GERIATRIC OPTOMETRY

1. Spectacle dispensing in
elderly
OPTOM ASKAR.PK

2. • A recent Internet statistical report stated that the fastest-growing population
segment using the Internet is seniors-defined as persons aged 55 or older.
• In fact, the growing involvement of seniors with the visually intense task of
computer use is expected to bring seniors back to their eyecare providers
more often and in larger numbers than ever.

3. • With statistics like these, now is a good time to re-evaluate how older
patients are processed in your practice or business.
• To help you do just that, let's take a look at how the visual needs of seniors
differ from those of the general population, the importance of addressing
their "wants" as well as their needs, and how catering to seniors can help a
practice or business prosper.

4. • Merely growing old doesn't assure that elders understand the subtle changes
that have taken place in their bodies (and eyes).
• Moreover, even when they do understand, they can be reluctant to accept
these changes. They often expect, and even demand, the same vision at 70
that they enjoyed when they were 20. Your job then becomes inform
informing them of these changes in their visual system...without being
offensive.

5. • This requires considerable empathy on the part of both doctor and
dispenser.
• One good way to do this is through use of the word "natural." Explain that
these changes in the patient's visual system are natural, simply a part of the
body's aging process and that you are prepared to provide answers to help
them cope with these changes.

6. • To do that, explain everything-during both the exam and the dispensing
process-and explain your recommendations in detail. Equally important,
don't take these people for granted.
• Though they may be reluctant to make it known, older people appreciate
personal attention. Give it to them and you'll see how influential they are in
steering others to those who impress them.

7. • The activities of an 85 year-old can be as different from the activities of a 65
year-old as those of a 40 year-old vary from the activities of a teenager.
• Recent statistics reveal that 35 percent of people over 65 are still working, so
it's important to inquire about occupational vision requirements at any age.
The same holds for activities.

8. Multiple Pair Possibilities
• As people age, their priorities change, and they are more likely to cater to
their personal needs and desires. This, plus more disposable income, creates a
customer who is more apt to spend extra for a second pair ... if you show
them it can make life more comfortable for them.
• In dealing with seniors, first- and second-pair recommendations should
cover: Frames, lenses, tints, computers, and supplemental glasses, as well as
home and office environments.

9. Lens decentration
• As people age, their skin loses elasticity and the fatty tissue under the skin
thins. This is particularly noticed on the nose where there is little cushioning
between skin and the bone or cartilage underneath.
• It helps to steer the patient toward frames that have a PD close to his or her
PD because excessive lens decentration only adds to eyewear weight.

10. Bridge and frame size.
• The way the bridge fits is important. With plastic frames, the bridge area
should be in contact with the nose over as broad an area as possible. And, of
course, be sure the frame provides sufficient room for a multifocal segment
or progressive channel.

11. Material considerations.
• Lightweight lens materials such as polycarbonate help, and lightweight
designs such as aspheric or atoric lenses help even more. Consider using
materials that can be surfaced to 1.0mm centers to produce the lightest
lenses.

12. Clip-on concerns.
• Many older people consider clip-ons to be the perfect answer for multiple
needs. While clip-ons offer convenience, they have one major disadvantage-
weight. Explain this is why you strongly recommend multiple pair rather than
clip-ons.

13. Tints and coatings.
• Glare is a common complaint of older people. Because of this, seniors
sometimes request a tint to help them when driving at night. A person with
20/20 vision during daylight hours drops to 20/32 at night.
• If you then add a #2 pink tint to their lenses, they now see only 20/40 at
night. The better answer, of course, is an anti-reflective coating. This boosts
light transmission for driving at night by 8 to 10 percent and provides the
best answer for elders. Eliminating annoying reflections at night is an added
plus.

14. Photochromic benefits
• Many older people see photochromic lenses as the most practical answer to
their visual needs. These can be a good choice, but several precautions
should accompany the dispensing of photochromics to seniors.
• The first regards wearing them while driving at night. Even in the lightened
state, photochromics do not transmit as much light as clear lenses, so
recommend that the lenses be AR-coated. They won't darken quite as much
in the sun, but they will transmit 8 to 10 percent more light at night. Also, be
sure to remind seniors that photochromics take time to lighten when coming
indoors.

15. • Sensitivity to light is a common problem. If your patient complains of such
sensitivity or suffers from age-related conditions such as macular
degeneration, cataracts, and glaucoma, Corning's CPF series of glass
photochromic lenses is a good choice. Be sure to emphasize that they are not
for driving at night.

16. Computer glasses.
• James Sheedy, O.D., Ph.D, is president of CVS Doctors and Doctor Ergo,
two Websites dealing with computer vision syndrome (CVS). He reports that
14 to 17 percent of all refractions are now prompted by CVS-related
complaints.

17. • Since virtually all seniors are presbyopic, their computer problems are usually
more complex than those of younger users. There is a variety of ways to
help presbyopes working at computers. In this regard, seniors don't differ
much from younger presbyopes.

18. Multiple pair.
• You have one major goal to accomplish with seniors, and that is to firmly
implant the idea that answering visual needs as people age requires more
than one pair of eyewear. One pair of glasses simply can't provide everything
they need for "natural" vision.
• Sheedy recommends advising seniors of their options regarding additional
eyewear and explaining the impact that each pair will have on their daily
visual activities. If they feel they can't afford what is required, they will let
you know; but at least they understand exactly what will be best serve their
visual needs.

19. Progressive Lenses
• If they aren't wearing PALs, don't be intimidated about suggesting them. In
describing PALs, stress their visual benefits over the cosmetic advantages.
• Even with experienced PAL wearers, it's important to keep in mind that
seniors have stronger add powers, producing smaller reading areas. To
explain this, prepare plot illustrations that show how the size of the add area
decreases with stronger adds. Explain that experienced progressive wearers
often keep a second pair of special reading glasses for many uses.

20. Special reading glasses.
• These are invaluable for seniors in a variety of settings: For prolonged near
work (hobbies or work-related); for prolonged reading; for working or
playing at computers.
• The best lenses to recommend for special reading glasses will be variable
focus lenses.

21. Other considerations
• Most home lighting is inadequate to the visual needs of older persons. This
need is best explained by the doctor during the refraction. It doesn't take
much time-just a reminder for the patient to carefully evaluate the lighting in
his or her home and probably replace a few lamps with stronger bulbs. It's
particularly important in areas of the home where the activities are visually
intense such as the living room or hobby area.

22. • Some seniors suffer from Parkinson's or arthritis, which can make reading
difficult. Suggest where they can find reading stands and other aids.
• Whatever their needs, seniors are increasingly sensitive (thanks partly to
managed care and HMOs) to being considered a minute part of a vast herd
of patients receiving inadequate attention to their needs. When they find an
eyecare professional who demonstrates care and concern for those needs,
they become loyal patients. And they make sure their families learn about
that eyecare provider.

23. • Plus, they often have more disposable income than in their youth, so when
you relate a purchase to their quality of life, they're usually interested.
• Practitioners who take time to develop a dedicated routine for addressing the
needs and wants of seniors will inevitably dispense more multiple eyewear to
older patients. This may well be the best investment you can make for the
future.

24. THANK YOU