COOKIE Issue 14 - The Eyeglasses Issue by Media MICE

THE EYEGLASSES ISSUE

January 2024

cookiemagazine.org

Letter to Readers

Eyeglasses Have Come a Long Way Europe every year to introduce the latest designer frames and sunglasses. Anti-glare coatings, polarized lenses, and transition lenses have become popular because they alleviate common eye discomfort, such as glare and light sensitivity. Glasses that provide real-time information, such as directions, weather updates and social media notifications, are becoming increasingly popular. They have also been used for virtual and augmented reality. The public’s demand for frames that are eco-friendly and more sustainable is being met through innovations, such as 3D-printed frames. Additionally, myopia control spectacles like MiYOSMART by HOYA (Tokyo, Japan) are readily available as tools for myopia management. EssilorLuxottica (Charenton-le-Pont, France) has introduced its latest progressive lenses powered by behavioral artificial intelligence, which considers visual behavior to enable fast and precise eye movements.

he eyeglass industry has changed before my eyes. In the early ‘70s, patients traveled three hours to my grandfather’s optometry clinic in Manila to have their eyes checked. They then had to wait nearly a day to get their glasses, which were mostly fitted with breakable lenses. Our grandmother would prepare sodas and crackers to feed and entertain them while they waited! But glasses have come a long way from the first recorded dispensing of eyeglasses in 1926 in Italy. These eyeglasses consisted of two glass lenses held together by a frame made of bone, metal or leather. They were customized and considered a luxury in those days because only scholars, monks and wealthy individuals had access to them. The invention of bifocal lenses by Benjamin Franklin in the 18th century revolutionized the world of eyewear. However, bifocal lenses are now less popular. The digital era has ushered in progressive lenses, prompting vision care specialists to address the needs of individuals with intermediate working distance requirements. Nowadays, eyewear not only addresses users’ vision care needs but also caters to their fashion sense. Famous fashion designers flock to the MIDO Eyewear Show in

COOKIE MAGAZINE | January 2024

Some glasses claim to correct color vision deficiency, such as EnChroma (California, USA) glasses. However, evidence doesn’t seem strong enough to support this claim. Bionode (Indiana, USA) glasses, designed to be used in conjunction with contact lenses to lower intraocular pressure and potentially save the sight of glaucoma patients, are in the early phase of investigation. Certainly, corrective glasses and those designed for myopia control will persist and continue to grow. This growth is spurred by advances in technology and buoyed by increased patient demand. As always, we hope you enjoy this issue of COOKIE Magazine!

Best, Dr. Carmen Abesamis-Dichoso

OD, MAT, FPCO, FIACLE, FBCLA, FAAO

In This Issue...

Cool Optometry

Optics

Eyewear Couture Malaysian eyeglass experts aim to bridge style, comfort and innovation in eyewear through optical styling

Cover Story 10

Eyeglasses in the Age of Virtual Reality Standing at the intersection of tradition and innovation, are eyeglasses revolutionizing ocular health or facing a blurry future?

Enlightenment

Kudos

Meet Optometry’s Rising Star Modern optometrist Dr. Nadia Afkhami leverages technology and social media to connect with her extensive patient base

Innovation

Telling Technicolor Tales with Color Vision Deficiency Malaysian optometrist Ms. Oh Poh Ling shares insightful perspectives on transforming lives with color vision devices

Framing the Future How artificial intelligence is revolutionizing vision correction, from precise prescriptions to early disease detection

COOKIE MAGAZINE | January 2024

Advisory Board Members

Matt Young CEO & Publisher Hannah Nguyen

Dr. Carmen Abesamis-Dichoso Abesamis Eye Care & Contact Lens Center, Manila, Philippines

Dr. Joseph J. Allen

COO & CFO

Doctor Eye Health, Minnesota, USA hello@doctoreyehealth.com

carmen.dichoso@gmail.com

Gloria D. Gamat Chief Editor Mapet Poso Editor

Matt Herman Associate Editor Maricel Salvador

Dr. Kristie Nguyen

Dr. Feenstra and Associates; Dr. Kristie Nguyen PLLC, Florida, USA

Dr. Mark Eltis

Graphic Designer

View Eye Care, Toronto, Canada drmarkeltis@vieweyecare.com

kristie817@gmail.com

Writers Andrew Sweeney Chow Ee-Tan Joanna Lee Tan Sher Lynn Ruchi Ranga Society Relations & Conference Manager

Dr. Monica Chaudhry

Learn Beyond Vision, New Delhi, India monica.rchaudhry@gmail.com

Dr. Elise Brisco

NearSight, California, USA elisebrisco@hollywoodeyes.net

International Business Development Brandon Winkeler Robert Anderson Sven Mehlitz

We are looking for eye doctors who can contribute articles to COOKIE magazine. Interested? Let's talk! Send us an email at editor@mediamice.com.

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Media MICE Pte. Ltd.

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COOKIE MAGAZINE | January 2024

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Cool Optometry |

EYEGLASSES

like Harry Potter, which has contributed to making glasses cool. Today, it’s not unusual to spot models or actors sporting eyeglasses. Glasses are now in! But has this change in perception extended to a worldwide phenomenon?

Crossing borders, changing perspectives “Over the years, the societal view of glasses has undergone notable transformations, transitioning from a negative impact decades ago, largely influenced by portrayals in movies, to a more positive image with the advent of stylish eyewear,” shared Dr. Saif Aldeen AlRyalat, an ophthalmologist at the Houston Methodist Hospital in Texas. “This evolution prompted the conceptualization of our research project, to have more robust data when we counsel our patients who need glasses.”

A Jordanian study highlights changing trends in eyeglasses perception by Andrew Sweeney

The perception of eyeglasses has evolved over time—and in Western populations, eyeglasses have become more popular. Has a similar shift occurred in other societies, such as the Arab world—and could this have implications for the growing rates of myopia? A Jordanian study could hold the answers.

hen it comes to fashion, there’s only one constant— change. You know that from your own experience. There’s no doubt there are a few pictures from your teenage years that you’d rather block out from memory, whether that’s because you were wearing some rather bizarre clothing or sporting an ill-advised haircut. No part of society is immune to change, and that includes optometry. For a long time, eyeglasses were very much not in—deemed uncool,

unfashionable, and generally perceived to be unappealing. A common movie trope from a couple of decades ago often involved a character’s beauty being unveiled by them taking off their eyeglasses. This reinforced the old notion that glasses were for geeks, nerds, and people who, though smart, might lack confidence and beauty. Times have changed, however, and now the concept of ‘geek chic’ has become popular. Some attribute this to the popularity of media franchises

The research Dr. AlRyalat is referring to is his own study, entitled The Effect of Wearing Eyeglasses on the Perception of Attractiveness, Confidence, and Intelligence.* Conducted at the University of Jordan in the country’s capital of Amman, the study examined the issues outlined in its title generally and with specific insights from an Arab cultural perspective. “Our study, primarily focused on Arab populations, prompts consideration of the broader implications of our results for diverse ethnic groups. However, we assert that while our study, published by The Cureus Journal of Medical Science in 2022, concentrated on a particular ethnic group, the identified patterns may have broader universal implications for diverse populations, given that our sample recruitment encompassed diverse universities in Jordan with international students,” Dr. AlRyalat explained. “Our decision to specifically examine attractiveness, confidence, and intelligence was grounded in a thorough literature review. It is imperative for us to study how wearing glasses extends beyond mere vision correction,” he continued.

COOKIE MAGAZINE | January 2024

Cool Optometry |

EYEGLASSES

The social impact of eyeglasses The research was carried out as a cross-sectional study at five main Jordanian universities. A total of 517 participants were given a survey containing photos of four people, both with and without glasses (a total of eight photos). The researchers used two photos of males and two photos of females, all with Arab features and within the college-going age range. They were then instructed to rate the photos on a scale of 1 to 10 regarding attractiveness, confidence and intelligence. Participants were then asked to provide a score for each of these three domains. To prevent bias, the images were shuffled to ensure that the image of a person with or without glasses would appear again after every five to six images. Among the 517 participants in the study comprising 182 (35.2%) men and 335 (64.8%) women, the mean age was 22.02 (±1.85) years. Of the participants, 346 (66.9%) did not wear glasses, and the majority of the included sample (88.2%) had not undergone refractive surgery. Pictures without glasses received higher ratings across all three domains compared to the same images with glasses. The difference in ratings was more evident for female images than for male images. The main difference among respondents was observed among those who did not wear eyeglasses—they were significantly more likely to assign higher scores for attractiveness, confidence, and intelligence to noneyeglasses wearers than those who did wear glasses.

Eyeglasses equal perceived intelligence In previous studies, the effect of wearing eyeglasses on intelligence perception varied among different areas and ethnicities. In one French study cited by the Jordanian researchers, people with eyeglasses were considered to have a higher socio-professional status than those without glasses. While acknowledging

that incorporating more diverse images, including more variations in eyeglass rims, diverse facial features, etc., would provide better context for future studies, Dr. AlRyalat believes the study highlights that the perception of eyeglasses is not immutable across cultures. “While our study showed a negative impact of wearing eyeglasses on intelligence rating, studies on Western populations found a positive impact on intelligence perception for people wearing eyeglasses. This might represent a sort of social stigma related to wearing glasses among Jordanians,” Dr. AlRyalat said. “Emphasizing the positive social impact associated with wearing glasses may serve to increase patient compliance and contribute to an enhancement in overall self-esteem. A noteworthy trend that appeared recently is when patients express a desire for [wearing] glasses even in the absence of refractive error for aesthetic reasons. This underscores the evolving positive perception of glasses in contemporary society,” he added. Highlighting a ‘positive social impact associated with wearing glasses’ could prove beneficial to many optometrists as they grapple with growing rates of myopia. The disease has taken on nearpandemic dimensions and affects Arab nations like Jordan and Western societies alike. Solutions such as contact lenses, refractive lasers, and surgeries offer alternatives to eyeglasses. However, these options are more expensive than eyeglasses.

Changing perceptions to fight myopia Dr. AlRyalat believes that the results of his study illuminate the role of social factors in the perception of eyeglasses, and that these factors can be changed. Alternatives to eyeglasses are ‘prestige’ options, prohibitively expensive in many parts of the world, including Jordan. By portraying glasses in a favorable light, he believes that individuals may lean towards considering eyeglasses as

COOKIE MAGAZINE | January 2024

a socially acceptable and beneficial option for conditions like myopia. “The escalating global rates of myopia underscore the significance of our study's potential impact on the array of options available to patients, including eyeglasses and alternative modalities, such as contact lenses, refractive lasers, and surgical interventions. In the face of the surging prevalence of myopia worldwide, our findings highlight eyeglasses as a secure, cost-effective treatment option compared to alternative modalities,” Dr. AlRyalat confirmed. “Our study looked into an invention from the 9th century by an Arabic inventor and how it is still the most cost-effective treatment modality for refractive error—an increasingly prevalent problem in the 21st century. Emphasizing positive social impact associated with wearing glasses may serve to increase patient compliance and contribute to an enhancement in overall self-esteem,” he concluded.

Reference * AlRyalat SA, Jumaah M, Al Hajaj SW. The Effect of Wearing Eyeglasses on the Perception of Attractiveness, Confidence, and Intelligence. Cureus. 2022;14(3):e23542.

Contributor Dr. Saif Aldeen AlRyalat is an ophthalmology fellow at Houston Methodist Hospital in Texas, USA. He completed his medical school and ophthalmology residency at The University of Jordan. He has published over 150 peer-reviewed articles, the majority discussing advances in diagnostics and treatments. Ranked among the top 2% of researchers by the annual Stanford list, Dr. AlRyalat has received national and international awards in medical research and ophthalmology. His current focus is on the use of artificial intelligence in ophthalmology. saifryalat@yahoo.com

Optics |

DESIGNER GLASSES

Eyewear Couture

Malaysian eyeglass experts aim to bridge style, comfort and innovation in eyewear through optical styling by Joanna Lee

Gone are the days when prescribing glasses was as simple as merely choosing a frame based on the prescription. Today, it’s all about optimal fit and style. With the evolving emphasis on comfort coupled with the current demand for aesthetics, an engineer and an optician have teamed up to give consumers exactly what they need.

sian consumers are generally known to be highly image conscious. According to Mr. Aw Tai Hau, co-founder and optical stylist at Pott Glasses—a Malaysian eyewear boutique focused on blending functionality with style and fashion— eyeglasses from many popular international brands, in most cases, may not carry what he calls the “Asian fit,” defined as low-bridge fit glasses.

Not a designed campaign. This photo is for representation only.

Addressing the ‘Asian fit’ issue “A majority of Asians do not have nose bridges as high as those of Caucasian faces. Also, ergonomicswise, they generally have a smaller head width. So, ill-fitting glasses may result in frames that slip down or rest on the cheeks rather than sit comfortably on the nose bridge,”

explained Mr. Tan Chaang Hoong, the other co-founder of Pott Glasses. “Not only that, this misfit can create pressure on the sides of the head, causing discomfort.” Thus, when Mr. Tan and Mr. Aw started Pott Glasses about eight years ago, they decided that more considerations needed to be taken into account in the spectacle

COOKIE MAGAZINE | January 2024

Optics | DESIGNER GLASSES

selection process. Over time, they have not only created their own brand of spectacle frames and offered some niche styles, but also pioneered the concept of ‘optical styling.’ “When it comes to the technicalities behind achieving the right fit for comfort, we, as professionals, need to consider not only selecting the right type of glasses and lenses but also making necessary adjustments,” said Mr. Tan. “We have eight steps, condensed into four dimensions, or aspects, for our customers. While fitting may sound simple to many, there is actually a lot of work that goes into the process.”

understand the pupil distance. Then, we need to consider the pupil height and the pantoscopic tilt, whether it’s tilt in or tilt out. Fourth, we look at the vertex distance, which is the distance between the lens and the eye. Fifth, we also need to consider the curvature of the frame, as it can affect the weight of the glasses and, consequently, influence the sensitivity of the frame’s feel on the skin,” he said.

Framin’ it in eight steps

“Subsequently, weight balancing is crucial. For example, if a person’s ears are positioned higher than their nose, their glasses are more likely to slip off easily,” Mr. Tan added. “Finally, opticians need to consider the grip factor and measure the head width.”

Mr. Tan explained the eight-step process further: “It’s not just about the power itself. First, we have to

Further, Mr. Tan admitted that executing the same process consistently across all their outlets

is easier said than done. “That’s why, at Pott Glasses, we provide training for our staff to follow our eight steps, ensuring consistency,” he enthused. This optical styling process is simplified for their customers as “4D” or “four-dimensional styling.”

The art of 4D styling What are the 4Ds? Mr. Tan explained: “The number one factor is the customers’ prescription power. Higher power results in thicker lenses. So, we guide our customers to choose lighter lenses and frames. Otherwise, the entire spectacle would be too heavy, making them slip often and cause discomfort.” “The second factor is attire and occupation,” he said. Here, the customer and the optician would discuss various occasions when the glasses will be worn, especially in professional settings. “One type of glasses may not suit all occasions, even if they are comfortable. We believe that style is also a very important consideration,” he added. “For instance, we fit individuals in white-collar professions with glasses that exude an executive look. In contrast, we offer those in the design industry unique and distinctive frames. For professionals like doctors, lawyers, and architects, we may fit them with frames that feature materials that showcase their own distinctiveness,” said Mr. Tan. “This allows them to portray a specific desired image. We believe that glasses are among the first things we notice when meeting someone in person.” “The third factor is the purpose or function, where we discuss why the customer would choose their glasses. Some people opt for glasses exclusively for office wear, while others choose them for sports. Additionally, some choose glasses only for the purpose of having a spare pair,” he continued.

Not a designed campaign. This photo is for representation only.

COOKIE MAGAZINE | January 2024

“Fourthly, we consider face shapes and length,” he said, emphasizing that this aspect primarily focuses on aesthetics.

Street, structure, and millennial chic “One thing is certain: Eyewear fashion has evolved rapidly in the last few years compared to 10 years ago. A significant transition was, for example, from rectangular, thick frames to thin, metal frames,” observed Mr. Aw. “This initial transition was inspired by South Korea and Japan, embracing a minimalist style. We simply cannot underestimate the impact and influence of K-pop and Japanese fashion, as they lead the way in setting trends across Asia,” he continued. As far as trends go, Mr. Aw envisions two directions on the horizon. “First is streetwear. Here, you have glasses resembling those from Balenciaga. They’re unique, loud and, most of the time, these are sunglasses, giving off a very futuristic vibe,” he shared. “After conquering clothing, streetwear has now moved on to glasses,” Mr. Aw said. “These glasses are bold, colorful and very metallic. However, you may have to compromise on comfort and shape, as these are primarily fashion statements,” he continued, adding that they also carry Y2Kinspired sunglasses, tapping into the resurgence of designs from the 2000s that is currently trending among millennials. If you’re wondering how to strike a balance between offering style and comfort, Mr. Aw advised understanding the customer’s purpose for getting the glasses. He suggested following up by stating the pros and cons of each choice to clearly set their expectations. The other new direction on the horizon, according to Mr. Aw, revolves around functionality and design. “New mechanics are coming up on the structure and combination of materials. For instance, instead of a normal hinge, we’re talking about more unique hinges, like the ones by Lindberg and 999.9 [Four Nines], a Japanese brand,” he said. “These are the brands that focus more on

the structure of the glasses. They’re not only comfortable but also very elegant and delicate.”

In a league of their own Pott Glasses produces its own frames and designs. “We believe that our brands, which are similarly categorized and positioned as Warby Parker and Oscar Wylee, could fill the market gap in terms of comfort, pricing, structure and style. For instance, sometimes the designs of Korean brands can be overwhelming for Asians who prefer more subtle styles. That’s where we come in,”Mr. Aw explained. Similar to the fashion industry, Mr. Aw and Mr. Tan continue to refine

the details of their designs and processes, evolving through constant self-evaluations based on customer feedback. As a testament to their unique approach at Pott Glasses, the upcoming season in 2024 will witness the launch of four new outlets. There’s also the 3D optical printing trend. “We’ve recently visited an optical fair, and we believe that the finishing for 3D printing still has room for improvement. “This is if we’re talking about the whole set of glasses. However, if we’re talking about parts of glasses that we could assemble, then, that would be doable and quite appealing,” Mr. Aw concluded.

Contributors Mr. Aw Tai Hau, cofounder and partner at Pott Glasses, is an exceptional entrepreneur with a passion for fashion and a keen eye for business development. Despite graduating in Engineering, Tai Hau’s entrepreneurial spirit motivated him to venture into a whole new industry. It was during a backpacking trip to Europe that Tai Hau was struck by the trend of professionals wearing stylish glasses that accentuated their personalities. Realizing the lack of such a trend in Malaysia, he saw an opportunity to create a niche in the market. He then embarked on a journey to establish an online glasses store that provided stylish glasses at a justifiable price. As the co-founder of the company, Tai Hau oversees the business development and marketing of the brand. His unparalleled skills in networking and establishing strategic partnerships have significantly elevated the brand’s image and exposure, successfully positioning Pott Glasses as a leading player in the market. Through his drive, passion, and commitment, Tai Hau continues to push boundaries, drive innovation, and shape the future of Pott Glasses.

Mr. Tan Chaang Hoong, co-founder and partner at Pott Glasses, has over seven years of previous experience in the optical industry before cofounding Pott Glasses with Tai Hau. His extensive knowledge and insights into the industry have been invaluable in shaping the direction of Pott Glasses. With a long-standing desire to open his own business, Chaang Hoong was excited to join forces with Tai Hau and inject his own ideas into the venture. He focused on fine-tuning the not-so-perfect aspects of his previous work experiences, placing a strong emphasis on glasses fitting and customer service. These two critical elements have become key pillars, explaining why customers keep coming back. Currently, Chaang Hoong leads the operations, training, and supply chain of the company. He has implemented in-house training programs to equip the team with the necessary skills to provide top-notch customer service. Optimization is always at the forefront of his approach to running the business, with a strong emphasis on process flow, effectiveness, and efficacy— helping Pott Glasses maintain a competitive edge in the market.

taihau.aw@pottglasses.com

chanhong90@gmail.com

COOKIE MAGAZINE | January 2024

Cover Story

by Andrew Sweeney

Eyeglasses have been around for longer than optometry has been an established medical discipline. Times are changing, however, and new technology emerges with each passing day. What does this mean for eyeglasses? Augmented and virtual reality might hold the answers.

sk any average person on the street what they most associate with both optometry and ophthalmology, and you’ll likely get one answer—eyeglasses. Nothing is more closely associated with our field than humble spectacles.

Associations with the visual aid are numerous and unavoidable. In the United Kingdom, there’s even an optometrist’s chain called Specsavers that once sponsored football referees, who were often accused of being blind.

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There has never been a time when eyeglasses have faced more competition than ever as solutions for ocular health problems. Contact lenses are gaining popularity, and refractive surgery has become safer and more accessible. So the question is, could eyeglasses be going the way of the dodo? Are we about to see the demise of the optometry industry’s trusty packhorse, shoved off on its way toward the metaphorical glue factory? Technology considered this possibility and responded with, “Hold my beer.” Despite the abundance of alternatives to eyeglasses, a tech leap forward is on the horizon. This will not only provide consumers with more corrective options for their eyesight but also enhance their lifestyles through alternate reality (AR) and virtual reality (VR). Patients with poor eyesight will continue to enjoy vastly improved vision, thanks to their eyeglasses.

Eyeglasses evolution: Navigating the tech leap forward Eyeglasses have a long history, with the invention of the lenses credited to 9th-century Arab mathematician and inventor Ibn al-Haytham. The first recorded use of eyeglasses dates back to the 13th century.1 This marked the first practical application of magnification in society at large. By the 15th century in Europe, religious paintings depicted saints wearing eyeglasses.2 As technology improved over the years, the use of eyeglasses continued to rise in popularity. By the 17th century in England, a class distinction had emerged. Eyeglasses worn by the upper classes were perceived as hallmarks of intelligence and sophistication, whereas the riffraff of lower status who wore them were roundly ridiculed.2 Fast forward to the present, and over half of the adult population worldwide uses prescription eyewear to protect or correct their vision. Today's eyewear industry is a massive business, offering a variety of styles,

shapes, and sizes for customers across the globe.3 Yet despite all that, it’s not difficult to find articles speculating that eyeglasses are more likely than ever to fade in popularity. So, what’s prompting the industry to say, “Hold my beer?” “In comparison to conventional eyeglasses and the use of singlevision, bifocal, and progressive lenses, the advancement of integrating AR/VR technology into eyeglasses is truly fascinating and mind-blowing. Simply put, the use of AR/VR eyeglasses signifies a new way of living life with the seamless integration of futuristic ideas with present needs patients experience now,” said Dr. Kevin Chan, senior clinical director at Treehouse Eyes - Myopia Care For Kids in Vienna, Virginia, USA. Dr. Chan believes that the adoption of new smart eyeglasses could make medical care more affordable, reduce testing time and enhance the overall efficiency of optometry clinics. Rather than heading in the dodo direction, eyeglasses have huge potential, thanks to the integration of AR/VR. This is particularly evident in myopia treatment. “Robust evidence strongly suggests that peripheral hyperopic blur in the retinal field is one of the key potential culprits of myopia progression, which results in axial elongation of the eyes. Ophthalmic devices, such as Kubota Glass, employ AR/VR technology to enable stimulation of peripheral myopic defocus on the retina, which is believed to exert inhibitory effects against the axial elongation of the eyes,” explained Dr. Chan. “Other potential parameters, such as luminance, contrast, degrees of peripheral defocus, and spectral levels, can also be modulated by AR/ VR devices that have shown to impact diurnal variations of axial length,” he added.

The role of eyeglasses in myopia management The rates of myopia are growing exponentially around the world, with projections indicating that up to 50%

of the population could be myopic by 2050. This prevalence is accompanied by a rise in early onset cases, which in turn leads to an increased risk of high myopia, increasing the potential for more issues with visual impairment.4 This domino effect of condition to complication represents a significant threat to patients, global healthcare systems and optometrists alike.

“In comparison to conventional eyeglasses and the use of singlevision, bifocal, and progressive lenses, the advancement of integrating AR/ VR technology into eyeglasses is truly fascinating and mind-blowing. Simply put, the use of AR/VR eyeglasses signifies a new way of living life with the seamless integration of futuristic ideas with present needs patients experience now.” Dr. Kevin Chan

Some professional organizations, such as the College of Optometrists in the United Kingdom, have urged caution against strong responses, stating that “not enough evidence [exists] to support the widespread rollout of myopia control.” Other clinicians have argued that there is an increased risk of serious ocular infections arising from prescribing contact lenses to children.4 However, millions of children around the world still face the potential of serious complications arising from myopia. Can smart eyeglasses help mitigate the impact of the disease? Evidence is clear that early

COOKIE MAGAZINE | January 2024

Cover Story

intervention in myopia control is good for the patient, with benefits including better uncorrected and corrected visual acuity, improved vision-related quality of life and reduced dependence on correction. Therapies, including topical atropine application, have proven as effective as eyeglasses in their most basic form.4

“When it comes to eyeglasses, I'm really excited about new options for myopia management. In the United States, we can prescribe topical atropine drops, multifocal contact lenses, and orthokeratology to treat myopia. But we can't prescribe glasses for myopia management here just yet. This is despite promising results in other countries where eyeglasses can be prescribed.” Dr. Elise Kramer

AR/VR and other new technologies could provide significant benefits for patients by themselves. However, optometrists should not lose sight of the fact that eyeglasses still offer clinically meaningful slowing of progression. Depending on where you are in the world, you may find this statement either obvious or a call for a new regulatory approach to myopia management. “When it comes to eyeglasses, I'm really excited about new options for myopia management. In the United States, we can prescribe topical atropine drops, multifocal contact lenses, and orthokeratology to treat myopia. But we can't prescribe glasses for myopia management here

just yet. This is despite promising results in other countries where eyeglasses can be prescribed,” shared Dr. Elise Kramer. Dr. Kramer, an optometrist and contact lens specialist at the Miami Contact Lens Institute in Florida, is an expert in myopia control. She has seen increasing numbers of patients with the condition at her clinic, particularly in children. Dr. Kramer believes that this younger cohort stands to benefit the most from eyeglasses options designed for myopia control, especially those that focus on axial length elongation, as outlined by Dr. Chan. “Some children may find it easier to engage in myopia management when eyeglass options are available. Some kids are afraid of eye drops, or they may not be ready yet for contact lenses. If they don't use any of these treatment options, then they don’t have any means to prevent the progression of their myopia. Eyeglasses will make the treatment more accessible,” Dr. Kramer explained.

Smart glasses: Are we ready for them this time around? Smart eyeglasses have been around for a decade, but they never gained popularity for various reasons. Google Glass is the best example. You may be surprised to know that it was only killed off in May this year despite becoming publicly available in 2014. The heady days of 2014 marked a special time—the world was a simpler place politically, conspiracy theories were relegated to the darkest corners of the Internet, and the COVID-19 pandemic was six years away. It was also the first time that smart eyeglasses made their way into the public domain, and to say that they were a bust would be something of an understatement. At $1,500 a pop, Google Glass was out of reach for the average consumer. Despite subsequent versions of the core product over the years, it failed to achieve widespread popularity.

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Times have changed, however, and smart glasses are back with a bang, with most offerings opting to focus on AR/VR as well as social media integration. The idea is to create alternatives to traditional devices like laptops and mobiles, allowing users to manage day-to-day interactions, such as checking emails or catching up on work, directly through eyeglasses. However, the longterm effects of using such devices remain unknown and require further research. There are also blue-light filtering eyeglasses designed to filter ultraviolet radiation and varying portions of short-wavelength visible light, preventing them from reaching the eyes. These devices claim to mitigate symptoms of eye strain with computer use. While they offer little to no effect on BCVA, this would have been a niche option 10 years ago.5 “I think there's huge potential for new technologies in eyeglasses, much more so than it was 10 years ago. People are more used to technology, whether that's with biometrics, day-to-day life, navigation tools like Google Maps, etc. Society wasn’t prepared for technology like Google Glass [then], but it is now,” shared Dr. Pete Kollbaum, associate dean for research at Indiana University. “This means there’s great potential not just for medical conditions but for diagnostics as well. Smart eyeglasses could be used to monitor conditions like blood pressure, blood sugar, heart rate, etc., all using technology that could be incorporated now. This could also be applied to glaucoma and intraocular pressure (IOP),” he continued.

Eyeglasses are here for the long haul The point Dr. Kollbaum makes is an important one, as smart eyeglasses have the potential not only to treat but also to diagnose and monitor various conditions. Consistently monitoring IOP could offer several benefits to glaucoma patients, allowing them to exercise greater control over other conditions, such

as diabetes. When used effectively, smart eyeglasses can provide a more holistic approach to medical treatment and are not limited to the domain of optometry alone. “Patients will come in asking for this type of technology as it's already advertised in the mainstream media. This allows people to identify and brainstorm ideas about what could be done with this type of technology,” Dr. Kollbaum added. Measuring IOP is a dynamic process that can’t be completed solely through an eye exam or by taking a few measurements. Dr. Lisa Ostrin, associate professor at the University of Houston’s College of Optometry in Texas, emphasizes the great potential for developing new technology that will not only measure IOP but also consider related physiological processes. She believes such devices would be widely popular with patients and clinicians alike—a win-win for all involved.

"Smart eyeglasses could be used to monitor conditions like blood pressure, blood sugar, heart rate, etc., all using technology that could be incorporated now. This could also be applied to glaucoma and IOP.” Dr. Pete Kollbaum

“We're going to look at the clinical trials when they're available and the research demonstrating that these smart eyeglasses have a positive benefit. This is undoubtedly an area where technology will help increase our understanding of our patients’ ocular conditions, including their physiological processes and the treatments we can use to address their specific issues,” Dr. Ostrin explained.

However, Dr. Ostrin is also keen to emphasize that, despite the onset of new lens technology and smart eyeglasses, the original and classic forms will remain. Conventional eyeglasses will continue to play a vital role in eye care treatment, especially in less developed countries, where they serve as a dependable method. “Eyeglasses are always going to be a necessity, and I don’t really see them being replaced by anything. While there's a lot of novel technology out there that is fun to play with, they tend to make eyeglasses more expensive and complicated than necessary, putting them out of reach of most of the public,” clarified Dr. Ostrin.

Change is a constant in life Technology always carries the potential for disruption. Yet at times, its power to revolutionize our lives and work can be overstated. When computers first became publicly accessible, it was frequently said that secretaries would lose their jobs en masse. Similarly, predictions about AI tools like OpenAI rendering writers obsolete have yet to materialize. Yet the point remains: Change can be challenging, and the impact of technology can be unsettling. Eyeglasses are here to stay even if pre-existing alternatives continue to improve in quality and efficacy, and new alternatives emerge. So, what advice do some of our contributing optometrists have for their fellow professionals concerned about change? What pearls of wisdom can they offer? “I don’t think that new technologies like AR and VR are avoidable, and there's huge potential for optometry. However, I do think we need to have new privacy policies in place, as there will be a lot more information online about smart eyeglasses. Always consider if something could represent a breach of privacy,” Dr. Kramer shared. “I think that education is very important. [When introducing new technologies like AR and VR], go

over the potentials of side effects, advantages and disadvantages—as you would with any other product. Also consider the following for your patients: Why should they start using something, what could it mean for them?” she added.

“Eyeglasses are always going to be a necessity, and I don’t really see them being replaced by anything. While there's a lot of novel technology out there that is fun to play with, they tend to make eyeglasses more expensive and complicated than necessary, putting them out of reach of most of the public.” Dr. Lisa Ostrin

“When it comes to smart eyeglasses or augmented reality, it’s crucial to ask yourself why you are recommending them. What are the benefits they offer to your patients?” Dr. Kramer continued. “For eye care practitioners, the use of AR/VR technology no longer carves the future, but the present as well. The best way to test out whether these innovations align with your goals and suit your practice is to first experience them yourself,” Dr. Chan said. “Patients in this era are generally more technology-savvy and they largely embrace innovations. Some patients may be willing to try it out at home as ‘test subjects’ and provide you with feedback before a full-scale plan is implemented in your office. This will help engage their curiosity and build loyalty with your practice,” he concluded.

COOKIE MAGAZINE | January 2024

Cover Story

Contributors Dr. Lisa Ostrin, OD, PhD, is an associate professor at the University of Houston College of Optometry. She received a BA in Studio Art at the University of Texas and then completed an OD/PhD at the University of Houston College of Optometry. She attended Johns Hopkins University for post-doctoral research in low vision and retinal prosthetics and then worked as a clinicianresearcher at the University of California Berkeley, with a focus on myopia. She returned to the University of Houston to continue her work in myopia, conducting studies in both human participants and animal models. She is interested in environmental factors and visual cues that contribute to myopia onset and progression, as well as in the development and testing of novel myopia treatments. In addition to research, Dr. Ostrin teaches gross and ocular anatomy and has authored a book, Anatomy of the Human Eye: a Coloring Atlas. Dr. Ostrin is a fellow of the American Academy of Optometry, a Gold Fellow of the ARVO, and a recipient of the American Optometric Foundation Ezell Fellowship and the University of Houston College of Optometry Cora and J Davis Armistead Teaching Award. kollbaum@indiana.edu

Dr. Elise Kramer is a residency-trained optometrist in Miami, Florida, who specializes in ocular surface disease and specialty contact lens design and fitting. Her doctorate degree was awarded in optometry from the Université de Montréal in 2012. During her fourth year, she completed her internship in ocular disease at the Eye Centers of South Florida and went on to complete her residency at the Miami VA Medical Center. Her time there included training at the Bascom Palmer Eye Institute, the nation’s top eye hospital. After her residency, Dr. Kramer became a fellow of the Scleral Lens Education Society (SLS) and now serves as the treasurer for the SLS. Dr. Kramer is a member of the American Optometric Association and the International Association of Contact Lens Educators, as well as a Fellow of the American Academy of Optometry and the British Contact Lens Association. She is also the Delegate of International Relations for the Italian Association of Scleral Lenses. Dr. Kramer has published several important articles and reviews and participates in clinical research trials. She enjoys lecturing all around the world in several different languages about ocular surface diseases and specialty lenses. elise@miamicontactlens.com

References 1. Tbakhi A, Amr SS. Ibn Al-Haytham: Father of Modern Optics. Ann Saudi Med. 2007;27(6):464-467. 2. Roman F. The Invention of Eyeglasses. Br J Ophthalmol. 1993;77(9):568. 3. Tian Y, Ball R. Parametric Design for Custom-Fit Eyewear Frames. Heliyon. 2023;9(9):e19946. 4. Bullimore MA, Ritchey ER, Shah S, et al. The Risks and Benefits of Myopia Control. Ophthalmology. 2021;128(11):1561-1579. 5. Singh S, Keller PR, Busija L, et al. Blue-light Filtering Spectacle Lenses for Visual Performance, Sleep, and Macular Health in Adults. Cochrane Database Syst Rev. 2023;8(8):CD013244.

Dr. Kevin Chan, OD, MS, FAAO, is the senior clinical director at Treehouse Eyes Myopia Care For Kids, an eye care clinical network with facilities located in 19 different states in the US. As a professional affairs consultant for Johnson & Johnson Vision, he also provides clinical consultation and educational events pertaining to orthokeratology. A graduate of the New England College of Optometry, Dr. Chan is an internationally recognized advocate for increasing awareness of myopia as a disease continuum among practitioners and the general public. kevin.chan@treehouseeyes.com

Dr. Pete Kollbaum, OD, PhD, FAAO, FBCLA, is a professor, associate dean for Research, and director of the Borish Center for Ophthalmic Research at Indiana University. He is also a professor (by courtesy) at the Weldon School of Biomedical Engineering at Purdue University. Dr. Kollbaum attended Iowa State University studying mechanical engineering in undergrad. After receiving his OD degree from Indiana University, Dr. Kollbaum worked in a private multidisciplinary practice prior to returning to IU where he received a Master’s Degree in Clinical Research and a PhD in Vision Science. He has since been on the faculty at IU, where he teaches in the areas of contact lenses and optics. His research interests include lens design, optics, myopia, presbyopia, eye fatigue, and predictive modeling. He has been fortunate to receive funding through the NEI and industry partners to support his research initiatives. Dr. Kollbaum holds membership in AAO, ARVO, BCLA, and ISCLR. He received the Borish Award from the AAO and was a three-time recipient of an Ezell Fellowship provided by the AAO Foundation. lostrin@Central.UH.EDU

COOKIE MAGAZINE | January 2024

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Kudos |

WOMEN IN OPTOMETRY

pproachable, determined, and creative, Dr. Nadia Afkhami loves establishing a connection with people and changing their lives with something as simple as an eye exam. “I am deeply passionate about making a tangible difference in people's lives by optimizing their vision and overall eye health,” she shared in an interview with COOKIE Magazine.

Navigating a path to excellence in healthcare Fluent in both English and her native language, Farsi, Dr. Afkhami came from a close-knit family that has always encouraged academic pursuits.

Meet Optometry’s Rising Star Modern optometrist Dr. Nadia Afkhami leverages technology and social media to connect with her extensive patient base by Chow Ee-Tan

Dr. Nadia Afkhami, a first-generation Iranian-American optometrist, has gained recognition as one of the winners of the 2022 Eyecare Business Game Changer Awards. Passionate about making a tangible difference in the industry, she embraces technology and social media to connect with patients, boasting over 16.9K followers on Instagram.

COOKIE MAGAZINE | January 2024

“My educational journey has been focused on pursuing excellence in my field. I always knew I wanted to be in the healthcare industry since I was a child. The thought of helping people was greatly embedded in me from a young age,” she shared. “Optometry wasn't my initial career ambition, but my fascination with vision science and its impact on people's lives inspired me to explore this field.” According to Dr. Afkhami, the ability to improve someone's quality of life through better vision care has become her motivation to pursue optometry. During her university years, she completed a vast array of internships, including at private and public OMD/ OD practices, Veterans Affairs Hospitals, and an Indian Health Services Hospital. She gained experience treating and managing ocular diseases, as well as addressing binocular vision needs. “University provided a solid foundation, but internships truly enriched my learning. They exposed me to diverse cases, allowing me to apply theoretical knowledge to real-world scenarios, fostering both professional growth and confidence,” she shared. Dr. Afkhami is also one of the original Student Ambassadors for Transitions and has worked with companies like

Essilor, Zyloware, Prive Revaux, and Luxottica.

Optometry in the social media spotlight One of her strengths lies in her technological and social media savvy. Through her Instagram account, @eyeamdrnadia, which boasts more than 16.8K followers, Dr. Afkhami shares insights into optometry. Since her undergraduate days, this optometrist has been uniting a new generation of eye care providers with her relatable social media content. “When studying optometry, I was happy to take breaks from bookwork to manage my social media page. Especially during the COVID-19 pandemic, I felt that it helped me connect with people at a time when many were lonely and needed an outlet for connection. I’m happy to have been one of those people that others connected with,” she shared.

“I don’t worry about numbers. I post what is meaningful to me and to my patients. I think people can see that my posts are authentic and connect to me more because they really feel as though they know me.”

A game changer in eye care Dr. Afkhami feels extremely honored to have been recognized as a winner in the 2022 Eyecare Business Game Changer Awards. “Winning such an award early in my career was incredibly humbling. I believe my innovative approaches to patient care and dedication to leveraging technology for better outcomes contributed to being chosen,” she enthused. “It was truly my dream to be recognized for my accomplishments in the industry. I think that the industry recognized that I had made such big strides early in my career. It was truly an honor to be chosen,” she gratefully shared. After graduating in 2022, Dr. Afkhami joined a team of optometrists at

Vision Source Oviedo, a provider of quality vision services in Oviedo, Florida. It has been an enriching experience for her so far. “I’m passionate about exploring specializations related to ortho-k lenses, scleral, and amniotic membranes. I also have a keen interest in medical-based optometry. I think I would enjoy having a combination of private practice and gaining more medical-based experiences at the VA and Indian Health Services Hospital,” she shared. Dr. Afkhami is also involved in community outreach for young women and children who have an interest in science. In her spare time, she likes spending time with friends and family. She believes that being a modern optometrist entails maintaining a practice that embraces technology, offering personalized care, and focusing on preventive measures. Building strong relationships with clients and being a source of trusted guidance are also crucial in providing comprehensive eye care.

Dr. Afkhami believes that social media serves as a platform to educate and engage with the community on eye health. It helps in spreading awareness, sharing valuable tips, and establishing a connection beyond the clinical setting, thereby enhancing the patient-provider relationship. “I’ve been fortunate to share my optometry life and my personal life all in one page. My followers connect with me on some level, and I’m grateful for that. Seeing them laugh, share, and comment lets me know that for just a moment in their day, I was able to bring joy to them in some way,” she continued.

COOKIE MAGAZINE | January 2024

Kudos |

WOMEN IN OPTOMETRY

“As a new generation of modern optometrists, I believe we are also more empathetic in our approach to practice. We want our patients to feel cared for by someone who thinks of them as their friends rather than just another patient. Modern optometrists are also more vocal and more involved. And as optometry changes over time, we can help change and shift things for the better,” Dr. Afkhami continued.

Collaboration with the eyeglasses industry Dr. Afkhami also believes optometrists play a pivotal role in collaborating with the eyeglasses industry. “Working hand-in-hand allows us to provide patients with a wide array of options that cater to both their vision needs and lifestyle preferences,” she said. She highlights recent advancements in the eyeglasses industry, which include incorporating innovative lens materials, customizable frames and augmented reality for virtual try-ons. These developments aim to enhance

comfort, aesthetics, and the overall user experience.

the ability to continuously learn and adapt in a dynamic field.

“Another great thing about optometry—you can embrace a fashionable side with frames and glasses while projecting an academic and medical persona. This always interested me because eyeglasses can help strike a great balance,” she added.

Indeed, Dr. Afkhami’s dedication to her field is evident, as well as her passion for making a tangible difference in people's lives by optimizing their vision and overall eye health.

Dedication and passion in action In her practice, challenges can also arise in managing diverse patient needs and expectations. She admits that gender and ethnicity have occasionally posed challenges, but through open communication, empathy, and a focus on quality care, she is confident that she can overcome such barriers. She added that her inspiration and motivation include witnessing the immediate positive impact of proper eye care on patients' lives, as well as

“Working hand-in-hand allows us to provide patients with a wide array of options that cater to both their vision needs and lifestyle preferences,”

“I am immensely grateful for the opportunities to serve the community and contribute to the field of optometry. I'm excited about the future possibilities in eye care and committed to providing the best care to my patients,” she concluded.

Contributor Dr. Nadia Afkhami, OD, was born in Iran and embarked on a new journey at the age of two, immigrating to the United States with her family. From an early age, her fascination with optometry sparked a passion that would shape her future. Driven by a deep-seated curiosity about vision science and its impact on people's lives, she pursued a career in optometry, aiming to provide exceptional eye care to her community. Outside her professional endeavors, Dr. Afkhami cherishes spending quality time with her friends and family. Whether engaging in leisurely activities or lively conversations, she values these moments dearly. Her free time often revolves around creating cherished memories with loved ones, be it exploring new places, sharing meals, or simply enjoying each other's company. Throughout her journey as an optometrist, Dr. Afkhami has remained dedicated to her patients, ensuring they receive the best possible care. Her commitment to the field extends beyond the clinic, intertwining with a passion for fostering meaningful relationships with those she serves and cherishes. She has been able to connect with others through her social media page on Instagram and with her new collaborative podcast, The Depth Perception. eyeamdrnadia@gmail.com @Eyeamdrnadia

COOKIE MAGAZINE | January 2024

Industry Update

Ray-Ban and Meta Launch the Next-Gen of Smart Glasses

eta Platforms, Inc. and EssilorLuxottica introduced their next generation of smart glasses,

the Ray-Ban Meta smart glasses, during the annual Meta Connect event. The new collection offers the first ever eyewear with live streaming and Meta AI built-in, higher quality camera, and improved audio and microphone systems paired with a redesigned, more intuitive app and charging case. The live streaming function allows content creators to broadcast their experiences and POV in real-time, hands-free. It opens a new level of authenticity and relatability in the content that’s being created, sharing live from their eyes. The wearer can toggle between the glasses and phone camera to Instagram Live or Facebook Live for up to 30 minutes. The Meta AI offering is exclusive to the US at launch, and wearers will be able to use the voice prompt “Hey Meta” to dive deeper into a moment of creativity and control features on the glasses. As a commitment to privacy continues to be at the core of the product,

the company has made the privacy LED light

collection is in a league of its own with features

bigger and more noticeable.

that have never fit inside a pair of glasses

The Ray-Ban Meta smart glasses collection has taken a leap forward in audio and camera quality. Its camera goes from 5 MP to an ultra-wide 12 MP, which takes high-quality photos and immersive 1080p videos in portrait orientation. The discreet open-ear speakers now have increased bass response and noise suppression, enhancing the overall audio quality. Each pair can be found with five built-in microphones to support seamless switching between music and calls, while still allowing the wearer to hear the ambient

favorite Wayfarer, perhaps with your own prescription and Transitions lenses that go from day to night, but you know you have this powerful universe of tech inside. Meta AI, live streaming, and insanely crisp audio and calling capabilities—all hands-free,” said Rocco Basilico, Chief Wearables Officer for EssilorLuxottica. “This is what we imagined when we first decided to enter this space. Truly wearable, life-enhancing technology. And it will only get better.”

sound of their surroundings and stay attuned

Starting at a suggested entry price of $299,

to the world around them. The listening

the Ray-Ban Meta collection comes with a

experience now includes bass response and

classic compact and portable charging case

noise suppression, enhancing the overall

to keep the glasses powered. The collection

audio quality for a more complete audio

notably features an improved companion

experience—whether it’s for listening to a

app, Meta View (iOS and Android), offering a

favorite album or reliving moments personally

seamless way to import content.

created.

The Ray-Ban | Meta collection is available for

“We’re incredibly proud to collaborate with

purchase at Ray-Ban stores, Ray-Ban.com,

Meta to build this nascent category from

Meta.com, as well as select EssilorLuxottica

the ground up. The new Ray-Ban Meta

retail stores.

EssilorLuxottica launches HELIX, a digital ecosystem to simplify the lives of ECPs

before. The world sees you in a pair of your

Industry Update

ssilorLuxottica is taking another

are interested in leveraging the opportunities

run their practices without the headaches we

significant stride in the digitization of

made available by modern technology.

hear about so often. We already have strong

the eye care industry with the launch of

HELIX, a new division of the company focused on helping eye care professionals (ECPs) leverage modern technology to improve the efficiency of their practices. HELIX aims to address all digital needs of ECPs through a smart, interconnected platform, helping them with tasks ranging from booking and ordering to teleoptometry and managed

This new division will harness the power of EssilorLuxottica’s US digital solutions, including VisionWeb, CLX, 4PatientCare, and Revenue Cycle Management, upgrading a historically fragmented approach with a more unified, data-driven modern one. ECPs can soon benefit from having one intuitive user interface where they can navigate back and

and historically effective digital tools in our portfolio including VisionWeb. When we put them into a single interface where all the tools speak to each other seamlessly, it will be like putting a new engine into your practice. This, in turn, gives ECPs more time to dedicate to their patients,” said Fabrizio Uguzzoni, President of Professional Solutions for EssilorLuxottica NA.

forth between tools seamlessly throughout

The first offering from HELIX, a next-

their day. This ease of use, eventually

generation platform called Vision(X), will be

complemented by one customer care team,

available to US ECPs beginning in Q2 2024 and

will unburden ECPs so they can focus on their

the company will offer a demo of it at Vision

practices.

patients and what’s important to them.

Expo West in Las Vegas. Current customers

The launch of HELIX is part of

“There is a staggering amount of new practice

EssilorLuxottica’s strategy to offer a broad

technology available today, which is incredible

portfolio of products and services to further

for the eye care industry, but also really time-

improve the eye care experience for patients

consuming for ECPs who are juggling multiple

and help doctors run their practice more

platforms, systems, invoices, and service reps.

effectively. HELIX solutions will be available as

With HELIX, we will completely reimagine the

a first step to all ECPs in North America who

way ECPs can leverage modern technology to

vision care (MVC). HELIX will help doctors reduce the overwhelming amount of tech and administrative burdens found in today’s

of Vision Web, Uprise, 4PatientCare, CLX, and other EssilorLuxottica US digital solutions will all continue to operate as usual with full support from the HELIX team. For more information, visit www.helixsolution.com.

COOKIE MAGAZINE | January 2024

Innovation |

AI-POWERED GLASSES

Framing the Future

How artificial intelligence is revolutionizing vision correction, from precise prescriptions to early disease detection

by Tan Sher Lynn

In the ever-shifting landscape of vision care technology, artificial intelligence (AI) has emerged as a transformative force, and its impact on prescription glasses is particularly noteworthy. In an interview with COOKIE Magazine, Dr. Monica Chaudhry, a retired optometrist from India, explored the intersection of AI and prescription eyewear.

ne of the groundbreaking applications of AI in prescription glasses involves the processing of visual data. “Smart eyeglasses equipped with AI technology can capture videos and images, utilizing advanced algorithms to identify people and their surroundings,” Dr. Monica Chaudhry noted. This not only enhances the user experience but also opens doors for innovative applications.

“Moreover, smart glasses that are equipped with microphones are capable of converting environmental sounds into audio information. For individuals with visual impairments who may struggle with reading, the text can be seamlessly converted into speech, providing a newfound level of independence,” she shared. Dr. Chaudhry added that low-vision devices are now being made based

COOKIE MAGAZINE | January 2024

on this principle. From severe to moderate visual impairment, individuals can now leverage AIintegrated glasses to navigate their surroundings and live more independently. This marks significant progress towards inclusivity and improved quality of life for those with visual challenges.

Augmented reality in prescription glasses Augmented reality (AR) prescription glasses are also making great strides in the field. One example is the new 2D Z Lens technology by Lumus (Ness Ziona, Israel) , an AR optics company, that will enable smaller, lighter AR eyeglasses with highresolution image quality, outdoorcompatible brightness and seamless prescription lens integration. This addresses the challenges faced by AR glasses, balancing functionality and aesthetics. The Z-Lens prototypes boast a 50° field of view, with plans to exceed 80° in the coming years, enabling immersive AR experiences. Another company pioneering AR glasses is startup Tooz Technologies (Aalen, Germany) , a joint venture of ZEISS and Deutsche Telekom. With their curved waveguide technology, the company aims to produce prescription AR optics that are lightweight, scalable, and stylish— glasses that people can use on a daily

basis, and can be sold next to regular prescription glasses in optic stores. Also, big players like Meta, Google, and Apple are actively developing AR products that, if well-received, have the potential to revolutionize our interactions with the real world in the years ahead.

AI in eye examination and disease detection On a different note, AI has made substantial inroads into the field of eye examinations as well. “Retinal cameras, equipped with integrated software powered by AI, can now interpret the outcomes of examination procedures. Whether identifying abnormalities in retinal images or assisting in spectacle centration and prescription, AI plays a pivotal role in detection and diagnosis, contributing to more accurate and efficient eye care,” Dr. Chaudhry noted. Drawing from personal experience, she remarked that the integration of AI into the clinical setting has been transformative. “I utilize the retina camera device which provides AI-integrated interpretation of abnormal findings in the retina. It has become an integral part of my clinical practice, aiding in the early detection and diagnosis of diseases even before clinical presentations arise. Conditions such as diabetic retinopathy and glaucoma are easily identified through this interpreted artificial intelligence device, significantly enhancing the efficiency of my examinations and contributing to my growth as a clinician,” she continued. Dr. Chaudhry added that she also uses a low-vision device with virtual and augmented reality specifically developed by OxSight (a spinout of Oxford University, UK). Equipped with an algorithm capable of replicating the natural visual interpretation process, this innovative tool has earned acclaim as a life-changing solution for individuals facing central and peripheral field loss. Nonetheless, even though AI has proved to be so useful for now,

Dr. Chaudhry asserted that manual assessment remains indispensable.

Contributor

“While AI is undoubtedly the future, the human touch must endure. Consider the auto-refractor procedure, a decades-old method for calculating spectacle prescriptions. My generation operated without such devices," she said. “Today, when cross-checking with our manual methods, we still find errors in what the machine has calculated. These aids undeniably expedite work, yet the synergy of examiner assessment and machine calculation yields the best outcomes. I believe these advancements will enhance and confirm our manual findings, but there is unequivocally no substitute for manual clinical assessments,” she asserted.

Eyeing the future The future of AI in prescription glasses holds promising possibilities. From precise prescriptions to early disease detection and AR enhancements, AI-driven technologies are reshaping the landscape of vision correction. As technology continues to evolve, personalized and adaptive approaches to eye care are becoming a reality, offering a glimpse into a future where everyone can experience the world through lenses tailored to their unique needs. According to Dr. Chaudhry, “AIdriven technologies are the future. They will enhance the capabilities of optometrists, helping them become better clinicians, and streamlining the processes of detection and diagnosis,” she said. “I firmly believe that optometrists who utilize these devices for screening and prescribe spectacles based on AI assessments will significantly elevate the quality of patient care. It is imperative for every optometrist to acquire knowledge and integrate these technologies into their practice. Embracing this future is crucial; failing to do so will render us outdated,” she remarked.

Dr. Monica Chaudhry is a consultant optometrist and educator who has more than three decades of experience as an academic and a clinician. With her extraordinary skills in optometry education, she has recently ventured to be a freelancer educator, strategy advisor and practitioner. She is the founder of an online optometry up-skilling education platform – Learn Beyond Vision. Also, she has instituted some centers of excellence and vision centers, which aim to be a unique referral, academic and research units. Her name is well-known as a contact lens and low vision specialist and has a far and wide patient referral in India. Dr. Chaudhry has served at the All India Institute of Medical Sciences (AIIMS) in New Delhi, had academic experience with various universities, including the Indira Gandhi National Open University (IGNOU) and Amity University (India), and has recently retired as director of School of Health Sciences at Ansal University (Gurgaon, India). She has been associated with leading eye care companies such as Menicon, Johnson&Johnson, Baush +Lomb, Alcon, Essilor, among others, as a key opinion leader, faculty, consultant or advisor. In recognition of her contribution to the field of academic medical service, she has been awarded the Shreshtshree Award by the Delhi Citizen Forum, the Australian Leadership Fellowship award in 2012 and the IACLE Contact Lens Educator of the Year (Asia Pacific) award in 2015. Dr. Chaudhry was chairman of the Optometry Council of India. She has been actively involved in organizing conferences, seminars, national and international workshops, faculty development programs and many corporate training programs. She has chaired many scientific sessions and presented many papers in national and international optometry and ophthalmology conferences. She has travelled abroad extensively and attended many international trainings and conferences. She has written chapters in books and has published three books. monica.rchaudhry@gmail.com

COOKIE MAGAZINE | January 2024

Enlightenment |

COLOR VISION DEVICES

Telling Technicolor Tales with Color Vision Deficiency by Tan Sher Lynn

In a recent interview with Malaysian optometrist Ms. Oh Poh Ling, we explored the impact of color vision deficiency on individuals' lives—and the cutting-edge technologies designed to alleviate the challenges associated with this condition.

opportunities and progression, and may lead to feelings of depression, isolation, and frustration due to constant questioning about their color perception,” Ms. Oh continued.

Decoding color vision deficiency The scientific explanation for color vision deficiency revolves around the photoreceptors found in the retina of the eye. These receptors react to light, translating its signals into information that the brain utilizes to generate visual images. “There are two categories of photoreceptors: Rods and cones. Rods are responsible for detecting only black and white and function effectively in low-light conditions, whereas cones are instrumental in perceiving color. Color vision deficiency manifests when one or more of the color cone cells are missing, malfunctioning, or detecting a color different from the norm,” Ms. Oh shared. She further detailed the three types of color vision deficiency. “The first type is red-green color vision deficiency, which is the most prevalent type. Individuals with this condition struggle to discern between various shades of red and green due to genetic mutations affecting the opsins responsible for detecting red or green," she continued.

olor vision deficiency is a real eye condition, and for those without it, comprehending the daily challenges of navigating life with this condition is something we can only imagine. “These individuals struggle with distinguishing colors, significantly impacting various aspects of their daily lives,” shared Ms. Oh Poh Ling, a practicing optometrist at Vision Space Optometrist in Malaysia. “Challenges include difficulties in activities such as driving (identifying

traffic light colors), selecting daily clothing (matching and identifying appropriate outfits), and navigating food contexts (identifying the correct cooking time for meat or judging the ripeness of fruits and vegetables),” she said. “Additionally, tasks like reading maps, whether digital or hard copy, pose challenges as individuals with color vision deficiency cannot easily identify routes. This condition can hinder access to education, affect exam grades, limit career

COOKIE MAGAZINE | January 2024

“The second type is blue-yellow color vision deficiency, a rarer condition where individuals experience challenges in distinguishing between shades of blue and green, as well as difficulty differentiating dark blue from black. The third type is complete color vision deficiency, representing a severe form of color deficiency where individuals are unable to perceive any colors,” Ms. Oh explained.

Impacts on professional and personal life In professional settings, color vision deficiency affects individuals in occupations such as electricians, fashion designers, graphic artists, pilots, and chemical engineers.

“Chemical engineers, for instance, often operate in laboratories where they handle various chemical combinations. Observing color changes is a crucial aspect of their work. If someone has difficulty perceiving colors, they may struggle to identify these changes, potentially affecting their performance and safety,” continued Ms. Oh. “Pilots, on the other hand, rely on different colored light indicators for navigation. A pilot with color vision deficiency might face challenges in adhering to aviation regulations.” Individuals with color vision deficiency encounter challenges in various everyday activities, such as food selection and preparation, gardening, sports, driving, and choosing clothing. “Those born with the condition adapt to the colors they perceive. However, if someone develops color deficiency later in life due to an eye disease, adjusting to the altered colors can be challenging. Colors that once appeared bright and vibrant may now seem faded,” she wrote.

A spectrum of technological aids Fortunately, there are various devices available to assist individuals with color vision deficiency. Ms. Oh shared some of these devices. X-Chrome (Purecon; New Delhi, India) contact lenses feature specialized red or green color filters at the center, which enhance the perception of different light wavelengths, thereby improving color vision. On the other hand, EnChroma’s (Enchroma; California, USA) color-blind lens technology selectively filters light, increasing the contrast between red and green color signals to alleviate symptoms of red-green color blindness. About 80% of individuals with this condition experience some improvement in color distinction. Wearable augmented reality devices, such as smart glasses with integrated augmented reality systems, are designed to aid people with color vision deficiency. These devices provide wearers with information about the colors they

are observing in their surroundings, offering a description of the color even if the wearer cannot see it. Mobile-downloadable color vision apps utilize cameras to analyze and provide real-time information about colors in the environment, assisting users in identifying and differentiating between colors. Some software applications offer a ‘color-blind mode,’ helping individuals with color deficiency for better performance in applications and games. For instance, certain games in Xbox Game Studios and EA Sports incorporate this feature. Individuals with color deficiency can also use image-enhancing applications like Photoshop to adjust the colors in digital content, facilitating better differentiation between colors. “While these devices and aids do not cure color blindness, they serve as tools to help individuals with color vision deficiency interpret colors, perceive contrasts more effectively, and navigate their surroundings. Different devices operate on different principles, and individuals must try them before determining their suitability for personal use,” Ms. Oh emphasized.

From awareness to solutions Research is currently underway in the fields of gene therapy and artificial intelligence, though commercial availability is pending. "The majority of available devices aim to enhance color vision deficiency rather than provide a definitive treatment. No singular device exists that can effectively treat color vision deficiency. Therefore, a trial-and-error approach is necessary,” she added.

"In Malaysia, our primary focus revolves around prescribing EnChroma spectacle lenses and X-Chrome contact lenses. However, it is important to note that awareness of these options is not widespread,” she shared. A particular case Ms. Oh encountered involved an optical sales assistant who found it increasingly challenging to provide opinions on frame colors when customers sought his advice. “Despite being aware of his color vision deficiency for some time, he was uncertain about possible solutions. Fortunately, a friend recommended our services, and upon visiting us, we prescribed X-Chrome color contact lenses. Since incorporating these lenses into his daily routine, he has experienced an improvement in the quality of his life and can now suggest the frames more confidently,” Ms. Oh concluded.

Contributor Ms. Oh Poh Ling is a dedicated optometrist who completed her studies at SEGi University, Malaysia, in 2017. With over six years of valuable experience as a practicing optometrist at Vision Space Optometrist, she dedicates herself to providing patients with comfortable vision. Her primary focus includes helping children effectively manage short-sightedness through myopia control treatment. Additionally, Ms. Oh’s strong passion lies in aiding those with keratoconus to achieve improved visual acuity. pohling@visionspace.com.my

COOKIE MAGAZINE | January 2024