Low Vision Blog

For all of you who missed the webinar, here is a video of the presentation:
http://youtu.be/Wkxme5JKdSQ

“Make it Happen with Low Vision Technology- Practical Applications for Daily Living” will be presented by Kathy Foster and Janet Bernhardt CLVT, TVI. Kathy and Janet are co-owners of Low Vision, Etc., located in Monroe, Louisiana. Low Vision, Etc., won the Louisiana Contractor of the Year Award 2010 and has been Louisiana Lion’s Eye Foundation Provider.

Janet has over 30 years’experience in education and rehabilitation for students that are blind and low vision. She has served as an expert witness for both the United States Department of Justice, Civil Rights Division and for the National Federation of the Blind. She has helped establish a state training center for the blind and taught college courses on Low Vision in the Classroom.

Janet obtained certification in Elementary Education, Education for the Blind and Low Vision Rehabilitation from LSU, Florida State University and the Pennsylvania College of Optometry respectively. Janet also completed internships in Low Vision at the Feinbloom Center in Philadelphia, as well as Johns Hopkins Lion’s Low Vision Clinic in Baltimore.

For those of you who are new to the vision world of macular degeneration, the two most common types of age related macular degeneration (AMD)  are dry AMD and wet AMD.

The reason for the use of the words “dry” and “wet”  is that in the wet form, tiny capillaries start growing under the macula, the center of the retina.  These capillaries are very fragile and start to leak fluid and blood which causes photoreceptor cells to die . The fluid and blood also raises the normally flat macula. The result is sudden and severe vision changes such as straight lines appearing wavy and a gray or black spot appearing right in the middle of one’s vision. Dry age related macular degeneration does not have these leaking blood vessels and so it gets the name “dry.”

Cause of Macular Degeneration

However, people who have wet macular degeneration almost always start out with the dry form.   The dry form of this retinal condition is the result of changes in the layers of the retina. These layers are responsible in delivering important nutrients and oxygen to the macula and to remove waste products that have built up. When either of these delivery systems no longer function optimally, the results is degeneration of the photoreceptor cells.

Dry Macular Degeneration Symptoms

Vision changes for dry macular degeneration are more gradual and subtle. You may notice that you need more light to read a book or to check your mail. It may be harder to distinguish the navy blue socks from the black socks. Colors appear dull and less vivid. You may become more sensitive to glare or your eyes may have a harder time adjusting when going from bright sunlight to a darker room .  Objects appear somewhat blurry rather than sharp and distinct.

Dry Macular Degeneration Stages

Although wet macular degeneration normally causes more severe vision changes, advanced dry macular degeneration can also mean a loss of central vision.  The three stages are early AMD, intermediate, and then advanced AMD or geographic atrophy.  Macular drusen are small yellow deposits found during a retina exam. The size, shape and number of drusen are an indicator of the stage of AMD.

Dry Macular Degeneration Treatment

There are several clinical trials that are looking for effective ways to treat dry AMD. Inflammation seems to play a key role in this degenerative eye disease.  An anti-inflammatory diet helps to reduce chronic inflammation in our bodies. Many studies have shown that antioxidants whether from food or supplements play a key role in our eye health.

Find out more about what causes dry AMD and what you can do to help support your vision health by going to:
Dry Age Related Macular Degeneration

Better Health for Better Vision
Leslie Degner, RN, BSN
www.WebRN-MacularDegeneration.com

Did you know that our eyes have internal “sunglasses?”  Known as the macular pigment (MP), this yellow pigmented spot is found in the center of the retina known as the macula.  Made up of two carotenoids, lutein and zeaxanthin, the MP plays a critical role in protecting the macula from harmful blue light and in helping to maintain the function of the macula.

Macular PIgment Optical Density

The thickness or the density of the MP varies from person to person.  The density can also change over time depending on several factors such as aging and lifestyle and dietary choices.  There has been several clinical trials and studies that have focused on measuring the MP and have researched  how the thickness of it correlates to one’s risk of developing age related macular degeneration (AMD).  The research has shown that a low macular pigment optical density (MPOD) is a key risk factor for AMD while a high macular pigment optical density not only reduces one’s risk for AMD but also helps to improve visual performance.  Vision changes such as better contrast sensitivity, better acuity and reduced glare are just some of the benefits to a high MPOD.

Measuring Macular Pigment Density

How does one know the thickness of their MP?   Several different instruments were used in different clinical trials . But now there is a scientifically proven instrument that measures Macular Pigment Optical Density that is available to those who are not in a research study. It is called QuantifEye.  According to the company’s description, it uses “ heterochromatic flicker photometry technology that provides accurate and reproducible results.”  This simple, non-invasive exam is done in the eye doctor’s office.

Monitoring Macular Pigment Density

The values or score that is used for MPOD ranges from 0 to 1. A low MPOD is in the range of  0 to .21, mid range is .21 to .44 and high range is .45 to 1.0.  According to ZeaVsion the company that makes the  QuantifEye instrument, the average MPOD in the United States is .35.

Measuring the density of the macular pigment provides important information, but  even more important is what does one do if test results show a low MPOD score? Find out more about this macular degeneration test, who should have it, where to get tested,  and what to do if you test low for MPOD:

Macular Pigment Density – Measuring, Managing, and Monitoring

Leslie Degner, RN, BSN

Better Health for Better Vision
www.WebRN-MacularDegeneration.com

Perhaps you or someone close to you has recently received a diagnosis of age related macular degeneration (AMD).  Depending on the eye doctor, an explanation of this retinal disease was very brief or perhaps the diagnosis was so overwhelming it was difficult to hear anything else that was said.

I remember when my father-in-law was first diagnosed with macular degeneration, all he could tell us was that he had the type of AMD that didn’t cause severe vision loss.  Several years later my mother-in-law informed us that his wet macular degeneration had turned to dry macular degeneration – which is not possible.  Clearly she and my father-in-law did not have a good understanding of his macular disease. Knowing one’s diagnosis is the first step in dealing with vision loss.  Did you know that each eye can have a different form or a different type of macular degeneration? One eye can have dry AMD while the other eye may have wet AMD. So be sure to ask your doctor about each eye.

Macular degeneration is a progressive disease – meaning that without any intervention the normal progression is for one’s vision to get worse.  However, it is one’s central vision or straight ahead vision that is affected, not one’s side or peripheral vision.  The two main forms of AMD are dry macular degeneration and wet macular degeneration.

Dry Macular Degeneration

Dry macular degeneration is the most common form of AMD. According to the National Eye Institute,  “More than 85 percent of all people with intermediate and advanced AMD combined have the dry form.”  There are several different stages to this eye disease.  Vision loss varies from person to person and is dependent on the stage of their macular degeneration.  The most common symptoms are the need for more light, blurred vision, and less vivid color vision. This type of AMD progresses more slowly than the wet form, however dry AMD can turn to wet AMD in one or both eyes.

Wet Macular Degeneration

Wet macular degeneration gets it name from the leaking fluid that comes from tiny, fragile blood vessels that develop under the macula. This fluid buildup causes the death or degeneration of photoreceptor cells and also causes the macular, a tiny spot in the middle of the retina to raise up. As a result vision changes are more sudden and more severe.  Straight lines appear wavy and a dark or gray spot appears in the middle of one’s vision.

For a better understanding of the stages of macular degeneration and to help you identify which stage your macular degeneration is in go to:

Stages of Macular Degeneration

Better Health for Better Vision

Leslie Degner, RN, BSN

www.WebRN-MacularDegeneration.com

Macular degeneration and stem cell research is in its infancy – as is most stem cell research. However, there has been some progress to report in humans .  And even though the progress is quite small, it is still ground breaking.

A  bio-tech company called Advanced Cell Technology (ACT) has its principal laboratory and GMP facility in Marlborough, Massachusetts, and its corporate headquarters in Santa Monica, California. The company specializes in cellular therapy for specific health conditions such as macular degeneration and Stargardt’s disease.

What makes this company unique in the area of stem cell research and treatment is that they have discovered and developed a “first-ever proven alternative method for successful hESC generation without harm to the embryo,  called the “single-cell blastomere” technique, on which it holds broad intellectual property (IP) protection.”

Retinal Pigment Epithelial Cells (RPE)

The RPE layer is one of the layers of the retina that sits right next to the photoreceptor cells which are critical for our vision.  A healthy RPE is critical to the function and health of photoreceptor cells and to the retina as a whole.  If the RPE loses some of it’s function the result is photoreceptor loss or degeneration which leads to loss of central vision.  The progression of macular diseases such as dry macular degeneration to wet macular degeneration may also be the result of the RPE layer becoming less functional.

Macular Degeneration Stem Cell Research

What cells will be transplanted and what procedure will be used to transplant the cells?  Based on the importance of the RPE to macular health, the first stem cell transplant for macular diseases will use hESC-derived RPE cells.  The cells will be given as a subretinal injection into a pre-selected are of the macula.

On July 12, 2011 the first patients in the dry macular degeneration and Stargardt’s disease clinical trial were treated by Dr. Steven Schwartz, M.D at Jules Stein Eye Institute (UCLA). All clinical trials in humans start out as Phase I trials. A Phase I trial has one main purpose – it is  to determine safety. The number of participants in this phase is always very small.  Only 12 people will be recruited for each study. However, the trial will proceed very slowly with only 1-3 participants initially then followed by  a thorough review several weeks later before proceeding with another patient or procedure.

If the transplant proves safe, the next step is to go to a Phase II trial to start looking at efficacy or effectiveness in vision improvement.  According to ACT if RPE cell therapy proves effective it may impact over 200 retinal diseases.

To read more about this groundbreaking research with updates on patients and new clinical trial sites go to:

Macular Degeneration Stem Cell Research

Leslie Degner, RN, BSN

www.WebRN-MacularDegeneration.com

The two “best friends” for those with macular degeneration are magnifiers and lights. But when we think of a magnifier, we usually think of the traditional large round magnifying glass with a handle that can be used to enlarge the words of what we are reading or perhaps to see a photograph or picture more clearly. This is called “near vision.” But really we only use our near vision a small portion of the time.

Seeing things in the distance, like recognizing a friend’s face at church or enjoying the spring
time blossoms on a Yoshino cherry tree are just as important as seeing things close up.  Magnifying one’s distance vision keeps us more connected to the world around us.   So does that mean you have to carry around a pair of binoculars all the time, constantly bringing them up to your eyes and focusing them to see things a couple of feet or several yards away?

Not at all.  Thanks to the work of Dr. Henry Greene, optometrist, founder of Academy Eye Associates, and co-founder of Ocutech, Inc., distance magnifiers can be mounted on a pair of
glasses so that they can be used any time.  These glasses, also called bioptic telescopes, make it possible to enjoy activities you thought only belonged to your past.  Golfing, gardening, or enjoying a football game or a local play not only keeps you active, it keeps you connected to friends and family.  Poor central vision or the inability to see the winning football touchdown or the beautiful costumes of a musical separates people from those who can see. It can be isolating and lonely and leads to feeling disconnected from those around you.  It is not just being together that bonds family and friends, but it’s the shared enjoyment of seeing your grandchild play soccer or admiring the paintings of your favorite artist that builds relationships and special memories.

Those who have loss of central vision due to macular degeneration, diabetic retinopathy, Albinism, Stargardt’s Disease, optic atrophy, myopic degeneration, nystagmus, or macular holes can benefit from these special glasses.  Bioptic telescopes can be used for other activities as well like watching television, seeing faces, traveling, shopping, seeing blackboards in school, computer screens, board games, or playing cards.

Dr. Henry Greene explains how these glasses work, what kinds of bioptic telescopes are available, who is a candidate for them and what makes Ocutech glasses different from other brands in a recent interview:

Macular Degeneration Glasses – Bioptic Telescopes for Distance Vision

Leslie Degner, RN, BSN
www.WebRN-MacularDegeneration.com

Awareness of macular degeneration is increasing as the baby boomer population continues to age. In generations long ago, family members knew that grandma or grandpa had lost some of their vision, but they didn’t know why there was loss of vision or the name of the eye disease.  Now thanks to years of research and better diagnostic testing, so much more is known and understood about this retinal condition.

One thing we know is that there is a strong genetic component, which means that if one of your parents or one of your siblings has macular degeneration, you are at a much higher risk for developing age related macular degeneration (AMD). My husband’s father has wet macular degeneration as did many of his father’s brothers and sisters.  So of course we’d like to know as soon as possible if any early signs of AMD start to appear.  However, there are also many people who develop AMD who do not have any family history or the commonly known risk factors.

So how do you find out if your eyes are at risk for  developing the number one cause of legal blindness in seniors?  Or how do you find out if your changes in vision like loss of visual sharpness, the need for more light or sensitivity to glare are symptoms of macular degeneration?  Perhaps you have been told that you have dry macular degeneration and are now wondering if it has progressed to wet macular degeneration.

Several different macular degeneration tests are now available that provide useful information for determining one’s risk for AMD, diagnosing early signs of dry macular degeneration or checking to see if one’s dry AMD has turned to wet AMD.   Some tests are done by special machines that can check changes in the retina and some can be done at home to monitor vision changes.   Retina specialists are needed for some tests while general opthhamologists or optometrists can perform general testing of the retina.

There are many benefits to finding out if you are at high risk for developing AMD or have a diagnosis of AMD.  Early intervention whether it is through diet, lifestyle changes, supplements or treatment can have positive results in halting, reversing or slowing the progression of macular degeneration and the vision changes that come with it.

Get informed about what diagnostic tests are available and if you or someone you know should be asking your eye care professional about performing these tests.

Macular Degeneration Tests

Leslie Degner, RN, BSN

www.WebRN-MacularDegeneration.com

Why are antioxidants so important in the world of macular degeneration? Whether you have been diagnosed with the early stages of this retinal disease, trying to prevent it or have advanced AMD, antioxidants play an important role in the macula  - a very tiny spot in the center of our retina that gives us that sharp, distinct detailed vision, our color vision, and our straight ahead vision.

The macular pigment (MP) is just that – yellow pigment found in the macula and especially in the area of the fovea – an even tinier spot in the center of the macula.  The fovea plays an even more important role in our color vision and detailed, sharp vision.  The two antioxidants that make up the macular pigment are lutein and zeaxanthin. Many people have heard of lutein, but are less familiar with its twin, zeaxanthin.  The fovea actually maintains a natural  ratio of 2:1 Zeaxanthin to lutein.  So to have a healthy macula it is important that both antioxidants are part of a macular degeneration diet or an eye vitamin program.

How doe these antioxidants help the macula? The MP protects the retina in two ways – one is from oxidation which is the process that causes rusting and the other is from light.   Thinning of this pigment leads to macular diseases, while thickening protects the macula. It has been found that those with higher MP density are at less risk for developing age related macular degeneration. .

“This pigment is thought to protect the retina from damage by light and excess oxidation, which over a lifetime can accumulate and contribute to the process of macular degeneration,” says Dr. Max Snodderly, Medical College of Georgia vision scientist.

The good news is that research shows that MP density can be increased through eating foods high in lutein like spinach or kale and  foods high in zeaxanthin like goji berries or orange peppers. Supplementing with vitamins for eyes that include these antioxidants also help to build the MP.

How do you know if your MP is thick enough to protect your eyes or too thin putting you at risk for macular degeneration?  If it is too thin because of genetics, smoking, diet or other causes can one increase their macular pigment density?

Find out how you can have your macular pigment measured, what the numbers mean and how to increase your MP density along with supporting research here:

Lutein and Zeaxanthin and Macular Pigment Density

Leslie Degner, RN, BSN

www.WebRN-MacularDegeneration.com

Wet macular degeneration (AMD) treatment often involves intro-ocular or eye injections using anti-VEGF medications. VEGF stands for vascular endothelial growth factor. VEGF is a protein that the body makes that promotes blood vessel growth. Another term for new blood vessel growth is angiogenesis.  Wet AMD is aptly named because the macula – a very small spot in the center of the retina – gets “wet” as a result of these new, but abnormal vessels that leak blood and fluid. The goal of wet macular degeneration treatment is to “dry up” this area in the retina that is responsible for our detailed  and straight ahead vision. Another goal of wet AMD treatment is to prevent the new growth of these abnormal and fragile vessels.

This fairly new class of drugs, called anti-VEGF medications, is given as injections directly into the eye to help shrink existing abnormal blood vessels and to prevent the growth of new leaky blood vessels. There are four different medications that are used to treat wet macular degeneration. They are Macugen, Lucentis, Avastin and the most recent one is Eylea.

Macugen

The first anti-angiogenic or anti-VEGF medication used to treat wet AMD was Macugen (pegaptanid). It was FDA approved in 2004. This eye injection was normally given every 6 weeks for up to two years.  New anti-VEGF drugs have come on the market since 2004 that have shown to be more effective, so Macugen is not used as frequently for wet AMD. However, there are several clinical trials looking at the effectiveness of Macugen in the treatment of macular edema.

Lucentis

In 2006 Lucentis (ranibizumab) was FDA approved after several clinical trials. It is manufactured by Genentech, Inc. in California.  These monthly eye injections were shown to help maintain vision at 12 months in almost 95% of the participants in the three multicentered, randomized studies.  Sixty percent of patients who received the control treatment maintained their vision in the same time frame.

Avastin

Avastin is also an anti-VEGF therapy that was originally approved for use – not in patients with wet macular degeneration – but for patients who had colon cancer. Cancer tumors also develop new blood vessels that feed the tumor and cause it to grow. Anti-VEGF treatment prevents the growth of these blood vessels causing the cancer to “starve.”  What made this medication so appealing compared to Lucentis is the dramatic difference in cost.  Avastin is molecularely very similar to Lucentis, so physicians were administering Avastin to patients with wet macular degeneration in what is called off-label use. In other words this medication is FDA approved – but FDA approved for the treatment of cancer – not macular degeneration.  As a result there are clinical trials comparing Lucentis to Avastin in the treatment of wet macular degeneration.

Eylea

Eylea is the most recent anti-VEGF therapy on the market at the time of this writing. Recently FDA approved in November of 2011, the benefit to this eye medication is that it can be given less frequently. Less visits to the eye doctor and less eye injections are very appealing to most patients.

Knowing about the different medications used for wet macular degeneration treatment helps you to be an informed patient. Learn more about these injections, how they are given, possible side effects and current studies:

Anti-VEGF Therapy for Wet Macular Degeneration Treatment

Leslie Degner, RN, BSN

www.WebRN-MacularDegeneration.com

Wet macular degeneration treatment is very different from dry macular degeneration treatment.  Even though both eye conditions cause central vision loss, how and why that vision loss occurs is because of very different processes going on in the body.  Dry macular degeneration is a slow, gradual degrading or dying of the photoreceptor cells located in the macula, the center of the retina that is responsible for our straight ahead vision.

Wet Macular Degeneration
Wet macular degeneration causes a more sudden and severe vision loss. This is the result of abnormal and fragile tiny blood vessels developing under the macula which then start leaking blood and fluid. This fluid build up causes the macula to raise up which then distorts one’s vision. That’s why straight lines – like a telephone pole look bent or wavy. The blood and fluid also damages existing photoreceptor cells – rods and cones. When there are less photoreceptor cells there is diminished vision – vision is somewhat blurred and not sharp, more light is needed, and colors are not as vibrant.

Anti-VEGF Medications
Angiogenesis is a term that you may hear from your doctor. It simply means the growth of new blood vessels.  A protein called VEGF – Vascular Endothelial Growth Factor is responsible for the body creating these harmful and abnormal blood vessels under the retina.  So the goal of wet macular degeneration treatment is to  prevent or inhibit this growth or angiogenesis.  Researchers have developed medications that help block the VEGF protein – hence the name anti-VEGF treatment.  The four names of the anti-VEGF drugs that are used to treat wet macular degeneration as eye injections are  Lucentis, Avastin, Macugen and Eyelea.

Macular Degeneration Eye Injections
These medications are given as intraocular injections or injections that are given right into your eye.  There may be some improvement in vision when the blood vessels shrink or when the fluid under the macula is absorbed. Unfortunately,  the treatment is not a one time visit to the doctor. The frequency of the injections depends on many factors such as which anti-VEGF medication the doctor uses, the amount of abnormal bleeding one has and how well one responds to it.  A person may have to see the doctor as frequently as every month.

Questions to Ask Your Retina Doctor
Ask your retina specialist these questions if you have wet macular degeneration:

1.  What medication are you giving me?
2.  What is the goal of the treatment? What kind of improvement in my vision should I expect?
3.  What are the possible short term or long term side effects?
4.  How often do I need to come in for injections?
5.  What visual changes or eye symptoms require immediate attention?

Finding a retina specialist that you feel comfortable with and that addresses your concerns and questions is an important part of your treatment decision. Learn more about wet macular degeneration treatment here:

Wet Macular Degeneration Treatment

Leslie Degner, RN, BSN
www.WebRN-MacularDegeneration.com