Good day all,
Photophobia and what to do as opticians, a most vexing issue with mixed solutions. I am reaching out to the ODs and gurus here to collect information on how our profession should actually handle this with our patients.
Now, we know that there are a myriad of causes, from medical (ocular and non-ocular) to pharmaceutical to psychological. I also subscribe the the hypothesis that some patients self induce this issue by insisting on tints that are well beyond the traditional grey 3. My favorite "I don"t want to be able to see my eyes through my lenses at all". Many opticians just say "OK" and move forward with "ADAP". The pupils only dilate so much, and being in a constant state of dilation, like any muscle memory, will fail to constrict normally over time, requiring even darker tints (indoors and out). A self perpetuating cycle.
My biggest concern is that many opticians fall for this and consistently request darker than the darkest available tint, then reject them because they are not dark enough. Um, excuse me, but at what point are you trying to interfere with the VA by eliminating the light necessary to see properly? It doesn't matter how many conversations I have with these opticians, the issue remains. As an optician, I was fairly successful in convincing my patients to gradually ween themselves of over-dark lenses by fitting them with progressively lighter tints over the course of a few years.
FL41 is great for migraines, brown, rose and amber are great for reducing the blue/green spectrum. These are great solutions for light sensitive patients, but none of these are ever 'dark' enough for the self-prescribed photophobics, even with a mirror.
So, my question to all of you. How do you handle these situations at the office, or your chair? Do you do provide a more thorough exam, refer them to an OPH, prescribe drops, recommend tints (and if so, which ones), engage in a Q&A to determine the possible cause. This inquiring mind would love to know.
TIA
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