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Thread: Tinted Lenses post Brain Injury

  1. #1
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    Wave Tinted Lenses post Brain Injury

    Colleagues,

    There is very little literature on this topic and every optometrist (and I suspect optician) who encounters these patients has an opinion (sometimes a strong one) on this issue. FL-41 lenses have some (limited) mention in the headache literature. For those who are inclined to include tint in lenses for post-brain injury patients - how do you determine the tint and the density of tint for the lenses? Is there any science behind your practice on this?

    (By the way, if there is no science in selection you are in the majority so no judgement.)

    Kevin

  2. #2
    OptiWizard
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    I know specialists in this field. PM me for referrals.

  3. #3
    What's up? drk's Avatar
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    It can't be a certain density. Everyone is different.

    It probably can't be a certain wavelength. Everyone (and everywhere in the environment) is different.

    So...what do you do, practically-speaking?

    You have TWO and only TWO versions of only one tint and it works or it doesn't.

    The better versions I've seen are dark, like...sunglass dark (80%-ish absorbtion, but 70 or 65 would be OK, right?). They would wear them outside, probably. Some would wear them indoors, too.


    NOW, could everyone tolerate a dark pinky-purple tint all the time? Would all migraines require all that darkness? Do people want to look weird? NO!

    So for that you have "option 2" or, FL-41 "lite". Maybe 20% (maybe 15%, maybe 25%) absorbtion for them.

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    Eyes eastward... Uilleann's Avatar
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    It still surprises me how few prescribers and dispensers alike are familiar with what a "true" FL-41 tint looks like. Given that it was developed in the early 90's, and was primarily developed and used for crazy flickering greenish fluorescent tubes, and single color CRT computer monitors, it could definitely stand a refresh to an actual modern working environment.

    But as the good Doctor points out, a "true" FL-41 is crazy dark, and you'll be guaranteed an almost 100% rejection rate.

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    I've been doing this for decades and just found out about the FL-41 last year. I was shocked that I had never heard of it. That being said, I had a TBI patient with chronic headaches and it helped her tremendously! She had been to several places before trying this with us and it was the only thing that helped.

  6. #6
    What's up? drk's Avatar
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    Hey, Merv!

    I'm gathering experience, too. How dark do you think that helpful tint was? (I'm hoping you say "well, not all that dark".)

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    Quote Originally Posted by drk View Post
    Hey, Merv!

    I'm gathering experience, too. How dark do you think that helpful tint was? (I'm hoping you say "well, not all that dark".)
    To be honest, I had never heard of it and had my lab send me a sample before I met with the patient. (The patient had called asking for it as it was recommended by the neurologist). So the lab sent me a sample and it was darker than I thought it would be. It was also more orangey than I thought it would be.

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    I just spoke to my lab and they said it really needs to be at 80-90% density in order to guarantee the therapeutic properties. The tint itself is more expensive and not a standard tint charge. Probably more like double that. We kept it on the lower side here since people really need it, but we did charge more than the usual tint.

  10. #10
    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    I fear the worst for Ian Jordan who I can no longer locate. I hope he is well and no longer posting due to an ongoing legal battle with the opticians UK Guild. His shop in Ayr Scotland is no longer open. He was outside the box in his work with tints for many conditions and his web site is no longer accessible.
    Here's an article sure to be dismissed by many here:

    http://www.sulamot.ru/files/5.pdf

    And the book "A Professionals Guide to Prescribing Tints and Filters", which I bought a while ago, I can no longer find with a google search.


    Can anyone more savvy than me find one on line?

  11. #11
    Master OptiBoarder
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    When I googled him, I found more legal issues that were not optical in nature.

  12. #12
    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Quote Originally Posted by mervinek View Post
    When I googled him, I found more legal issues that were not optical in nature.
    Wow! I haven't goggled the name but just his sites and shop and thought it might be covid related. Obviously not!
    That answers that.
    What a shame for someone I admired as I thought his work was akin to a Faraday waiting for a Maxwell.

  13. #13
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    Yes, that definitely not what I was expecting to see! Sad situation.

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    interesting. The FL-41 my lab uses is more of a red orange color than those shown in the article. Those are more purple. I think my lab gets the tint from BPI and it is not a mix of colors that they do in house. They did tell me the tint itself is more expensive than a normal tint so we do charge more. (We don't upcharge our normal upcharge though because it is therapeutic and we just want people feeling better!)

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    One eye sees, the other feels. OptiBoard Silver Supporter
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    Quote Originally Posted by mervinek View Post
    interesting. The FL-41 my lab uses is more of a red orange color than those shown in the article. Those are more purple. I think my lab gets the tint from BPI and it is not a mix of colors that they do in house.
    Hi mervinek,

    The BPI dye is #37616. Dye to 46% on the photometer, for a luminance transmission of 27%. The goal is to reduce the blue-green spectrum. The appearance is rose/sand. I use coated optics whenever possible.

    Best regards,

    Robert Martellaro
    Last edited by Robert Martellaro; 12-04-2021 at 11:27 PM.
    Roberts Optical Ltd.
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    Science is a way of trying not to fool yourself. - Richard P. Feynman

    Experience is the hardest teacher. She gives the test before the lesson.



  17. #17
    What's up? drk's Avatar
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    Sounds like you wrote the book, and are doing it by the book.

    Saying that, what's the experience? Do patients like them for indoors and out?

  18. #18
    One eye sees, the other feels. OptiBoard Silver Supporter
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    Quote Originally Posted by drk View Post
    Sounds like you wrote the book, and are doing it by the book.
    No, I just RTFM.

    http://www.callbpi.com/Therapeutic_Tints.html

    Saying that, what's the experience? Do patients like them for indoors and out?
    I've probably received twenty or so RXs form neuro-ophthalmologists over the years. Migraines were the most common CC. The recommended density seems to be dark enough for outdoors, but one client ordered a separate, dedicated sun pair with an optimal light seal. I was concerned about traffic light recognition, but I can't remember if they reported any problems. The effectiveness is anecdotal, but the RXs keep coming...

    Best regards,

    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

    Experience is the hardest teacher. She gives the test before the lesson.



  19. #19
    What's up? drk's Avatar
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    Very good link!

    If nobody is barking back at you, after N=20, then it must be somewhat useful.

    I always try to learn and not be a Negative Nelly. One thing I don't agree with on that link is that "If you want to reduce glare and relieve discomfort for your patients, there is one simple thing you can do; filter out UV and blue light."

    (Font shift alert!) I don't think filtering invisible light matters. Can you see invisible light scatter? Or, is there some wavelength shift of scattered light, from invisible to visible? I doubt that.


  20. #20
    What's up? drk's Avatar
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    BPI's testimonial on FL-41: http://www.callbpi.com/FL_41.html

    I really dig that BPI link. It does show a significant color variance between what they are calling FL-41 and what the above resources I linked to (the optometry college and LiveEyewear). WHO IS RIGHT? WHAT COLOR ARE WE TALKING ABOUT? I WON'T BE ABLE TO SLEEP TONIGHT!

  21. #21
    What's up? drk's Avatar
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    https://journals.lww.com/jneuro-opht...e_What.21.aspx

    https://journals.lww.com/jneuro-opht...phobia.16.aspx

    https://journals.lww.com/jneuro-opht...eadache.9.aspx

    You know, this would be a kick-*** subspecialty for an optometrist or optician that wants to work hard. Can you see this, combined with a low vision practice? You'd make a pretty good-sized splash, I'd think.

  22. #22
    What's up? drk's Avatar
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    From the BPI link: The BPI® FL-41™ Tint is rusty-rose in color and is usually tinted to a darkness of 50%. It has been found useful to reduce eyestrain, tension headaches and migraine. It is thought that indoor lighting contains flickering blue light. This filter blocks about 80% of that component.


    I really think the fluorescent thing is real, if you are walking the aisles of WalMart or Costco. I think with LEDs in homes and offices, we may be on the verge of eradicating this horrible health hazard :).

    What about "refresh rate" (or whatever I'm trying to say) on LED screens for computers/laptops/phones? I doubt it's "flickery" enough to cause trouble.

  23. #23
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    Quote Originally Posted by Robert Martellaro View Post
    Hi mervinek,

    The BPI dye is #37616. Dye to 46% on the photometer, for a luminance transmission of 27%. The goal is to reduce the blue-green spectrum. The appearance is rose/sand. I use coated optics whenever possible.

    Best regards,

    Robert Martellaro
    Yes, the "rusty rose" would be a good color description. I never gave it a thought to affecting traffic light colors. I thought that was a concern in the past but it has since been more regulated. Personally, I put a lot of trust in my lab and would expect that they would warn me if there were any issues like that.

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    Maybe 20+ years ago Younger had a multi color disc sample of different colors and I remember a retinitis pigmentosa patient hold it up to one eye and he was over the moon giddy over his visions improvement. Younger made these distinctly red blanks but discontinued them years ago. I assume the BPI dye ended the market for finished blanks.

  25. #25
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    I am specializing in this field. Look up AXON Therapeutic lenses.

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