Eye Opener

Pia Hoenig, OD

Chief of the
Binocular Vision Clinic at the
University of California School
of Optometry
at Berkeley

By Andrew Karp

Throughout her extensive career as an optometrist and vision care researcher, Pia Hoenig, OD, has treated patients with problems ranging from Computer Vision Syndrome to head and cerebral vascular injuries. In her private practice in Santa Rosa, Calif. and as chief of the Binocular Vision and Visual Skills Clinic and assistant clinical professor, School of Optometry, University of California, Berkeley, Dr. Hoenig devotes much of her time to working with children.

“I’ve always had a burning interest in binocular vision,” she says. “When I was little girl I had a strabismus. I encountered all the interesting scopes and machines used to diagnose it, and was fascinated by the details. Later, in my professional life, I worked in a strabismus clinic in Europe.”

In private practice, Dr. Hoenig offers full-scope pediatric care. She treats toddlers and children who have multiple challenges and learning disabilities. “I enjoy working with children because you can usually have an impact and be successful with treatment,” says Dr. Hoenig. “As the patient ages, you’re not dealing with a very plastic system any more, so it becomes harder to get results. Also, working with a pediatric population, it’s hard to have a gloomy day because the kids create a happy atmosphere that adds an upbeat aspect to clinical life.”

What types of spectacle lens designs, materials and lens treatments can help children combat Computer Vision Syndrome?
If the patient’s amplitude is low, or their facility is below the norm, consider a near-prescription lens. An adult might be able to use a single-vision lens that will make things nice and clear up close, but will be blurry farther away. That might be okay if they’re working in a cubicle. Children are not as tolerant. They tend to look around more, so you need to consider a near-variable focus lens with a powerful intermediate zone. When you prescribe a near-variable, you need to keep in mind the total power that you have for near as well as the drop, which is the total amount the lens is going to change power once the eye has traveled from the bottom to the top of the lens.

Is polycarbonate a must for children who wear near-variable lenses?
If the child is going to be in front of a computer in a classroom, you’re not dealing with shatterproof issues, so you don’t necessarily have to worry about polycarbonate. But if you’re going to be careful, a child should be protected by polycarbonate. However, near-variable focus lenses are only available in polycarbonate from one company.

In addition, I use lenses made from Trivex [from PPG Industries]. The lenses are as shatterproof as polycarbonate, but also have an aspheric surface. That [high] abbe value allows for less chromatic abberation, so vision will be crystal clear.

What types of progressive lenses do you prescribe for children?
I’ve had some success with the new short-corridor progressives. If the child is using a laptop not a desktop computer, you can sometimes get away with a short-corridor lens. Some of them come in polycarbonate. But it’s not my first choice.

Do kids benefit from AR lenses?
AR is not something I push. It doesn’t help children too much, because the AR coating is going to get rid of the glare an observer sees on your lens, but not necessarily the glare the wearer sees. My best recommendation is to eliminate the glare source. Also, AR smudges, and kids and smudges don’t go together. But I like them to have a good scratch coating.

When are photochromic lenses appropriate for children?
Young kids move very fast. Here in California, they’re always running back and forth from inside to outside. So I tend to not prescribe photochromics to children because the changing speed of the lens may not keep up with them. On a hot summer day, it would be like wearing sunglasses indoors for a couple of minutes, until the lenses change. My best recommendation for children on a sunny day is to put their sunglasses on.