|
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
Presbyopia 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 |
Another 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.
|