Keeping them in focus

Copyright 2007 Sharon Crawford

When we age, so do our eyes, but baby boomers and seniors are at different points in the road. Their vision requirements usually differ but so do their attitudes. Eyecare professionals need to remember that they are not only treating the eye condition, they are also treating the client.

“If you’re dispensing advice and glasses, you need to instil in the patient confidence in you,” says Eye Contact’s Lorne Eidinger. Eidinger, an optician for 27 years, provides on-the-spot eyeglass fittings at senior’s facilities in the Greater Toronto Area. He also shares an office with two Oakville ophthalmologists.

“They (seniors) should be treated the same as anybody else,” says Eidinger. It [age] doesn’t take away from who they are. They may perceive that being a senior they have more time.” Listen to them. “There is so much that happens because of the lack of communication.” He adds that seniors don’t want to go blind. They are aware of age-related eye diseases such as cataracts and macular degeneration “but they don’t know a whole lot about it.”

Baby boomers are “a much more demanding demographic,” says Eidinger. “They’re much more aware of new products, more price-conscious, more educated. We as eyecare professionals need to be able to deal with them about eye products. We need to know our stuff; if you don’t you’ll be passed by and they’ll go with someone they feel more comfortable with.”

“Sometimes expectations are too high, especially [those] in their 50s and 60s,” says Toronto optometrist, Kristin Heeney. A male patient, who had cataract surgery, “was expecting it to be perfect the day after and was worried when it wasn't.” 

So, what eyecare products are available for baby boomers and what vision problems do they address?

As people age, their eyes can become “dry;” the tear glands make insufficient tears or the quality of tears decreases. Eyes can burn or itch, which is not conducive to wearing contact lenses. There is also the lifestyle factor – busy boomers may not have time to clean contacts, says Eidinger. “People get complacent, lazy. Glasses become a viable option [for] easy care.” Besides glasses to help them see, boomers want style. That means invisible bifocals for distance and reading –“They’re [bifocals] getting better every year,” says Eidinger. “There’s less distortion for reading, for computers.” Frames are smaller. However, “if they spend a lot of time with the computer, they should get separate glasses” because the bifocal’s reading area can be too small, resulting in possible neck and eye strain from lifting the head and neck to see the screen.

For boomers sticking with contacts, there are disposables, which are replaced every two weeks maximum, frequent replacement lenses for discarding after a month, and traditional disposables lasting up to six months.  “They can continue to wear contacts at any age; depending on how dry their eyes are,” says Dr. Heeney. “The newer generation of contact lenses [are made] for dry eyes.” They are designed to decrease moisture loss on the eye’s surface. “As their eyes get drier, [patients can] take Omega-3 fish supplements to help improve the oils in the tears.” She advises boomers start with contacts for functional wear. Glasses or contacts are “an individual choice, as long as there are no health concerns.”

Eidinger suggests the following best-care scenario for boomers: computer-dedicated glasses with anti-reflective coating, UV coating and a tint appropriate for colour of their screen, plus a separate pair lightweight and comfortable glasses, which may be bifocals for [print] reading and walking, and sunglasses.  Photochromic lenses can prevent the necessity of having a separate pair of sunglasses.

As we age further, medical problems can hinder eyesight. Some, such as cataracts, glaucoma and macular degeneration, are eye diseases, but diseases such as diabetes, poor blood circulation and Parkinson’s disease can affect vision.

“Diabetes can lead to permanent vision loss,” says Dr. Heeney. She recommends annual eye examinations for diabetics. The longer they’re diabetic, the easier they can develop diabetic retinopathy with small haemorrhages and edema. Vision correction products include bifocals and progressive lenses.

Retired Toronto real estate agent Robert Marwick, 74, was recently diagnosed with Parkinson’s disease. It hasn’t yet affected his eyesight or his bifocals. It could, says Eidinger. “Sometimes [they] have issues with bifocals because of stiffness and have trouble moving the eye.” Then, bifocals need replacing with separate reading and distance glasses.

Jean Taylor, 87, of Toronto had both legs amputated – above and at the knee – in the last two years because of poor circulation. She’s now in a wheelchair. She had a stroke seven years ago, a mini-stroke between amputations, glaucoma in both eyes for 20 years, and had cataracts. She’s at Lorne Eidinger’s vision clinic at Shepherd’s Village for new glasses because the reading portion of her old bifocals is too small to read the newspaper.  “She’s fashion conscious,” says daughter Doreen Taylor who, with Jean’s grandson, Greg, has accompanied her to the residence’s clinic. “She’s going back to the old-fashioned half and half.”

“If it’s going to help me, then that’s good,” says Jean.

Doreen says Jean also “has this problem where one eye seems to be closing more since her stroke.” 

 “There are certain strokes that can affect your vision,” Eidinger says. “It’s an individual thing.” He checks Taylor’s optometrist report and confirms the newspaper-reading problem. He hands her a mirror, removes two plastic-framed clear glasses from a tray and helps her try them on.  One frame is pink, the other mauve. “We want to keep it proportional to the size of the face,” he says. “It’s important that it feels comfortable around the nose – that can’t be adjusted.” He says you need to gauge the eyes’ location vis-a-vis the frames.

But Jean doesn’t want to see her eyebrows.

“Eyebrows and frame top should go in the same way.” Eidinger pushes the bridge. “How does that feel? Do you feel any pain?” Then he says he’s measuring for the bifocal part. “Look straight ahead and just ignore me.” He places tape on the glasses. “Tell me if that tape just blocks your vision or if it is just comfortable.”

“I can see over it,” says Jean. She decides on the pink frames. 

Taylor also had cataract surgery on both eyes within the last 10 to 12 years. Surgery isn’t the first visual correction for cataracts, if caught early. “Cataracts are an aging of the lens inside the eyes,” says Dr. Heeney “It’s a degradation in vision that happens slowly over time. I’ve seen them in people as young as 30.” 

“We’re all going to get them,” adds Eidinger. “It’s like gray hair.”  Glasses can be prescribed for a time and “ultra violet [tint] is really a good idea if one has cataracts – the filter is good.”  He doesn’t recommend [other] tinting because it blocks the light coming in. Surgery is necessary, “when we can’t make the necessary changes to the prescription, when we can’t catch up to the changes in the eye.”

For clients anxious about surgery, Heeney suggests offering these reassurances: “[Cataract] surgery today is much different than 20 to 30 years ago.” It’s day surgery – one eye at a time – into surgery for prepping,  20-minute surgery to remove the cloudy lens and implant a plastic lens to try correcting distance vision, one-hour stay afterwards; patient goes home and returns next day for a checkup. Healing takes about a month. Afterwards, clients need glasses for reading and distance and they should be changed a month after surgery. Here, Heeney’s 59-year-old patient “was amazed at how clear his vision was.” 

Glaucoma affects the peripheral vision first, says Dr. Heeney. The pressure on the inside of the eye increases, causing vision loss. Often people don’t notice until damage is severe. “If caught early, there are treatment options.”  But she says not everybody wants the eye drops glaucoma test. “Some outright refuse the drops. Some are scared of the drops. Some have had bad reactions to the drops.” She stresses the importance of educating clients but if they refuse drops, she “makes a note in their file and has them sign it,” and uses the visual field to check for glaucoma.

For early treatment, she applies the two M’s – medication and management. Medication relieves eye pressure. Management includes low visual aids, such as magnifiers to see better, canes to get around and lifestyle such as diet, exercise and quitting smoking.

“Macular Degeneration is basically an aging of the retinal tissues,” says Dr. Heeney. It is best to diagnose early and do preventative treatment such as vitamins and minerals, including antioxidants and zinc recommended from the US National Eye Institute’s AREDS (Age-related Eye Disease Study). The study showed high doses of these products can greatly decrease risks of macular degeneration and the accompanying vision loss and may retard the disease and vision loss if someone has it. Cortisone medication can slow down leaking from blood vessels and prevent more vision loss. For advanced macular degeneration, surgery is available. “The key point to stress for patients with macular degeneration is that doing surgical or medical intervention is to preserve vision not restore lost vision,” says Dr. Heeney. “In some cases the vision may improve but they shouldn't have that expectation.” To help patients with the trauma of vision loss she refers them to the C.N.I.B.

However, says Eidinger, usually seniors’ vision correction involves upgrading glasses for cataracts or aging. He recommends glasses, not contacts, because of manual dexterity problems and concerns about possible infection. He advocates bifocals instead of separate distance and reading glasses because seniors could misplace a pair or become confused which one to use. For depth perception problems, he suggests separate glasses.

“If you can make a difference,” Eidinger advises, “that’s a good thing.”