visioncare

Make the Right Sunwear Recommendations

Understand the benefits of tinted and polarized lenses to better educate patients and increase sales.

DAVID KADING, O.D., F.A.A.O., SEATTLE, WASH.

Optometrists struggle to find the time during the eye exam to make optical recommendations. The pull to perform more exams can lead to reduced chair time and significantly reduced quality of care.

Ensuring that we make the right recommendations for each patient is critical. Not only does it lead to greater optical sales, but each optical recommendation has the potential to change a habit for a patient and improve their visual well-being and ocular health.

Throughout this article, I discuss the importance of sun prescriptions for patients and how to educate them in order to generate more revenue for our practices.

UV effects

Educate patients that sun damage, or broad-band UV (UV-A and UV-B) radiation damage, can have devastating effects on their eyesight. Pterygium development, dry eyes, cataracts, postoperative aberrations and drug-induced photosensitivity and mydriasis are all common side effects.

Many of our patients begin thinking of sunwear when the weather starts to improve and the sun comes out or while they are skiing in the bright winter snow. As such, many eyecare practitioners pattern their recommendations off seasonal changes as well. However, it is critical for us to ensure that our prescriptions will protect our patients all year long.

Tint

Most sunwear corrections have a tint to them. Many patients make assumptions that the darker the tint, the better protection they achieve from the sun. Although tinted lenses have their benefits in terms of overall comfort, they can have some negative side effects as well. As tint increases, so does pupil dilation.

Additionally, patients develop a sense of protection from sun wear, as they assume their sunglasses provide the protection that they need and desire.

Polarization

When a patient wants to achieve the best vision possible, it is highly important they have sunwear with polarization. By utilizing polarized filters within the lens technology, light transmissions from certain angles are blocked, which reduces unwanted glare. Due to glare off of water, boaters and fisherman have long since appreciated the benefits that polarized lenses provide. Now, this technology has become more readily available and is recognized by people of all hobbies and occupations.

UV blocking

From a patient’s perspective, they understand that eyewear needs to have UV-blocking protection, but they don’t have the proper guidance for how much protection they receive. So long as patients have the proper UV protection, any amount of tint is appropriate as long as the patient has the desirable level of comfort and vision.

UV-blocking standards and E-SPF

Traditional standards for sunglasses have been based off the American National Standards Institute (ANSI) Z80.3 standards. Class 1 lenses must absorb 90% of UVA (316nm to 380 nm) and 99% of UVB (280nm to 315 nm). Class 2 lenses must block 70% of UVA and 95% of UVB. However, this standard does not recognize the true amount or percentage of UV blocking that lenses provide patients. Research has revealed that anti-reflective coatings reflect UV radiation.¹

Well-recognized by sun lovers, the Sun Protection Factor (SPF) label on sunscreen indicates the effectiveness of protective skin preparation. But sunglasses have lacked a similar rating until recently. Now, Eye Sun Protection Factor (E-SPF) is gaining a foothold for a method to indicate the effectiveness of sunwear vs. no sunwear. This takes into account both the direct UV radiation as well as reflected radiation that can penetrate the ocular surface.

E-SPF is an international index that certifies the overall UV protection that lenses provide. This can be measured for clear, non-sun lenses or tinted sunwear. Like SPF for sunscreen, E-SPF gives a multiplier of how much protection a lens provides compared with no lens at all.

Making recommendations

When it comes to UV recommendations, I like to work with the patients early in the exam. When completing the visual assessment or slit lamp evaluation, I discuss the findings with patients. With any symptoms or signs of pinguecula, pterygiums or cataracts, I ask what the patient is doing for sun protection. I’ll explain that I see signs of some sun damage and want to make sure that they are doing the best things for their eyes.

Additionally, when a patient has had LASIK surgery or a corneal thinning disorder (such as keratoconus), I emphasize to these patients that the cornea is one of the major sun-blocking structures of the eyes, and, in their case, their cornea is thinned, which reduces their built-in UV filter. For these patients, I’ll let them know that sun protection is critical.

We need to be recommending that our patients wear as high of E-SPF sunwear as possible. If the sunwear that you recommend does not have an E-SPF rating, ensure that it is close to 100% UVA and UVB blocking, but also that is has a good wrap that will decrease peripheral light from reflecting off the back surface of the lens and onto the ocular surface.

In our offices, we discuss sunwear with nearly every patient — particularly in the Pacific Northwest, as our patients often joke that they do not need sunglasses because there is no sun. This presents an excellent opportunity to educate patients about the damaging effects of UV light upon their eyes and how being protected has a cumulative effect. We recommend that they wear some form of sun protection if they are going to be outdoors for more than 20 minutes at a time, unless it is raining or dark.

For other patients who have work outside or have hobbies that require significant outdoor time, our recommendations are much stronger. We educate these patients about sun transmission and tinting of their glasses. We find out the types of activities they do and the lighting conditions. We then have the patient work with the optician to find the most appropriate tint to maximize their vision.

Perhaps of even greater importance is the discussion of polarization. We have to have a reason to not prescribe polarization to patients. For nearly every patient, I give them a prescription for polarization, particularly if they work outside or participate in hobbies or occupations that require maximized vision, because the clarity of vision is so superb. Two possible exceptions would be for a pilot who benefits from glare off runways and other planes for altitude and localization maneuvers and golfers who sometimes rely on glare to better read greens (though some golfers swear by having polarization).

Usually sunglass prescriptions are part of the two to three glasses treatment package that we prescribe. In addition to everyday glasses, computer or hobby glasses, sunglasses play a critical role in preserving patients’ overall visual well-being and ocular health.

The rewards

Patients come to our clinics for the best recommendation for them. So eyecare practitioners have an obligation to recommend products and services that are in the best interest of every single patient. When we accomplish this, it creates patient loyalty, and it generates increased revenue for the practice. OM

1. Citek K. Anti-reflective coatings reflect ultraviolet radiation. Optometry. 2008 Mar;79(3):143-8.

Dr. Kading owns two practices in Seattle, Wash. He writes, consults and lectures internationally on practice management, communications methods, ocular surface disease and specialty contact lenses. E-mail him at drdave@specialtyeye.com, or send comments to optometricmanagement@gmail.com.