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Mark Hinton

Want a Pinguecula? How About a Nice Attractive Little Pterygium?

What?? No one wants one of these. Here’s how you communicate with the patient what it is, how it got there, and why they need to buy their sunglasses from you to slow their risk of further damage.

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NO ONE WANTS ONE of these, and yet most doctors report seeing pingueculas on the surface of the sclera many times each week. What’s to be done? How do you communicate to the patient what it is, how it got there, and what can be done about it?

When I ask doctor clients what they do when they spot a pinguecula, they often say, make a note in the patient record and follow it over time.

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It’s been researched and published that more than 80 percent of OTC, off the rack, unregulated imported plano sunglasses available from department stores, gas stations, dollar stores and countless other sources are created using mass-molded acrylic lenses. These lenses do not refract light efficiently; in fact, acrylic is not an acceptable refractive material, as they tend to defract incoming light. These imported goodies lack permanent short and long wavelength filters to protect eyes and prevent sun damage. These plano sunglasses do not have AR absorption on the backside of the lens; and as you know, dark sun lenses act as a mirror surface, reflecting upward of 30 percent of the reflected back-surface wavelengths directly on and into the eye. Though the OTC lens may indicate “UV 400” or “UV Protective,” it’s reported that these “coatings” are “sprayed on” and degrade with wiping and/or washing, leaving the patient vulnerable to sun damage and irreversible vision loss. Many of these OTC sunglasses are not polarized and roughly 1 out of 3 daytime driving accidents are caused by blinding glare. Only polarized sunglasses eliminate blinding glare.

You may recall some years ago when news sources reported imported tainted baby formula caused illness to babies? And perhaps you recall tainted imported dog food that made our dogs ill? With little or no regulations on these imported products it’s no wonder you shouldn’t trust OTC plano sunglasses.

The opportunities are to educate patients during the exam — not in optical. Patients buy their doctor, so it’s the doctor’s responsibility to show, inform and prescribe with the why!

New CL wearers, and parents of new CL wearers, are ideal candidates to express why they don’t want to buy sunglasses OTC elsewhere. Asking current emmetropes, post-Lasik, and CL wearers how they chose their current sunglasses is important in assessing their current risk of surface and retinal sun damage.

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Glasses wearers will typically have UV protection with the eyeglass lenses, but remove the glasses and replace with a contact lens “cap” and now the sclera is exposed and compromised by potentially damaging wavelengths outdoors that lead to irreversible Pinguecula and contribute to Pterygium growth.

What to do? During the exam, when you detect a pinguecula, show the patient the image of their scleral pinguecula and an image of their retina and educate them on why you’re prescribing Rx or plano sunglasses. Then ask the patient if your plan makes sense.

When you detect a pinguecula or pterygium, be curious and question the patient’s sunglass use and where and how they decided on their current sunglasses. Then always show personal retinal images. Inform, prescribe, and get buy-in. Then handoff to the “optical pharmacist,” to fulfill with your prescribed sunglasses, and finish with: “So your risk of advanced sun damage and irreversible vision loss is reduced. Make sense?”

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