Focus On Low Vision
Low Vision's New Coat
By Erinn Morgan

Premium lens coatings have been making quite a show in the optical industry. As the sales of premium lenses, such as high-index and Trivex, continue to grow, customers are looking to coatings to protect and enhance their investment.

Now, it appears the same is holding true in the low vision area. Once the appropriate lens has been decided upon for the patient, dispensers say it is important to protect it with a scratch coating. In addition, AR coating and UV protection will benefit low vision patients in ways specific to their needs.

"Coatings are all beneficial and preventative measures for the patient," says Bruce P. Rosenthal, OD, who is chief of low vision programs, Lighthouse International. "You have to weigh the cost with the advantages. We have an eye that is compromised--if we give them a lens that is not 100 percent, the problems multiply each other. We want the best optical situation for that eye."

While some low vision practitioners and dispensers are making new inroads with coatings, others have been employing this as a tried-and-true technique for years. "The use of coatings in low vision is not new," says Carolyn Carman-Merrifield, OD, with the Low Vision Centers of Texas in Arlington. The 17-year industry veteran notes, "They have a place in low vision that can be of great help to the patient."

Whether lens coatings for low vision are a new endeavor or old hat in your practice, some background information on why dispensers choose AR, UV, or scratch-resistance for their patients is useful in making your plans for the future.

AR coatings improve light transmission, a key consideration for low vision patients PHOTO COURTESY OF CARL ZEISS OPTICAL, INC.

SCRATCH PROTECTION

Some dispensers report they regularly suggest scratch-resistance to their low vision patients. "Scratch coating is done here routinely," says Bill Rusin, an optician with Twin Tiers Eye Care, which has seven locations in the Binghampton-Elmira, N.Y., area.

One of the main reasons is to protect their investment in better vision. "Scratch coating makes a lot of sense," says Carman-Merrifield. "When you finally come up with the lens that is right for them, you want to protect it."

Rusin also notes that he also frequently uses polycarbonate lenses with low vision patients because they want the protection, and it is much more durable. "The poly has inherent UV protection," he says. "So, in that respect, we address the scratch resistance and UV."

Some practitioners say that scratch coating can sometimes take a back seat, however, to AR and UV. "We usually only recommend that the patient has two coatings on a lens," says Rosenthal. "Since AR is the most important and UV is imperative, scratch coating is often the third choice."

However, he says that if the patient is a younger person, he wants that lens to be scratch resistant. "They are harder on lenses," he says. "I would recommend that for any patient who is hard on lenses. I can't afford for any of my patients to have scratched lenses. It acts like a dirty windshield because it increases glare sensation."

GLARE PROTECTION

Anti-reflective coatings provide a hat trick of benefits for low vision patients--improved light transmittance, reduced glare, and improved contrast. According to many practitioners, this is the most important coating to offer to low vision patients. "AR is great for someone who is especially sensitive to glare and even low levels of glare," says Carman-Merrifield.

Adds Rosenthal, "I am an advocate for AR for all low vision patients. It works well for low vision patients in particular because many have early cataracts or other issues, and light comes into the eye and causes an annoying glare reflection. AR certainly decreases this."

AR also helps to improve contrast. "People with glaucoma, cataracts, etcetera have problems with contrast," says Rosenthal. "These problems are further cutting down on their contrast sensitivity. AR increases light transmissions by up to 99.9 percent. I almost can't think of a case where I wouldn't recommend having this, unless the patient can't afford it."

Adds Nick Mileti, AR Council president and manager for technical support at Cole Vision, "AR can help aid light transmittance to the retina and reduce the glare on lenses. In some conditions of low vision, lighting is critical for the patient to be able to see. In addition, higher intensity lamps that are used to see may cause reflectance, ambient light, and back reflection. You can help get rid of that with AR."

In addition, anti-reflective coatings can also benefit those with cataracts. "We also always recommend AR to patients who have inoperable cataracts or if their surgery has been delayed," Mileti says.

Finally, most binoculars and telescopes that low vision patients may use to aid their vision are typically coated with AR on the lens. And AR is also available on high-end magnifiers. This point can be made to patients to help them understand the importance of AR's function.

SUN PROTECTION

Last but certainly not least is ultraviolet coating. Some say this is also an important protective option for every low vision patient. "You certainly would want your patients to have a UV coat for both indoor and outdoor use," says Carman-Merrifield.

According to Rosenthal, UV coatings are very important for a variety of reasons. "For those individuals who have macular degeneration, factors such as sunlight, ultra-violet light, and blue light may speed up the process," he says. "A UV coating will help protect them from these things. It will also protect those who have cataracts. UV light will increase the development of cataracts as well."

Overall, premium lens coatings can be a boon to both low vision patients and your dispensary. Understanding their functions--and how they can suit varying patient needs--will help you dispense them correctly.

"With coatings, you need to look at the benefits and risks," says Rosenthal. "If not, you are going to get patients coming back in with scratches, problems with contrast detriment, etcetera."