely. They test visual acuity and peripheral vision but often fail to ask about other factors—such as medical conditions or medications—that might affect the ability to drive. Inquiries about glare, driving at night and reading signs were very common (87 percent) but questions about challenging driving situations—merging or backing up—or the patient’s driving record were very infrequent (8 percent).

Many eye care providers (81 percent) stress that certain resources—driving assessment guidelines, clinical screening instruments and a patient self-evaluation tool—would help them in assessing the driving capabilities of their senior patients, and help to address higher accident rates for older drivers.

“We’ve identified a need and a desire on the part of vision care professionals to help,” says Dr. Musch, who cites research indicating that when seniors lose the ability to drive, there are consequences. These individuals have higher rates of depression and social isolation, more limited access to health care services, and are more likely to need long-term care. “Our goal is to intervene and work with our patients in modifying their driving habits. This will allow them to drive appropriately and maintain their independence,” he says.

While most eye care providers feel confident in their ability to determine whether vision is adequate for safe driving, few consider themselves the most-qualified professional to identify unsafe drivers. Only a small number of eye care providers (8 percent) communicate driving concerns with the patient’s primary care physician or refer patients to driving rehabilitation specialists or driving school. And, when asked about reporting unsafe drivers, some common concerns were negative impact on the doctor-patient relationship, liability issues, doctor-patient confidentiality and patient’s quality of life

Still, eye care providers are among the most important professionals in seniors’ health care, and they need to be on the lookout for seniors who may need special attention, says Dr. Musch. Identifying and providing effective resources to eye care providers to aid them in evaluating and assisting patients is the next step in the process, he adds.

www.kellogg.umich.edu

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Stem Cell Therapy for Age-Related Macular Degeneration a Step Closer to Reality

April 1st, 2011

The notion of transplanting adult stem cells to treat or even cure age-related macular degeneration has taken a significant step toward becoming a reality. In a study published in Stem Cells, Georgetown University Medical Center researchers have demonstrated, for the first time, the ability to create retinal cells derived from human-induced pluripotent stem cells that mimic the eye cells that die and cause loss of sight.

Age-related macular degeneration (AMD) is a leading cause of visual impairment and blindness in older Americans and worldwide. AMD gradually destroys sharp, central vision needed for seeing objects clearly and for common daily tasks such as reading and driving. AMD progresses with death of retinal pigment epithelium (RPE), a dark color layer of cells which nourishes the visual cells in the retina.

While some treatments can help slow its progression, there is no cure. The discovery of human induced pluripotent stem (hiPS) cells has opened a new avenue for the treatment of degenerative diseases, like AMD, by using a patient’s own stem cells to generate tissues and cells for transplantation.

For transplantation to be viable in age-related macular degeneration, researchers have to first figure out how to program the naïve hiPS cells to function and possess the characteristics of the native retinal pigment epithelium, RPE, the cells that die off and lead to AMD.

The research conducted by the Georgetown scientists shows that this critical step in regenerative medicine for AMD has greatly progressed.

“This is the first time that hiPS-RPE cells have been produced with the characteristics and functioning of the RPE cells in the eye. That makes these cells promising candidates for retinal regeneration therapies in age-related macular degeneration,” says the study’s lead author Nady Golestaneh, Ph.D., assistant professor in GUMC’s Department of Biochemistry and Molecular & Cellular Biology.

Using an established laboratory stem cell line, Golestaneh and her colleagues show that RPE generated from hiPS cells under defined conditions exhibit ion transport, membrane potential, polarized VEGF secretion and gene expression profile similar to those of a normal eye’s RPE.

“This isn’t ready for prime time though. We also identified some issues that need to be worked out before these cells are ready for transplantation but overall, this is a tremendous step forward in regenerative medicine,” Golestaneh adds.

She explains that the hiPS-derived RPE cells show rapid telomere shortening, DNA chromosomal damage and increased p21 expression that cause cell growth arrest. This might be due to the random integration of viruses in the genome of skin fibroblasts during the reprogramming of iPS cells. Therefore, generation of viral-free iPS cells and their differentiation into RPE will be a necessary step towards implementation of these cells in clinical application, Golestaneh says.

“The next step in this research is to focus on a generation of ‘safe’ as well as viable hiPS-derived somatic cells,” Golestaneh concludes.

Other authors on the paper include first author Maria Kokkinaki, Ph.D., Department of Biochemistry and Molecular &Cellular Biology, and Niaz Sahibzada, Ph.D., Department of Pharmacology at GUMC.

About Georgetown University Medical Center

Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC’s mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis — or “care of the whole person.” The Medical Center includes the School of Medicine and the School of Nursing and Health Studies, both nationally ranked, the world-renowned Georgetown Lombardi Comprehensive Cancer Center and the Biomedical Graduate Research Organization (BGRO). In fiscal year 2009-2010, GUMC accounted for 79 percent of Georgetown University’s extramural research funding.

gumc.georgetown.edu

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This Holiday Season EyeCare America Asks Seniors, “Do You See What I See?”

December 20th, 2010
National Non-Profit Provides Eye Exams at No Cost to Eligible Patients

“Do You See What I See?” For seniors who suffer with eye disease the answer is always, “No.”

This holiday season, EyeCare America has launched a campaign called, “Do You See What I See?” The campaign aims to connect eligible seniors with sight-saving eye exams and eye health information. EyeCare America’s year-round program provides eye exams at no out-of-pocket cost to people age 65 and older and offers free educational materials. The eye exams will be provided by nearly 7,000 volunteer ophthalmologists across the U.S. Those interested in the program can visit http://www.eyecareamerica.org to see if they are eligible. The organization’s online referral center also enables friends and family members to find out instantly if their loved ones are eligible to be matched with an EyeCare America volunteer ophthalmologist.

“Early detection and treatment can decrease the chances of permanent vision loss and slow the progression of eye disease,” said Richard P. Mills, M.D., Chair of EyeCare America. “The entire process was a pure gift. Heartfelt gratitude to your staff. Thank you for this tremendously good service,” said Mary Kelly, an EyeCare America patient from CA.

EyeCare America bridges the healthcare gap for the aging U.S. population. Through this service, those who are eligible receive a dilated medical exam and up to one year of care at no out-of-pocket cost. EyeCare America is able to provide this no cost care through its network of volunteer ophthalmologists who waive patient co-payments and accept Medicare as payment in full for their services. Eligible patients without insurance are not charged.

EyeCare America is designed for people who:

  • Are U.S. citizens or legal residents
  • Are age 65 and older
  • Have not seen an ophthalmologist in three or more years
  • Do not receive eye care through an HMO or the VA

To see immediately if you, a loved one or a friend, 65 and older, is eligible to receive a referral for an eye exam and care, visit http://www.eyecareamerica.org.
EyeCare America is co-sponsored by the Knights Templar Eye Foundation, Inc., with additional support provided by Alcon. The program is endorsed by state and subspecialty ophthalmological societies.

About EyeCare America

Established in 1985, EyeCare America, the public service program of the Foundation of the American Academy of Ophthalmology, is committed to the preservation of sight, accomplishing its mission through public service and education. EyeCare America provides eye care services to medically underserved seniors and those at increased risk for eye disease through its corps of 7,000 volunteer ophthalmologists dedicated to serving their communities. More than 90 percent of the care made available is provided at no out-of-pocket cost to the patients. Since its inception, EyeCare America has helped more than 1.5 million people. EyeCare America is a non-profit program whose success is made possible through charitable contributions from individuals, foundations and corporations. More information can be found at: http://www.eyecareamerica.org

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Bausch & Lomb to Feature Actress Florence Henderson in Crystalens National Advertising Campaign

September 30th, 2010

Bausch & Lomb, the global eye health company, said it will work with Broadway, film and TV actress Florence Henderson in an integrated marketing campaign starting this fall for its Crystalens approved accommodating intraocular lens (IOL).

Henderson will share her experiences as a Crystalens patient in local television, national print and online advertising. She is best known for her role as Carol Brady in the iconic television series “The Brady Bunch,” which ran on network television from 1969 to 1974 and continues in syndication today. She has enjoyed a storied entertainment career that has spanned five decades.

 

The Crystalens is the only FDA-approved accommodating intraocular lens. The marketing and advertising program will feature Henderson talking about what it is like to have a cataract, how cataracts adversely affected her vision and what life has been like since she had her Crystalens surgery. It will emphasize that the Crystalens not only corrects the cataract but also provides a full range of vision.

“We are thrilled to be working with Florence Henderson,” said Amy Jacobs, director, global marketing, for Crystalens. “It is already proving to be a great partnership because she embodies the Crystalens brand with her very active lifestyle. She is a proven, effective spokesperson who has great influence with the 50 years and older audience. Her experience as a Crystalens patient heightens her already considerable credibility with our surgeons and their potential patients.”

An estimated 20 million aging Baby Boomers and seniors have cataracts. Approximately three million cataract surgeries are performed in the U.S. every year.

“When something works for me like Crystalens has, I like to share my experience. I am happy when telling my story helps empower, inspire and motivate people to take care of themselves. It is important for people over 50 to understand what a cataract is and what they can do about it,” said Henderson.

crystalens.com

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Muffins and Bread Show Lutein Carrier Potential for Eye Health

September 14th, 2010

Fortifying bread and muffins with lutein may be a suitable vehicle to boost intakes of the compound, according to a new study from Spain.

High-lutein wheat and corn flour was used to prepare lutein enriched cookies, muffins and bread, with “reasonable amounts” of the carotenoid still measurable in the final baked products, according to results published in the Journal of Agricultural and Food Chemistry.

“Despite the significant losses of lutein during processing, the developed fortified baked products still contain reasonable concentrations (up to 1.0 mg/serving) of lutein and would hold promise for the development of high-lutein functional foods,” wrote researchers from Guelph Food Research Centre, Agriculture and Agri-Food Canada.

All Eyes On Lutein

Lutein, a nutrient found in various foods including green leafy vegetables and egg yolk, has a ten-year history in the dietary supplement market as a nutrient to reduce the risk of age related macular degeneration (ADM).

The global lutein market is set to hit $124.5 million (€93 million) in 2013, according to a 2007 report from Frost & Sullivan, with skin health offering a major new avenue for the carotenoid.

According to the report, manufacturers need to address this growing maturity in dietary supplements by identifying new and potentially lucrative application segments that offer opportunities for the continued growth of the lutein market.

“Because the role of lutein in human health has become evident, it is essential to boost the daily intake of lutein, which is low worldwide. For example, the average daily intake of lutein in the United States is about 1.7mg/day and in Europe is 2.2 mg/day,” wrote the researchers, led by El-Sayed Abdel-Aal and his co-workers.

“These values are below the levels purported to reduce the risk of eye diseases such as cataracts and AMD […] Thus, the development of high-lutein staple foods would be of interest to the food industry to enhance lutein intake,” they added.

Study Details

The Guelph-based researchers prepared pan bread, flat bread, cookies, and muffins were with high-lutein and lutein-fortified whole wheat flours. Processing and baking detrimentally affected the lutein and zeaxanthin content of the bakery products. For example, in the flat bread the all-trans lutein decreased by about 40 per cent, while the reduction in cookies was about 63 percent. The loss in muffins was similar, with about 58 percent of the trans-lutein lost.

Despite such losses the researchers were positive about the potential of fortified bakery to offer lutein-rich products.

Next stage

The researcher confirmed that further study is already underway, with the focus on “how much lutein is transferred from the food matrix into the bile acid micelles and how much lutein is absorbed/passes through intestinal walls”, wrote Abdel-Aal and his co-workers.

“In addition, more research is being carried out to evaluate antioxidant properties of these wholegrain high-lutein food products,” they added.

by Stephen Daniells
nutraingredients-usa.com

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NASA Testing Adjustable Liquid-Lens Eyeglasses for Space

August 21st, 2010

When our vision starts fading, glasses or contact lenses (or laser surgery!) are a simple cure.

But for NASA astronauts working in the near weightlessness of a space environment, it’s not that easy.

After all, they’re trying to read from all sorts of angles. And many of them are middle-aged and facing presbyopia, that classic “Mom needs reading glasses” condition. Adding insult to injury, the microgravity environment actually helps degrade vision.

So what’s an astronaut to do? Larry Greenmeier in Scientific American details a solution called TruFocals, a new type of adjustable eyeglass lens that NASA has been testing for use in space.

Made by Van Nuys, Calif.–based Zoom Focus Eyewear (and sold for $900 per pair, retail), the three millimeter-thick, flexible lenses can change their focus on the fly.

Greenmeier describes how they work:

Each TruFocals lens—about three millimeters thick—actually consists of two magnetically attached lenses. The lens closer to the eye is flexible, with a transparent distensible (expandable) membrane attached to a clear rigid surface. The space between the membrane and the clear rigid surface holds a small amount of clear silicon fluid. A sliding lever on the bridge of the eyeglasses is used to push the fluid forward to alter the shape of the membrane and, by extension, the flexible lens. TruFocals for people with more advanced presbyopia contain more fluid than those made for people with a milder form of the condition. The second, outer lens features the wearer’s normal prescription.

In other words, the flexible lens replaces the eye’s eroding natural ability. That’s important because much of what NASA astronauts do — use complex equipment, read checklists and overhead instrument panels, etc. — is difficult to do with conventional eyeglasses, which have a small corrective zone.

And astronauts aren’t getting any younger, either.

NASA says its plan is to roll adjustable glasses out for use on the next space mission, either from Zoom Focus or Roanoke, Va.-based PixelOptics, which makes electronic adjustable lenses called emPower!.

Now all the astronauts will have to do is figure out how to make Harry Potter-style round lenses stylish.

by Andrew Nusca
smartplanet.com

trufocals.com

FDA Approves First Implantable Miniature Telescope to Improve Sight of AMD Patients

July 19th, 2010

The U.S. Food and Drug Administration announced it has approved the Implantable Miniature Telescope (IMT) to improve vision in some patients with end-stage age-related macular degeneration (AMD).

Surgically implanted in one eye, the IMT is a small telescope that replaces the natural lens and provides an image that has been magnified more than two times.

AMD, a condition that mainly affects older people, damages the center of the retina (macula) and results in a loss of vision in the center of the visual field. About 8 million people in the United States have AMD and nearly 2 million of them already have significant vision loss, according to the National Eye Institute. AMD can make it difficult or impossible to recognize faces or perform daily tasks such as reading or watching television.

“This innovation has the potential to provide many people with an improved quality of life,” said Jeffrey Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health.

The IMT is available in two models: one that provides 2.2 times magnification and another 2.7 times magnification. The IMT is designed to magnify and project images onto a healthy portion of the retina. The IMT is intended to be implanted in only one eye; the non-implanted eye is used for peripheral vision.

The IMT is used in patients ages 75 years and older with stable severe to profound vision impairment (when vision impairment has not changed over time) caused by blind spots (bilateral central scotoma) associated with end-stage AMD. These patients also have evidence of a visually significant cataract.

Patients agree to undergo training with an external telescope with a low vision specialist prior to implantation to determine whether adequate improvement in vision with the external telescope can be obtained and to verify if the patient has adequate peripheral vision in the eye that would not be implanted. Patients also agree to participate in a post-operative visual training program.

In a 219-patient, multi-center clinical study of the IMT, 90 percent of patients achieved at least a 2-line gain in either their distance or best-corrected visual acuity, and 75 percent of patients improved their level of vision from severe or profound impairment to moderate impairment.

Because the IMT is a large device, implantation can lead to extensive loss of corneal endothelial cells (ECD), the layer of cells essential for maintaining the clarity of the cornea, and chronic endothelial cell loss. The chronic rate of endothelial cell loss is about 5 percent per year. Significant losses in ECD may lead to corneal edema, corneal decompensation, and the need for corneal transplant. In the study, 10 eyes had unresolved corneal edema, with five resulting in corneal transplants. The calculated five-year risk for unresolved corneal edema, corneal decompensation, and corneal transplant are 9.2 percent, 6.8 percent and 4.1 percent, respectively.

To ensure that the risks of IMT implantation are sufficiently and consistently communicated to patients, the FDA and the manufacturer created detailed labeling, including an Acceptance of Risk and Informed Decision Agreement, which patients must complete prior to IMT implantation. The agreement provides a guide for patients and their physicians to discuss the risks associated with IMT implantation. Patients should be given adequate time to review all of the information regarding the IMT.

As a condition of FDA approval, the manufacturer, VisionCare Ophthalmic Technologies Inc. of Saratoga, Calif., must conduct two post-approval studies. In one study, VisionCare must continue follow-up on the subjects from its long-term follow-up cohort for an additional two years. Another study of 770 newly enrolled subjects will include an evaluation of the endothelial cell density and related adverse events for five years after implantation.

U.S. Food and Drug Administration

Caffeine May Help Prevent Cataract Formation

June 21st, 2010

Caffeine may be effective in protecting the lens against damage that could lead to the formation of cataracts, according to a study presented on May 4 at the 2010 Annual Meeting of the Association for Research in Vision and Ophthalmology.

Researchers from the University of Maryland School of Medicine in Baltimore, MD hypothesized that caffeine may inhibit the intraocular generation of reactive oxygen species in the lens and consequent damage to the tissue.

The team studied the oxyradical effects in vitro by incubating mice lenses in medium exposed UVA in the presence of kynurenine with and without caffeine. In vivo studies were conducted in rats by incorporating caffeine with galactose in their diet. In both cases, caffeine was found to be effective in protecting the lens against damage.

As reported in the abstract, “These effects of caffeine have not been reported before and are hence considered highly interesting in view of its relatively high content in widely consumed beverages.” Additional research to determine the pharmacological significance of this study is underway.

The Association for Research in Vision and Ophthalmology (ARVO) is the largest eye and vision research organization in the world. Members include more than 12,500 eye and vision researchers from over 80 countries. ARVO encourages and assists research, training, publication and knowledge-sharing in vision and ophthalmology.

The Association for Research in Vision and Ophthalmology

Make Buying Eyewear a Wow and Not a Woe

March 25th, 2010

“Experiences are as different from services, as services are from goods.” Read it again. Then, read it backwards. You now succinctly have the evolution of where we are as patients, consumers and business people.

For years, businesses have met the demands of consumers and patients by competing on products and quality. We differentiated ourselves based on the brands we carried. This worked for many years but soon consumers/patients became numb to quality and brand availability. A new “norm” was established requiring business to change their service levels in order to further differentiate and compete.

In optical, retail introduced one hour services, extended hours of operation and flexible doctors’ hours to accommodate the changing work place in America. Eventually, these too became “the norm” as those changes resonated with the consumer and were widely adapted and implemented. Consumers then began seeking a higher level of expectation: The Experience. Starbucks epitomized the shift from an ordinary cup of coffee to one that brought with it the experience of a place to congregate, a cushy chair, music or a book when savoring a grande latte.

Patient or Consumer Choice

Today, we have choices and options. We have the ability to vote with our feet and our wallets every single day on nearly every single decision we make. For instance, we have many choices of restaurants when we want to go out for dinner. Depending on the occasion, we may want casual or formal, ethnic or not, sit down or stand up, inside or out. Not only do you have these basic choices, in each of these categories there are also more choices. What determines where you ultimately go? Most likely it is the experience you desire to have, heard about or had in the past. For patients or consumers seeking eyecare today, it is no different. And yes, I purposely interchange the words patients and consumers for a reason. Patients who seek eyecare have choices, they are consumers. So, what are the ways we can ensure that each patient chooses your office and doesn’t go elsewhere? It lies in understanding your own brand, making everything that the patient experiences in your office faithful to that brand, and turning those experiences into a “Wow.”

Creating the Brand

First, create an eyecare experience that is different than what has been traditionally offered. It begins with understanding and defining what your office or practice is ultimately going to be known for in the market. What is your brand and what are the effects of the brands, products and services you offer? What patients tell their friends about your practice will become your brand, your professional identity.

Be sure that what you intend becomes reality. If they describe their visit as “okay” “it was a nice visit” versus “Let me tell you about the experience I had the other day at the eye doctor” will speak volumes to where you are in brand and experience building. According the American Management Association, if you have a wonderful experience with a service provider, you will tell about 10 people. Conversely, if you had a bad experience you will tell about 80. That’s eight times the bad publicity and it doesn’t take much to turn off a patient. So understanding who you are in the market and what your employees and services are conveying to your patients determines your brand. Once a brand is known or has been developed, make sure that every facet of the office experience exemplifies the brand message you want to convey.

First Impressions

The experience begins with the phone call for an appointment; it’s the first touch point where your brand (identity) is exposed to the customer. Physically, it begins in “reception”—this is the first touch point the patient will have with the brand. In both cases, these first few moments will set the tone for the entire experience. Is it friendly? Is it inviting? Is it warm or is it clinical? Is it personal or transactional? Is it formal or informal?

Have you heard the expression “You only have one shot to make a first impression?” Well, this is it. This quick interaction will determine in the patient’s mind what kind of experience they feel they are in for during their visit. You can create a “wow” experience or a ho-hum experience for your patient. Taking time to create the desired patient frame of mind is critical in establishing and maintaining the brand.

The customer experience is created through a series of touch points that result in informed, loyal and enthusiastic patients. It’s a continually rotating circle of visits with participation of your office before and after. The more continuity that you introduce, the more a part of your practice the patient feels. Look at all the components, make them part of your process.

Make Them Feel Special

Next, use some form of lifestyle questionnaire. Make sure to explain why the information is important and how it will be used throughout their visit. Then, take that valuable information and begin using it in conversation to learn more about them as a person as well as a patient. According to the AMA nearly 7 out of 10 people leave a service provider because they felt that employees were indifferent to them while at a visit. The greatest disservice you can give to a patient is to take all that valuable information and never use it. “Wow” patients by making them feel special, important and one-of-a-kind, based on the information collected in the questionnaire. Refer to their answers and probe for details throughout the pre-testing, exam and dispensing process.

Engage the Patient

Add to the “wow” with a special attitude. Don’t just apply an office process to the patient, engage the patient and make them part of the process. A very effective selling skill is to have a conversation with patients. It makes the process personal and sharing of critical details that can get a pair of glasses completely tuned in to that patient.

It’s a simple three step process:

(1) Explain what we want to do
(2) Detail why it is important and
(3) Ask if they are okay with moving forward.

Try it; it’s essential to including them in the process. Following this simple formula throughout each phase of the exam and office visit, will take a patient from feeling like they are being “processed” to one of being engaged and part of the solution and the resulting glasses.

Ask Questions

Asking good questions enables the patient to respond with more than a “yes” or “no” answer; this is a key ingredient in creating meaningful conversation.

People love to talk about themselves and they hold all the information needed to recommend the right products and solutions for their optical needs. There is only one way to gather that information and it is by asking probing questions. Probing questions come in two forms: Open—those that elicit more than a one or two word answer; and Closed—those that require a short or definitive answer.

Always start with open probes so the other person feels comfortable and begins sharing information. Once you hear something that is important and germane, follow up with a question that essentially repeats what they have said to confirm what you have heard. For example, “So I understand correctly Ms. Smith, you are in the garden several hours a day?” Ms. Smith would reply, “Yes, that’s right.” The process of asking open and closed probes allows you to gather the information needed and provides you with a clear and complete understanding of your patients’ needs. This is also helpful to determine if assumptions have been made or if information was actually gathered. Take a few moments to ask the patient questions about their lifestyle, their hobbies, interests, profession and how much time they spend doing various activities. When you feel confident that you have a complete picture of the persons’ lifestyle, proper context will have been established for recommending products and treatments to meet all their optical needs.

It’s Personal

The more engaged the patient becomes in the process, the more emotionally attached they will become with your practice, staff and your brand. Emotionally attached patients are loyal patients. One marketing source claims that we don’t just buy brands, we join them.

One of the more emotionally significant moments during the visit is the patient hand off from the doctor to the dispensary. At that moment there is an unspoken transfer of trust. Does the doctor escort the patient into the dispensary, introduce the patient to the dispenser, summarize the exam experience and findings, go over the recommendations for correction and give them one final reassurance? If not, consider it.

A disturbing trend emerging over the last two years shows that 66 percent of the exams in the U.S. are given at an independent doctor of optometry office. However, only 42 percent of the prescriptions for eyewear are filled at that the same office. A third of all patients are not buying eyewear at the same office in which they were examined. While we don’t expect that 100 percent of all exams will result in an eyewear purchase (contact lens check, eye health check, etc.) clearly a significant portion of patients leave to purchase eyewear elsewhere. (Source: VisionWatch, a study conducted by Jobson/Vision Council.)

How can you stop patients from going to another location to fill their prescriptions? One way is making sure the patient feels like their emotional and medical needs are being met. There is nothing more important than a well-managed hand-off and assuring the patient they can trust they will be best served by staying in the dispensary. “Wow” them with personal attention.

Positioning the Solution

There is an adage in sales that simply says, “People buy with emotion and justify with logic.” In real time we translate that adage into the skill of using features and benefits when describing products and services.

wowandwoe2Features are the facts or characteristics of a product and therefore equal the “logic” portion of the adage. Benefits are what the feature provides as a solution or answer to the question “so that you can ___.” Patients buy benefits because it solves their problems.

Think about how often we describe progressive addition lenses or anti-reflective coatings. Often what is heard are nouns and adjectives describing fitting heights, segment heights, wider reading areas, variable corridors, glare, smudge resistant, digital surfacing, etc., all things that mean little to a patient who sees an eyecare professional an average of about two-and-a-half years. Features are simply facts or characteristics of products or treatments, but they don’t convey any message that they will solve the patient’s problem. In fact, stating features without describing the benefits will arm the patient with a list of items they can either choose to accept or decline. Not dissimilar to ordering off a menu at a restaurant and ordering a la carte.

Position your solution with patients by focusing on the benefits of each feature, as opposed to the feature. Patients want to hear how you are going to solve their problem with procedures, processes or products. Benefits, loaded with emotion because of what they resolve or improve, are very difficult to decline.

Patients come into the office with needs. Needs are defined as “having the desire to change something.” As an eyecare professional, there are many procedures, processes and products that can be prescribed to address those needs.

Table Talk

Conversations at the dispensing table are where sales are made and many are lost. One common reason why sales are often lost is because the patient doesn’t perceive the value in what is being offered.

wowandwoe3For instance, it may be heard “This pair of glasses costs how much?” Discussing only the features of lenses, frames and treatments, and not about how it will solve their optical need, make them look better, more attractive, more accepted, the patient will opt out of what may be very beneficial to them and the right solution. However, if we link the features to benefits, a scenario is created that is much less likely rejected. “Wow” them by speaking in ways that help them visualize life with their new eyewear.

Challenge each other to explain common recommendations of products using only benefit statements. See if describing a PAL with AR goes from all statistics to: “We recommend a lens that lets you see clearly in all situations; while you read, doing your hobbies and while driving, just like you did in the exam chair. This lens is treated to give you crisp, clear vision helping reduce distracting glare that can make your eyes tired. In addition, we’ll put coatings on the front and back to insure your lenses will be resistant to every day scratching so you can see clearer, longer.”

Attributes are the features of what the practice, products or processes offer the patient. Emotional benefits are what the patients ultimately seek from the solutions provided. Functional benefits are statements describing solutions that have been created.

The Ask

At each stage, careful consideration has been made to bring the patient into the process. Efforts have made the experience more engaging, emotional and meaningful.

Eliminate the list of features from the dispensing table conversation.

Focus on the benefits your products provide. Take away the options of saying no by stressing what life will be like with enhanced or corrected vision. Benefits tell them why you are recommending the product and how it will help them live better over the life the prescription.

Now’s the tough part for many opticians, they struggle at this point in the conversation. Some struggle because they feel the eyewear they are recommending might be too expensive for them and therefore must be as well for the patient. Others are uncomfortable asking for money. If the previous steps have been followed, asking for the order is just a natural extension of the groundwork that has already been laid.

It should be noted at this point we haven’t discussed price and that also means one would not discuss price until the patient has a context of value. Until your recommendation of all the benefits that await them have been described, hold off on telling a price. If you lead with a price, it is just like leading with features. A patient can say no and opt out as soon as the price is given. However, when you build a compelling value story by describing benefits, you will have created a package that will be very difficult to decline.

I Only Want What Insurance Covers

Enough has been written already about the role of insurance in today’s marketplace. It is a down payment for eyewear—a way to pay for the basics so the patient can get what they really want to the benefits that they really need. All of us are accustomed to co-payments for medical and dental visits. We expect a portion of the balance to be covered by insurance, with the final payment being covered by the patient.

Present the eyecare solution in a top down fashion; best, better, then good. Understand the difference in patient investment from the best solution to what insurance will cover. Patients that understand benefits and learn the value of those benefits will also add to what insurance covers. After all, they’ll have them to enjoy for two plus years and who doesn’t want clear, comfortable and fashionable eyewear. “Wow” them with what’s possible.

Conclusion

Organizations that embrace creating an experience and challenge the norm will be rewarded by the marketplace. Engage your patients and impress upon them your sincere dedication to resolving their optical needs while caring to make an emotional connection. Focus on the benefits of all the products and services that are part of your brand and be courageous enough to step out and do something different. Give your patients an experience that wows them so enthusiastically that they become your best advertisers, marketers and storytellers.

by Michael Karlsrud, M.ED, ABOC
2020mag.com

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Eyewear Musts for the Senior Patient

March 1st, 2010

Happy birthday. Every day of the year an average of 5,574 Americans celebrate their 65th birthday, a rate of nearly two million per year. Every seven seconds a Baby Boomer turns 50. The number of mature Americans age 65-plus will double to 70.3 million by 2030 according to the US Census Bureau. America is getting older by the minute as we all march down the path to our golden years. But what does this mean to todays optician? What are the prescription musts for todays senior market? Before we answer that question, lets look at the needs of this group a little further.

Age-Related Eye Issues

The senior patient presents an array of challenging ocular pathology that is more prevalent in this age group than any other. We will look at the top concerns and explore the challenges associated with these concerns.

Presbyopia

seniorrx1Presbyopia is defined as impairment of vision due to advancing years. This includes reduction in accommodative ability, reduction in contrast sensitivity, need for additional lighting, increased light scattering, and reduced ability to cope with glare. This all becomes clinically significant beginning after the age of 40, according to the Dictionary of Ophthalmic Optics. Even though all adults will suffer from presbyopia, solutions are readily available. Spectacle lenses utilized to correct this condition include single-vision readers, flat top bifocals and trifocals, progressive lenses and near variable focus lenses. A critical must for the dispenser to remember in dispensing to the senior patient is the working distance of the near addition. Simple lifestyle questions will help ascertain the visual needs and habits of the patient. A senior patient who is still in the work place will have different needs than someone who is already retired and contending with recreational pursuits. Even though the activities will differ, the solutions will be very similar.

Whether your patient is a flat top bifocal wearer who needs to move into a trifocal to better see crosswords and puzzles or the progressive wearer who may be better served with a near variable focus lens to better see the paint easel, bear in mind the special needs of those who are moving into their golden years. A prudent course of action is to present the ophthalmic technology that is appropriate for each individual. Allow the patient to make the informed decision regarding lens options and features that appeal to their need. Prejudging an elder patient, thinking they must only want that flat top in a 58-eye frame is not only a disservice to them, but also missing an opportunity to increase profits.

Cataracts

Cataracts are the clouding of the eyes natural crystalline lens. There are many theories regarding the reasons for the formation of cataracts. Some of them are health related while the leading theory is environmental. Most experts agree that the most prevalent theory is the lifetime exposure to ultraviolet light. It is believed that the effects of ultraviolet light lead to the formation of cataracts. According to the World Health Organization, cataracts are the leading cause of blindness in the world. Common symptoms of cataracts include increases in nearsightedness, sensitivity to light and glare, especially while driving at night, blurred, cloudy, or filmy vision, changes in the way you see color and color changes in the appearance of the pupil. However, here in the United States, cataracts are all but considered a conquered disease. Treatment of cataracts is widely available. A surgical procedure is used which removes the cataract and replaces it with an artificial lens called an intraocular implant. This restores the function of the crystalline lens that was removed. Although over a million and a half surgical procedures are performed each year, vision impairment from cataracts is still widespread. Cataracts affect nearly 40 million adults over the age of 40 or nearly one in six. That number jumps to 70 percent in adults age 80. Cataracts cause vision impairment by scattering light as it enters through the crystalline lens.

Age-Related Macular Degeneration

Age-related macular degeneration or AMD is a loss of sight in the central portion of the retina, which is responsible for sharp vision. The cause of AMD is unknown and there is no cure. AMD affects 1.6 million Americans over the age of 50. There are two forms of macular degeneration, dry AMD and wet AMD. Dry AMD is the most common form of the disease affecting 90 percent of all cases. It involves the presence of drusen, fatty deposits under the light sensitive cell layer of the retina. This progression slowly damages the central vision causing dimming and blur. In late cases, this cell layer atrophies causing permanent loss of vision. Early AMD results in moderate vision loss and progresses slowly. Late AMD will result in more significant vision loss. Wet macular degeneration is less common but more devastating in vision impairment. In this case, tiny new blood vessels grow under the retina causing leaks of fluid or the blood vessels break open.

Dry Eyes

Dry eye syndrome is a prevalent condition that affects millions of Americans. As the name suggests, a dry eye is detrimental to good vision. The cornea requires a moist surface to maintain uniformity as an optical medium. As the cornea develops dry patches, the corneal surface produces irregularities that will affect good vision. Symptoms of dry eye syndrome will include burning, irritated eyes, blurred vision that improves with blinking, excessive tearing and increased discomfort from reading, watching television or working on computers. Dry eyes have many causes including the natural aging process. Americans over the age of 65 produce 60 percent less oils in their tears than an 18 year old. This oily component helps to contain the tears watery layer preventing evaporation. Common treatments may include using an artificial tear lubricant, inserting punctal plugs or changing your environment. Punctal plugs are used to block the lacrimal drainage causing the tears to remain in the eye longer.

Lifestyles

The image of a senior citizen is much different today than it was 10 or 20 years ago. We no longer envision grandma or grandpa sitting in a rocking chair on the porch reminiscing about back when I was your age stories. Todays senior is far more active in all aspects of life. They are no longer content to take a back seat to life but are instead seeking adventures and experiences that their grandparents never dreamed. A New York Times report cited mature Americans over 50 are the fastest growing market in adventure traveling. They are more likely to be riding elephants in India, horse back riding in Costa Rica or bungee jumping in New Zealand than their predecessors. In fact, according to Travel Industry Association of America, trips by mature travelers, age 55-plus peaked at nearly 180 million by the close of 2000. Baby Boomers accounted for almost half of the domestic trips and senior citizens accounted for nearly one-third of domestic travel. However, the most mature age group65-plus made up roughly half or 92 million trips. It is clear that todays senior is no longer content to sit on the sidelines of life and watch time go by.

Older Americans are also increasingly embracing computer technology. Mature Americans who access the Internet do so at the highest rate and time of usage than any other age group. Of 1,001 individuals aged 50 plus surveyed, 891 owned their own computers, 704 accessed the Internet at least 10 hours a week (326 at more than 20 hours), 927 regularly send and receive emails, 770 utilize the Internet for active research, 826 taught themselves how to use the Internet and 90.6 percent were over age 55, according to SeniorNet: Home User Research, 2000. Media Metrix also reported mature users access the Internet more often, stay online for longer hours and access more web sites than younger users. Seniors are more active in their lifestyles than in previous generations. Take a look in your neighborhood on any given morning and youre likely to see walkers and joggers out for their morning exercise. Or stop by the local mall in the early morning hours and you will see many seniors doing the malls walk program. Older Americans are more active as they participate in activities that are designed to keep them healthy and increase longevity.

Must Have Requirements

Now that we have a better understanding of todays senior, what are the requirements of the patients prescription that must be incorporated? The ophthalmologist or optometrist has determined the patients prescription and they have come to you, the optician, for their glasses. What is going to be different in assisting this individual with their eyewear selection from all the others?

Several factors may come into play that you will need to be aware of. First off, begin with a lifestyle assessment. Like with all the other patients that entrust their eyewear selection to you, having a thorough understanding of how the patient will utilize their eyewear is critical to the process. Not only will you gain insights into how the mature patient will use their eye-wear but also this lifestyle assessment will open other opportunities for suggestions regarding supplemental eyewear choices. Pay particular attention to the working distances that the patient prefers. This critical factor becomes apparent as the addition of the prescription increases. Remember that a young presbyope with an add of +1.25, will have immensely greater amplitude in working distances than a mature individual with moderate cataracts and an addition of +2.75. This information will help as a guide to begin talking about the different lens style choices that are available. For example, an aging Boomer who has worn a short corridor progressive may be better served with a standard corridor progressive because now her prescription add has increased to the point that she no longer has the amplitude in reading range and will enjoy the added benefit of a longer, more spacious intermediate range that the traditional progressive offers.

Lens style will also play an important role in the fitting of glasses. Being over 65 does not automatically relegate a senior to having to wear a flat-top bifocal or trifocal. Do not make the mistake of presuming that just because the patient is mature they will not be interested or open to a more modern solution. Many seniors have complained that since they began sending email to the grandchildren on the Internet, they are finding they have to tilt their head back to properly see the screen. This is an opportune time to talk about the options of computer eyewear whether the glasses are single vision or a newer style such as the near variable focus lenses. Or perhaps the solution is simply adjusting their flat-top bifocal from a 28mm wide style to a 35mm wide bifocal. The solutions are many and do not necessarily mean a complete change in the patients choice of lenses.

Active lifestyles, particularly outdoor lifestyles, bring to mind the importance of ultra violet protection in eyewear. Ultra-violet radiation is the leading suspect in many of the ocular conditions that affect the mature market. Research strongly points to UVs role in the formation of cataracts. Long term exposure has a causative effect to the health of the eye. Beginning preventative measures at an early stage is best but it is vitally important to continue or even start measures later in life as well. Advocating glasses that address these concerns should be a high priority. This can be accomplished through either an ultra violet inhibitor added to the patients lenses or utilizing a higher index material. Polycarbonate, as well as other high index materials, naturally blocks ultra violet radiation from entering into the visual system. Photochromic lenses would also be a good choice for absorbing UV. Sunglasses for outdoor use are also a must for todays mature American. A good sunglass will provide adequate coverage of the surrounding adnexa, absorb ultra violet radiation and greatly diminish blue light. Blue light exposure has been linked to higher levels of macular degeneration in men. Using a blue blocker sunglass lens would be prudent for this age group.

Eyeing the Issues

 
Cataracts

  • UV attenuating lenses
  • Photochromics
  • Poly
  • High Index

Higher Adds

  • Longer progressive corridors for increased width
  • Higher minimum fitting heights

Lifestyle Lenses

  • Near Variable focus
  • Wider Flat top Bifocal

Glare Control

  • Anti Reflective Lenses
  • Photochromic Lenses
  • Polarized Lenses


seniorrx2Another major concern or must for the senior patient is visible light. A 65 year old needs nearly six times the amount of visible light than an 18 year old. This presents a dilemma for adequate visual acuity. In a National Highway Transportation Safety Administration study, several conclusions were made in regards to seniors and driving and how light relates to these tasks. The NHTSA study concluded that aging directly reduces contrast sensitivity by about a factor of three; thus older drivers are at a relative disadvantage at lower luminance levels than younger drivers. It also found the glare level was greater by a factor of two when compared to a 70-year-old driver to that of a 20 year old. Assuming the effects of age and glare on contrast sensitivity are independent, older drivers is very much at a disadvantage in night driving situations in which glare is prevalent. However, these effects are certainly not limited to older drivers. The NHTSA study went on to report that between older drivers and their non-driver counterparts ex-drivers had more problems with glare from watching television, reading small print, reading an advertisement on a passing bus, seeing clearly at dusk, and rated their vision as less than satisfactory. This data clearly points to the need for glare control in the prescription.

The most effect method is using an anti-reflective coating on the glasses. Anti-reflective lenses will dramatically reduce the surface reflections present. A non-coated CR-39 lens will have a loss of transmittance of 8 percent. Higher index lenses will show higher losses, up to 12 percent. Application of anti-reflective treatments on both surfaces will increase transmittance to ~99 percent. From the NHTSA study, it is clear that usage of an anti-reflective treatment will have far greater implications to better help the lives of our seniors and their visual needs.

Two additional forms of glare that must be addressed are disabling and blinding glare. Todays AR coatings are far more advanced than they were even as little as 5 years ago. Durability against scratching, cracking and crazing are virtually non-existent with most of the higher quality coatings. The second most voiced complaint from consumers, that of cleanability, is currently being addressed by many AR manufacturers as oleophobic top coats become more commonplace. This development is allowing the AR coatings of today to be easier to clean and most importantly stay cleaner for longer periods. The optician, optometrist and ophthalmologist should have no reservations in prescribing AR treatments to the senior patient.”

  • Disabling glare will occur on a bright sunny day or overcast weather. It is generally associated with light levels that are above 3,000 lumens. An example would be a clear day, sun overhead and the light reflected off the sidewalk or a high overcast when one squints even though the sun is not directly seen. A tinted lens would be recommended in these scenarios with a variable tint or photochromic lens as the ideal option. Not only will it attenuate the light as needed to the conditions but it will also filter ultraviolet light in the process. This will provide the correct amount of tinting to handle the glare without unduly sacrificing contrast sensitivity. A brown or melanin color offers the best choice for contrast enhancement. It is important to not give the senior too dark of a lens color. The light gathering ability of the eye is diminished with age and the wrong choice of density will unnecessarily rob the patient of light and therefore good vision.

  • Blinding glare, that intense light that causes temporary loss of vision, is controlled with polarized lenses. An example of blinding glare is the reflection off the chrome bumper of the car in front of you or light coming off snow or water. The luminance levels are so intense that vision is lost and only polarizing lenses eliminate blinding glare. Polarized lenses are good choices as they offer excellent color contrast, densities and filter capabilities. Long term exposure to this type of glare can lead to extreme eye fatigue and degrade night vision. Over exposure to high intense levels of light will deplete the rhodopsin levels in the retina. Cumulative effects occur in the decrease of these levels that make nighttime adaptation time significantly decrease. A two to three hour exposure can delay initial adaptation time by as much as 10 minutes and a 10-day exposure can reduce effectiveness by 50 percent. The good news is with proper protection the visual degradation experienced from over exposure will return within 24 hours. Consider brown polarized sun lenses for all seniors.

Conclusion

Todays senior market is in a state of confluence. At the upper end there is the World War II generation of older Americans. This group, with their saving mentality, is more likely to continue to embrace traditional lenses, tinting and larger frame styles. The lower or up and coming group of Boomers, whom have been characterized as spend happy, will tend to continue utilizing technology that they embraced in their younger days. This group will enjoy the benefits of progressive lenses, anti-reflective lenses and higher priced, fashion oriented frames.

So what are the prescription musts for the senior patient? Todays optician must have a thorough understanding of the ocular conditions that are present in the age group. A strong background will better prepare the optician for dealing with the unique issues that will be presented from this arena. Secondly, you must be aware of the lifestyle activities that will be prevalent. The senior market is changing today like it never has before with patients being more active in pursuing a broader range of activities. The optician must have solutions for the problems and issues of the mature patient. This can range from dealing with issues of glare related to cataract formation to taking on a new hobby and wanting task specific eyewear to meet that need. Finally, you must understand the emerging market. Will the seniors of today be willing to continue to spend as they have in the past on newer technology? Will they settle into a mode of maintaining the status quo? Opticians face a growing market segment that will have unique demands both as they address the realities of their ocular conditions and meet their lifestyle needs.

Lee Prewitt, ABOM
2020mag.com