PATIENT CARE

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How Should You Prescribe Blue Light Protection?

UV and blue light-protecting lenses have been positioned as a boutique item; the numbers suggest we change this approach

ALLAN BARKER, O.D., ROCKY MOUNT, N.C., AND GREG STOCKBRIDGE O.D., M.B.A., HOLLY SPRINGS, N.C.

In terms of marketing, blue light-filtering lenses are often positioned as a boutique item for the doctor to recommend to only selected patients, for example, those at a high risk for AMD.

However, now that research has demonstrated the harmful effects of blue-violet light between the wavelengths of 415nm and 455nm and ultra violet (UV) radiation, we take the position that all patients should be given the opportunity to benefit from these lenses.

Put another way, would you allow patients to risk conditions such as fatal malignant melanoma and/or AMD by not educating them and recommending that their eyewear contain adequate protection?

Let’s look at the facts.

The risk is everywhere

Historically, eyecare professionals were concerned about UV exposure only in those patients for whom direct sunlight was an occupational hazard (i.e., fishermen, construction workers, tennis professionals, etc.) Today, we know that both UV light and blue-violet light are ubiquitous in our environment — our patients who work in direct sunlight present only the tip of an iceberg when it comes to those needing protection.

Occupational hazards that require UV and blue light protection include computer monitors, smart phones, LED monitors, flat-screen televisions and more. In addition, we also now know that reflected light can be just as damaging as direct light, and that a hazy day may produce as much damage from UV and blue light as a bright, sunny day.

What about the science?

Scientific data continue to show the harmful nature of UV and blue light. A number of publications have summarized this research, including Optometric Management (see “Blue Light Basics,” October 2014 and “A Bolt From the Blue,” March 2014).

Researchers continue to build a case for the oxidative stress caused by blue light-induced chemicals, which leads to retinal pigment epithelium damage. Misfiring, loss of and damage to retinal pigment epithelium cells can contribute to AMD.

Going by the AMD numbers

Keeping the science in mind, let’s concentrate on AMD, blue light damage and our obligation to protect patients and the public at large. AMD is a leading cause of vision loss in people older than age 60.

Each year, 153,000 people in the United States develop wet AMD, in comparison with the 1.6 million new cases of dry AMD developed yearly. The number of patients with wet AMD is expected to rise to 1.87 million by 2020. Currently, the number of patients with some form of AMD is slightly more than 11 million and is expected to reach 22 million by 2050.

We also need to recognize the economic burden that AMD has placed on our country. According to an article published in December 2005 in the Transactions of the American Ophthalmological Society, the total loss to the U.S. GDP is $29.79 billion ($24.39 billion for dry AMD and $5.40 billion for wet AMD). Keep in mind this article was published almost 10 years ago — we now have an even higher prevalence of our population with AMD.

Since the article was published, researchers have developed anti-vascular endothelial growth factor (anti-VEGF) therapies for the treatment of wet AMD. Though effective in improving or stabilizing vision in a number of patients, they come with a price tag. Ranibizumab (Lucentis, Genentech), which is indicated for AMD, as well as diabetic macular edema and retinal vein occlusion, added more than $1 billion to healthcare expenses last year.

As patients remain with these therapies for the rest of their lives, often receiving anti-VEGF injections monthly, we can imagine how astronomical that treatment expense will become with 153,000 new patients a year developing wet AMD.

Adding up the risk factors

The risk factors of AMD include a family history of AMD, UV and blue light exposure. Adding to the causal factors are smoking, obesity and poor nutrition with a high-fat diet and/or one that is low in nutrients and antioxidants. Females are at a higher risk of AMD (probably because they live longer), as are Caucasians (primarily with blue eyes) and those who have high blood pressure.

If we look closer at AMD and family history in terms of US Census Bureau statistics, we can do some simple math. Let’s assume all 11 million Americans who have AMD are age 60 and older. Families of that age generation had 2.3 children on average. This would produce 25.3 million people with a family history of AMD. If we assume that these children are now in the 40-year-old age group, their households would average 1.9 children. Using the same math yields 48.07 million additional people with AMD family history. Adding 25.3 million to 48.07 million yields 73.37 million people with a family history of AMD from the original 11 million AMD cases. Obviously this number would be reduced if multiple husbands and wives had AMD or if some family members were deceased. However, the take home point is that hereditary history for AMD cases in an optometrist’s office is very significant.

Looking at other risk factors, we know that approximately one-third (78 million) of Americans are obese, 42 million smoke, and 76 million have hypertension. We can only imagine the substantial number of Americans who are exposed to blue light through LED devices, including computers, tablets, TVs and smartphones, but we can all agree it is the majority of the U.S. population.

With this information, you can see that a very large percentage of the population has risk factors for developing AMD.

Taking action

When blue light-protecting lenses were first introduced, the manufacturers anticipated that doctors would prescribe the lenses to patients who had AMD or early macular pigment changes.

However, based on the numbers we have presented, and taking into consideration all the AMD risk factors (including the aging population, the dramatic increased usage of LED devices and the rise in obesity and hypertension), it seems quite logical to offer the blue light-protecting lenses to all patients.

Consider the benefits these lenses will provide to our patients, not to mention the positive impact on the healthcare costs and the economy, if we can take part in reducing the amount or severity of AMD.

Would we ever consider not using sunscreen until someone develops skin cancer? The answer seems obvious, however, you can use the same analogy to ask, would we not prescribe blue light protection until someone has AMD?

Educate and prescribe

Not every patient will elect to purchase blue light protection, but at the very least, your practice must educate them about the product and its benefits. Do not let concerns regarding the amount of money patients spend on glasses influence your prescribing and recommendation practices. The bottom line is that patients need to know their eyecare provider has acted in the best interest of their ocular health.

In helping the patient protect their eyes, practices can also benefit financially. For example, if your practice profits an extra $30 from the sale of blue light-protecting lenses and you see 3,000 exams per year with 40% of your patients purchasing blue light protection, then this could add an additional $36,000 to your bottom line (1,200 patients x $30).

A model for health care

It is important that your practice revolves around a model that educates patients about their health and their risk factors for disease.

If your patients learn health information from another source, they might question whether you, as their eyecare professional, were not acting in their best interest.

Keeping in mind this model, the growing number of those at risk for AMD and an understanding of the dangers of UV and blue light, consider offering all patients the advantage of blue light filtering lenses, not just a selected few. OM

Dr. Barker is president of Eyecarecenter, serves as vice president of Optometry Cares and is on the Essilor ECP Advisory Panel. E-mail him at abarker@eyecarecenter.com.

Dr. Stockbridge graduated from New England College of Optometry and received his M.B.A. from Duke University and is VA residency-trained in hospital-based optometry. E-mail him at gstockbridge@eyecarecenter.com, or send comments to optometricmanagement@gmail.com.