The Science and Technology of

Jenean Carlton BA, ABOC, NCLC Prescribing Photochromics 9 Protect patients from harmful UV (cataracts, aging 9President, Carlton & Associates, LLC – Carlton Jenean Carlton BA, ABOC, NCLC around eyes, pterygium …) and Associates, LLC provides communications and educational materials for the optical industry. 9 Provide glare protection – especially important for 9Contributing Editor for Refractive Eyecare Course #214 patients with glare issues or photophobia magazine and freelance writer to the industry. Monterey Symposium 9Communications Committee member OWA. 9 Are convenient – easier than keeping up with two or 9Has worked in the optical industry for more than more pairs of 25 years with more than half of this time spent managing practices. 9 Are variable – they automatically adjust to light 9Vision Monday’s Most Influential Women Award in conditions in the environment Optical 2005

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9 Americans at risk increasing Men Experiencing Women Experiencing 9 Only 9% of Americans know UV can as baby-boomers age cause eye damage Dry eye 9% 15% 9 4 leading causes of blindness Trouble seeing 11% 22% Proportion Awareness/Action at night 9 Age-related macular degeneration 1 out of 4 Do not know there’s a treatment Light sensitivity 6% 11% 9 Glaucoma for glaucoma 9 Cataract 1 out of 3 Do not know there’s a treatment 9 Diabetic retinopathy for astigmatism 9 More women say headaches impact 9 2 out of 3 Do not know there’s a treatment vision, and are caused by glare Total annual cost of adult for presbyopia Basketball superstar eye diseases = $35.4 billion Lebron James only recently realized that he 9 All issues increased with age could correct his vision 9 Can be detected / treated through regular eye care to see distant objects.

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1 9 Visual Acuity & Color Vision 9 Trouble seeing up close (presbyopia) 9 Are fashionable and speak to patients interested in 9 yellows leading to cataracts 2010 Sunwear Sales fashion-forward items… 9 Colors less bright – reduced contrast 9 98.3 million pairs of plano sold 9 Value of 3.42 Billion 9 Latest and greatest regarding lens technology… 9 Sensitivity to Light/Glare 9 Bring much needed revenue to your 9 Pupil shrinks = need more light bottom line profits 9 Causes light sensitivity 9 A product that benefits every age patient… 9 Approximately 40% of your patients come

9 Tear production slows 9 State of the art perform better than older to your office interested in purchasing 9 30% of those age 50+ models and have a life span of two years or longer… photochromics have dry eye 9 Light/Glare sensitivity worse with dry eyes

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1992 Transitions Plus lenses introduced to the market 1997 Transitions III lenses released, first Transitions 9 Latest technology can do more than correct lenses in made using Trans- bonding™ vision 1966 Corning introduces Photogray lenses with halide. (Silver halide is an inorganic material.) 2002 Next Generation Transitions lenses released 9 Enhance vision for real world applications 1973 PPG begins CR-39® photochromic experiments. Corning, Rodenstock, Signet Armorlite, other 9 Lens treatments like photochromics and anti-reflective manufacturers create their own proprietary coatings minimize glare and reflections 1981 American Optical debuts Photolite – the first 9 Reduce eyestrain and fatigue photochromic lenses soon after photochromic lens. Photolite has a trendy dark blue color, no sun protection. 2008 Transitions VI lenses released- BIG differences 9 Protect eyes against trauma 9 Impact-resistant lenses, safety frames 1990 PPG and Essilor International establish a joint 2009 Expanded line of Transitions performance sunwear, venture called Transitions Optical, Inc. Transitions® was SOLFX now… 9 Preserve vision for a lifetime plastic photochromic lenses introduced the same 2010 Transitions® XTRActive™ lenses released of healthy sight year. 9 Photochromic lenses block UV ® 9 Understanding the science of these lenses will aid you in making 2012 Transitions Vantage™ lenses released! The first better lens choices for your patients photochromic + variable polarization!

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2 How Photochromics Work…………

Electromagnetic Spectrum 9 Organic – natural, composed of carbon or 9 Neutral Dyes – desirable, result in best color The visible spectrum consists of electromagnetic hydrogen materials perception for the wearer, esp grey wavelengths that are between 380nm -760nm 9 Inorganic – artificial, not composed of carbon 9 Fade time – the amount of time it takes for an short long or hydrogen activated photochromic lens to revert to it’s clear state Gamma X - UV Infrared Radar Radio Waves, A-C 9 Electromagnetic Spectrum – an orderly Rays rays TV 100-380nm arrangement of all known radiant energy 9 Fatigue rate – measurement of the lifetime of photochromic compounds, dependent on.. 9 Silver Halide – an inorganic material used in Visible Spectrum 9 Leuco state – when a photochromic lens has 380nm 760 glass photochromics faded back to it’s clear form 400 500 600 700 9 Activation time – the time it takes for a lens 9 Matrix – the lens material in which violet blue green yellow orange red to darken to it’s full depth of color photochromic dyes are incorporated- the monomer. Sir Issac Newton demonstrated the of white light into its component colors. Roy G. Biv

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How Photochromics Work…………

UV Spectrum When activated by UV light, dye molecules Short Long Beneficial uses: change their shape – as a result of this the UVC UVB UVA Visible 9 Curing coatings on lens changes from a leuco (clear) to a light 100-280 280-320 320-400 ophthalmic lenses starts 9 Drying inks in printing colored state. is a reversible here Filtered by ozone sunburn tanning processes change of color upon exposure to UV. 9 Fluorescent lighting HEAT 9 Sterilization of surfaces 100nm------380nm

What reaches earth? Primarily UVA, less than 1% is Bad and Just Plain Ugly: UVB. 9Cornea, lens and retina problems 9Photokeratitis MOST Photochromic dyes are stimulated by 9Skin damage and cancer UV wavelengths (300-360nm).

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3 Dye Performance Goals lightened darkened 1) Neutral, predictable and consistent color in the activated states (photochromic dyes are VERY unstable) 2) Clear in their inactivated state, unless… 3) Good activation and fade rates… 4) Fatigue resistance – what does the term “fatigue” closed open mean? 5) Good performance even in high temperatures. 9 Photochromic reaction Photochromic performance is influenced by 9 The dye crystals change shape in the presence of temperature, UV exposure and lens material. UV and then revert back to their original shape when UV source is removed.

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How Photochromics Work…………

UV intensity fluctuates greatly depending on: Most commonly used dyes today are: 9 Photochromic properties fatigue after a few years, resin lenses fatigue….. 9Season (winter, summer, etc.) 9 Oxazine – offer fast activation and fade rates, resist 9Time of day photodegradation, and have a longer life span but are 9 Won’t activate to a dark level like sunglasses temperature sensitive and don’t perform well in warm inside an auto because… 9Latitude (north to south in relation to the climates. equator)

9 Some do activate (reportedly) to a slight degree 9Altitude (height or elevation- ex. Mt. 9 Naphthopyrans – stable, less temperature resistant by visible light … Everest) dyes. 9Weather conditions (cloud coverage) 9 Temperature problems are historic for resin 9Temperature – the dyes always get darker 9 Indenonaphthopyrans lenses but the new dyes are better… and switch faster in colder climates

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4 Photochromic Dyes Photochromic Dyes Dye Applications C.I.E.L.A.B. is an acronym for Commission Internationale de l’Eclairage, Lightness axis, A axis, B axis C.I.E.L.A.B. - Stable colors result in a small ring For ophthalmic lenses there are currently 5 dye opening. application methods: 9Imbibing – Transitions Optical Inc. 9In-Mass or En-Mass – Rodenstock “ColorMatic Extra, Corning “SunSensors” 9Matrix/Composite – Signet Armorlite, Inc., “KODAK InstaShades” 9Trans-Bonding – Transitions Optical Inc. 9Coating – Beloptix, Inc, OptiSource International

A axis measures green to red coordinates, B axis measures blue to yellow. Lower values indicate neutral colors while higher values indicate more intense colors.

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Dye Applications-- In Mass Dye Applications

Imbibing Process In-Mass Imbibing Dyes are blended throughout the resin before the lenses are cast. activated 0.15mm

Not activated Dyes are uniformly = .15mm mixed with the monomer. activated

Image source: http://www.essilormanufacturing.in.th/index.php?lay=show&ac=article&Id=501374&Ntype=7

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5 Imbibed and In-Mass Technologies Matrix/Composite Lens

9 Lens material used is of utmost importance… Signet Armorlite KODAK InstaShades

9 We know photochromic dyes don’t work well 9 Methacrylate polymer w/photochromic dyes in higher index lenses but they also don’t work on front surface- well in common monomers…

9 Proprietary monomers are used that are 9 Resin monomer on rear surface compatible with the dyes… CR-307

9 Both layers thermally cured together. 9 Other resins used…

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9 Higher index materials like polycarbonate and 9 Proprietary surface treatments and a series of 9 Dinamica lenses offer lots of colors… 1.67 indexes are a poor host for photochromic ophthalmic grade layers provide adhesion, 9 X-Cel Optical- occupational segs available dyes…. scratch resistance and optical purity 9 ProFit Optix 9 KBco Light & Day 9 Transitions Optical developed their Trans- 1. Substrate 9 Three Peaks™ Bonding process to offer photochromic 2. Photochromic coating added to the substrate 9 Serengeti’s Polar PhD™ technology in higher index lenses. 3. Protective coating and SRC added over the 9 Transitions Vantage , not a traditional polarizer photochromic layer instead……

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6 9 Transitions Performance Sunwear – Dynamic sunwear 9 Superior abrasion resistance… offering photochromic + polarized film (in some cases) Polyvinyl Acetate Polarized Layer 9 Silver halide fatigues much slower than 9 They differ from other Transitions lenses because they organic dyes for resin lenses…… have an initial or “fixed” tint for glare protection in low- sunlight situations

9 Corning: PhotoGray® Thin and Dark®, 9 Designed to provide wearers a visual advantage during PhotoBrown Extra®, PhotoGray Extra specific outdoor activities by adjusting to changing light conditions…. 9 Pros: Life span, scratch resistance…. 9 So many branded sunwear products now Transitions® Vantage™ lenses available…..Nike, Callaway, Drivewear…. 9 Cons: Heavy, safety issues, frame limitations, “raccoon effect”, manufacturing issues.. Copyright Carlton & Associates, LLC 2012 37 Copyright Carlton & Associates, LLC 2012 38 Copyright Carlton & Associates, LLC 2012 39

9 Available in grey, slight tint indoors 9 Work together to cut glare, deliver the 9 Availability as of May 2012: SV and PAL’s, clearest, most adaptable vision 1.50, poly, Trivex, 1.67 9 Go to www.TransitionsVantage.com to sign up 9 Deliver a double dose of what eyes need for materials… most: comfort, convenience and improved quality of vision. VARIABLE POLARIZATION VARIABLE 9 Candidates are everyday Rx patients… 9 Except when patients need a constant 9 Glare caused by ocular diseases: corneal polarizer like… edema, cataract, post-cataract, macular edema, surface irregularities. Indoor LENS DARKNESS Outdoor 9 Variable polarization means…

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7 Photochromic Benefits Explained • Affects 1.6 million Americans over age 60 UV protection UV rays can harm the eye 9 AR reduces the darkening ability of – 2% risk in middle age photochromics… Convenience Automatic amount of tint, – Risk jumps to 30% after age 75 appropriate for condition 9 AR enhances the performance of • Leading cause of blindness in America Photo Comfort Decreases eyestrain Credit: photochromics… www.aoa. org AR Benefits Explained • Slowly destroys clear, 9 AR increases the lifespan of photochromics… sharp central vision Safety Glare doesn’t compromise vision • Cumulative UV exposure Health Less reflections, more natural 9 AR exacerbates the darker when cold, lighter vision key factor when hot issues… Comfort Eases eyestrain • Treatment but no cure Copyright Carlton & Associates, LLC 2012 43 Copyright Carlton & Associates, LLC 2012 44 45

9 Photochromics to minimize glare 9 Affects nearly 20.5 million Americans 9 Photochromics or age 65+ 9 Adapt level of darkness to let in just right sunglasses amount of light 9 Clouding of the eye’s lens (usually to block damaging UV 9 Reduce light sensitivity slow development) 9 Short-term exposure 9 Reduce eyestrain/fatigue, headaches 9 Sunburn of eye (temporary 9 Help with color recognition 9 Can cause blindness) While 82% of Americans 9 Blurred / hazy vision 9 Cumulative exposure know that extended 9 Anti-reflective coatings to reduce 9 Trouble w/ color recognition 9 Cataract exposure to the sun can reflections, enhance night driving 9 Sensitivity to glare cause skin cancer, only 9% 9 Macular Degeneration 9 Difficulty seeing at night know that the sun can harm 9 Skin cancer around eyes the eyes Photo Credit: NIH National 9 Cumulative UV exposure key factor Eye Institute 9 Impact-resistant lens ~ Transitions Optical Survey 9 Treated with surgery materials to prevent trauma Glare from everyday sunlight Glare from your lenses Glare in extreme conditions 46 47 48

8 • Affects 10% of population by age 80 9 Diabetic Retinopathy = most Diabetes can lead to 9 Most common eye disease associated • 5X more common for African-Americans! common diabetes-related with diabetes several eye diseases eye disease 9 Practically all diabetics will experience • Increasing due to growth in at-risk Percent of Consumers Ever Experiencing groups (but only ½ know they have it) the Following Eye Diseases 9 Caused by changes in blood Diabetics Non vessels of retina • Internal pressure in eye damages 9 May leak fluid, blurring vision optic nerve, causes peripheral vision loss Diabetics 9 Abnormal vessels may grow Photo Credit: www.aoa.org Cataracts 10% 4% • Often develops gradually, without symptoms 9 Patients may not notice changes Photo Credit: NIH National Eye Institute Diabetic Retinopathy 10% 0% at first – but vision is lost over time Damage to vision will • Can be controlled, although vision loss permanent Macular Degeneration 1% 1% have already 9 Increased risk of damage from UV occurred in 5% of • Meds can cause light sensitivity diabetics diagnosed Glaucoma 10% 2% 9 Issues with light sensitivity, color recognition at age 30+ • 1 / 2 don’t know they have it Transitions Optical Global Healthy Sight Survey, 2008 ~ Diabet Metab, 2004 49 50 51

Diabetes and related diseases pose danger for vision in future 9 Some medications for 9 Vision wear for prevention 9 Increased susceptibility to hypertension can cause and treatment UV damage light sensitivity 9 Corrected vision associated 9 Light sensitivity with fewer problems, 9 Poor contrast sensitivity, night vision enhanced mood 9 Photochromics can 9 Glare protection • UV and glare protection alleviate discomfort (photochromics/AR) to enhance - Fixed tint and contrast, photochromic lenses address light sensitivity from meds - AR treatments 9 UV blockage to prevent damage

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9 9 Older adults take more medications 9 Up to 90% Take Rx, OTC or Supplements • Breast Cancer – Top Fatal 9 Incorporating a lifestyle 9 1/4 don’t usually tell their eye doctor • Bleeding, Cataract, Dry and 9 2/3 of older adults unaware of side effects light sensitivity discussion/program in your practice 9 on eyes • Medication use: blurred vision, Doctor – Driven - Dispensing 9 Medications can cause: UV/light sensitivity, dry eye 9 Blurry vision • Pregnancy: Rx changes 9 Discuss the benefits of 9 Sensitivity to light/glare Older adults taking 9 Susceptibility to UV damage • Menopause: Rx changes, photochromics during the exam antidepressants have 9 Increase in certain dry eye 9 Medical benefits of photochromics higher risk for cataract eye diseases • Auto-Immune Diseases 9 e.g. Steroids/inhalers can ~ Journal of AAO lead to cataract, glaucoma • Sjorgrens – Lupus 9 Include a listing of all lens options on 9 Some effects can be • Rheumatoid arthritis your Rx alleviated through proper • UV/glare-protecting 9 And if possible – the benefit of the vision wear 55 vision wear recommended 56 option 57 Copyright Carlton & Associates, LLC 2012

9 Explain Features and Benefits to patients 9 “Hand Off” in exam room is ideal 9 Forget “Techno-babble” 9 9 9 Opticians reinforce the Stay on top of the latest in cutting- What if all lens options were FREE? recommendations edge lens technology and designs by: Features Benefits

9 Multiple times the patient hears the 9 Utilizing your lab staff for training… Absorbs UV Protection for eyes Rx 9 AttendingBusiness courses… Variable tint Adapts to light conditions, comfort 9 Make use of try-on sample lenses 9 Reading periodicals… VCPN, Eyecare Specialty options for sports Enhance performance 9 Offer a lens menu describing features , etc. Convenience Easier than carrying multiple of advanced offerings pairs of eyewear

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10 9 “How do you use your eyes?” 9 Photochromics protect patients from harmful UV and glare… 9 Discuss why photochromic lenses won’t 9 “How do you protect your eyes from glare and 9 Photochromics + polarized are now available darken in an automobile. UV?” with either a constant polarizer layer or as a variable polarized lens (Transitions Vantage) 9 Does AR affect the performance of 9 Doctor driven dispensing has proved to be 9 “Let me tell you about what I wear to protect photochromic lenses? my eyes.” successful… 9 Patients want to know about features and 9 Discuss how photochromics + polarized benefits… 9 Language to use when discussing benefit patients. photochromics- 9 Are convenient and cost effective…

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Jenean Carlton [email protected]

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