Make the Right Call
This OLA-sponsored article provides an update on duty to warn--and the critical role it plays for you and your patients
By Alex Yoho, ABOM

Called duty to warn, it is a vital part of our role to discuss with patients all aspects of their eyewear--especially the impact resistance of lens materials. Is this a law per se? No, but informing patients about eyewear safety is an obligation on the part of the doctor and dispenser.

The point is to help them make an informed choice, a selection they can make only when they are knowledgeable about the relative impact resistance of lens materials. In other words, they need to be informed that polycarbonate and Trivex are more impact resistant than other materials.

Does that mean only polycarbonate and Trivex lenses should be dispensed? No, but it does mean that doctors or dispensers should recommend these materials to patients subject to risk of impact to their eyewear because of their work or leisure activities. And, that includes all children.

	Above: A drop-ball test displays the durability of Trivex lenses; in sunwear or ophthalmic eyewear, durable lenses are important to eye safety PHOTO COURTESY TRIVEX

WHAT TO SAY

Unfortunately, many of us have neglected our duties, focusing only on the positive aspects of eyewear. It's a challenge to design the ultimate in eyewear for the patient by sharing the lens and frame options available.

The last thing an ECP wants to do is tell a patient that the product being dispensed is, in the wrong situation, capable of taking their eyesight forever. But what you do and say depends on the type of patient.

Positive patient. To some folks, you can almost make duty to warn an aside by saying something like, "Of course, you'll want the safest lenses you can obtain." Most will place themselves in your trust altogether, while some will fight you tooth and nail if you suggest that they should have different frame and lens combinations for different circumstances. The OLA Duty to Warn kit (see sidebar) can help you in this situation. This kit offers a formula that keeps the whole office on track.

Distrustful patient. If, on the other hand, you encounter the patient who thinks your just out to get every cent from them, you may need to use other tactics to convince them that you have their safety at heart and are only looking after their well being. Again, the OLA Duty to Warn kit will help with this type of resistance.

BEYOND THE BASICS

In addition, you need to have firmly implanted all the reasons behind our obligation to inform the patient of all of their options. Here are some of them.

PHOTO COURTESY TRANSITIONS OPTICAL

Dress and industrial eyewear. It's not appropriate to just suggest Trivex or polycarbonate lenses. Eyewear for dress safety (Z80.1) is downright dangerous in many sports. And, industrial eyewear (Z87.1 - 2003) can be just as dangerous. Sometimes patients will make the comment that, "Well, if I use impact resistant lenses at least it's better than nothing." In response, we need to explain that, in some cases, it's actually just as bad or worse.

Adults and sports accidents. Over 42,000 sports-related accidents occur each year. Most authorities agree that 90 percent of these could have been prevented with proper eye and face protection. We need to alert our patients to this fact; and we should be able to recommend sport-specific eyewear.

Consider that the average hockey puck travels at 90 to l00 mph; professional baseball players throw balls at about 95 mph; and squash players strike the ball at l25 to 145 mph.

Kids and sports. Children are particularly vulnerable in sports. Each year there are more than 25,000 serious eye injuries related to children's sports. Nearly all of these injuries could be prevented if the child wore appropriate protective eyewear. Though you might wonder about the parents, it is the eyecare professional who has the responsibility to make sure those parents have the knowledge to make proper choices for their children's eyewear.

Parents should be instructed that protective eyewear should be as natural as putting on a seat belt or bike helmet. This applies to those who don't need a prescription filled just as much as those who need one.

FRAME CONSIDERATIONS

Sports eyewear should always be made with frames that are approved for the particular sport the patient participates in by the American Society for Testing and Materials (ASTM). For sports with no standard--such as soccer and rugby--a minimal eye protection should be recommended.

ASTM and ANSI standards are voluntary. Though they are not law, they are the recognized standards for eyewear. And, recommending products bearing their approval would carry some weight should you find yourself in a lawsuit.

Have a plan and procedure in place for safety eyewear. Make a point of lifestyle interviewing patients and be knowledgeable of the technology that matches these needs. Documenting your recommendations shows that you acted in good faith when called upon to prove your actions.

Informing patients of eyewear options will provide peace of mind that you have done all you can to protect your patients from injury and yourself from litigation. Sleep well!