| HEALTHY SIGHT DEFINED
Healthy Sight is defined as the enhancement of the everyday quality of vision
and the preservation of long-term ocular health—simply put, seeing well now
and into the future.
Increasing numbers of eyecare professionals are adopting an integrated
approach to achieve healthy sight. Called Healthy Sight Counseling (HSC),
it considers factors beyond visual acuity—such as quality of vision, visual
comfort and convenience, and long-term ocular protection and eye health—
when making eyewear recommendations.
While Healthy Sight Counseling is a concept for all ages,
achieving healthy sight in children needs to go beyond simple
vision correction. It becomes
even more important for children than for adults. After all,
vision care in childhood can
affect healthy sight for a lifetime.
Therefore, when making
product recommendations for
children, eyecare professionals
can do more than prescribe and
dispense eyeglasses. These
include visual acuity, quality of
vision (particularly light sensitivity and glare), trauma and ultra-violet radiation (UVR) protection as well as self- and
peer-acceptance of spectacle
wear. By taking the time to educate everyone on what is
required to provide healthy
sight now we can protect and
help preserve it for the future.
HSC provides the eyecare
professional with a blueprint
for promoting Healthy Sight
in the practice through a customized eyeglass prescription, maintenance
and preventive eye care, and raising awareness of Healthy Sight through
education.
Healthy Sight Counseling is a patient-centered approach based on primary
care-medical methodology. Crucial to the successful implementation of Healthy
Sight Counseling is the integration of three key components: Vision Care, Vision
Wear and Education. Healthy Sight Counseling addresses both quantity and
quality of vision issues, leading to what is called the customized eyeglass prescription, where specific eyewear recommendations are made taking into
account the individual patient’s specific visual needs, occupational and recreational requirements, ocular and systemic health issues, risk factors and lifestyle.
HSC FOR CHILDREN
HSC is arguably more important for children than adults because of its preventive aspects. In general, the earlier preventive measures are adopted, the more
effective they become. Furthermore, a child’s eyes are more susceptible than an
adult’s to certain risk factors that affect long-term ocular health. These include
impact-related trauma and UVR exposure.
Early detection and treatment of serious ocular abnormalities in children (particularly high and/or asymmetrical refractive errors, vision-threatening diseases
and strabismus, which can lead to amblyopia) and the prompt and accurate correction of ametropias are critical. The use of various eyeglass lens enhancements to
maximize both the quantity and quality of vision can play an important role in
the development of the child from an ophthalmic, educational, functional and
social aspect.
THE CHILD AS A PATIENT
A child is not simply a miniature adult.
Children’s eyes, as well as their visual
needs, differ from those of adults in a
number of important ways. They are
more vulnerable to UVR-related ocular
damage. Good vision is critical to a
child’s early educational, functional and
social development. For the most part,
children have different lifestyles than
adults. Children spend more time outside than adults, experiencing up to three times more sun exposure. Children
are the most physically active of any age group with a higher risk for sports-related eye injuries. Computer and video game use create special demands on
vision. These differences make the approach to vision and eyecare quite different in the child than in the older patient.
THE COMPONENTS OF HEALTHY SIGHT
COUNSELING FOR CHILDREN
Quantity of vision, quality of vision, health and counseling constitute the
primary components of healthy sight for children.
Children’s Quantity of Vision may be limited by ocular disease or refractive
error Quantity of Vision is defined by how well a child sees using a standard visual acuity chart, usually the Snellen chart. Accurately assessing the Quantity of
Vision becomes more difficult the younger the child, but even in pre-verbal children, the experienced examiner can get some idea of visual status. Measuring
the quantity of vision is useful in detecting medical and refractive abnormalities
that can limit visual function. With refractive errors, measuring vision quantity
can be helpful in assessing the adequacy of vision correction with eyeglasses.
Children’s Quality of Vision is defined as visual comfort and convenience,
light modulation and glare protection. Again, the younger the child the more
difficult but here decisions can be made by a knowledgeable professional that
are best practice.
Children’s Eye Health concerns involve impact protection, UVR protection
and attention to the systemic diseases and medications that may affect vision.
Putting all the above into action with Healthy Sight Counseling for Children
should result in a customized eyeglass prescription, education of the parents as
well as the child (to the level that they understand) and the development of a
collaborative approach with other professionals so that care is seamless.
STEP 1 — THE VISION EXAM, QUANTITY
A vision examination is the first step in HSC. This is critical in order to the identify both significant refractive errors and vision-threatening ocular diseases at a
young enough age so that appropriate measures can be taken to either correct
these or minimize their effects on healthy sight. While differences of opinion
exist on specific recommendations for vision examinations in youth, one fact is
indisputable: children should be examined.
The most important components of the vision examination in the child are
the early detection of potentially vision-threatening ocular diseases and strabismus and the prompt and appropriate intervention to maximize vision and
decrease the potential for the development of amblyopia. The recognition of
significant refractive errors that can impair visual functioning, impede educational progress and hinder psychosocial development is also crucial, as is the
identification of special risk factors requiring specific optical precautions.
While there are many components to a vision examination, the simplest and
most basic is the assessment of visual acuity. Other basic components of the
child’s exam are the evaluation of the alignment of the eyes and stereopsis testing.
The World Health Organization has estimated that 5 to 15 percent of children worldwide have significant refractive errors. The potential price of failing
to address this quantity of vision issue is tremendous from the viewpoint of
school performance, acquisition of hand-eye-mediated motor coordination skills
and psychosocial development. Visual impairment in the child can have a profound life-long socioeconomic impact in developing nations where large numbers of refractive errors go uncorrected.
STEP 2 — QUALITY
If quantity of vision measures visual acuity, then quality of vision measures visual comfort and satisfaction.
Up until recently, quality of vision issues in children has not received much
attention. This is not because they do not exist; they’ve been largely overlooked.
Two recent studies have demonstrated that eyeglass-wearing children are bothered by the same quality of vision issues (specifically light sensitivity and glare) as
adults, and, of even greater interest, the vast majority of them (more than 90
percent), when given the choice, prefer using eyeglass lens enhancements to
address these quality of vision problems.
In assessing patient satisfaction with eyeglasses prescribed/dispensed, Healthy
Sight Counseling expands the optician’s checklist to include quality of vision
issues—specifically visual comfort, visual convenience, glare and light modulation.
Children do have quality of vision issues, the same as adults. But unlike adults,
children may not readily identify these issues. It is the role of the optician in
Healthy Sight Counseling for the child to explore quality of vision issues in the
eyeglass-wearing child and use the customized eyeglass prescription, as in the
adult, to specifically address them.
The results of two studies, assessing children’s preferences between clear and
photochromic lenses with regard to visual comfort, visual convenience and
self/peer-acceptance of eyeglass wear, shows the possibilities.
Madeline Romeu, OD and Susan Stenson, MD performed the first study in
the U.S. in 2003. Carole Lakkis, BScOptom PhD and Kate Weidemann, BOptom, at Clinical Vision Research Australia at the University of Melbourne in
2006, performed the second.
In both studies, after completing two 30-day trial periods wearing photochromic lenses and clear lenses sequentially, participating children completed specially formulated pediatric quality-of-vision surveys, with questionnaires
designed to assess their experiences wearing their lenses in different situations
such as outdoor use, indoor use or when watching television, using computers or adjusting to lighting changes. The children were also queried regarding personal and peer acceptance of their eyeglasses.
These studies were based on similar studies previously performed in the adult
population. (Four out of five patients preferred the visual comfort of Transitions Lenses 1.50 over regular, clear lenses. Stenson SM, Baldy CJ, Scherick KJ:
Evaluation of vision-related quality of life for patients wearing photochromic
lenses. CLAO Journal 2002; 28:128-135.)
Both studies found children significantly preferred photochromic lenses over
clear lenses. In the Australian study, 88 percent of children chose to continue
wearing photochromic lenses at the conclusion of the study. In the U.S. study, nine
out of 10 children similarly chose photochromic lenses over clear lenses.
In the U.S. study, significant factors influencing this preference for photochromic
over clear lenses included improved visual comfort as well as higher peer acceptance. Children in the study experienced a
significant improvement in their ability to
see in bright sunlight outdoors with photochromics over clear lenses. Forty-seven percent
said they had “no trouble
at all” seeing in bright sun
when wearing photochromic lenses compared
with 27 percent of those wearing clear lenses. Sixty-one
percent reported their friends liked them better wearing
photochromic glasses as compared to 46 percent whose
friends liked them better wearing clear lenses.
Results from a parent survey also indicated a clear preference for photochromic
lenses, with 98 percent of the children’s parents saying they would be likely to
select photochromic lenses over clear lenses for their child in the future.
Both the U.S. and the Australian study convincingly demonstrate that children
can and do appreciate the benefits of quality-of-vision eyeglass lens enhancements like photochromic lenses and, when given the opportunity, they appear
to overwhelmingly prefer photochromics over standard clear eyeglass lenses.
STEP 3 — EYE HEALTH
Healthy Sight is all about seeing well now and into the future. This latter consideration makes preventive eyecare of paramount importance in Healthy Sight
Counseling. When considering Healthy Sight Counseling, preventive eyecare
and ocular protection in children, several factors deserve special consideration:
impact and ultraviolet radiation (UVR) protection and systemic disease and
medications.
Impact protection — Children live and prosper in an active, rough-and-tumble world—much more so than adults. And, all too often, children—and specifically children’s eyes—pay the price for living in this kind of world.
Approximately 40,000 sports-related ocular injuries occur in the U.S. each year.
Of these 43 percent occur in children under 15 years of age. It has been estimated that 90 percent of these ocular injuries could be avoided with the use of
appropriate sports-protective eyewear, but only about 15 percent of children use
eye protection for sports. For this reason, all children’s eyeglasses should be dispensed in impact-resistant materials such as polycarbonate or Trivex materials.
In addition, for spectacle-wearing and non-spectacle-wearing children
engaged in contact sports or sports involving high velocity projectiles (e.g. tennis, etc.) protective wrap-around sports glasses or goggles with impact-resistant
lenses should be routinely recommended.
Ultraviolet Radiation — Ultraviolet radiation protection for the skin and the
eye is among the most important aspects of preventive medicine in this century.
This is because of the increasing hazard of UVR exposure due to the ongoing—
and seemingly accelerating—depletion of the protective ozone layer.
Ocular UVR protection is particularly important in the child for two reasons:
first, because the bulk of the lifetime UVR exposure occurs prior to age 18; and
second, because the clear lens of the young child transmits 7.5 times the amount
of potentially harmful UVR as the yellowing lens in the adult. Damage caused
by exposure to UVR is cumulative and therefore protection needs to begin as
early as possible.
Both acute and chronic UVR exposure can be harmful for the eyes. Acute
intense exposure leads to what is essentially sunburn of
the eyelids and the eyes (conjunctiva, cornea or retina).
Chronic UVR exposure is more insidious and probably
more important from the viewpoint of potential visual
disability. While these conditions may not present in children, long-term cumulative UVR exposure has been
identified as a risk factor in such diseases of later life as
skin cancer of the eyelids, the development of cataract,
age-related macular degeneration and pterygium.
Therefore, it is important for all lenses to have 100 percent UVA and UVB absorption. Besides protecting the
eyes from UVR, photochromic lenses have the ability to
modulate light and, with AR-coatings, to decrease distracting, discomforting
and disabling glare, thus acting to improve the quality of vision.
Next, take into consideration systemic diseases and the medications used to treat
them and how these might impact on children’s vision and long-term eye health.
Certain childhood diseases may impact on vision and long-term ocular health and
these should be identified in the young patient. Of special relevance are childhood
diabetes, asthma, cancer and attention deficit hyperactivity disorder (ADHD).
In addition to childhood diseases, a number of commonly prescribed medications used to treat these diseases in children can impact negatively on Healthy
Sight. These include steroids (including inhalers), ADHD drugs, antihistamines,
chemotherapeutic agents, insulin and oral diabetes medications. According to a
Center for Disease Control survey, approximately 13 percent of children in the
United States had a problem for which prescription medication had been taken
regularly for at least three months [Summary Health Statistics for U.S. Children:
National Health Interview Survey, 2004].
STEP 4 — THE ACTION PLAN
Healthy Sight Counseling in children begins with a comprehensive eye examination, including a meticulous refraction. Using the medical/primary care model, a careful systemic history is also taken, with review of all illnesses and medications
in past or current use. A family ocular history is next followed by a detailed survey
of the patient’s individual visual lifestyle to determine any special visual requirements and relevant ocular risk factors. This leads to an eyeglass prescription customized to the individual patient and that patient’s visual needs.
The Customized Eyeglass Prescription generated enables the optician to promote healthy sight. Modern eyeglasses can do more than simply correct vision.
Lenses and lens enhancements actually do enhance vision, providing quality of
vision and helping to protect the eyes and prevent vision-threatening ocular disease in later life.
Ocular protection from ultraviolet radiation and impact injuries, glare reduction and light modulation can all be effectively addressed with the right choice of
lens materials and lens enhancements.
Spectacle lens materials and enhancements to be considered include impact-resistant lens materials such as polycarbonate or Trivex, high-index materials
where appropriate, anti-reflection (AR) coatings, fixed tint lenses, photochromic
lenses and polarized lenses. If the child is engaged in sports—especially high-velocity impact sports—protective sports goggles may also be required.
| UV Protection — A Must for Children |
- The average child receives three times the annual UV exposure of
an adult
- 7.5 times greater UVR transmission through the young lens
- 75% transmission at age 10, 10% at age 30
- Damage from UVR is cumulative
|
PRACTICAL TIPS
Use the variety of spectacle lens materials and lens enhancements to
accomplish your goals. All spectacle lenses prescribed for children must be impact-resistant and 100 percent UVA- and UVB-absorbing. Anti-reflective coatings and
fixed tint, photochromic or polarizing lenses provide improved quality of vision and
should be considered in children’s eyewear the same as in eyewear for adults.
Don’t forget the importance of the frame. During frame selection, advise
parents what constitutes not only a good frame but also one that fits well. Don’t
let them—or their child—fall in love with a frame that simply doesn’t work.
When deciding on a frame for the child, keep in mind that it is the child who
will be wearing it. Children are unlikely to wear those eyeglasses if they don’t
think they look good in them. Eyeglass frames are a fashion statement and
should be treated as such. Also remember the parents who will be paying for
them, so recommend frames that are durable and as “child-proof” as possible.
Additionally, consider recommending special sports goggles if the child plays
sports or is involved in active pursuits.
Bring out the best. Never withhold offering premium products for children. Parents want the best in everything for their children—why not in their eyewear?
Hands-on attention. Get the child physically engaged with eyewear selection.
Utilize in-office educational tools to introduce parents to the importance of everyday eye health and available lens options.
Speak the right language. Talk to the CHILD about how good they look
and how well they will see in their eyeglasses; talk to the PARENTS about specific lens benefits for their child. Stress the worry-free convenience of photochromics to parents; they want a simple optical solution that protects their
kids’ eyes and makes them see well and comfortably under any and all light
conditions. Basically parents want eyeglasses for their children that their children will wear.
Create healthy habits early. Remember, you want to instill healthy eye habits
at a young age so children will be on their way to a lifetime of healthy sight.
COLLABORATE
Practitioner and patient education are crucial to the successful implementation of
Healthy Sight Counseling. While adult
patients are expected to partner with their
eyecare professionals and members of their
medical team to work to achieve Healthy
Sight, the situation becomes more complicated in children who are dependent on the
many adults in their lives who look out for
their well-being.
A team approach to children’s HSC is an
important concept for the eyecare professional who is attempting to integrate HSC
into the practice. As opposed to the situation in the adult, where HSC is typically a
one-on-one interaction between the patient and the practitioner, when dealing with
the child multiple patients are involved (i.e. the child, the parents, pediatricians, siblings, teachers, coaches, counselors, etc.).
Transitions research has revealed some startling gaps in education and
awareness when it comes to Healthy Sight. Kids are twice as likely to wear
sunscreen, as they are sunglasses. A recent survey (March 9 to 13, 2006 by
ICR, Media, Pa.) found that one third of parents were “very unlikely” to get
UVR blocking lenses for their children. This same survey found that parents
were twice as likely to choose UVR blocking lenses for themselves, than they
were for their children.
EDUCATE
Patient education can be part of every patient encounter, in the exam room,
the reception area, the dispensary and throughout the office. To aid you in
explaining the importance of UVR and glare protection for kids, Transitions
offers educational posters that can be displayed in the office.
Transitions also offer a series of brochures to let patients know “What to
Expect” from their eyes based on their age. The kids’ brochure provides
information for parents on what’s happening to their child’s eyes and lists
steps for preserving healthy sight.
CONCLUSION AND REVIEW
Every child benefits from Healthy Sight Counseling.
Use this review checklist with each patient:
1) Check for visual satisfaction with eyeglasses prescribed.
2) Be sure all eyeglass lens designs and lens enhancements that will serve to
improve the quantity and the quality of the child’s vision, protect the eyes and
promote long-term ocular health have been offered.
3) Assist with appropriate eyeglass frame selection.
4) Discuss the importance of screening and regular follow-up eye exams in the
child and adolescent.
5) Emphasize the need for ocular UVR and impact protection.
6) Let the parents know that Healthy Sight Counseling can work for them as
well as for their child.
In this way—through Healthy Sight Counseling—we can help to promote a lifetime of healthy sight for children. ■ |