Adopting Healthy Sight Practices

Go beyond simple vision correction to provide patients with the best possible quality of vision now and for years to come

Healthy Sight is defined as the enhancement of the overall everyday quality of vision and the preservation of long-term ocular health.

Healthy Sight Counseling (HSC) provides the eyecare practitioner with a holistic approach to promoting healthy sight in everyday office practice. It adapts the standard medical model to expand on the refractive eye exam and incorporate quality of vision and ocular health concerns to generate what becomes an enhanced spectacle prescription.

VISION CARE VS. VISION WEAR

Healthy sight implies good sight; good sight depends on ocular health. Two aspects of HSC must be considered: vision wear and vision care. The two are closely interrelated.

Vision correction and the vision wear that provides that correction are the primary concerns of most individuals routinely consulting an ECP.

Modern spectacle lenses and lens treatments can go beyond simply correcting vision, offering the potential to actually enhance the quality of vision and contribute to long-term eye health.

In doing so, spectacles become a crucial component of vision care and act, in combination with other factors, to promote healthy sight.

VISION CARE AS MEDICAL CARE

When vision care is viewed as a component of medical care, it assumes a much broader scope. It takes into account the need for regular maintenance and preventive eyecare.

Vision wear, with its many available specialized lens designs and enhancements, plays an important role in overall vision care, impacting on both immediate and long-term ocular health.

As the individual on the front line for vision care, the eyecare practitioner is in the unique position not only to provide vision correction, but also to counsel patients on how best to optimize that vision and protect and preserve it.

STEP 1: INTELLIGENT VISION CORRECTION

The first step in HSC is intelligent vision correction, which includes vision assessment, determination of refractive error, and what might be referred to as lifestyle prescribing—the prescribing of spectacles that will provide the best possible vision correction and contribute to the long-term maintenance of ocular health and well-being.

With true lifestyle prescribing, the enhanced eyeglass prescription takes into account the unique personal, occupational, social, and recreational vision needs of the wearer so as to provide quality eyesight under diverse lifestyle circumstances.

The intelligent spectacle prescription also considers any relevant ophthalmic or medical conditions, including medications, that might impact vision and ocular health.

STEP 2: MAINTENANCE AND PREVENTIVE EYECARE

Both maintenance and preventive eyecare are important to ensure healthy sight for the patient. There are three basic components of the complete eye exam: the history, the refraction, and the physical ophthalmic exam.

While the refraction is generally considered to be the basis for prescribing spectacles, findings obtained in the history taking and in the course of the physical ophthalmic exam may be relevant to creating the lifestyle prescription.

Ophthalmic history taking typically begins with the presenting complaint. Here, patients might describe such diverse problems as decreased vision, eyestrain, light sensitivity, glare, and headaches—or say that they are dissatisfied with their current spectacles.

History taking, however, does not stop with the ophthalmic history. It is critical to conduct a thorough medical history as well. Both optical and medical considerations may be relevant in addressing patients' complaints.

QUALITY OF VISION

Once the best correct visual acuity has been determined through the refraction, the next task of the ECP is to use the history to address those quality-of-vision areas that will ultimately determine how satisfied the patient will be with the eyeglasses prescribed.

This shift in emphasis from quantity of vision to quality of vision is crucial in moving beyond normal sight to achieve the good sight most patients are really after.

Many quality-of-vision complaints voiced by patients are related to excessive light or to light presenting in the wrong way.

Ways to moderate natural light must be used to promote visual comfort. It is here that spectacle lens enhancements, including tinted lenses, photochromics, AR coatings, and polarized lenses, play an important role in improving the quality of vision and increasing patient satisfaction with spectacles.

STEP 3: EDUCATING THE PATIENT AND CREATING PUBLIC AWARENESS

The final component of Healthy Sight Counseling relates to heightened practitioner and patient awareness of the importance of healthy sight and the best ways to promote it for a lifetime.

Major ophthalmologic and optometric associations worldwide have been active in recommending schedules for routine vision care and in promoting screening programs for preventive eyecare, with special emphasis on high-risk groups (e.g., diabetics) and high-risk ocular diseases (e.g., glaucoma).

In addition to these efforts, the development of Seal of Acceptance programs (such as the World Council of Optometry's Seal of Acceptance for UV Blockers and Absorbers) ensures that eyewear products maintain acceptable levels of performance against strict independent testing protocols.

Communicating these safeguards to the public underscores the importance of these eyecare issues and heightens consumer confidence in products that have earned acceptance.

The goal of HSC is a lifetime of good sight. It is the task of the ECP to educate the patient on how to achieve the best quantity and quality of vision possible, to prescribe spectacles intelligently to achieve that goal, to promote the appropriate use of spectacles, and to advocate preventive eyecare to help protect and preserve eye health and well-being for a lifetime of healthy sight. EB

This article is an excerpt from the report "Healthy Sight Counseling: A New Approach to Healthy Vision" by Susan Stenson, MD.