Sun, Sport Safety+Vision A Continuing Education Supplement to VCPN April 2017
Protective Lenses and Safety Frames
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EDITOR’S NOTE
Contents
Protective Eyewear: Sun, Sport and Safety
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TODAY, sun, sport and safety have grown to be-
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come a broad niche among eyewear categories, each
Sun, Sport and Safety Eyewear
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Sports Vision
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Packaged for Protection
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Product Showcase
Image courtesy of Wiley X
its own sub-group among protective eyewear. Starting with sunglasses that protected military pilots and beachgoers early in the last century, sunwear has grown to become both fashionable as well as protective. In the sport eyewear category, various technologies in both frames and lenses have been developed to accommodate both professional athletes as well as weekend warriors. Lens add-ons and tints address the challenges of specific sports, while frame materials and designs improve fit and enhance performance. The safety eyewear category has grown to the point of being divided in three— standard, industrial and ballistic—each required to meet their own criteria to achieve the necessary certification. In this special supplement to VCPN, we bring you a comprehensive look at the overall protective eyewear category with an ABO-certified continuing education course on Sun, Sport and Safety Eyewear. In addition, the optometrist for a group of professional sports teams shares his techniques for going from “spring training” to the “World Series” of providing eyecare to athletes of all levels. Also, learn how to prescribe frames designed for safety combined with impact-resistant lenses to ensure that your patients who require protective eyewear get it. Sun, Sport and Safety, three individual eyewear categories that protect the wearer, are all detailed here in this special supplement to VCPN. A consistent challenge and opportunity for today’s eyecare professional is the promotion of safety eyewear to the patient; this supplement will show you how to achieve it. John Sailer is vice president, editorial, First Vision Media Group.
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ABO LEVEL I
SUN, SPORT AND SAFETY EYEWEAR By Joy L. Gibb, ABOC
APPROVAL: ABO Approved for 1 Hour COURSE: STFVM001-1 Technical Level 1 ISSUE DATE: April 1, 2017 EXPIRATION DATE: March 3, 2018 COURSE DESCRIPTION: In addition to improving patients’ vision, eyecare professionals prescribe eyewear to protect ocular health as well. UV-protective sunwear, lenses that filter blue light and safety eyewear can protect patients’ eyes from the sun, damaging portions of the spectrum emitted by digital device screens, and risky activities such as participating in sports, working in certain industrial environments and even some home-based activities. This course will provide the background necessary to learn what these sources of potential harm are and how to protect against them using various types of specialty eyewear.
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yecare professionals everywhere agree that offering the best product solutions possible to our patients is part of our professional responsibility and a moral obligation. Statistics and studies can show us that the eyeglasses we recommend can not only improve patients’ vision and lifestyle, but they can also protect their ocular health on both a long- and short-term basis. Unfortunately there are times in our practices when we face obstacles in recommending, or even discussing, the importance and value of sun, sport and safety eyewear. A better understanding of products, information to educate the patient and ways to market these products can help every team member in your office gain confidence in their commitment to present appropriate solutions. START WITH THE SPECTRUM
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An understanding of the electromagnetic light spectrum is helpful when educating yourself and your patients about the need for sunglasses. The spectrum is made of varying wavelengths of light and color that are measured in nanometers and consist of the colors red, orange, yellow, green, blue, indigo and violet. The longest wavelengths are red and measure 620nm to 750nm, and the shortest wavelengths
are those in the blue end of the spectrum and run 495nm to380nm. Both the ultra-violet (UV) rays at one end of the spectrum and the blue light portions at the other end of the spectrum have their own unique set of dangers and problems that can be addressed to improve visual acuity and overall eye health. There are three different types of UV radiation―UVA, UVB and UVC, which range in length from 400nm to 100nm. UVC rays are the shortest and have the most energy, potentially causing the most harm, but they are blocked by the ozone layer of the atmosphere. UVB and UVA rays harm skin cells and can do irreversible damage from both short- and longterm exposure. We’ve heard that wrinkles and the premature aging of the skin can be caused by UV exposure, but what are some of the specific effects that UV exposure can have on the eyes? Cumulative UV exposure can cause the normally clear lens of the eye to become clouded, causing difficulty with vision, making it a bit like looking through a fogged-up window. Other conditions associated with cumulative UV exposure can include various forms of skin cancer on and around the eyelids and on the thinner tissue around the eyes, as well as growths
on the eye itself in the form of pingueculae and pterygiums. Both are growths of pink, fleshy tissue on the conjunctiva with pingueculae staying in one area, while pterygiums tend to spread and grow toward the pupil area, which could eventually interfere with vision. There are also conditions that can occur from strong amounts of UV exposure in a short period of time. Strong doses can cause a sunburn to the front of the eye, or photokeratitis. This condition can range from being mildly irritating to being very painful. When it’s severe enough it can even cause temporary vision loss. Some patients may find themselves in activities where they are not only exposed to typical UV radiation from the sun, but the radiation can also be intensified when it reflects off of water (up to 100% UV reflection) or snow (up to 85% UV reflection). These are the conditions in which you will find more severe cases of photokeratitis. In addition to UV radiation, those who spend time in the sun should also be aware of high-energy visible radiation, also known as HEV and blue light. High energy visible blue light is comprised of the wavelengths in the 400nm range, including the blue, indigo and violet portions of the spectrum. Research has found
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that these wavelengths in particular can do irreversible damage to the retina, increasing the chances of macular degeneration, which can rob patients of their central vision and leaving them with only peripheral vision. Some patients may have the misconception that the darker a sunglass lens the more UV protection they are receiving. This is not only untrue, but wearing a dark lens without UV protection could actually do more harm. Behind a dark tinted lens the pupil will naturally dilate, allowing more light and UV radiation through the pupil to do damage. UV protection is a lens treatment feature that is independent of the color. While UV protection is not related to the color of the lenses, most HEV radiation can be blocked by certain lens colors, including bronze, copper or reddish-brown. The Vision Council’s Spare Your Sight: Using Shades for Protection and Style―2016 UV Protection Report showcases the passive relationship that Americans have with their UV protective eyewear. In a recent VisionWatch survey, more than one-third of adults have experienced symptoms due to prolonged UV exposure, such as eye irritation (16%), trouble seeing (14%) and red or swollen eyes (7%). The study also showed that consumer’s priorities in selecting shades appear to be skewed. Americans place comfort (65%) and affordability (54%) before UV protection (44%). One final statistic to consider from the study is that 75% of Americans are concerned about UV eye exposure, but only 31% wear sunglasses every time they go outside.
is making sure we discuss why sunwear is important with every patient during as many touch points as we can when they are in our office. It can be as simple as asking the patient to bring their glasses and sunglasses to their appointment when you make a reminder call. Ask to neutralize all their glasses, including sunglasses, during the pre-exam, and ask if they wear sunglasses during their outdoor activities. During the exam, doctors have an opportunity to explain the benefits of UV and HEV protection and the potential vision and health risks that could potentially occur as a result of not wearing sunglasses, not only on bright sunny days but also on overcast days when UV radiation is still present. Some doctors choose to write a separate prescription specifically for sunglasses as a way to reinforce the importance of the purchase, and some practices choose to offer a discount when sunglasses are purchased in addition to a primary ophthalmic pair of glasses during a specified time period. When it comes time to select sunwear, eyecare professionals should ask questions that will help them recommend appropriate product solutions. These questions can include asking what types of activities they participate in when outdoors and if they or any family members have a history of eye-related health problems such as macular degeneration. The product needs of a
gardener will be different than the product needs of a hunter or than that of a spectator who watches her grandchildren play soccer on Saturday mornings. The answers to these types of questions will help eyecare professionals select proper frame materials and designs, lens materials and designs, and lens color. VISIBLE LIGHT TRANSMISSION
When working with sun lenses you may see and hear the term visible light transmission (VLT). VLT is measured as a percentage and is affected by the color and thickness of a lens, the material they are made of and any other coatings they may have. Many manufacturers of non-prescriptive sunwear share the VLT of their lenses in their product information. A general rule of thumb is 0-19% VLT is ideal for bright, sunny conditions, and 2040% VLT indicates that the lens is good for all-purpose use. If you are recommending a lens for use in overcast and low-light conditions you may wish to choose something with a 40+% VLT and a lens with 80-90+% VLT, which typically indicates a virtually clear lens for very dim and night conditions. Some patients experience a great deal of glare during their daily activities. Light waves are emitted and travel in a wide variety of directions. When those light waves are reflected off surfaces, such as water, backs of cars, or highly angled and polished dashboards, they become more concentrated and create what is often referred to as blinding glare. Polarized lenses contain a filter that aligns dichroic crystals (think of a metal chain) in such a way that it will not allow light traveling in a certain direction to penetrate through the lens and create glare.
EXPLAIN SUNWEAR’S IMPORTANCE COURTESY OF INSPECS
So how can eyecare professionals use this information to better help their patients understand the importance of sunwear and how to choose the best frame and lens designs? Perhaps the first step we can take
LENS TREATMENTS
Polarized lenses are an excellent choice for patients who spend time on the water or snow and also for those who drive. It 5
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Mirrors or flash mirrors can also be an option for patients who struggle with glare and light sensitivity that can be more pronounced due to medical conditions or medications. These treatments reduce glare by reflecting much of the light that hits the lens surface. Mirrored treatments can make objects appear darker than they are, so lighter tints are often used to compensate for this. CHOOSING A LENS COLOR
COURTESY OF SPY
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is always wise to discuss with the patient the possibility that they may see a checkerboard pattern on their back windshields or on windshields that have a tint while wearing polarized lenses. Caution should also be exercised when working with those who drive motorcycles or use helmets with polycarbonate face shields because the material’s chromatic aberrations can be accentuated and cause blind spots or exaggerated checkerboard patterns. You will also want to remind patients that some of their LCD readouts and digital devices may be not only difficult to read but disappear altogether when horizontal light is eliminated by the polarized filter. Not only will polarized lenses reduce glare, but they will also improve contrast and enhance color, making it a desirable and comfortable lens to wear. Another lens treatment option in sunwear is a photochromic lens. Photochromic lenses automatically adjust to changing light intensities and conditions with the lenses getting darker in full sunlight and lighter in conditions when not as much light is present. These types of lenses are excellent for patients who may spend
time outside in the earlier morning hours as the sun rises and intensifies as the day progresses. Another practical use would be for those who hike or mountain bike and may find themselves moving from areas that have heavy foliage or rock overhangs into other areas where nothing obscures the sun. This dark to darker lens is an excellent choice for the busy and active patient who wants the ability to change the VLT without having to change glasses. Another lens treatment that can enhance not only the performance of the lens but also vision is a backside anti-reflective (AR) treatment. When a lens is darkened it can act like a mirror catching the reflection of the wearer’s eye or moving objects behind the wearer such as cars or people. Sometimes these backside reflections can be more than just an annoyance but a safety hazard. If the patient becomes too aware of the reflections going on in the back of the lens, they could miss activities going on in front of them. A backside AR treatment should always be offered when making prescription sunwear to enhance the function and features of the prescription and lens.
Because lens color is a very personal choice and preference, it is always recommended to have tint samples in your office for the patient to look through and even walk outside with the tint sample for a test drive. A few things to consider when making lens color recommendations are what activities and conditions the wearer will be using them in. Dark tints and hues are ideal for everyday use and most outdoor activities, and they are intended primarily to reduce eyestrain in moderate to bright conditions. The dark colors typically include brown, gray and green. Gray and green lenses are less likely to distort colors, while brown lenses may cause minor color distortion such as intensifying green tones and making changing autumn leaves look more vibrant. Lighter tints and hues are better choices for sun lenses being used in moderate to low level light conditions. Colors such as amber, rose and vermillion are often preferred colors for those who participate in snow sports such as skiing or snowmobiling because they can enhance the contrast in tricky, flat-light conditions. Yellow lenses are an excellent choice for hunters or shooters looking to have their surroundings appear brighter and who want sharpened contrast and improved visibility of objects. There are many sports and activities that can be enhanced based on the lens color of the wearer. Again, wearer’s will vary in their color preferences based on
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their personal opinions, but all eyecare professionals should be able to acquire from their labs or sun lens manufacturers some specific sport and lifestyle color recommendations to use as a starting point to aid in the tint color conversation with their patients. LENS AND FRAME MATERIALS
Lens materials are a very important component in sunwear selection. Impact resistance should always be a priority when recommending and creating sun lenses. Materials such as polycarbonate, Trivex and NXT meet standards of impact resistance that will protect the patient’s vision in case of an unfortunate accident. Even if patients say they will only be using their sunwear for driving, the potential damage that could occur should an accident happen and an airbag deploys toward the face should be considered. The aforementioned lens materials also include UV protection as part of their features, which should be presented as an important benefit during the sunwear sale. Frame design and materials should also be considered in the sunwear selection process. For patients who may be exposed to elements such as wind or debris, consider recommending a frame with a slight wrap that sits closer to the face. There are also sunglass frames that feature soft foam padding that hug snuggly yet comfortably around the orbital area to block any wind or debris from entering the wearer’s eye. Frames without nosepads will sit more closely to the brow line, allowing less light and UV radiation from entering the top of the frame, while a frame with nosepads will tend to sit further out, allowing more light and UV radiation to penetrate the eye and surrounding tissue. There are several frame materials available, and some of the most common include metal, nylon and acetate. Metal frames can come in stainless steel and titanium to name a few. Titanium is the
lightest of the metals, is hypoallergenic and holds up well to perspiration. Stainless steel is also lightweight with hypoallergenic qualities. Keep in mind that a metal frame can be less obtrusive to the wearer’s field of vision due to its thinner profile, however, it can also bend more easily and may not be a suitable choice for high-impact activities. Nylon is another common sunglass frame material and features characteristics of being very lightweight as well as more impact resistant than other materials. Unless a nylon frame has an internal, adjustable wire core, they can be very difficult to adjust and typically require very high heat to make the material pliable. Acetate is one of the most commonly used frame materials in the industry. While there are numerous color possibilities in acetate, they are less flexible and are not intended for high activity lifestyles. EYE INJURIES ARE COMMON
According to the Tri-Service Vision Conservation and Readiness Program, there are more than 600,000 eye injuries related to sports each year, with approximately one-third of these injuries occurring in children. Only 15% of children reported wearing eye protection “always” or “most of the time” when participating in sports, hobbies or other activities that could cause eye injuries, yet the majority of eye injuries that occur in school-aged children are sports related. According to the U.S. Consumer Products Safety Commission, an emergency room in the U.S. treats a sports-related eye injury every 13 minutes, and it’s also estimated that sports-related eye injuries in the U.S. account for more than 100,000 physician visits per year at a cost of more than $175 million. Eye injuries can range from corneal abrasions and bruising of the lids to internal eye injuries such as internal bleeding or retinal detachments. Of the 1.6 to 2.4 million Americans who sustain
eye injuries each year, an estimated 40,000 will be legally blinded in the injured eye. It is interesting to note that many state and sports organizations will have requirements for shin guards or mouth guards in place but not for sports protective eyewear. Parents will make sure to equip their children with elbow and knee pads or spend large sums of money outfitting their kids with the most popular shoes and arm sleeves to mimic their favorite all-stars but give little to no thought about protecting their children’s vision. PREVENTING EYE INJURIES
So how can eyecare professionals help patients who participate in sports have a better understanding of the importance of sports protective eyewear? The first step might just be getting them to think about their lifestyles and to raise awareness for the need of protecting their vision during activities. Do you have literature or signage in the waiting room that promotes sports eyewear safety? During the pre-exam, ask questions about what sports and activities the patient participates in, and then follow up the answers with a very simple question such as “Do you wear eye protection?” or “How are you protecting your eyes while you play?” As part of the examination, doctors should ask patients about their physical activity and explain what injuries could possibly occur from a lack of wearing sports eyewear. Explain that any activity that uses a ball or racket, involves rough contact with other players or requires moving at high speed should be using some form of eye protection. The inventory in the dispensary should also feature sport eyewear so patients know they have the option of buying them from you. They may not see it as a necessary purchase during their first visit, so plant the seed that they can purchase it in a few months or when their sports season comes around. Write up the order, take all mea7
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surements and then tell the patient you will contact them in a pre-determined amount of time to verify placing the order. You may also want to implement some type of multiple pair discount or offer payment options to make the total amount more manageable. There is also a need to educate the patient about the difference between everyday fashion eyewear and sport-specific protective eyewear. Help them understand that the lens in regular eyeglasses could easily pop out and cut or puncture the eye, that fashion eyewear frames are not designed to withstand the rigors of sports activities, and that a broken piece of eyewear could also injure the eye and ocular area of the face. All sports protective eyewear should meet the impact standards of the American Standards for Testing Materials (ASTM) that test the strength of the frame and the strength and clarity of the lenses. There are very specific tests used for specific sports to ensure that the frame and lenses will withstand the rigors of specific sports-related activities and keep wearers safe and their vision uncompromised. One such test is the High Velocity Impact Resistance Test in which the eyewear must withstand projectiles sized from 40mm to 65.1mm fired at a rate of 90 mph. Making sure the frame fits well is another aspect that should be considered when dispensing sports safety eyewear. Many frames come with a soft foam padding on the inside of the frame to help not only comfort but to also keep stray fingers or debris from entering the orbital area. This padding also helps absorb the impact of stray racquets or balls. Many sports eyewear will also have a strap to help secure the eyewear and make sure it doesn’t move or come off during activities. You will also want to ask your patient if they are planning to wear a helmet during their activities and have them bring the helmet into the dispensary and try on the eye-
wear with their equipment. For example, if your patient is a catcher on the baseball team you may want to encourage them to not only try the sports eyewear on with their mask but also mimic their reactions to taking their mask off while trying to spot a pop fly ball at home plate to ensure the eyewear is securely fitted and won’t go flying off with the mask. Many of today’s sports eyewear frames are made from a high-impact nylon material that not only provides durability but also lightweight comfort. Nylon also comes in several color options so wearers can match their eyewear to their uniform or the colors of their favorite team. Lenses should be made from polycarbonate materials because it provides the highest level of impact protection. You can also add a treatment to the lenses, such as photochromics, to enhance performance. A soccer goalie who is defending the goal while facing a setting sun will find added benefit in the ability to see well without the distractions of a blinding sun and added glare. Just as education is the key for sports eyewear, education is also the key to helping patients understand the importance of protecting their vision around the house or on the job. According to Prevent Blindness, each year more than 700,000 Americans injure their eyes at work and another 125,000 injure their eyes at home. Most protective eyewear for use in the home falls under American National Standards Institute (ANSI) Z87.1 safety standards. Eye protection needed at work is determined by the Occupational Safety and Health Administration (OSHA). When patients ask for safety glasses for their job make sure to verify if they are in need of dress or industrial safety eyewear. If unsure, have the patient verify with the company’s human resources department or the person who is responsible for overseeing OSHA compliance.
HOME-BASED PROTECTION
To help your patients determine if their activities within the home merit eye protection, ask them to consider if it will involve the use of hazardous chemicals or other substances that could damage the eye upon contact; flying debris or other small particles that could affect both the participant and bystanders; and projectiles or objects that could fly into the eyes unexpectedly. Some of the most common activities in and around the house pose a risk to eye safety, including cleaning with common household cleaners that include bleach and other hazardous chemicals, cooking foods that can splatter hot oil and grease, mowing the lawn, using a power trimmer or edger, clipping hedges and bushes, using power or hand tools, tasks that produce fragments, dust particles or other eye irritants, changing automotive fluids, and securing equipment or loads with bungee cords. It has been estimated that wearing protective eyewear when participating in these types of activities in and around the home can reduce a person’s risk for eye injury by 90%. That is why the American Academy of Ophthalmology recommends that consumers keep at least one pair of protective eyewear on hand in the home and that they are worn during projects and activities that may present risk of injury. Eyecare professionals always want what is best for their patients, including protecting their vision. Many irreversible eye conditions can be avoided by simply wearing the appropriate sun, sport and safety eyewear. It’s understandable that it takes time to educate and discuss with patients their risks and how to avoid them, but spending an extra few seconds asking simple and direct questions can mean avoiding some vision loss consequences. When the professional is motivated to do what is in the best interest of the patient everyone benefits. How many patients will you talk with about sun, sport and safety eyewear this week?
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FREE CE SPORT+VISION
CE SELF-ASSESSMENT TEST Please fill out the answer sheet. Respondents with a passing score will receive one (1) hour of CE credit. Those seeking ABO credit need a passing score of 80 and must answer all 20 questions. The test is valid through March 3, 2022. 1) Which wavelengths of light are the longest? a. green b. blue c. yellow d. red 2) How many different types of UV radiation are there? a. one b. two c. three d. four 3) Which UV rays are the shortest and have the most energy? a. UVD b. UVC c. UVB d. UVA 4) What are growths of pink, fleshy tissue on the conjunctiva that spread and grow toward the pupil? a. cataracts b. pterygiums c. pingueculae d. chalazions 5)
What percent of UV does snow reflect? a. up to 35% b. up to 63% c. up to 85% d. up to 100%
6) Which condition can leave a patient without central vision? a. cataracts b. pterygiums c. diabetic retinopathy d. macular degeneration 7) Bronze, copper or reddish-brown lenses are best at blocking what? a. HEV radiation b. UV radiation c. long wavelengths of light d. blinding glare
8) A VisionWatch survey found that this is most important to Americans when buying sunglasses: a. affordability b. UV protection c. comfort d. brand 9) What percentage of Americans wear sunglasses every time they go outside? a. 20% b. 31% c. 43% d. 75% 10) What percentage of visible light transmission is recommended for bright sunny conditions? a. 0-19% b. 20-40% c. 40-65% d. 80+%
14) Of the more than 600,000 eye injuries related to sports each year, how many occur in children? a. one-eighth b. one-quarter c. one-third d. one-half 15) All sports protective eyewear should meet the impact standards of what? a. American Standards for Testing Materials b. Colts Laboratories c. Sports Safety Commission d. American Society for Total Manufacturing 16) The High Velocity Impact Resistance Test must withstand a projectile fired at what rate? a. 50 mph b. 70 mph c. 90 mph d. 110 mph
11) What is aligned in a polarized filter to block specific light waves? a. dichroic crystals b. tint c. HEV d. pupillary distance
17) What feature on a frame will help with comfort and keeping debris from entering the orbital area? a. nosepads b. strap c. a 6 base curve d. soft foam padding
12) Because mirrored treatments can make objects appear darker than they are, what can be done to compensate for it? a. use polarized lenses b. use photochromic lenses c. use a lighter tint d. induce prism
18) Which is the best frame material for sports eyewear frames? a. titanium b. stainless steel c. acetate d. high-impact nylon
13) What frame design will allow less light and UV radiation from entering the top of the frame? a. frames with large lenses b. frames without nosepads c. extreme wrap d. long temples
Answer Sheet S TFVM001-1 Sun, Sport and Safety Eyewear, Technical, Level 1
19) According to Prevent Blindness how many Americans injure their eyes at home? a. 125,000 b. 300,000 c. 561,000 d. 700,000 20) Which organization determines the need of eye protection at work? a. ANSI b. ASTM c. OSHA d. DOWS
Fill out and mail this portion to: SPORT + VISION CE c/o First Vision Media Group Inc., 25 East Spring Valley Avenue, Suite 290, Maywood, NJ 07607, or fax to: 201-587-9464. Be sure to fill out form completely. This CE article is also available online with immediate grading at TotallyOptical.com/education.
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SPORTS
Sports Vision Take your practice from spring training to the ‘World Series’ by following these examples set by an eyecare professional who has achieved success treating local professional teams. By Keith Smithson, OD
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he term sports vision has been used for several decades, but what does it really mean? Does it mean that the sports vision practitioner participates in pre-season vision evaluation for sports teams? Does it mean that the practitioner fits glasses and contact lenses a bit more precisely for sport? Does it imply that vision therapy is conducted in the practitioner’s office? Does it mean that the practitioner manages the visual effects of sport-related concussions? Does it mean that the doctor is on site at sporting events, wearing the affiliated team polo, treating emergencies and overall just looking cool? To me, it is all of the above. I truly believe that any motivated individuals can take their own practice from spring training to the ‘World Series’ by treating teams in any sport.
strong foundation for sports vision. This is what I consider the “spring training” phase of developing a sports vision practice.
SPRING TRAINING PHASE
‘THE SEASON’ BEGINS
The first piece of advice that I discuss with eyecare profesionals (ECPs) who are considering adding sports vision to their practice, is to truly love sport. It may sound silly, but attempting to meet the visual needs of an athlete, as well as discussing sports-related topics, must be a genuine conversation. In addition, effective communication requires the practitioner to have a working knowledge of sports. I have over 15 years of experience with locker room conversations, so building trust with an athlete has, fortunately, been an easy thing for me. Utilize any involvement and passion in sport to show that you truly care about athletes and assisting with their sports performance. The ability to share your passion for sport, communicate with athletes, and discuss ways to help are keys to a
Once desire has been established, the office’s transition has begun. At this point the practice launches into the grind of “the season.” During a sport’s season the day-today activities, practices and games are the grind, as is the daily practice of sports vision. Don’t mistake this description as negative; it is quite the opposite. The season is an essential part of improving the player and the team in preparation for the eventual post-season and championship run. ECPs apply our craft every day and help build more perfect athletes by improving their visual systems. Essential components of our “season” include fitting glasses and contact lenses more precisely for sport, managing eye emergencies, managing post-concussion syndrome, performing team evaluations and spreading our message to our communities.
RightEye eye-tracking technology enables optometrists to offer a two-minute neurologic “baseline concussion test” or a seven-minute sports vision test.
Remember, recent studies by the University of Cincinnati have linked vision training to potential injury prevention, in addition to previously studied performance enhancement possibilities. Pre-season visual evaluation of team members give the practitioner the chance to provide a more comprehensive and sport-specific examination, as well as educate the athlete, coaches and parents about the importance of higher level vision testing for sport. The foundation of a precise refractive correction with appropriate intervention is critical. Additional components, such as depth perception, peripheral awareness, contrast sensitivity, and visual and processing speed assessments are vital for many sports and activities. EVALUATING AND PRESCRIBING
Several computer-based technologies now exist to create a more dynamic and acute visual skills evaluation. These technologies,
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HUNT | MATTE BLACK NAVY Happy Bronze Polar w/ Dark Blue Spectra
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SPORTS
Finally, pay attention to small amounts of toricity when fitting glasses and contact lenses for sports. Consider aspheric or toric lenses to manage astigmatism when present as these can have a considerable impact on contrast and vision.
is important during the athlete’s season, the practitioner needs to be accessible to the teams and the athletes to deliver care and to intervene as quickly as possible in an emergency situation. Quick response times can aid in returning the athlete to play as quickly and safely as possible.
WHEN THERAPY IS NEEDED
A sports vision practice can benefit from specialized contact lenses, such as the SynergEyes Duette, which gives the astigmatic athlete the increased acuity of an RGP with the stability of a large soft lens because of the soft skirt.
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which are often exciting and interesting for the athletes, include those from M&S Technologies, RightEye, Synaptec, Neurotracker and Enhanced Vision Testing System (EVTS). The next step is prescribing precise interventions to meet the individual sport-specific demands of athletes to help them start their season on the right foot. Discuss UV protection in glasses and contact lenses if the athlete participates in an outdoor sport. Prescribe specific tints and photochromic technologies for relevant activities. Remember, the ECP is the expert in matters of optics and lens options, not the athlete. Educate the athlete on contrast and the impact of enhancing filters versus standard gray tints. Take care when fitting sports glasses to be sure that the frame fits well, and when necessary, fits under a helmet. I would suggest having more than one sports frame line in your optical to give the athlete a larger selection. Use contrast sensitivity testing as a marker for those who may stand to gain the most impact from contrast-enhancing tints. Just remember that some tints are designed for outdoor use, so indoor contrast sensitivity testing may not have the illuminance necessary to properly assess the impact of a contrast-enhancing tint.
Now that your athletes have a firm foundation for their vision, if the practitioner detects a depth perception or muscular focusing concern then the ability to apply or refer for vision therapy services is a must. A multitude of therapeutic interventions are in place to manage eye muscle concerns. Home-based vision training programs such as HTS or Vizualedge, as well as free space-training tools such as Brock Strings, Stereoscopes, Vectograms and Barrel Cards can be implemented at a relatively low cost to the patient and practitioner. Visual performance training for aspects such as visual reaction, visual processing efficiency or peripheral awareness can be accomplished using low cost vision training drills such as a colored ball toss or vision ring exercises. ECPs can also use higher technology training devices such as stroboscopic technologies from Senaptec or Sensory Performance Technologies. There are also platforms that offer multiple training tools in one system such as Senaptec’s sensory station, Wayne Engineering tools, Dynaboard, RightEye, Neuotracker and more. In my opinion, one or more of these advanced technologies need to be in place to work effectively with elite athletes. This is a significant investment, and the “season” is long, so practitioners can add technologies to their practice over time. EMERGENCY AND CONCUSSION CARE
Other concerns when affiliating with specific teams are emergency and on-call obligations. Understanding that each game
The final portion of the sports vision practitioner’s “season” is gaining a comfort level with managing the visual symptoms related to concussions. These patients should be referred to the ECP after a confirmed outside diagnosis of concussion for the implementation of visual rehabilitation. This process incorporates many aspects of those interventions previously discussed. Correction of refractive error, applying tints and utilizing muscular and neurological vision training can all be important components to rehabilitating athletes through concussion symptoms. As these parts of our sports vision season come into place, the practitioner should market the practice as offering specialty care to athletes. Set your practice apart by sponsoring youth sports teams and marketing the practice externally with any team affiliations. With hard work, dedication and desire to add sports vision, we can all hope that it will lead to the ultimate goal of post-season and ‘World Series’ success! To the ECP, aside from financial growth, the joy that comes from getting a chance to do what you love on a daily basis is a worthwhile and achievable goal. It also creates an opportunity to stand on the sidelines, wearing your affiliated team polo and possibly someday holding up a big, shiny trophy as an integral part of a team’s success! Keith Smithson, OD, practices with the Northern Virginia Doctors of Optometry in the Washington, DC, metro area, and he is the team optometrist for the Washington Nationals, D.C. United and the Washington Mystics.
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W H E N
Y O U
S U P P O R T
B U Y
T H O S E
R E V O
T E N
F I G H T I N G
D O L L A R S F O R
G O E S
T H E I R
T O
S I G H T .
Vision Expo East Booth #1621 | 800.645.3733
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SAFETY
PACKAGED FOR PROTECTION Carefully prescribe frames designed for safety combined with impact-resistant lenses to ensure that your patients who require protective eyewear get it. By Richard W. McCoy BA, LDO, ABOC, NCLEC, and Frank Gimbel
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he modern eyecare professional encounters a multitude of challenges every day in a modern eyecare practice. A consistent challenge and opportunity is the promotion of safety eyewear to the patient. According to the Centers for Disease Control, 800,000 work-related eye injuries occur every year. Approximately 2,000 workers need medical treatment for an eye injury sustained at work. These eye injuries incur a staggering cost of almost $300 million per year in medical costs and lost productivity to employers. Safety eyewear falls into the category of personal protective equipment, and when it is utilized by the worker, over 90% of eye injuries could be avoided. According to Prevent Blindness, some common industrial eye injuries are caused by: • flying objects (metal, glass) • tools/equipment • particles • chemicals • harmful radiation (welding) • a combination of these and other hazards unique to a workplace FRAMES FOR SAFETY
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One of the big problems that safety engineers and risk managers contend with are workers who do not wear safety eyewear when required. Reasons for non-compliance parallel some of the issues of dress eyewear such as discomfort, poor fit, weight and functionality. Of particular importance is functionality when the worker has to wear additional personal protective equipment such as hard hats, filter masks and hearing protection on the job.
Today’s safety eyewear, such as WorkSight from Wiley X, rival dress frames in style and comfort while still meeting Z87.1 safety standards.
Fortunately for workers and ECPs alike, safety eyewear has seen a revolution in style and functionality. Using new materials, updated designs and fabrication techniques, frame manufacturers now make safety eyewear that rivals dress frames in style and comfort while meeting the Z87.1 safety standards. PROTECTIVE LENSES
In addition to safety frames, lenses can also protect your patients by being impact resistant. While the lenses we recommend also provide a visual benefit, they too can protect the wearer when they are made from impact-resistant materials. As care providers we have a duty to offer proper options to individuals who require protection and at a bare minimum make them available and provide awareness to all eyeglass wearers we treat. Who needs impact-resistant lenses? All children as well as active individuals who are looking for safety and appropriate protection from impacts need impact-resistant lenses. Simple accidents happen, and when they do, knowing that your eyesight and
lenses may both be saved simply by having an impact-resistant lens is priceless. Let’s face it, kids like to have fun, they run, they play, they throw things…all children under the age of 18 require impact-resistant lenses; as dispensers, it’s our duty to provide them. Others who benefit from impact-resistant lenses are active sporty individuals and those who require protective safety eyewear on the job. They both need to be wearing the right protective gear, and one quick way to learn about what they may need is simply to ask.
Safety eyewear has seen a revolution in style and functionality as exemplified by Hilco’s Leader Rx Work Wear series.
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SAFETY HOW ARE THEY PRODUCED?
Today’s two most common impact-resistant prescription lens materials are polycarbonate and Trivex. Both have beneficial qualities to protect the wearer from impacts and active lifestyles. While the two materials provide similar attributes, they are produced in two completely different processing methods. Even though polycarbonate has been around since the mid ‘70s, it gained prominence during the 1980s because it was lighter in weight and allowed thinner lenses to be produced. It’s 10 times more impact resistant than standard CR-39 material and 20% lighter and thinner than plastic. Polycarbonate is created from a thermoplastic, and when it’s produced, it starts off in a pellet form that is injected into a lens mold. In these molds, the pellets are heated and compressed until they bond and melt, becoming one solid material. This injection-molded process is what makes the lens super soft yet still extreme-
ly durable upon impact. The process takes mere minutes, and once cooled, you are left with a finished lens. Trivex was developed in 2001 by PPG Industries. It also boasts impact-resistant claims similar to polycarbonate, yet it has one distinctive advantage when processed. Instead of beginning as a formed thermal plastic pellet, Trivex is a urethane-based monomer that is poured slowly into molds, which allows for sharper optics when compared to polycarbonate. The reasoning for this is due to what is known as chromatic dispersion within the lens. In simplest terms, the process is gentler on the lens produced, greatly reducing stress and compression required to create the finished lens. WHAT MAKES THEM IMPACT RESISTANT?
Compared to other materials such as glass, CR-39 and other plastics, polycarbonate and Trivex are made softer. When an ob-
ject hits glass or CR-39 there is a higher risk that the lens will shatter and harm the wearer. These materials are just more brittle to impacts, making polycarbonate or Trivex the better choice for kids, sports, safety, grooved lenses and even drill mounts. Keep in mind that all impact-resistant lenses automatically come with inherent UV-400 protection built in. Some additional items to consider are photochromics for outdoors or even polarized lens options, especially for outdoor sports. Also, regardless of the lens material, reflections are always present with optical lenses, so a proper anti-reflective coating will always provide a greater benefit to achieving clearer optics. Richard W. McCoy, LDO, ABOC, NCLEC, is the head of the opticianry program at Reynolds Community College in Richmond, Virginia. Frank Gimbel is an advanced certified optician, and owner of Gimbel Eye Associates in Wayne, PA.
PRODUCT SHOWCASE
SPY, HUNT The Hunt is the perfect blend of style and
performance. A flat front design matches the trend that patients want. Overmolded grip tips on the temples keep it in place, and it’s nearly indestructible Grilamid frame, complemented by pin hinges, keep it in one piece whether you crash your bike or leave them in your pocket when you sit down. Patent-pending Happy Lens technology help keep patients’ vision sharp and spirits up even when they are having a bad day. 800.779.3937, SpyOptic.com.
CLEARVISION OPTICAL CO., REVO Founded in 1985, Revo
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quickly became a global performance eyewear brand known as the leader in polarized lens technology. Revo sunglasses were first created by utilizing lens technology developed by NASA as solar protection for satellites. Three decades later, Revo continues to build on its rich tradition of technology and innovation by offering the clearest and most advanced high-contrast polarized sunglasses available. 800.645.3733, CVOptical.com, CService@CVOptical.com.
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ANNUAL SUPPLEMENT SERIES FROM FIRST VISION MEDIA GROUP Sunwear+Vision The guide to building a successful sunwear business
Sport+Vision A supplement to VCPN March 2015
The ECP’s guide to building a sports vision practice
Peak Visual Performance For Athlete Patients
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Creative Collaborations
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High-Tech Frame Materials That Stay Put
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Bring On The Brands
Winning Tips For The Kids’ Market Sport+Vision_2016.indd 1
Increasing Sunwear Sales
A Continuing Education Supplement to VCPN May 2016 Approved for one ABO credit hour of continuing education, Level II
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Targeting topics most important to you.
Kids+Vision
Blue Light+Vision Understanding blue light protection for all your patients
Eyecare and Eyewear for Your Young Patients
Fashionable and Sporty Tween Eyewear
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Child-Appropriate and Kid-Approved Lenses
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Mapping a Blue Light Game Plan
Frames With Character
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Into the Blue
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Lenses to Protect Your Patients A Continuing Education Supplement to VCPN, June 2016
A Continuing Education Supplement to VCPN, July 2016 Approved for one ABO credit hour of continuing education, Technical, Level III
Approved for one ABO credit hour of continuing education, Technical, Level 1
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B.L.U.E. A one-hour continuing education course for both optometrists (C.O.P.E.) and opticians (ABO). Attendence is Free... to register GO TO: KNOWBLUeLIGHT.com 6/29/16 4:47 PM
PRODUCT SHOWCASE
HILCO VISION, CROAKIES Hilco Vision has enhanced its
consumer accessories collection by incorporating the eyewear retainer brand consumers ask for by name, Croakies. The majority of Croakies sport retainers are made or assembled in the U.S. and are built to protect every style of sunglasses and other eyewear at affordable prices. Each retainer is made to grip frames tightly even after years of use. The breadth of line spans from the original, best-selling, sporty style to fashion retainers, which blend elegance with a lasting technical fit. Whether your patient climbs the highest peak or takes the dog out for a neighborhood stroll, Croakies has it covered. 800.955.6544, Hilco.com, Requests@Hilco.com
WILEY X, CLIMATE CONTROL, WX ENZO Wiley X Climate Control sunglasses
feature a patented, soft removable Facial Cavity Seal designed to block out wind, airborne debris and reflected light to create a comfortable, climate-controlled environment for the eyes during work and play. New for 2017, WX Enzo comes in matte black with bold-looking polarized emerald mirror (amber tint) lenses, ideal for wear around snow, water, roadways and other high-glare environments. There is also a Black Ops edition that matches a matte black frame with smoke gray lenses as well as one in gloss black with clear lenses, which are ideal for work/safety wear and other situations in which full light transmission is desired. 800.776.7842, WileyX.com, Info@WileyX.com
INSPECS USA, O’NEILL, DRIFTIN’ New from
O’Neill, one of America’s oldest and best known surf and beach lifestyle brands, the Driftin’ model combines a retro square eyeshape with modern stainless steel temples. Pictured in a striped matte horn (color 101) acetate front and temple tips, this frame works great for plano but is designed with Rxability in mind. With a range of fashion and performance sport designs for both men and women, the 2017 O’Neill sun collection features 106 SKUs across 21 different models. 727.771.7710, InspecsUSA.com, Sales@InspecsUSA.com
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A LEGACY OF PROTECTING AMERICA’S EYES
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LUCIA MARTINO & JOAO KOPKE O’NEILL TEAM RIDERS
B O N D E D
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