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Sunwear, the Other First Pair

By Mark Mattison-Shupnick, ABOM

Release Date: March, 2011

Expiration Date: April 7, 2015

Learning Objectives:
Upon completion of this program, the participant should be able to:

  1. Understand the changing needs of the presbyope as electronic gear affects lifestyle and visual demand.
  2. Learn how the design of a progressive can be altered for a specific distance, mid-range need.
  3. Know that new research helps to determine lens designs for specific wearing preference.

author Faculty/Editorial Board:
Mark Mattison-Shupnick, ABOM is currently director of education and training, program development for Jobson Information Services LLC, has more than 40 years of experience as an optician, was senior staff member of SOLA International and is a frequent lecturer and trainer.

Credit Statement:
This course is approved for one (1) hour of CE credit by the American Board of Opticianry (ABO). Course SWJM503-1
This course is approved for one (1) hour of CE credit by the National Contact Lens Examiners (NCLE). Course # CWJM021-1

**Please note that this course is available for either ABO OR NCLE credit only. Credit for both will not be granted during a renewal period. **

This program is supported by an educational grant from: LUXOTTICA


SUN PROTECTION IS YOUR RESPONSIBILITY

fig1More consumers than ever before are active outdoors, making sunwear just as important as indoor eyewear. And if they work outdoors, sun protection can be even more important.

I work a few days each month for an independent optician. I feel that I have done patients a disservice when they leave without being aware of the importance of UV protection and the availability of prescription sunwear.

Considering what is known about the sun’s potential damage to skin and eyes, and because we’re living much longer, it’s every optician’s responsibility to introduce information to every patient about the risks of not protecting their eyes with quality sunwear. That information should include:

  • A discussion of who needs quality sunwear
  • Potential damage caused by UV and blue light radiation
  • Lifestyle cues for choosing the best types of sunwear
  • How the optician should position sunwear in the office

In general, consumers know little about the sun’s effects on their eyes and equally less about quality sunwear. Three things are required on your part.

First condense your conversation into simple phrases, sound bytes that give patients reasons to want to own the sunwear you recommend. To do this you must understand the technical background that allows you to talk with confidence. In this way, sunwear becomes a valuable eyewear asset and just as important, their “other first pair.”

Second, show your knowledge of some of the technical aspects of quality sunwear.

Third, present the benefits and value of purchasing quality frames and lenses.

THE SUNWEAR DISCUSSION

Since most patients have contact with front office staff and technicians before seeing the doctor, they should mention the necessity of good quality sunwear while taking a patient’s history and during early contact. Both the ophthalmologist and the optometrist should include discussing the need for good quality sunwear while the patient is in the chair.

Then the optician should discuss good quality sunwear with every patient. During their lifestyle consultation with the patient, identify the times not only when a patient would benefit by having sunwear, but the fact that it may even be more important than their indoor pair. It’s really the responsibility of everybody who works in the practice and interacts with the patient to discuss good quality sunwear.

Talk to parents about the importance of sunwear for children. The average child receives three times the annual UV exposure of an adult mainly because the bulk of lifetime UV radiation exposure occurs prior to age 18; and because the clear lens of the young child transmits 7.5 times the amount of potentially harmful UV radiation as does the yellowing lens of an adult (75 percent transmission at age 10, 10 percent at age 30). Damage caused by exposure to UV radiation is cumulative and therefore protection needs to begin as early as possible.

For these reasons, ECP’s should not limit their discussion of sunwear to just adults, but should include all ages including children.

LIFESTYLE QUESTIONING

Lifestyle questioning uses direct and openended questions to find out the lifestyles of your patients. It allows a personalization of benefits that resonates with patients. Example 1: “Mr. Jones, please discuss your outdoor activities with me, so that I may guide your choices.” A statement such as this, followed by a question will get your patient thinking.

“Mr. Smith, you stated that you drive for a living. Did you know that blinding glare is responsible for a very high percentage of traffic accidents? Let me explain how quality polarized no-glare prescription sunwear could actually make you safer while you drive.” Example 2: “Ms. Jones, you mentioned you do a lot of boating. Let me demonstrate to you how good quality, polarized lenses can make you more comfortable on your boat. You can also get prescription lenses in these great designer brand frames, just like celebrities.”

KNOWING THE FACTS: RADIATION, EXPOSURE AND PROTECTING THE EYES

Three Concerns: UV, Blue Light and Glare
The eye is exposed to the sun’s radiation, both invisible and visible. Called the Electromagnetic Spectrum, the visible portion provides color, blacks, whites and grays. Invisible radiation borders the visible. The shorter wavelengths are called ultraviolet (UV), the longer called Infrared (IR).

Glare (visible) or the excess of light is another concern. It can be everything from annoying to blinding. With an understanding of the ways that patients will wear their sunwear, an optician can personalize the lens materials, colors and coatings so that both the wearer and eyewear perform spectacularly.

Invisible: Ultraviolet Radiation and its Effects
Ultraviolet Radiation is invisible. It is divided into three categories—UVA, UVB and UVC. UVC, 190 to 280 nanometers (nm), is filtered by the earth’s ozone layer. UVA (aging rays, 315 to 380nm) and UVB (burning rays, 280 to 315nm) can cause damage to the tissues of the body including the eye. The effects of UV are cumulative. Excessive exposure as a child can’t be undone as an adult wearing sunwear. In fact, it is estimated that 80 percent of the eyes’ UV is accumulated by the age of 18. The sooner the right sunwear is worn, the better.

Both UVA and UVB are known causative agents for skin cancers, i.e., basal, squamous and melanoma cancer. UV is the only proven carcinogen found in the natural environment. Given long life and a lack of understanding, these cancers have reached epidemic proportions. Tanning salons contribute to the problem since they deliver not only high levels of UVA, but also reinforce the notions that a tan is inherently appealing, suggests health and is associated with wealth, privilege and mobility. As a result of the popularity and use of tanning parlors, we may be now seeing the appearance of what were formerly old age cancers in a much younger population.

Sources of UV include direct exposure from the sun and reflective surfaces like water, sand and snow. UV exposure to the eye leads to increased risks of sunshine or brown cataracts, pingueculae, increased pterygium, and photokeratitis, not to mention lid and skin cancers around the eyes. In addition, we can see an increase in accelerated ocular aging, weakened color vision as well as other permanent visual damage.

Infrared (IR) radiation produces heat but when present is uncomfortable, so it is typically avoided. Therefore, most eyewear experts agree, there are few applications where IR is considered a hazard in eyewear.

Visible: Blue Light and Glare
High-Energy Visible Blue Light (HEV) encompasses the blue and violet portion of the visible light spectrum. Research has shown that it is a contributing factor to agerelated macular degeneration (AMD).

High Energy Visible (HEV) light, i.e., blue light, when accumulated over a lifetime, is of concern because the shortest wavelengths of the visible spectrum contain significant energy. HEV light is powerful enough to injure human cells, mainly through the production of oxygen free radicals. This prevents the normal metabolism of the retinal cells, causing damage or cell death. Extended exposure to HEV blue light, like UV radiation, can also cause damage to the eye and the skin around the eye.

Glare from too much visible light always reduces clear and comfortable vision. It can be as simple as the reflections off the back of a sun lens that interrupt clear vision; to a super bright sunny day, to that blinding reflective flash off the dewy wet pavement while driving on a sunny morning. Glare causes squinting, eye fatigue and reduced vision. It is generally annoying and can become the cause of a car accident if you’re blinded to something in the road that you should be able to see. Probe the patient for the real ways they will use sunwear. Be sure to get glare control right.

For example, a baseball player needs to see accurately when searching for the ball against a blue or overcast sky; a skier must pick out the ice and moguls at speed; and when fly fishing, seeing how the fly just touches the surface of the river may be the difference between fish or steak for dinner. Professional drivers, like mom and dad, need all the visibility they can get with the right pair of sunglasses. Seeing clearly, with the best contrast, can sharpen reaction time. In fact at 60 mph, even a quarter of a second equals 22 feet. A decision that is even a second faster can make the difference and avoid an accident.

GLARE CONTROL SUNWEAR

Protective Lens Options
Glare control lenses can do all of the following:

  • Provide comfort in any outdoor light
  • Eliminate blinding glare
  • Prevent squinting as well as the pain experienced by some in very bright light
  • Protect the eye from the harmful effects of UV and blue light
  • Enhance contrast and colors

Describing each of the benefits of glare control lenses and choosing the right combinations is the optician’s job. Determine the color, selective absorption and darkness of the lens based on the age of the patient and the conditions in which they will wear their sunglasses. Always describe the benefits of polarized—they are the only lenses that can eliminate blinding glare. Then choose the right lens material to deliver the best protection and looks. To best eliminate glare, I always recommend a no glare back lens surface on all sunwear.

POLARIZED LENSES

Only polarized lenses filter the intense reflections of light that become polarized and intensified when bouncing off flat surfaces. A specially oriented polarizing film, encapsulated within the lens, selectively blocks the horizontal waves of reflected glare. With ordinary sunglasses, any blinding flash from reflected surfaces would be reduced in brightness but still transmitted through the lens and into the eye.

Since the liquid crystal screens (LCD) on cell phones, PDAs, car dashboards and gas pumps are also polarized (at 45 degrees), the 180 degree orientation of polarized lenses may block some of the screen—that’s normal. Be sure to advise patients and suggest tilting their head or the cell phone 45 degrees for greater visibility.

TINTED LENSES

Tinted lenses are dip-dyed or molded with an encapsulated film of uniform color. Like polarized lenses, tints are identified by color and darkness or percent transmission. Order them from your lab at the darkness or density required. Most labs supply tint sample sets so patient, optician and lab can all agree on lens color and transmission.

PHOTOCHROMIC LENSES

Photochromic lenses change tint and darkness. They start clear and turn sun lenses dark in the presence of UV radiation, sunlight (i.e, Transitions VI, Vision-Ease LifeRX, HOYA SunTech, etc.) and sun lens versions, somewhat dark to darker (Transitions XTRActive, Younger Drivewear). Be sure to discuss with patients their sun needs since the major advantage of photochromics is their conve nience—they are as dark or light as needed. In some conditions (hot weather, inside the car), they may not get as dark as the patient prefers. Therefore, the patient should think about their photochromics as general purpose and consider polarized, dark tinted or XTRActive sunwear for sunglasses. Fixed tint or photochromics can be argued both ways for many sports and outdoor activities— understand your patient’s preferences and recommend accordingly.

LENS COLOR

Different sports and outdoor tasks are best with different tints or polarized lens colors, since it is the color (chemistry) that filters wavelengths of light differently. This means that a yellow tennis ball or objects against a green background (golf) benefit with lenses that can accentuate visibility.

WHICH LENS MATERIAL?

Sun lenses—think sports, outdoors, bungee jumping or just lazing by the pool. The activity suggests the lens material. Easy sunning—plastic—though be sure that the lens is UV protective. However, sports activities and sunwear worn around the house even to do chores also requires better impact strength. Recommend polycarbonate and Trivex as good general purpose materials especially in Rx because aside from its excellent impact resistance, it creates thinner and lighter lenses.

MIRRORED LENSES

Mirrors are applied in a vacuum process to the front surface of a lens only. It reflects light, is beneficial in reducing the light transmission through the lens, adds additional absorption (darkness) and offers protection from intense sunlight. Mirror coatings are also beneficial in reflecting or absorbing both UV and IR (depending on the metal used to make the colored mirror). The mirrored surface is effectively a one-way mirror. An observer can see him or herself in reflection, but the wearer can see clearly through the lens from the back.

Reflex mirror coatings are produced in standard colors of silver, gold, blue and rainbow colors. They can be done in solid mirrors, single or double gradients. The intensity of the reflection determines whether the mirror is called “flash” (more transparency, less reflective intensity) or “dielectric” (no front surface transparency, high reflectivity).

While infrared (IR) is not considered hazardous for the sunglass wearer, one example to consider is the lifeguard, sitting for hours in the heat at the beach. The IR will produce extra heat, especially behind a wrap sun lens. A gold mirror absorbs IR so the lens space behind the lens will be kept cooler.

PUTTING IT ALL TOGETHER

Great sunwear lets you show patients your “Truly I Care” side.

People love wearing sunglasses and trying them on. They see themselves differently in sunwear and will wear more daring styles than they would for clear eyewear. So it’s easy to help them push their own limits. They love to look like the celebrities so often photographed with their great shades.

Make sunwear a big part of the practice. Research shows that consumers are more likely to purchase sunwear if it appears the practice is in the sunwear business. It is recommended that 25 to 50 percent of your inventory be sunwear, with about 35 percent being ideal. Sunwear can easily be incorporated with a variety of displays in areas outside the dispensary.

Everyone needs quality sunwear, either plano or prescription. In order to successfully sell sunwear, first condense and simplify the message, then understand the latest in lens and frame technology, and finally have lots and lots of fun. Present “sound bytes” to get the patient’s attention and enable them to understand the true value of Rx sunwear—that other first pair.