9/27/2012. Children Ages 8 10 yrs. Preteen Ages yrs. Dr. Kris Kerestan Garbig. Teen Ages yrs. Millenials Ages 21 35

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1 Children Ages 8 10 yrs. Preteen Ages yrs. Dr. Kris Kerestan Garbig Teen Ages yrs. krisgarbig@fuse.net Millenials Ages Generation X Ages Baby Boomers Age Silent Gen Above Age 61 Survey completed August 2010 Studied the Prescribing habits of 576 American O.D.s when fitting Kids in CLs AGE FACTORS in prescribing 97% of the O.D.s surveyed said they fit CLs on patients younger than 18 years In fact, 41% of all the CL patients in their practices are actually kids under the age of 17 years Of the 41% of Kids fit in CL: 2% were between 8-9 yrs 7% were between yrs 13% were between yrs 19% were between yrs 1

2 <8 yrs Age 8-9 Age Age Age % of Docs years of age 50% of Docs years of age 20% of Docs years of age Below 8 yrs. 11.9% Age 8-9 yrs. 12.4% Age yrs. 51.2% Age yrs. 22.6% Ages yrs. 2.9% 33% say due to DAILY DISPOSABLES: Why Daily Disposables? 1. Most Healthy option 2. Minimal Care/ No CL Soln s 3. Extremely Flexible Healthiest option: New, Fresh, Clean CL Q day No chance for buildup of protein or CL debris Best choice for Allergy patients No protein buildup + Better wetting Minimal Care/No Solutions: Saves Time and Saves Money on Solns Eliminates Soln. Related Red Eyes Eliminates Soln. Related Allergies 2

3 Extremely Flexible: Sports Dance Gymnastics Drama Swimming Other Activities 23% say due to IMPROVED CL MATERIALS: (Silicone Hydrogel) Extremely comfortable Increased O2 to cornea Ease of handling UV protection (Important to 85% parents) 19% say due to Parent or Child Request: - More awareness of benefit of CL for school and sports activities - Friends wearing CL 10% say due to Current Research on the benefits of Kids and CL wear: Articles in Magazines: Woman s Day Ladies Home Journal U.S. News and World Report Info. on the Internet Interest and Motivation of the Child ( Most important factor to 96% of O.D.s) Maturity Level Hygiene Parental help and support Ease of Handling Oxygen Permeability Comfort Visual Acuity Frequency of Replacement UV protection 3

4 Total of 484 myopic children aged 8-11 years of age All children previously wore glasses 50% of children continued in Glasses 50% of children fit in CL s 93 % chose Daily Disposables 7 % chose 2 Week Disposables After 3 yrs. their Vision-Related Quality of Life was assessed using an in-depth profile questionnaire of 26 questions ( Strongly disagree to Strongly agree) Increase Q of Life of 14.2 units in CL wearers Increase Q of Life of 2.1 units in glasses wearers Improved Self Esteem in NonVision-related areas: Athletic Performance Appearance Peer Perception Lenses allow more freedom of movement, excellent peripheral (side) vision necessary for a full field of view, and less distortion than glasses because the lens sits directly on the eye. In the classroom, clearer vision allows for deeper participation and understanding of materials Fitting Criteria used the 3 Ms 1. Maturity 2. Motivation 3. Mom 4

5 Display office brochures to stimulate interest and to prepare parents and kids for a conversation about CL s Consider keeping trials in the exam rooms as a visual reminder for you and the parent Use conversation starters... Have you ever thought about wearing contacts? Many people like wearing contacts for activities like sports, would you like to try them today? Include both the parent AND the child in the conversation Optometric Staff must show patience and care during the initial fitting/training Send kids home with wear/care instructions On-line resources from CL manufacturers Sign up for Acu-minder Give the kids a way to communicate with the office or cell # they can text Short Attention Spans (Keep exam process simple) Small Palpebral Fissures (Choose a small diameter CL) Developing Dexterity (Train parents insertion and removal also) * Make sure an extra care kit is given for school* Challenging attention spans and easily bored Busy sports and school schedules Increasing life responsibilities and CL care Daily Disposables * Extra Care Kits* 5

6 KISS principle: - Keep -It - Simple - Succeed Always give Extra Care Kits Locker, Backpacks, Sports Bags Compliance Contract Signed by the CL wearer in which they take FULL responsibility for proper wear and care *Acuminder* Compared CL wear in Children vs. Teens 84 children between 8-12 yrs. 85 teens between yrs. Protocol fit, I/R training, FU 1 week, 1 month and 3 month Three variables were measured Eye Health Ease of Fit Quality of Life Issues EYE HEALTH Equal adaptation ti betw. Child and Teen No serious adverse effects or eye health issues EASE of FIT Essentially the same By 3 months 83% of the children vs. 89% of teens found it easy to clean/care for CL By 3 months little if any parental assistance was needed Quality of Life improved in ALL areas Activities Satisfaction Appearance Peer Perceptions Overall Vision Far Vision 6

7 Millennials...Age Gen. X...Age Boomers Ages Characteristics: Age % wear CL CL wearer from earlier age Characteristics: Tech Savvy - Grown up with technology Active lifestyles Self Educating ( Internet ) Visual Needs: Maintain clear and comfortable vision Maintain active lifestyle Best CL options: Daily disposables Two week disp. One month disp. PT Wearers: Special occasions Weekend trips Wedding Swimming Beach vacation Sports FT Wearers: Everyone! Dry Eye Allergies Hairdressers Bartenders Construction Pilots Flight Attendants 7

8 Since one of the reasons we may prescribe daily disposables is for improved compliance with lens replacement, we need to ensure that this is indeed occurring. By asking your daily disposable patients what solution they use (the answer should be none), you may soon realize they are re-using their lenses. Investigate whether they may be storing their lenses overnight, or whether they are using the solution to rinse before insertion. These practices may encourage further non-compliance and warrant re-education. Since we tend to also emphasize the value of daily disposables to a patient by explaining they won't have to purchase a bottle of solution on a regular basis, let your patients know that they really don't need any solution at all. If a lens falls on the floor, in the sink, or otherwise out of their eye, it is safest and easiest to just throw it away and open a fresh lens. If they feel they must use solution to put the lens in initially, I advise them to use the blister pack solution rather than a bottled solution. You can also educate your staff on these guidelines, so that they don't erroneously hand out contact lens solution care kits to these patients and negate all the information you just emphasized to the patient. Control the solution conversation by educating patients on why they don't need it and how to deal with potential situations before they arise. Erratic schedules New moms Shift workers Med. School residents Frequent travelers Firefighters EMS Police officers Characteristics: Between ages % wear CL (Gen X.) CL wearer from earlier age 92% want to stay in CL Characteristics: Tech Savvy Learned technology in late teens to early 20 s and have witnessed technological advancements Active Lifestyle Visual Signs: Moving reading material away Use of bright lights Avoiding small print Visual Symptoms: Eye Strain before BLUR Tired eyes Difficulty focusing 8

9 Visual Symptoms: Headache Eye Fatigue Burning & watering Dry Eye Visual needs: Maintain active lifestyle Maintain freedom and flexibility Maintain confidence Visual Needs: Mi Maintain i youthful hfl appearance Maintain clear and comfortable vision Maintain Clear Vision Reading paper Computer/Internet t t Cell phone/texting Mobile Internet Ipod/MP3 GPS Read a menu 90% use the Internet Spend at least 8 hrs. per week on line 82% use a cell phone Average 236 texts per month Best Candidates: Good motivation Good motivation Realistic expectations Healthy ocular surface 9

10 Discuss symptoms early, educate and set expectations Present treatment options 3-5 yrs before age 40 Mono.= Talking w/one person at a time Multi.= Talking w/one person in a crowd Treat any underlying DES Use SiHy CL to increase O2 Best treatment options: Multifocal CL - Daily or Planned Replacement Monovision - Daily or Planned Replacement Distance + Single Vision Near rx. Do you find wearing glasses to be a hassle? Motivation factor Would you be able to accept a CL that meets your visual needs for only 80% of your daily tasks? Expectation factor Outstanding Growth Opportunity: 56% of yr olds wear CL Only 30% of yr olds wear CL (Decrease of 26%) Characteristics: Age 48 and above Only 11% wear CL Already wear multifocal eyewear or reading glasses Characteristics: Learned technology in LATE 20s Need for near correction 80% interested in multifocal CL 10

11 Visual Signs: (Similar to EP s) Moving reading material away Use of bright lights Avoiding small print Best Candidates: Good motivation Realistic expectations Healthy ocular surface Educate and set realistic expectations Present treatment options Mono.= Talking w/one person at a time Multi.= Talking w/one person in a crowd Treat any underlying DES Use SiHy CL to increase O2 Best treatment options: Multifocal CL - Daily or Planned Replacement Monovision - Daily or Planned Replacement Distance + Single Vision Near rx. Contact lenses According to the 2011 American Eye-Q survey, younger generations are the most diligent about following their doctors contact lens wear and care instructions. Gen Y-ers, are the most likely to replace their daily disposable lenses on a daily basis as directed (43 percent), while baby b boomers proved to be the greatest offenders, with 67 percent admitting to wearing lenses longer than recommended. It s easy for patients to forget that contact lenses are medical devices and as such, should be handled with an appropriate level of caution, said Dr. Geist. Clean and safe handling of contacts is one of the most important measures wearers can take to protect their sight. Gen Y respondents also came out on top for appropriately storing their lenses, with nearly half (49 percent) reporting they replace their contact lens case every one to three months as directed. Baby boomers, however, have room for improvement with only 28 percent saying they replace their case every one to three months. 11

12 Americans of all ages have a lot to learn about cleaning their contact lenses, with nearly a fifth of generation X (19 percent) and Y (22 percent) making the mistake of soaking or cleaning contact lenses with water, compared to just 8 percent of baby boomers. Across the generational board, nearly one-third of respondents reported using rewetting drops to clean or disinfect their lenses. Doctors of optometry remind patients about the importance of cleaning and rinsing lenses daily to remove mucus, secretions, films or deposits that may have accumulated during wearing, while disinfecting is required to destroy harmful germs. Water and rewetting drops do not disinfect lenses; in fact, water can actually contaminate contacts. KDKA-TV in Pittsburgh (Jan2012) reported that next-generation contact lenses, "called SMART LENSES'...are packed with circuits, sensors and wireless technology all designed to keep an eye on your health." Researchers are now testing contact lenses that may someday "replace the standard blood test, " pointing out that "biomarkers found in the blood -- such as cholesterol, sodium, potassium and glucose -- can also be found on the surface of the eye." Currently, one type of smart contact lens already out on the market in Europe monitors eye pressure over the course of a day. Called the Trigger Fish, it can diagnose glaucoma. Contact lenses still in the developmental stage may one day slowly release eye medication over a long period of time. ANY???? Dr. Kris Kerestan Garbig krisgarbig@fuse.net 12