Managing healthy aging and vision

November 26, 2014

Seems like everyone is focusing on baby boomers as they enter a new phase of their lives, but vision in particular is a big topic. And why wouldn’t it be? What is more critical to healthy aging than maintaining healthy vision?

Seems like everyone is focusing on baby boomers as they enter a new phase of their lives, but vision in particular is a big topic. And why wouldn’t it be? What is more critical to healthy aging than maintaining healthy vision?

Preparing for this age wave is not only one of the greatest opportunities for the independent eyecare professional (ECP), it will also become one of our greatest responsibilities.

Why focus on baby boomer patients

Dealing with healthy aging among baby boomers requires an understanding of how this generation is changing the whole notion of growing old. People are working longer-more than a third of working Americans say they don’t plan to stop working.1 As life expectancy grows, baby boomers are looking at the financial strain of 20 or 30 or more years with no income. And many simply enjoy their work. In a 2012 survey conducted by The Vision Council, more than a third of U.S. adults reported spending four to six hours a day with digital media or related electronic devices.2 That kind of focus on digital content tires eye muscles, leading to eye strain and fatigue. Baby boomers pretty much invented the idea of personal fulfillment. Both relationships and fulfilling experiences are important to them; they are determined to lead healthy, active lives.

How digital devices are affecting vision

These patients are not interested in slowing down and demand products and services that allow them to continue to live their lives as they did in their 30s and 40s. One of the interesting effects of the Internet is that consumers seek out information on all manner of health topics. Seventy-two percent of Internet users say they looked online for health information within the past year.3 And older patients are no exception-over half of adults over 65 are Internet users.4 Even more interesting, 96 percent of baby boomers participate in word-of mouth or viral marketing by passing product or service information on to friends.5 Need more convincing that baby boomers are Internet savvy? According to Forrester Research, boomers outspend younger adults online 2:1 on a per capita basis.5

The implications are clear for ECPs: assume that your older patients are well versed on new products and new technology. You don’t want to be in the position of your patient feeling she knows more than you do. This information parity driven by the Internet and social media produces better buyers than sellers all too often.

The takeaway is to assume baby boomers, like all your patients, are interested in hearing about product options. In fact, recent research shows that 89 percent of patients say the lens options offered to them by their ECPs is important,6 and many patients expect their ECPs to make a product recommendation based on their needs.

It’s almost impossible to overstate how big of an impact what marketers are calling the “silver tsunami” can have on your practice. Think about that patient who is age 55. On average, this patient will live to be age 86. What is the lifetime value of this patient to your practice?

How to handle a bad online review

In 2000, there were 60 million Americans over 55. By 2030, there will be 112 million Americans over 55, 30 percent of the population.7 And not only are there a lot of baby boomers, their economic impact is greater than their numbers. Baby boomers outspend other generations by an estimated $400 billion each year on consumer goods and services.5 And boomers account for 55 percent of consumer packaged goods sales.5

 

Healthy aging

Aging is natural. As we age, the quality of our vision declines naturally. The eyes ability to control light diminishes with age and the new world of handheld technology makes it even more problematic for aging eyes.

What is not natural is vision loss.

It is up to us as ECPs to educate patients on how normal healthy aging affects their vision and to advise them on what changes are not normal. Then we can make clear to them their options for treatment that will restore, maintain, and enhance their vision.

Exploring new options in ophthalmic lenses

What we can do for aging patients

We are no longer living in a world where reading three-inch black letters against a white screen at 20 feet is an adequate representation of how we see. Today, we are looking at pixels on handheld technology at near distances for hours at a time. This has placed greater demands on the vision system than ever before. An aging population, living longer and working longer, needs a system of vision correction, protection, and enhancement to meet its needs. We have to ask more questions today than, “Which looks better: one or two?”

Consider how these changes affect the ability to perform daily tasks, to see well in different lighting situations, and can cause patients discomfort and annoyance.

Consider the following natural effects of aging:

• Age reduces tear production, creating dry eye syndrome, and technology has complicated it. Fatigue and computer vision syndrome are likely results. According to the National Institute of Occupational Safety and Health, computer vision syndrome affects 90 percent of people who spend three or more hours per day at the computer.8

• Cornea thickens with age, causing light to scatter. Patients may be increasingly light sensitive, causing discomfort and fatigue and reducing contrast sensitivity and color vision.

• Reduced pupil size results in less light coming into the eye. By age 60, patients have approximately one third of the light coming into their eyes as when they were age 20.9 This often presents problems with low light, making reading and any close-up work troublesome. The eye’s ability to adapt to the dark suffers.

• Discoloration of lens also reduces the light coming into the eye. Our older patients often experience cataracts and skin damage due to ultraviolet light. By age 65, on average 50 percent of patients are developing cataracts.10

• The lens loses flexibility. Patients develop presbyopia.

• Vitreous humor becomes thinner and more liquefied with age, which can give rise to higher incidence of floaters.

• Retinal pigment epithelium loses its ability to absorb excess light and prevent scatter, so the patient can be more sensitive to light, and glare becomes more problematic.

• Optic nerve loses fibers, and the visual field can shrink.

• People over age 60 are at increased risk for glaucoma, and there is a 22% increased risk with every decade of life.10

Age-related macular degeneration (AMD) is the leading cause of vision loss and blindness among our senior citizens. Twenty percent of patients over 65 are at risk for developing AMD.10

Looking into the future of presbyopia treatments 

 

The digital revolution

These major changes are a natural result of aging. They can be offset by a variety of new technologies, specifically photochromic lenses with antireflective (AR) coating in digital design.

We are at a tipping point where 21st century technology is poised to meet the needs of the 21st century patient: changeover to digital is taking place and redefining the desired qualities of a lens. The digital fabrication allows for the most customized vision solution ever. It is the most significant change in prescription lens fabrication in the history of ophthalmic lenses.

We can now offer patients a new way of correcting vision that provides superior visual acuity. Just as flat screen technology has revolutionized what we expect from our televisions, this new technology allows us to create the best visual experience for the patient.

For the baby boomer patient, this means a superior performance progressive lens. That is only one part of the best recommendation. A progressive lens for the boomer’s life at this point will include scratch resistant coating, a UV filter, AR coating, and photochromics in the material and index that best suits the patient’s Rx. Remember those vision challenges associated with the natural process of aging? 

• Too little light

• Too much scattered light/glare

• Light sensitivity

• Reduced color contrast

• Eye fatigue

• Poor night vision

The baby boomer wants to know his options for minimizing those problems. The combination of photochromics and AR coating is a lens recommendation that addresses these problems:

• Indoors, more light passes through the lenses so aging eyes don’t have to work so hard

• Outdoors, less light passes through for added comfort

• Glare and reflections are reduced, resulting in less eyestrain and fatigue

• Better clarity, comfort, and protection are provided while at the computer, reading, driving at night or outdoors

Supercharging your dispensary

It will be his primary pair and a marked improvement over regular clear lenses. This lens combination, especially in digital design, can offset the effects of aging. When patients are younger, they might be able to get away with clear lenses, but older patients have more difficult visual challenges, and the clear lenses option is simply not a solution for your baby boomer patient.

 

Vision risks for baby boomers

Early intervention and identification of issues is critical for long-term success. For adults in excellent health, an every-other-year approach is adequate between the ages of 20 and 40. After age 40, an every-year examination recommendation is safest. As with any condition or disease, the earliest detection usually delivers the best chance of successful intervention and treatment.

Primary aging is the aging of the body itself; secondary aging is the result of our lifestyle. Some experts think lifestyle may account for up to 70 percent of secondary aging.11 This, of course, means that to a great extent, secondary aging is within our control. 

Maximizing sunglasses sales

Healthy living is very important and should be encouraged at every point in the healthcare system. There are patients who ignore all aspects of their health except vision. Sometimes, the optometrist is the only physician who a patient may see. So, it is important to encourage better living to include dietary recommendations, exercise, smoking cessation, and proper nutraceuticals. 

The baby boomer age group is at higher risk for high blood pressure12 and diabetes.13 More than half of Americans over age 60 suffer from high blood pressure.14 And overweight older patients are particularly at risk. During the past 20 years, there has been a dramatic increase in obesity in the U.S., and rates remain high. More than one-third of U.S. adults (35.7 percent) and approximately 18 percent of children and adolescents aged 2 to 19 years are obese.15 The medical care costs of obesity in the U.S. are staggering. In 2008 dollars, these costs totaled about $147 billion.16

The primary-care optometrist needs to be up to date on the obesity epidemic and what optometrists should do in their practices to intervene-specifically, discuss how obesity contributes to diabetes and the devastating effect diabetes can have on vision. Obese patients should be made aware that during an eye exam, ECPs can pick up early signs of diabetes as well as high blood pressure, another obesity co-morbidity.

Every five years, the U.S. government publishes the healthy dietary guidelines for Americans. The next version will be published in 2015.

Limiting sun exposure can slow the formation of cataracts. Outside on a bright day, UV-protected spectacles (with or without prescription) can be worn and block nearly 100 percent of these harmful rays. Unfortunately, the prevention of cataracts is not that simple. 

Young children’s eyes are very sensitive to ultraviolet light. In fact at age 10, the immature crystalline lens allows 75 percent of ultraviolet light to pass through it. Comparatively, at age 30, only 10 percent of ultraviolet light can pass. Because the damage from ultraviolet light is cumulative, it is critical that even young children wear sun protection. The average child receives three times the annual UV exposure as an adult.17 This is due to the daily outdoor activity that young children regularly enjoy. By acting early, the late ill-effects of cataracts can be delayed.

Many people complain of facial wrinkles and crow’s feet. These unsightly wrinkles are exacerbated by squinting. Proper sun protection can help our patients in multiple ways.  The deleterious effects of UV light on the eyes can be prevented with the use of UV-protecting spectacles, just as sunscreen can protect exposed skin.

A primary-care optometrist should educate patients on the dangers of UV and instruct them on the ways to protect their eyes and their skin from not just pathologies but the visible aging UV exposure can cause.

It’s critical that as the caretaker of your aging patient’s healthy vision, you advise him of conditions that can result in vision loss. It’s particularly important to communicate to the patient that the earlier warning signs are recognized, the earlier treatment can commence.  So the annual appointment is a necessity for aging eyes.

Table 1 is a quick review of the common risks to your older patients’ vision. You know how to evaluate these risks, and you do so routinely.

But are you educating your patients on these risks and their symptoms?

 

Patient communication and education

When was the last time that you had your own eyes examined? When was your last refraction? What was your experience? The last time I had my eyes examined (complete eye exam from start to finish), I became acutely aware of something that I had not noticed before: Our profession is odd!

During most of the examination, there is some technology or equipment that is either directly between the patient and the provider or is distracting the provider from the patient. The art of conversation in an optometric exam is challenging. Worse yet, when we do have that short window of opportunity, we also feel the stress of finishing up and getting to the next patient, so we rush through the time that is most meaningful to the patient: discussing her needs, answering her questions, and explaining what we are doing and why we are doing it. A checklist can be very helpful.

Dr. Ernie Bowling: Patients say the darndest things

The goal of conversation with our baby boomer patients is removing the uncertainty around aging and vision. Today’s patients are far more educated than ever before. We are no longer the sages in the white coats. Patients are oftentimes armed with buckets of accurate information. It is wise to create a checklist of topics to cover with each and every patient. I have found my own checklist to be successful, easy to perform, and positively received from patients. 

1. Their vision is at present and where I predict it will be in the long term.

2. Their eyes relative to the most common eye conditions. What new technologies and research are arriving that would suit them if needed.

• Dry eye/Ocular surface disease

• AMD

• Glaucoma

• Cataracts

• Diabetes/hypertension/hypercholesteremia signs (or absence thereof)

3. What I recommend to them for refractive correction.

4. What I recommend to enhance vision and address the natural effects of aging eyes.

5. What I prescribe to them via pharmaceutics or over the counter preparations and why.

6. When they are to return and why.

The checklist is not long. It is easy to follow and remember. It ensures meaningful face-to-face dialogue and more importantly it meets or exceeds the needs and expectations of the patients.

Build patient loyalty 

Another key to encouraging dialogue with our patients is to wear what we recommend. Photochromic lenses with AR coating are especially well served by you and your staff wearing them: the indoor clarity of the lenses is surprising to some people. Activating your lenses allows patients to observe the benefits of the lenses in real life. While they are observing the properties of the lenses, you can delve into how the lenses address their needs.

 

Let’s rethink

We need to reconsider how we meet the needs of our aging patients.

• Natural aging relative to vision needs to be explained to patients: what is normal and what solutions we recommend.

• Baby boomers are not only a growing segment of the population, they have re-defined aging-postponing retirement and looking to maintain a vigorous lifestyle that demands enhanced vision.

• Recommendations are what your patients want. Baby boomers patients in particular will benefit from a recommendation of a lens that enhances their vision and allays the natural effects of aging: photochromic lenses with AR in digital design.

 

The power of recommendation

 

We also need to reconsider 20/20 as the standard for normal vision.

• Reconsider the relevance of seeing a three-inch black letter against a white screen at 20 feet. We live in a world of hand-held technology and computer vision syndrome is more prevalent than carpal tunnel syndrome.

• More and more offices are incorporating digital acuity charts. Look for more testing on these charts in the form of contrast sensitivity and dynamic visual acuity in the future. These are easy tests to add to a computer-based system. 

• Act aggressively to enhance vision and prevent problems instead of the more archaic approach of fixing problems once they emerge. Should we have problem-oriented exams?  Shouldn’t we have vision-enhancement exams instead?

 

We need to reconsider multi-app technology.

• We need to rethink how we introduce the latest lens applications that create a better quality of life and manage healthy aging.

• What are must-have lens qualities for healthy aging? Lenses that provide more light when needed and less light when not are not optional when you think about how light is at a premium as our eyes age.

• Take in-office education to the next level-think interactive, show and tell, high-tech, high-touch. Innovations like stick-on photochromic filters are great ways to highlight technology and engage the patient.

 

We need to rethink our responsibility as healthcare providers.

• Counsel patients on diet, vitamins, smoking cessation campaigns, and always educate patients on how to recognize risks.

• Annual appointments for all this age group are a must. Educate them on the importance of annual eye exams. The risks are too great to ignore. Early detection is critical to successful treatment.

 

Make your practice baby boomer ready

Take a look at the posters, counter cards, and other patient facing materials in your practice. Are the people and the visuals relatable to your older patients? Are printed materials in a large enough font size?

Talk with your frame supplier about frames that are good for more mature patients. They’ll be able to train your staff to guide patients to frame shapes that lift the face as well as colors and finishes that are most flattering to baby boomer-aged men and women. Is your waiting area well lit? Do the chairs make sitting and rising easy? Look into offering discounts or promotions to your baby boomers patients-a discount for AARP members or retired military, for instance.

Make certain to remind your boomer patients about the critical importance of sun protection. Stress that the sun can damage their skin as well as their eyes, and that eyewear and sunscreen that protects the delicate skin around the eyes can help avoid wrinkles.

As patients get older and more susceptible to eye diseases and conditions such as diabetes and hypertension, it’s important to increase exam frequency. Explain to patients that a yearly exam is your recommendation. If new eyewear isn’t indicated with some exams, make sure to inspect the patient’s eyewear for any fit issues and tighten any loose pieces and thoroughly clean the glasses as a courtesy.

In the end, we want you to accomplish what you set out on your educational and professional journey to accomplish. This large segment of the population needs your help like never before. The silver tsunami can lift up your practice or overwhelm it. Rethinking approaches and assumptions about aging patients, and focusing on managing healthy aging is the key to success and patient satisfaction.

Tips for serving Hispanic patients

 

References

1. “Global IOL Market Report.” Market Scope;2014. http://market-scope.com/products-page/cataract-reports/2014-comprehensive-report-on-the-global-iol-market/. Accessed 11/26/14. 

2.  AAAHC Institute for Quality Improvement, July-December 2013 Report.http://www.aaahc.org/Global/pdfs/AAAHC%20Institute%20content/aaahc_whitepaper_single%20sheets_final.pdf. Accessed 11/26/14.

3. Amiel H, Koch P. Tetracaine hydrochloride 0.5% versus lidocaine 2% jelly as a topical anesthetic agent in cataract surgery: comparative clinical trial. J Cataract Refract Surg. 2007 Jan;33(1):98-100.

4. Davis, MJ et al. Comparison of topical anesthetics for intravitreal injections : a randomized clinical trial. Retina. 2012 Apr;32(4):701-5.

5. Ezra DG, Nambiar A, Allan BD. Supplementary intracameral lidocaine for phacoemulsification under topical anesthesia. A meta-analysis of randomized controlled trials. Ophthalmology. 2008 Mar;115(3):455-87. 

6. Jobson Optical Research. Key Drivers of the Patient Experience. August 2012. Available at: http://www.jobsonresearch.com/scripts/prodList.asp?idCategory=38. Accessed 11/25/14. 

7. Resident Population Projections. US Census Bureau, Statistical Abstract of the United States, 2012. Table 9. http://www.census.gov/compendia/statab/2012/tables/12s0009.pdf. Accessed 11/25/14.

8. Beck M. Becoming a Squinter Nation. Wall Street Journal. August 17, 2010. http://online.wsj.com/news/articles/SB10001424052748704868604575433361436276340. Accessed 11/23/2013.

9. Medline Plus. Aging Changes in the Senses. http://www.nlm.nih.gov/medlineplus/ency/article/004013.htm. Accessed 11/23/2013.

10. American Academy of Ophthalmology. Eye health statistics at a glance. http://www.aao.org/newsroom/upload/Eye-Health-Statistics-April-2011.pdf. Accessed 11/24/2014.

11. Helping you care. New Book, Counter Clockwise by Lauren Kessler, Gives Hope: 70% of Aging Process Within Our Control. http://www.helpingyoucare.com/25761/new-book-counter-clockwise-by-lauren-kessler-gives-hope-70-of-aging-process-within-our-control. Accessed 11/24/2013.

12. Hainer R. User’s Manual: Your Heart. Health. 2 April 2008. http://www.health.com/health/condition-article/0,,20188456,00.html. Accessed 11/23/2013.

13. Mayo Clinic. Diseases and Conditions: Type 2 Diabetes. http://www.mayoclinic.com/health/type-2-diabetes/DS00585/DSECTION=risk-factors. Accessed 11/23/2013.

14. “Who Is at Risk for High Blood Pressure?” NIH National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/atrisk. Accessed 11/25/14.

15. Thompson D. One Third of US Adults Are Obese, CDC Says. Health Day. http://consumer.healthday.com/public-health-information-30/centers-for-disease-control-news-120/1-in-3-adults-in-u-s-are-obese-cdc-says-680754.html. Accessed 11/23/2013.

16. Center for Disease Control and Prevention. Adolescents and School Health. http://www.cdc.gov/healthyyouth/obesity/facts.htm. Accessed 11/23/2013.

17. Truham AP. Sun Protection in childhood. Clin Pediatr (Phila). 1991 Dec;30(12):676-81.