In the course of caring for over 5,000 patients each year, there are bound to be moments that we would rather not revisit: the patient who appeared to have simple conjunctivitis and returns with a dendrite, or the post-op cataract patient with what appears to be an infection. Fortunately for every one of these, we have dozens of happy endings.
Although I spend the overwhelming part of my work day finding solutions to medical eye problems, for me one of the most rewarding experiences is guiding my patients to the most appropriate spectacle lens option. I personally try as many new spectacle lens designs as possible, and I review whatever scientific studies are available, to learn whether newly marketed lenses live up to the claims made for them.
I wear digitally surfaced, no-glare, progressive addition lenses with Transitions® photochromic technology in a high-index material. As a wearer, there is no doubt in my mind that each of these lens options offers a real benefit to me.
This does not necessarily mean that every patient who comes through the door needs all this lens technology. For laborers who report that they are hard on glasses, I may recommend nickel-titanium frames and explain that the patient may not want AR coating, as even the best are harder to clean and scratch more easily than traditional scratch-resistant lenses. Patients with low degrees of ametropia will do well with less costly polycarbonate, Trivex®, or even standard plastic lenses. I explain the pros and cons of progressive lenses and offer them to all presbyopes, but patients happy with their flat top bifocal will often choose to stay with that option. I have also found that briefly explaining the pros and cons of glasses options, just as we do medical or surgical treatments, keeps patients coming back year after year.
While the world of spectacle lenses does not move forward at the pace of, say, advances in cataract surgery, the pace of change in ophthalmic lens design is rapidly accelerating. For example, in this issue Jenean Carlton describes a revolutionary lens from Transitions Optical. This is a plastic lens that, like other photochromic lenses, darkens when exposed to ultraviolet light. But there’s a difference: this lens also becomes polarized when exposed to UV and reversibly de-polarizes in the absence of UV. This is a tremendous boon to boaters and fishermen, who are often exposed to excess UV and visual disability from glare off the water.
But there is a caveat: these lenses require UV to activate both the darkening feature and the polarizing feature; and hence the lenses will not activate while inside a car. Patients need to be aware of this; however, the problem is readily solved by purchasing a polarized sunglass clip-on, which can be left in the car so that it’s always there when needed. This is what I do for myself when driving and it works well. Helping patients choose the right glasses can be a bona fide reward of being in eyecare.
Robert C. Campbell, MD, Editor-in-Chief