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Blue light is one of the most talked about vision care topics in recent years, both within and without the optical industry. Professional journals, trade publications and even consumer media are filled with articles about the potentially harmful effects of blue light on the eye, as well as its effect on sleep patterns, mood and overall wellness. The mounting concerns about exposure to blue light, particularly high energy visible light (HEV) which is centered around 430 nm (+ or - 20 nm), are largely due to our increasing use of smartphones, tablets and computer screens, all of which emit HEV light.

This scenario presents an ideal opportunity for eyecare professionals to educate their patients about blue light’s hazards and advise them on how to protect their eyes. Many ECPs, having educated themselves about blue light, are positioning themselves as blue light specialists, while others are rapidly getting up to speed on the subject.

VM spoke with nine ECPs who have made blue light management an important part of their patient care regimen. They gave us their perspective on the practical elements of addressing the issues, including the nature of the threat, the patient conversation and the products they use to alleviate blue light problems.

Although the ECPs offered a variety of opinions and approaches, the consensus was virtually the same—the threat is real, patients are responsive, the products are effective and the practice-building opportunity is significant.

The Blue Light Threat
The practitioners we interviewed discussed the blue light threat in three areas: retinal health, sleep issues and Digital Eye Strain (DES). Most noted that they see all three as areas of concern, but different doctors emphasized different aspects of the problem. For Bradley Schwartz, OD of Oneota Valley Family Eye Care in Decorah, Iowa, the potential for retinal damage is uppermost. “More and more we’re finding science models that are suggesting that chronic exposure to high-energy blue light could potentially lead to macular issues,” Dr. Schwartz said.













Gary Morgan, OD of Eye Tech Eye Associates in Peoria, Ariz., believes that “probably the biggest opportunity in practice right now for any doctor is the digital eye strain opportunity,” and he emphasized blue light’s contribution to the problem.

“Blue light is myopically defocused in front of the retina,” so it is already slightly out of focus when it reaches our eyes, he explained. Additionally, it is the hardest type of light for the eye to process. “When we look at photoreceptor populations in the retina, only 2 percent... are blue, and in the fovia there aren’t any blue cone photoreceptors. So the combination of the out-of-focus light and a little more difficulty in processing it leads to the symptoms of digital eye strain.”

Interviewees were divided regarding how to address blue-light-related sleep issues. While acknowledging that there are a lot of anecdotal reports about blue-filtering lenses that promote better sleep, Dr. Morgan said, “We don’t have any definitive studies or proof as to how much light… would have an effect on preserving that circadian rhythm, and we don’t have any definitive studies that lens products will help that.”

Dave Ziegler, OD of Ziegler Leffinwell Eye-care in West Allis, Wis., believes there are too many variables in sleep quality to draw a connection at this time. “It’s a tough topic asking somebody how they sleep, it’s so variable day-to-day…it’s hard to say…one day you sleep well, the next day you don’t for all sorts of reasons,” he said.

However, several ECPs felt there is enough evidence to address the concern with patients, especially parents. Said Dr. Schwartz, “I think most parents can relate to the idea that at night, when they or their kids are using these devices, they wonder why they don’t have a restful sleep. Part of that can be because of the blue light they’re exposed to at night.”

While all of the ECPs we contacted were concerned about indoor blue light, some noted that the connection to health issues hasn’t been established with certainty. According to Dr. Morgan,“The question that’s unanswered, is whether the intensity of that (indoor) light, the proximity of that light to the eye, and the duration of the exposure will lead to cellular damage that’s going to eventually lead to AMD (Age-Related Macular Degeneration). You have to remember that AMD is a multifactorial disease.” Or, as Dr. Schwartz put it, “We don’t know what we don’t know about blue light.”

Despite the uncertainties, all of the ECPs we spoke with felt that they knew enough to be concerned—and to protect their patients. Barry Toyzer, OD of The Eye Doctors in Havertown, Pa. expressed the general sentiment. “We don’t understand the effects of indoor blue light completely, but there’s plenty of reason to protect yourself. I compare it to a seatbelt: you may not need it, but why take the risk?”


The Most Vulnerable Patients
Most of the ECPs we talked with agree that everyone should be concerned about blue light, and everyone should be protected from it. However, several suggested that the greatest vulnerability was found in the youngest and oldest patients.

Several noted with alarm that even very young children are spending more and more time looking at digital devices. “I’m concerned that digital screens are being used as babysitters for young kids,” Dr. Toyzer said.

Exposure is compounded when children enter school. Jennifer Stewart, OD of Norwalk Eye Care in Norwalk, Conn., observed that “kindergartners are taking standardized tests on computers,” and in later years, most homework is done on computers.

Dr. Morgan explained why children are particularly vulnerable. “Children and even folks who are a bit older don’t have a lot of protection against blue light, simply because the lens of the eye hasn’t matured. We really don’t see any significant pigment in the lens up until mid- to late 30s or early 40s.”

Because they can focus on objects at closer range than adults can, children tend to hold smart phones very close to the eye, which exacerbates the problem, according to Dr. Toyzer. “We often see them holding the screen very close to the eye. Since light intensity increases exponentially as it gets closer to your eye, at six inches away you’re getting 16 times the intensity compared to holding the screen 24 inches away,” he said.

The gradual coloration of the eye’s lens over time provides some natural protection for older patients, but the level of vulnerability can change dramatically if the patient has cataract surgery. Michael Lange, OD of Lange Eye Care, a seven-location practice in Florida, noted that “you’re more likely to have macular degeneration after you’ve had cataract surgery.” When the surgeon removes the patient’s natural lens, “you’re back to where you were when you were a kid. You’re back to a clear implant that doesn’t filter out any of the blue light.”

For Trent Pitt, OD, and his colleagues at Oklahoma City Vision Source in Oklahoma City, Okla., the category of vulnerable patients has become all-inclusive. “When Essilor came up with Crizal Prevencia, we were thinking that patients who sit in front of computers should be the main patients who have should have this anti-glare product… but in reality everybody should have it now.”






Product Preferences
The ECPs we spoke with recommended a full range of blue light products, including blue-filter AR, blue-light absorbing lens materials, sun lenses and dietary supplements, often in combination.

A number of practitioners are fans of blue-filtering AR coatings, because they already understand that the benefits of AR coating make it easy to sell. Dr. Ziegler, who recommends Prevencia, said, “We have 100 percent AR usage in our practice. All the lenses we make have AR coating. Now we basically just say ‘in addition to the benefits you’ve experienced before with AR coating, non-glare, anti-scratch, anti-smudge, now we can block out harmful blue light.’”

Dr. Schwartz, who uses Hoya Recharge, agrees. “When patients see that it’s a minimal upgrade in expense, they see that is a no-brainer, so we find great acceptance from patients.”

For Dr. Toyzer, the blue-filtering properties of Zeiss DuraVision BlueProtect AR provides good basic protection for blue light exposure. “BlueProtect is a good start that works well for all patients. If the problems or the risk seems extreme, I sometimes recommend amber-colored lenses, especially to be worn after dinner.”

Dr. Ziegler noted the importance of demonstrating blue-filtering AR to avoid potential patient objections about the reflectance color. “We say ‘this is how it looks, it’s going to have a little of a bluish-purple color.’” This gives them the chance to opt for an AR coating without blue filtering. He and other ECPs have learned to spin the reflectance color into a positive. In Dr. Schwartz’s words “we say ‘if you see that reflection, you know that the lens is protecting you, because the blue light is being reflected back out.’ At least here in Decorah, wearing a blue reflecting lens is a cool thing.”

Dr. Stewart uses a blue-blocking AR lens such as Crizal Prevencia, Hoya Recharge or BluTech lenses from BluTech, depending on the situation.

“Basically it comes down to a cost factor,” explained Dr. Stewart. “The blue anti-reflective treatment, like the Hoya Recharge, I sell that for the same cost as I do for a regular anti-reflective treatment. That’s an easier sell than the additional add-on price for the BluTech lenses.

She uses BluTech primarily as an outdoor lens because “you get the protection, the sharp vision, and also the fact that it doesn’t distort your phone and the digital devices that we can’t do without.” She also uses BluTech’s OTC glasses for patients who don’t have a prescription or wear contact lenses.

“They’re inexpensive, you can leave them at the office, or throw them on over your contact lenses,” she said. They also make a good demonstration tool. “Just put them on and see how that glare (from the screen and the lights) goes away.”









Steve Ford, an optician at Bexley Optical Boutique in Bexley, Ohio, also sells a lot of sunglasses and describes himself as “an avid fan of the Coppertone lenses from Vision Ease for my sunglass lenses with HEV (High Energy Visible Light) protection. We recommend sun lenses to all of our patients, even when they’re coming in to get new prescription glasses.”

He has also found a way to provide outdoor blue light protection for people who aren’t ready to buy prescription sunglasses. “If they don’t want to get glasses that particular time, I’ve been doing clip-ons, and putting HEV polarized lenses into their clips for them.”

Dr. Morgan likes to use Sharper Image TechShield lens from VSP Optics Group, which combines blue-filtering AR with an in-monomer blue light absorber. “That particular lens is very effective at the shortest wavelengths. It has a very good effect on digital eye strain as well as protecting against retinal damage.”

One of the technical challenges for makers of blue filtering lenses is being able to deliver good color vision and contrast while still offering protection. According to Alyx Morey, OD of Makar Eye Care in Anchorage, Alaska, the Happy Lens, a sun lens from Spy Optic, excels in those areas.

“The Happy Lens keeps colors vivid while blocking short-wave blue and UV rays and letting in beneficial blue light,” Dr. Morey said, noting that the lens is also comfortable to look through because “it softens the image.”

Several practitioners commented on the importance of diet in protecting against harmful blue light effects. “I don’t think we can really have a discussion on blue light and digital eye strain and products without mentioning macular pigment,” said Dr. Morgan, who recommends MacuHealth, an over-the-counter neutraceutical.

Dr. Lange markets his own line of nutritional supplements called Fortifeye Focus, which contains lutein and zeaxanthin that provide “kind of an internal blue filtering sunscreen that impregnates into your macula. It’s kind of a double whammy for blue light, you block it from the outside and the inside,” he said. Several of the ECPs we spoke with also mentioned that they recommend Transitions lenses, which block at least 20 percent of harmful blue light indoors—up to two times more than standard clear lenses—and block over 85 percent outdoors.

Dr. Lange offers a proprietary brand of in-monomer blue light-absorbing lenses called Blue Light Defense, which are digital free-form lenses that are virtually clear with blue filtering technology throughout the monomer. This technology filters 99 percent of the highest intensity short blue violet waves from 400 to 420 nm, and selectively filters waves up to 500 nm, Dr. Lange said.


The Science Behind the Products
There are currently about 40 different blue light filtering products on the market, mostly spectacle lenses, and many are supported by scientific research. You’ll find details about them in our Comprehensive Blue Light Product Guide, available online at Visionmonday.com.

VM spoke with executives from several companies that produce blue light filtering lenses and asked them to explain the science behind their products. You’ll find their responses in separate sections throughout this article.


The Conversation With Patients
As with any health issue, especially one that is relatively new to most patients, good communication is the key. Several ECPs emphasized the importance of reinforcing the message throughout the patient’s experience with the practice. Dr. Stewart said, “Anyone on our staff can talk about blue light lenses, from the person who answers the phone to the technicians to the opticians. We try to have a consistent message about that. I think that’s what’s worked.” However, all of the doctors interviewed stated that they take the leading role in the patient conversation.

Analogies seem to work well in describing problems and solutions to patients. Dr. Morgan uses the analogy of holding a one-pound dumbbell. “After a few hours it would start feeling really heavy. That’s what’s happening with our eyes.

“So when we prescribe lenses for you to use for work or for schoolwork that have a blue filter in them, it’s going to allow your eyes to not have to support all that weight on their own. When I explain it to a patient like that—and that’s usually going to take 30 or 45 seconds—they get it.”

Dr. Morey relates retinal damage to other harmful effects of the sun. “You think about what the sun does to our skin, so you can imagine what it does to our eyes.”

Dr. Stewart, who is a parent herself, is sympathetic to parents trying to control their children’s exposure to digital screens. “In theory that’s great, but in reality, especially with kids who have homework, that’s not realistic. I’ll speak to parents and say, ‘I know as a parent you do the best you can, but if they’re getting an iPad at school and that’s how they’re learning, we have to find creative ways to protect them.’”

The over-the-counter BluTech lenses her office sells also provide an excellent demonstration. “You see people put them on and you see them relax…you see a lot of the strain kind of leave them... you just put them on and are sold,” she said.






Patient Response and Feedback
One encouraging aspect of the blue light discussion is that patients respond to it, and take action. Many have heard about blue light from mass media. Dr. Morgan remarked that “Patients are coming in educated… they’re coming in with questions on sleep and AMD…you can help them separate fact from fiction and build their knowledge a bit…It’s pretty amazing.”

Even when patients haven’t heard about the issue before, they seem to intuitively grasp the importance of the message. “I’ve never talked about something where patients are engaged and already nodding their head yes,” said Dr. Schwartz. “It’s been very refreshing to have patients be so excited and embrace what we’re talking about.”

Steve Ford, who gets a lot of business from a nearby college, noted that “The Millennials are more responsive to the blue light message itself, especially for indoor usage.” Dr. Lange commented that parents are particularly responsive to the message: “What parent is going to say ‘No, I don’t want my kid to have protection?’ I have Medicaid parents buying it for their children.”

Through patient feedback, ECPs have also discovered unexpected benefits of blue light products. “It’s not uncommon when we hear patients say that when they look at things with their lenses that have blue-blocking capabilities, the feel that they see better,” said Dr. Pitt. Dr. Morey feels the Happy Lens gets a similar response. “That was kind of an unexpected benefit.”

Dr. Stewart remarked, “I’ve had a couple of customers who have suffered from migraines that I’ve put into BluTech lenses, and they said it’s made such a tremendous difference for them.”


Measures of Success
Of course, a key type of patient feedback is the one that hits the practice’s bottom line, and several ECPs offered encouraging words, particularly those with practices that sell multiple types of blue light solutions. Dr. Stewart said that “very few of our jobs are leaving the office without some type of blue light protection, whether it’s Prevencia, Recharge or BluTech.” She has found BluTech to be “a great way to increase second pair sales,” whether as an outdoor lens or in a computer-specific design.

Dr. Morgan agreed. “It’s probably the best opportunity in eyecare we’ve had from a second-pair sale standpoint. Just like you’d wear safety glasses if you’re working in a wood shop, you need to wear some ‘safety eyewear’ that makes your eyes more comfortable when you’re working on these digital devices.”

What does that mean for the practice? “Our center for macular health was responsible for more than a third of our overall practice revenue. So there is a lot of potential to make that a lucrative part of your practice.”

And Dr. Lange described the increased growth as “huge,” reporting an 82 percent success rate with patients for his proprietary in-monomer solution.”

For some patients, upgrades to blue-filtering AR have contributed to growth. “Last year, we saw a 6 percent to 7 percent increase, and a lot of that came just in lens sales, patients upgrading to Recharge,” Dr. Schwartz reported. “It was a very pleasant surprise.”

For others who were already doing high levels of premium AR, the difference hasn’t been so noticeable, but some have seen growth in other ways. Said Dr. Stewart, “The referrals we’ve gotten from this are huge… we only market by word-of-mouth. It’s working very well.”


The Opportunity Awaits
Several of the ECPs expressed confidence that blue light products will continue to improve both their ability to filter harmful blue light and their cosmetics. But none thought this was a reason to hesitate in addressing blue light issues with patients.

The first step is to educate yourself, according to Dr. Schwartz. “If a doctor asks me, (I tell them) you need to understand the effects of high-energy blue light, and you need to believe that it is an issue for your patients,” he said.

If you do so, you will likely find that patients are primed to have the conversation. As Dr. Stewart said, “The message is out there, and I think people are more inclined to understand it, and it makes sense to them.”