Background. Financial disclaimer. The evaluation process. Objectives

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Prudence Floyd
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$In addition to the traditional use of lenses for refractive correction We now see true scientific studies showing ophthalmic lenses can provide an additional health benefit by blocking certain$ wavelengths of light. They are often referred to as therapeutic lenses. Financial disclaimer I Valerie Manso am President of Manso Management Resources, Inc.

wavelengths of light. They are often referred to as therapeutic lenses. Financial disclaimer I Valerie Manso am President of Manso Management Resources, Inc.

1 Background We are seeing the very early stages of a change in how we think about ophthalmic lenses. This is exciting stuff for optometrists and opticians! In addition to the traditional use of lenses for refractive correction We now see true scientific studies showing ophthalmic lenses can provide an additional health benefit by blocking certain wavelengths of light. They are often referred to as therapeutic lenses. Financial disclaimer I Valerie Manso am President of Manso Management Resources, Inc. A consulting company specializing in business and people development in the ophthalmic industry. I currently have ongoing contracts with BluTech Lenses, LLC and OD Excellence, LLC Therapeutic eyeglass lenses for treatment of: Achromatopsia (color blind) Age-related macular degeneration (AMD) Cataracts Corneal pathology Diabetic Retinopathy Glaucoma Night Blindness Retinitis Pigmentosa Attention deficit hyperactivity disorder ADHD Symptom Improvement Seasonal Affective Disorder (SAD) Ultra Violet and Blue Light Danger Prevention of migraine onset Objectives At the conclusion of this session the participants will: 1. Have an understanding of how eyeglass lenses can assist in the treatment of medical disorders 2. Become familiar with the most commonly treated medical conditions 3. Have the tools to discuss medical eyeglass lens treatments The evaluation process Selecting the appropriate filter to minimize eye discomfort and maximize visual resolution is dependent on an individual sense of what helps. As a rule of thumb for a successful vision assessment, determining the best filter requires balancing light sensitivity issues with appropriate filter color selection 1

Evaluation tips For maximized visual acuity, select the highest visible light transmittance (VLT) possible within a group of filter colors appropriate for the eye disorder.

Use a method of trial and error with various filter colors and visible light transmittances to determine the filter.

2 Evaluation tips For maximized visual acuity, select the highest visible light transmittance (VLT) possible within a group of filter colors appropriate for the eye disorder. Then, working from lightest to darkest, offer companion products until the patient responds favorably. Use a method of trial and error with various filter colors and visible light transmittances to determine the filter. Where possible, allow for outdoor testing of colors Achromatopsia Hereditary Non-progressive Often accompanied by nystagmus (shaking of the eyes) Patients perform best in low light conditions Therapeutic filters Absorb visible light energy to provide a more comfortable viewing experience. This visible absorption may also protect the retina against long-term exposure to highenergy wavelengths, which are associated with the deterioration of the center of the retina and contribute to macular degeneration. UV absorption (UV A, B & C) to 400nm radiation that is related to cataract formation. Achromatopsia Effects of Achromatopsia (Varying degrees of effects between achromats) Dazzling Glare Sensitivity Discomfort Glare Sensitivity and Colorblindness Poor Visual Acuity Problems adapting to high levels of light causing photophobia in bright lighting. Some photophobia in indoor and low lighting settings. Achromatopsia Filters for Achromatopsia Characterized by the lack of normal "cone vision." Where normal eyes have 6 million cone photoreceptors, located mostly at the center of the retina, achromats have far fewer and rely on "rod vision." Rods do not provide color vision or good detail vision, thus achromat patients are typically totally colorblind or almost totally colorblind, and have poor visual acuity. There are only 10,000 documented individuals with achromatopsia in the USA 2

Therapeutic Aspects of Eyeglass Lenses Age Related Macular Degeneration (AMD) 2/22/2016 How Serious Is AMD?

patient with intermediate to late AMD is that someone is going to have to bring their family member into our office to receive monthly

The disease causes a central scotoma, or a decrease in central vision.

In 2014 10,000 people will be turning 65 EACH DAY DR.

Genetics MACULAR PIGMENT Low Macular Pigment Density Gender, More Common in Women than Men AMD has reached epidemic proportions and is

AMD Risk Factors Smoking Out of this growing population, the conservative estimates would say there will be a minimum of 2.

3 Therapeutic Aspects of Eyeglass Lenses Age Related Macular Degeneration (AMD) 2/22/2016 How Serious Is AMD? If we do not work together to catch the disease early and slow with proper treatment & supplementation the best case scenario for a patient with intermediate to late AMD is that someone is going to have to bring their family member into our office to receive monthly injections directly into one or both eyes. Macular Degeneration is the progressive deterioration of the central area of the retina. The disease causes a central scotoma, or a decrease in central vision. While peripheral vision remains intact, mobility is often impaired. AMD, The Epidemic Are we ready? In ,000 people will be turning 65 EACH DAY DR. MICHAEL TOLENTINO, MD Retina Specialist Clinical Director- Center for Retina & Macula Disease AMD Risk Factors DNA Family History, Genetics MACULAR PIGMENT Low Macular Pigment Density Gender, More Common in Women than Men AMD has reached epidemic proportions and is already more common than alzheimer s, parkinson s, breast cancer, and prostate cancer combined AMD, The Epidemic Are we ready? AMD Risk Factors Smoking Out of this growing population, the conservative estimates would say there will be a minimum of 2.7 million new Dry AMD patients each year on top of the existing 15 million, and at least 210,000 new WET AMD patients that will need to have monthly or bi-monthly injections into one or both eyes added to the existing 1.7 million patients in the U.S. that are already receiving these injections. Blue Light Exposure Diet, Obesity, High Cholesterol (American Lifestyle) 3

Age Related Macular Degeneration (AMD) Filters for Macular Degeneration Research indicates one of the

can increase macular pigment Individuals with a family history of AMD and/or other risk factors should take

retina from damaging High Energy Visible (HEV) blue light Use of blue light filtering coatings or in mass

of Macular Degeneration Central Scotoma(s) Blue light is the highest energy visible light that gets to the

(Plancks Law the lower the wavelength the higher the energy or potential damage) Most UV or non-visible

Decreased Contrast Sensitivity Blurred Vision Discomforting Glare Dazzling Glare Sensitivity *The young

4 Age Related Macular Degeneration (AMD) Filters for Macular Degeneration Research indicates one of the pre-indicators of age related macular degeneration is the decrease of macular pigment Ocular supplements can increase macular pigment Individuals with a family history of AMD and/or other risk factors should take ocular supplements Age Related Macular Degeneration (AMD) Another preventative measure is to protect the retina from damaging High Energy Visible (HEV) blue light Use of blue light filtering coatings or in mass lenses is recommended Must provide protection / filtration from 400 nm to 440 nm Blue Light Hazard Effects of Macular Degeneration Central Scotoma(s) Blue light is the highest energy visible light that gets to the retina (back of eye) where AMD occurs. (Plancks Law the lower the wavelength the higher the energy or potential damage) Most UV or non-visible light is screened out by the cornea and lens before it can hit the retina. Decreased Contrast Sensitivity Blurred Vision Discomforting Glare Dazzling Glare Sensitivity *The young humanlens transmits a small window of UV-B light (320 nm) to the retina REFERENCE: Albert R. Wielgus, Joan E. Roberts. Retinal Photodamage by Endogenous and Xenobiotic Agents Photochemistry and Photobiology, 2012, 88:

The Real Wavelength Impact ADHD Symptom Improvement 400 nm 500 nm Blur & Glare 400-420 nm STOP Photoreceptor and RPE damage (AMD) 400-440 nm Max Disruption of Sleep/Wake Cycle at night 459-484 nm 25

Their discovery also has also been shown to improve sleep patterns among people who have difficulty falling asleep.

Anecdotal evidence is emerging that blue filtering lens materials such as OLP lenses are having the same impact; improving sleep patterns and behavioral improvements Ocular Lens Pigment Nature s

The special glasses block the blue rays that cause a delay in the start of the flow of melatonin, the sleep hormone.

Advancing the circadian rhythm has been shown to improve both objective and subjective measures of ADHD symptoms in studies at the University of Toronto.

00% 90.00% 90.00% 88.00% 87.00% 90.00% 92.00% 97.00% OLP Lenses OLP Lenses Vs Blue Light AR Coating 1.00% 0.90% 0.80% 0.70% 0.60% 0.50% 0.40% 0.30% 0.20% 0.10% 0.

5 The Real Wavelength Impact ADHD Symptom Improvement 400 nm 500 nm Blur & Glare nm STOP Photoreceptor and RPE damage (AMD) nm Max Disruption of Sleep/Wake Cycle at night nm 25 Scientists at John Carroll University, working in its Lighting Innovations Institute, have developed an affordable accessory that appears to reduce the symptoms of ADHD. Their discovery also has also been shown to improve sleep patterns among people who have difficulty falling asleep. The John Carroll researchers have created glasses designed to block blue light, therefore altering a person's circadian rhythm, which leads to improvement in ADHD symptoms and sleep disorders. Anecdotal evidence is emerging that blue filtering lens materials such as OLP lenses are having the same impact; improving sleep patterns and behavioral improvements Ocular Lens Pigment Nature s Protection ADHD Symptom Improvement How the Glasses Work The individual puts on the glasses a couple of hours ahead of bedtime, advancing the circadian rhythm. The special glasses block the blue rays that cause a delay in the start of the flow of melatonin, the sleep hormone. Normally, melatonin flow doesn't begin until after the individual goes into darkness. Studies indicate that promoting the earlier release of melatonin results in a marked decline of ADHD symptoms. Advancing the circadian rhythm has been shown to improve both objective and subjective measures of ADHD symptoms in studies at the University of Toronto. Twentynine adults diagnosed with ADHD participated in a threeweek trial. Unique Formula Advantage TRANSMITTANCE (%) Blue Light AR 18.00% 40.00% 80.00% 88.00% 90.00% 90.00% 88.00% 87.00% 90.00% 92.00% 97.00% OLP Lenses OLP Lenses Vs Blue Light AR Coating 1.00% 0.90% 0.80% 0.70% 0.60% 0.50% 0.40% 0.30% 0.20% 0.10% 0.00% OLP Lenses filter 470% MORE in the Blur/Glare range ( nm) OLP Lenses filter 260% MORE in the AMD space ( nm) 0% 2.30% 13.90% 28.10% 37.60% 46.30% 54.80% 59.10% 64.40% 71.80% 72.30% Blue Light AR WAVELENGTH (nm) OLP Lenses OLP Lenses filter 530% more in the Sleep/Health Impact arena ( nm) Cataract A cataract is the clouding of the lens of the eye. A cataract is apparent within the lens (nucleus, cortex and capsule) when the nucleus becomes opaque or when small opacities develop in the cortex, blocking or scattering light 5

Cataract Effects of Cataract Blurred distance vision, especially outdoors. Headlights and stoplights appear to have streaks or halos.

Color distinction is impaired, blues appear green and yellow appear white Corneal Pathology Corneal Pathology is characterized by an injury or damage to the cornea resulting in a distorted or clouded

Effects of Corneal Pathology Contrast Sensitivity Discomfort Glare Sensitivity Loss of Detail Cataract Filters for corneal pathology One of the eye s natural protections exists in our intraocular

6 Cataract Effects of Cataract Blurred distance vision, especially outdoors. Headlights and stoplights appear to have streaks or halos. Discomfort - Glare Sensitivity Veiling Glare Sensitivity Decreased Contrast Sensitivity Reading ability is impaired because print appears faded and lacks contrast. Color distinction is impaired, blues appear green and yellow appear white Corneal Pathology Corneal Pathology is characterized by an injury or damage to the cornea resulting in a distorted or clouded image and increased glare sensitivity. Effects of Corneal Pathology Contrast Sensitivity Discomfort Glare Sensitivity Loss of Detail Cataract Filters for corneal pathology One of the eye s natural protections exists in our intraocular lens ocular lens pigment Young eyes do not have sufficient levels of ocular lens pigment. Ocular pigment is at the optimum levels just before we remove the lens because of the formation of a cataract HEV filtering lenses for indoor and outdoor use are highly recommended Filters for Cataracts Corneal Pathology Contact Lens Treatments Indications for using soft contact lenses therapeutically include: protecting a compromised ocular surface pain management promoting epithelialization or wound closure 6

Corneal Pathology Contact Lens Treatments Filters for Diabetic Retinopathy Persistent epithelial defect

advanced longterm diabetics and affecting the macula or the entire retina and vitreous.

death of nerve cells and possible permanent vision loss Effects of Diabetic Retinopathy Discomforting

7 Corneal Pathology Contact Lens Treatments Filters for Diabetic Retinopathy Persistent epithelial defect (PED) Diabetic Retinopathy Diabetic Retinopathy is the leaking of retinal blood vessels occurring in advanced longterm diabetics and affecting the macula or the entire retina and vitreous. While not all diabetics develop retinal changes, the likelihood of retinopathy increases the longer a person has diabetes. Glaucoma Glaucoma is characterized by a blockage of the aqueous humor, the fluid which normally drains from the front part of the eye. As the internal pressure of the eye increases, the optic nerve is compressed, eventually causing the death of nerve cells and possible permanent vision loss Effects of Diabetic Retinopathy Discomforting Glare Sensitivity Decreased Contrast Sensitivity Blurred Vision Dazzling Glare Sensitivity Unimpaired Peripheral Vision Effects of Glaucoma Decreased Contrast Sensitivity Night Blindness Decreased Response to Magnification Loss of Peripheral Vision Increased Illumination Requirements 7

Filters for Glaucoma Effects of Retinitis Pigmentosa Discomfort Glare Sensitivity Dazzling Glare Sensitivity

Increased Illumination Requirements Night Blindness Filters for Retinitis Pigmentosa Night Blindness is characterized

posttreatment vision-corrective laser surgery Retinitis Pigmentosa A group of diseases, often hereditary,

Clinical signs include a reduced range of vision, an inability to see in dim light, loss of color of the retina,

Relief for Migraine Sufferers May be prescribed tinted lenses with an intuitive colorimeter a device used to

8 Filters for Glaucoma Effects of Retinitis Pigmentosa Discomfort Glare Sensitivity Dazzling Glare Sensitivity Decreased Contrast Sensitivity Night Blindness Decreased Response to Magnification Loss of Peripheral (side) Vision Increased Illumination Requirements Night Blindness Filters for Retinitis Pigmentosa Night Blindness is characterized by halos or dazzling glare around headlights, streetlights and street signs, often associated with AMD cataracts or posttreatment vision-corrective laser surgery Retinitis Pigmentosa A group of diseases, often hereditary, characterized by degeneration of both retinas, beginning in childhood and progressing to blindness by middle age. Clinical signs include a reduced range of vision, an inability to see in dim light, loss of color of the retina, degeneration of the central part of the retina, and eventual vision loss. Relief for Migraine Sufferers May be prescribed tinted lenses with an intuitive colorimeter a device used to illuminate text with different colored lights creating for each patient an optimal color of light that led to the greatest comfort by reducing distortion The lenses are called Precision Tinted Lenses PTL 8

9 Migraine Relief Scientifically Tested Once in the fmri machine, subjects were exposed to a range of striped patterns while their brain images were acquired. Then the researchers analyzed the effect of the tinted lenses on the activation of the different visual areas of the brain. Specifically, the tinted lenses decreased hyperactivation for migraine sufferers in visual area V2 of the visual cortex of the brain. Although patients reported some relief (a 40 percent improvement) using the control lenses, the precisiontinted lenses had a significant effect (70 percent improvement) when viewing the stressful stripes. Review Ophthalmic lenses can be used to treat medical conditions Work with your Ophthalmological and Optometric partners to become educated; then put your knowledge into practice so many patients will benefit 9

ADHD 2/15/2016. Blue Light Hazard. Implementing a Blue Light Practice. Goodbye Old Friend

ADHD 2/15/2016. Blue Light Hazard. Implementing a Blue Light Practice. Goodbye Old Friend 2/15/2016 Blue Light Hazard Implementing a Blue Light Practice 1 4 2 5 Goodbye Old Friend ADHD Standard incandescent bulbs have been phased out, legislated away Some specialty incandescent bulbs such as