Early Diagnosis Can Improve Age-Related Macular Degeneration (AMD) Outcomes

Managing age-related macular degeneration (AMD) is a significant focus for primary care optometrists.  With an early diagnosis, OD's can take potentially life-altering steps long before patients hit the intermediate stage and are forced to struggle with vision loss.  The longer clinicians can keep patients from advancing to wet AMD and needing injections, the better off they will be.

In a recent study, subjects with impaired dark adaptation were twice as likely to develop clinically evident AMD and eight times as likely to advance beyond the earliest stage of AMD.  Usually expressed as "night vision difficulties" impaired dark adaptation is often among the first detectable consequences of AMD and a method of identifying patients with potential sub clinical disease.

Many changes to an AMD patient's lifestyle can help avoid further central vision loss and retinal damage.  Once diagnosed with early AMD, optometrists can encourage patients to take the following steps:

  1. More frequent examinations.  Moving from a 12 to a six-month follow-up interval is useful for monitoring disease progression.
  2. Stay healthy.  Following a healthy diet, exercising regularly and maintaining overall health are sound goals for all patients.  One study found that women who followed a healthy diet, engaged in physical exercise, and avoided smoking had a substantially lower risk of early AMD compared with women who did not follow these healthy lifestyles. A Mediterranean diet is another consideration, as studies suggest those who consume a Mediterranean-style diet carry an overall lower risk of developing advanced AMD compared with those who regularly consume a traditional Western diet.
  3. Advocate for an active lifestyle.
  4. Recommend supplements and blue light-blocking lenses.
  5. Timely referral to a retinal specialist.  

With an earlier diagnosis, optometrists can do more than let AMD run its course and eventually rob patients of their sight.

Excerpted from Dr. Jeffry Gerson, OD Review of Optometry September 2017

Adding Powerful Antioxidants to Your Diet Can Improve your Eye Health

There's no substitute for the quality of life good vision offers. Adding certain nutrients to your daily diet—either through foods or supplements—can help preserve your vision. Researchers have linked eye-friendly nutrients, such as lutein and zeaxanthin, vitamin C, vitamin E and zinc, to reducing the risk of certain eye diseases.

Lutein and zeaxanthin are important nutrients found in green leafy vegetables, as well as other foods, such as eggs. Many studies show that lutein and zeaxanthin reduce the risk of chronic eye diseases, including age-related macular degeneration and cataracts.

Vitamin C (ascorbic acid) is an antioxidant found in fruits and vegetables. Scientific evidence suggests vitamin C lowers the risk of developing cataracts. Also, when taken in combination with other essential nutrients, it can slow the progression of age-related macular degeneration and visual acuity loss.

Vitamin E is a powerful antioxidant found in nuts, fortified cereals and sweet potatoes. Research indicates it protects cells in the eyes from unstable molecules called free radicals, which break down healthy tissue.

Fats are a necessary part of the human diet. They maintain the integrity of the nervous system, fuel cells and boost the immune system. Research shows omega-3 fatty acids are important for proper visual development and retinal function.

Zinc is an essential trace mineral or "helper molecule." It plays a vital role in bringing vitamin A from the liver to the retina in order to produce melanin, a protective pigment in the eyes. Zinc is highly concentrated in the eye, mostly in the retina and choroid, the vascular tissue layer lying under the retina.

Written in partnership with AOA members Stuart Richer, O.D., Ph.D., and Steven Newman, O.D.

Connecting with Today's Cataract Patient

Today's cataract patients are on the go.  Many are still working and having good vision is essential to helping them stay active and involved.  Patient satisfaction with cataract surgery hinges on gathering accurate lifestyle information and matching it with clinically appropriate surgical options.  Truly successful outcomes, as measured from the patient's perspective, simply cannot be achieved without knowing the patient's lifestyle and individual visual demands.

Most patients have very little knowledge of the types of IOLs (intraocular lenses) available to them.  Patients often understand they have astigmatism but they don't know what their choices are to compensate for it with IOL selection.  Addressing astigmatism is a key aspect in providing a true refractive correction as part of the cataract procedure.  Toric (astigmatic) IOLs correct two eye conditions; cataracts and astigmatism.  Toric IOLs deliver crisp, clearer distance vision and may reduce dependence on glasses to see at a distance.  Toric IOL's are proven to deliver the highest quality visual outcome versus a basic lens option. 
Without complete and successful treatment of astigmatism, the goal of achieving excellent uncorrected distance vision and reducing spectacle dependence for distance vision cannot be met.

Alcon's new consumer campaign at mycataracts.com helps to explain the concept that correcting astigmatism at the time of cataract surgery is like getting two birds with one stone.  Alcon's "My Cataracts" YouTube channel also helps to deliver the demand for online learning.  The "Two Birds" educational video has already surpassed 1.6 million views.  The new My Cataract call center (1-844-MYCATARACT) allows patients to communicate on their own terms.  This patient call center is staffed with dedicated, trained cataract counselors and offers a best-in-class patient experience.

We need to engage patients early and often to ensure that we make a positive impact on the patient's final choice and enable them to feel prepared to make what is for the majority of people a once in a lifetime decision.

Article excerpted from Review of Optometry May 2017 David Geffen, OD

Watching a Solar Eclipse, Part 2

Last month we talked about the impending solar eclipse on August 21, 2017.  This month we will talk about ways to safely view the eclipse without hurting the eye or retina.

Only a small sliver of the US will experience a total solar eclipse-the sun's complete occlusion by the moon-so the vast majority of viewers will need special solar filters or eclipse glasses to view the partial eclipse.  Solar filters or eclipse glasses are a must as along as the sun's face is visible.  An indirect way to view the eclipse is with a pinhole projector.

To make a pinhole "camera":

Materials:

  • *2 pieces of white card stock
  • *aluminum foil
  • *Tape
  • *pin or paper clip

Directions:

  1. Cut a square hole into the middle of one of the pieces of card stock
  2. Tape aluminum foil over the hole.
  3. Poke a hole in the foil.
  4. Place the second piece of card stock on the ground in a shadowed area.  Stand with the sun BEHIND you and hold the card stock with the aluminum foil (foil facing up) above it.  View the projected image on the card stock below.  The farther away you hold the pinhole card the bigger the projected image will be (jpl.nasa.gov/edu/learn).

An eclipse is a cosmic solar billiard shot- the Sun, Moon, and Earth line up to reveal the Sun's atmosphere; it's Corona.  Eclipses on Earth occur only because of an amazing celestial coincidence.  For more information visit greatamericaneclipse.com.
 

Watching a Solar Eclipse

On August 21, 2017 a solar eclipse will envelope the nation for 2-3 hours, while a small, 70 mile sliver from Salem, Oregon to Charleston, SC will experience a total solar eclipse for the first time since 1979.  Dubbed "The Great American Eclipse" this eclipse is noteworthy for its cross-country path of totality that will be visible from most Americans' backyards.  However, watching a solar eclipse isn't as simple as looking skyward.  Looking directly at the sun is unsafe except during the brief totality.  And that only happens in a small area.  Consequently, while millions can -and will- watch the eclipse, not all are aware of how to safely do so.

Solar retinopathy, or photic retinopathy, can occur when a person stares at the sun, causing retinal tissues to be damaged at the fovea, and resulting in a mild-to-moderate visual acuity deficit and central or paracentral scotoma.  Captain Tyson Brunstetter, OD, PhD, a U.S. Navy doctor working with NASA says the single greatest risk to viewing a solar eclipse comes from nonionizing (low energy) radiation, the visible and infrared light that easily passes through the eye and is focused on the retina.  The ramifications of improperly viewing a solar eclipse can be immense and permanent and because there are no pain receptors in the retina, this damage can occur without any sensation of pain.

The only safe way to look directly at the uneclipsed or partially eclipsed sun is through eclipse glasses or filters.

Stay tuned next month on DIY indirect viewing devices.

--Information for this article from Myron Wasiuta, OD, AOA Focus magazine, May 2017

Vision and Older Drivers

Optometrists can play a significant role in assessing driving ability in older patients.  Driving privileges for many represent a level of independence.  In older patients, visual impairment and losing driving privileges have a significant psycho-social impact related to fear and anxiety that can lead to social isolation.  Most state guidelines in determining licensure rely on visual acuity.  Some states also include visual field information.  For an unrestricted license in New Jersey, visual acuity requirements are 20/50 or better.  For a restricted license, visual acuity is typically 20/60 to 20/100.  Three common driving restrictions are: daytime driving only, a set speed limit, and driving in familiar areas only.

Motor vehicle injuries are the leading cause of injury-related deaths among those 65 to 74 years old.  After falls, driving is the second leading cause of injury-related deaths in those 75 years and older.

Many aging issues can impact driving ability: vision, slower response times, motor skills/coordination, hearing loss, cognitive function, multiple medical conditions and risk-taking behavior.  Certain conditions and diseases can also be red flags.  These include neurological diseases such as MS, dementia, Parkinson's, peripheral neuropathy, residual deficits from stroke, psychiatric disease, metabolic disease, chronic renal failure and respiratory disease such as chronic obstructive pulmonary disease and sleep apnea.  Medications that may influence driving safety include: anticholinergics, anticonvulsants, antidepressants, antiemetrics, antihistamines, antihypertensives, antipsychotics, benzodiazepines, and sedatives/anxiolytics, muscle relaxants, narcotic analgesics and stimulants.

Vision is just part of the equation is assessing a patient's safety for driving.  Although older patients tend to self-regulate driving, it is important to discuss driving with patients and their family to determine qualifications and if rehabilitation and/or alternatives to driving need to be explored.  Older patients may already modify their driving by including less highway and more local street driving, driving during non-rush hour, daytime only and making shorter and fewer trips.  

The term "driving retirement" is used in counseling a patient who can no longer drive safely.  It is best to involve the patient and family in the decision-making process and acknowledge that safe mobility is a priority.  Develop an alternative transportation plan to alleviate depression and loneliness.

--Excerpted from Primary Care Optometry News Swati C. Modi, OD, FAAO

Age-Related Macular Degeneration

Age related macular degeneration (AMD) is the leading cause of vision loss for individuals age 50 and older. Being visually impaired is going to be part of everyday life for many people.

According to the National Institutes of Health-Senior Health (nihseniorhealth.gov), people with low vision find everyday tasks difficult to do, even with the aid of regular glasses/contacts, medications, or surgery.  Having low vision can make basic activities like reading, shopping, cooking, writing, computer use, and watching TV extremely difficult.  Many times the individual's eye care physician has advised them that there is not much that can be done to improve their vision.  The consequences of vision loss may leave people feeling frustrated, helpless, scared and depressed.

The National Eye Institute suggest macular degeneration is a progressive disease that affects the macula, the spot on the retina responsible for central vision, causing central vision to blur but leaving peripheral vision intact.  In its earliest stages, AMD can be difficult to diagnose.  In some cases, AMD progresses slowly and in other cases the deterioration is very rapid.

A common risk factor is age.  AMD signs are present in about 14% of people under 64, 20% in people between 65 to 75, and up to 37% of people over 75.  Additionally, AMD is more common in women than men.  Some risk factor's are within one's control such as smoking, which interferes with the absorption of lutein, an antioxidant that protects the retina from UV light.  High blood pressure, diet and exercise, and exposure to sunlight without eye protection are also factors.  It is recommended that people wear protection that offers 100% blockage of UVA and UVB rays, which are mitigating factors in AMD.

A routine yearly eye examination is important for all adults to check the macular area and assess for any signs of macular degeneration.  Early treatment and intervention are very important to the progression of this disease.

Live Longer with Cataract Surgery?

New research suggests that if you undergo cataract surgery, you'll not only see more clearly, you also may actually live longer.  A National Bureau of Economic Research study says Americans over 65 are living longer and with fewer disabilities and that a chief reason is cataract surgery, which prevents falls and allows senior to continue working and driving safely.

Those who have cataract surgery are less likely to experience disability than people who don't according to the June NBER paper. Between 1992 and 2008, healthy life expectancy at age 65 increased by 1.8 years, the study says, and two treatments contributed:  better cardiac care and cataract surgery.

Those who opt for cataract surgery also lower their odds of breaking a hip.  In a group of Medicare beneficiaries 65 and older with a diagnosis of cataracts, patients who had surgery to remove them had lower odds of hip fracture within one year compared with patients who didn't have cataract surgery.

With a cataract, the lens of the eye becomes progressively opaque, which can significantly interfere with vision. There are many myths concerning cataract surgery among the elderly and minorities such as going blind.  but the technology is very advanced now using pain-free lasers and procedures that last just a few hours and patients go home the same day.

Many people don't get annual eye exams and don't realize they're losing vision.  Many are already legally blind, but don't know it because the brain adapts.  When you slowly lose peripheral vision, due to glaucoma or cataracts, your brain accommodates and tries to fix the field of vision.  You can only detect cataracts with an eye exam and early intervention is very important to your eventual outcome.

Vitamins Role in Ocular Health

One of the leading causes of reduced vision in an aging population is Macular Degeneration.  This condition affects over 2 million people age 50-80.  An important therapy is the use of specific vitamins to mitigate the damages of this condition.

Studies have shown that the vitamins Lutein and Zeaxanthin plus trace elements zinc and copper are associated with a lower risk of developing advanced Age Related Macular Degeneration.

Another component to retinal development and repair is Omega 3 fatty acids or "fish oil" vitamins.

The specific amounts can be found in readily available supplements that are labeled as AREDS 2 formula vitamins in any pharmacy.  Always check with you primary doctor if you are currently being treated for any medical condition before adding these supplements.

Children's Vision & Sports Vision

Vision, just like speed and strength, is an important component in sports.

Vision is much more than just seeing clearly. Many interrelated vision skills affect how well you play your sport. Just as exercise and practice can increase your speed and strength, they can also improve your visual fitness and accuracy.

An optometrist can thoroughly assess your unique visual system. He or she can then recommend the proper eyeglasses or contact lenses, or design a vision therapy program to maximize your visual skills for your specific sport. 

All athletes, and especially those in certain high-risk sports, need to consider eye protection. Thousands of children and adults suffer sports-related eye injuries each year, and nearly all can be prevented with the proper protective eyewear. 

If you participate in an outdoor sport, appropriate sunglasses are a must. Some sport-specific designs may even help you improve your game. Ask your optometrist which type is best suited for your favorite sport.

Children with uncorrected vision conditions or eye health problems face many barriers in life... academically... socially ... and athletically. High-quality eye care can break down these barriers and help enable your children to reach their highest potential.

Vision doesn't just happen. A child's brain learns how to use eyes to see, just like it learns how to use legs to walk or a mouth to form words. The longer a vision problem goes undiagnosed and untreated, the more a child's brain learns to accommodate the vision problem.

That's why a comprehensive eye examination is so important for children. Early detection and treatment provide the very best opportunity to correct vision problems, so your child can learn to see clearly.  Make sure your child has the best possible tools to learn successfully.