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Liam Butler interviews NZAO President Andrew Sangster

Liam Butler interviews New Zealand Association Of Optometrists NZAO President Andrew Sangster.

17 December 2013

Liam Butler

Andrew has a special interest in contact lens practice and is one the few accredited orthokeratology practitioners in New Zealand. Andrew has a post-graduate qualification in ocular therapeutics which enhances his primary eye health care. His other special interests are ocular pathology and pediatric optometry. Andrew has represented the NZAO  overseas.

Question One: 

Sometimes older people can be perplexed by the myriad of options that can form the price of a pair of glasses. What tips can you give older people so they feel in control of their investment in glasses?

Andrew Sangster:

I think the simplest analogy to purchasing spectacles is that of purchasing a new car. There is a spectrum from  the basic, entry level cars that will take you from A-to-B through to the luxury models that have all the bells and whistles. There are also the specialist vehicles that are more task-specific. Some look pretty boring and some look pretty awesome, or just a bit weird. This is pretty much the same as spectacles and even when you have chosen the type of frames and lenses that "will do the job" there are optional extras like coatings and tintings that seem a bit like park-assist and any number of three-letter acronyms that plague the automotive industry. I shall try to break the options for spectacles down into simple ideas, so that you can make better-informed choices.

First let us consider needs. Some people only require a spectacle correction specifically for reading, computer, sewing or other hobbies, driving and/or television. Some people require correction for more than one task or even for everything other than sleeping. Therefore some people can get away with one pair of single-vision lenses, maybe more than one pair for different tasks or multi-focal lenses that perform more than one function in the one pair of spectacles. Some people need protection from sun, bright lights and glare. Some people require protective safety lenses for workshop work and using power tools.

Here are some optical terms that may be used.

-Single vision lenses: These lenses are of just one correction in the whole lens. No matter where one looks through the lens, the correction is the same. These are often used to correct distance vision and are also used in straight reading spectacles. The advantages are that anywhere one looks through the lens, the focus is consistent and this is useful for reading in bed, for example. These lenses are the basic entry level type of correction.

-Bifocal lenses: These are self explanatory. They are made up of two discrete parts, one for distance vision and one for reading in the lower half of the lens. These are the entry-level into the spectrum of multi-focal lenses. They are convenient for when one needs some reading "on the go" with having to continually put on and remove spectacles, but are best suited for tasks that have well demarcated distance and near tasks. There is not really any part of the lenses that really works well for intermediate-range tasks, such as computer work.

-Multi-focal lenses: This is where a lot of confusion reigns as there are many name for the same thing. They are also known as 'progressive lenses", "graduated lenses", "blended lenses" and "occupational lenses". Like a bifocal lens, there is an area of distance correction and an area for reading. However, rather than two discrete zones, the lenses change gradually through a middle zone from one focus to another. This transitional zone, or "corridor" is responsible for the intermediate range of vision and gives the spectacles more general purpose functionality than bifocal or single vision lenses. People who need to wear spectacles full time often find these the best option due to their multifunctional nature. These days multi-focal lenses are available in "stock" designs, through to fully customised lenses, tailored to you specifically.

-Occupational lenses: These are lenses that are made for optimal use in a work setting and tend to favour near-to-intermediate distances. These are often specially designed multi-focal lenses, but a bifocal lens can be made to suit such tasks as well. 

-Transitions lenses: More correctly termed "photo-chromatic lenses", these lenses are the type that tint automatically to varying levels of daylight when outside. Transitions is a brand name that has become synonymous with the technology. These are a convenient option that many people prefer over a clip-on sunglasses or the "fit-over" style of sunglasses.

-Anti-reflection coating: This is a special coating applied to lenses to reduce the surface reflections and improve the light transmittance through the lens. It appears as a slight coloured bloom on the lens surface, and reduces both the bothersome glare and improves cosmetic appearance of the lenses. 

While not an essential item, this is an option that does improve the performance of the lenses.

-Polarised lenses: These are a specialised tinted sun lens that reduces surface reflections significantly. There are great around water, snow and wet roads.

Many lenses are available in materials that are thinner and lighter. These are known as "high refractive index lenses", "high index lenses" or "high density lenses". These lenses are very good for people with strong corrections that need thicker lenses, as they reduce the weight and improve the cosmetic appearance of the lenses. This is an option that may be discussed with you, if appropriate.

Just about all lenses these days are of a plastic polymer. Glass lenses are quite rare. This means the benefits of lighter, impact lenses are not ubiquitous. Although plastic lenses have a reputation for scratching more easily, these days all lenses provided ion New Zealand come with a high quality scratch-resistant coating as standard. 

The spectacle frames are an item of personal taste. Some people are happy with a basic, functional frame; others desire something with more style and fashion. As a general rule, as with other products, you get what you pay for. Cheap and high-quality generally are not in the same sentence. Reading spectacles require a frame that is quite robust as they are continually being taken on and off. Full-time spectacles tend not to be handled as much and so can afford to be more delicate, if required. 

My advice is to take the time with your optometrist to identify what outcome you really want with spectacle correction you are getting. Ensure that you explain to your optometrist what you feel you need to see better and listen to the advice and discussion carefully. Do not be afraid to ask questions. Like all people, your Optometrist likes to show how much they know, and they love to help. We get great satisfaction in helping people achieve their best visual outcome possible.

Please feel comfortable communicating the budget you have to work with. Your Optometrist will be able to give you the appropriate advise as to what will be possible within your budget.Some options may not be necessary and other less expensive options may be quite practical. Some options fall into the "it would be nice" category and can be incorporated if the budget allows, and some may well be a higher priority. Ultimately it is your call, but please feel comfortable that you have had the best advice to help you reach the best decision for you and your vision.

Question Two:

What are the best tips you for us so we can treat our eyes well?

Andrew Sangster:

The best tip is for older people to plan for regular eye exams every 2 - 3 years.  You might think your vision is fine or that your eyes are healthy, but visiting your optometrist for a comprehensive eye exam is the only way to really make sure. When it comes to refractive errors, some people don't realise they aren't seeing as well as they could with glasses or contact lenses. In terms of eye disease, many common eye diseases (glaucoma, diabetic eye disease and age-related macular degeneration) are associated with age but often have no warning signs."

For the times between exams here are a few more tips for healthy eyes and good vision:

Eat right to protect your sight. Eat plenty of fruits and vegetables, particularly dark leafy greens such as spinach, kale, or collard greens.  Research has also shown there are eye health benefits from eating fish high in omega-3 fatty acids.

Maintain a healthy weight. Being overweight or obese increases your risk of developing diabetes and other systemic conditions which can lead to vision loss, such as diabetic eye disease or glaucoma. If you are having trouble maintaining a healthy weight, talk to your doctor.

Quit smoking or never start. Smoking is as bad for your eyes as it is for the rest of your body. Smoking has been linked to increased risk of developing age-related macular degeneration, cataract and optic nerve damage, all of which can lead to blindness.

Wear protective eyewear. Wear protective eyewear when playing sports or doing activities like DIY or gardening.

Be cool and wear your shades. Sunglasses are important for protecting your eyes from the sun's ultraviolet rays. When purchasing sunglasses, look for ones that comply with the latest Australian/New Zealand standards.

Give your eyes a rest. If you spend a lot of time at the computer or focusing on any one thing, your eyes can get fatigue and you sometimes forget to blink. Try the 20-20 rule: Every 20 minutes, look up and away for 20 seconds. This can help reduce eyestrain.

Know your family's eye health history. It's important to know if anyone has been diagnosed with a disease or condition since many are often hereditary. This will help you determine if you are at higher risk for developing an eye disease or condition.


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