Both maintenance and preventive vision care are important to help ensure healthy sight for the patient. The model for this can be adopted from general medical/primary care practice. Consider the medical approach to general care:
- Patients receive examinations at regular intervals
- Careful history-taking with emphasis on the chief complaint and present and prior medical history
- Proper diet, exercise, and healthy lifestyle considerations for the individual are an integral part of the discussion with the clinician
- Based on the history and physical examination, specific preventive measures are indicated
- Laboratory and specialized diagnostic tests are ordered as indicated
- Specific prescriptions targeting the individual’s symptoms are generated so as to treat and/or to prevent disease
A very similar approach can be used in vision care. There are four basic components of the complete eye exam: 1) the chief complaint and patient history; 2) the eye health examination, including refraction, 3) additional diagnostic testing as indicated (eg, visual field, OCT, pachometry, fluorescein angiography, laboratory and radiologic studies); and 4) the generation of the customized eyeglass prescription for vision correction, along with prescriptions for topical and/or systemic medications in the event of disease.
The Medical and Ophthalmic History
Ophthalmic history-taking should be comprehensive and provide insights that allow the vision care professional to obtain a broad view of the patient’s individual needs.
These needs are based on a range of factors, including:
- Presenting complaint
- Age
- Gender
- Lifestyle
- Sports or recreational activities
- Computer use
- Occupation
- Existing or prior systemic medical conditions or illnesses
- Current or prior ocular conditions
- Medications in use—topical, systemic, prescription, and non-prescription (OTC) medications
- Any recent or prior eye surgery
- Any family history of ocular disease
- Eyewear history
There are 3 basic categories of potential adverse effects of medications on the ocular system:
- Blurred or decreased vision secondary to drug-related shifts in the refractive state. Here the quantity of vision is affected.
- Medication-induced glare, increase light sensitivity, or impaired light-dark adaptation. Here quality of vision is affected.
- Medication-related ocular diseases such as cataracts, keratopathies, retinopathies, maculopathies, optic neuropathies and glaucoma, which can affect both quantity and quality of vision.
Side effects from certain medications are typically long-term, potentially more serious, and pose a greater threat to vision. However, their progression can usually be prevented, or at least limited, if recognized early and the offending agent is discontinued or the dosage reduced.
Educating the Patient
With Healthy Sight Counseling, patient education embraces a number of important topics for discussion:
- Ocular health: the importance of maintenance and preventive vision care
- The relationship between ocular and systemic health
- Healthy lifestyle to promote overall health and well-being
- Healthy visual lifestyle to promote good vision and long-term ocular health and well-being
- The differences between quantitative and qualitative vision and how they impact on visual comfort, convenience, and satisfaction
In addition, Healthy Sight Counseling includes a discussion of the role of eyeglasses in promoting Healthy Sight, including:
- Tinted lenses, clips, and shields
- – Reduce excessive light and often provide UVR protection
- – When using these options always recommend 100% UVR blocking lenses or filters
- Photochromic lenses
- – Help protect vulnerable ocular tissues by automatically blocking 100% of harmful UVA and UVB radiation
- – Promote visual comfort and convenience and reduce eyestrain by titrating light as they adjust the level of tint based upon changing ambient light conditions
- – Preserve and enhance contrast sensitivity and decrease discomforting and disabling glare
- AR coatings
- – Reduce glare, indoors and at night
- Polarized lenses
- – Reduce the blinding glare caused by reflected light from water or snow
- Lens materials (such as Trivex® or polycarbonate)
- – Provide extra safety through impact protection
- High index lenses to improve cosmetics and decrease distortion in high power lenses
- Lens designs that utilize aspheric curves to decrease peripheral distortion
- Bifocal, trifocal, and multifocal (progressive) lenses to provide intermediate and near vision in presbyopes
Patients should understand the value-added functions of these eyeglass lens enhancements, materials, and designs and how they serve to protect their eyes, preserve their vision, provide visual comfort and convenience, and enhance their overall visual experience, serving as instruments for them to achieve and enjoy Healthy Sight.
Creating Public Awareness
A 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 to their members schedules for routine vision care and in promoting screening and examination programs for preventive vision care, with special emphasis on high-risk groups (eg, diabetics) and for high-risk ocular diseases (eg, glaucoma).
In addition to these efforts, the development of Seal of Acceptance programs (such as the World Council of Optometry’s Global Seal of Acceptance for UV Blockers and Absorbers) ensures eyewear products maintain acceptable levels of performance against strict independent testing protocols. Communicating these safeguards to the public underscores the importance of these vision care issues and heightens consumer confidence in products that have earned acceptance. In keeping with the spirit of Healthy Sight Counseling, vision care professionals should recommend only products that carry these seals.