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TREATMENT WITH INJECTABLES AND REFERRAL FOR LOW VISION CARE

By Richard J. Shuldiner, OD, FAAO Chief Clinical Editor

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There was a time when the only treatment for wet ARMD was laser surgery. At that time, eye care professionals knew that vision would be lost the moment that the laser beam hit the retina. At that time, it was recommended that low vision care be delayed until the final amount of vision loss was known.

Fortunately, those days are over. With the advent of the anti-VEG-F injectables, such as Avastin, Lucentis, Macugen, and Eylea, severe vision loss has become far less common. These injections help prevent neo-vascularization without damaging viable retinal cells. The first two injections help in the resorption of fluid leakage, which may restore some lost vision. On-going therapy is for the prevention of neo-vascularization, leakage, and further vision loss.

Many low vision patients arrive with a diagnosis of wet age-related macular degeneration and are undergoing treatment with injectables. One of the questions most asked is whether or not to continue with these injections. Obviously, the recommendations of the retina specialist should be followed to prevent further vision loss, so we always recommend continuing.

There are eye care professionals who recommend that low vision care be delayed until no further injections are required. This is a huge mistake. Treatment to prevent vision loss can go on for years. Some patients have had ongoing injections for years with reduced vision that is stable. There is no logical reason to deny these people the help of low vision glasses and devices so they can resume the activities now lost. If low vision glasses and devices allow the patient to read, see faces, watch TV, work on the computer, or even drive safer, there is no reason to deny them the opportunity. Should further vision loss occur, later on, the low vision glasses or devices can be re-evaluated and upgraded as necessary.

How to Know If You’re at Risk for Glaucoma

happy senior outside 640×350Glaucoma is a dangerous eye condition that can cause blindness. The condition occurs when fluids in the eye put pressure on the optic nerve. It is a leading cause of blindness worldwide, with more than 3 million cases in North America alone.

By testing your vision, dilating your pupils, examining your eyes, and testing your eye pressure, can detect whether you have glaucoma. Additional tests can determine whether your peripheral vision has declined.

Because glaucoma’s early stages affect the peripheral nerves in your retina, your side vision is damaged before your central vision. Furthermore, as this nerve damage is almost always pain-free, often this condition is discovered only after causing irreversible vision loss. While glaucoma’s effects can be managed, its damage is permanent.

Be Aware of the Risk Factors

You should be alert to the dangers of glaucoma, especially if you:

  • are over 40 years old
  • are African American or Hispanic
  • have diabetes, heart disease, sickle cell anemia, or high blood pressure
  • have a family history of glaucoma
  • sustained an eye injury
  • have extreme nearsightedness or farsightedness
  • have used corticosteroid medications
  • notice any vision loss

How Do I Know if I Have Glaucoma?

Contact at , who will dilate the pupil of your eyes and perform a comprehensive eye examination to determine whether you have the condition. If you do, we will start treatment immediately, usually by prescribing eye medications to prevent the glaucoma from worsening, and schedule follow-up visits.

The Centers for Disease Control and Prevention recommends getting a thorough dilated eye exam by age 40 to catch glaucoma and other eye diseases early.

Other proactive steps the CDC advises to prevent glaucoma include:

  • maintaining a healthy weight
  • monitoring your blood pressure
  • staying active
  • not smoking

 

treats patients with glaucoma — and people at risk for it — in , , , , and throughout ***state.

References

The 3rd Person in the Exam Room

adult woman with senior womanMany of the people who enter our offices seeking low vision care do so with a mixture of anxiety and trepidation. By the time we see them they will have already tried over-the-counter reading glasses, a variety of routine eyeglass prescriptions, hand-held magnifiers, and probably retinal treatments and AREDS vitamins — often to no avail.

Not only has their vision not improved, but they have been repeatedly told by their physician that “nothing more can be done,” at least from a medical perspective.

Eager for solutions, they reach out to to give it one more try, often accompanied by a friend or loved one.

We recognize how important it is for many patients to have a “3rd person in the exam room.” Having a support person can be invaluable for the patient, in a variety of ways, by providing emotional support and guidance during and after visits to the practice. This support person can be a significant other, spouse, partner, adult child, aide, or caregiver.

Reasons to Have a Support Person Present at the Low Vision Evaluation

There are many reasons for having that third person in the room. One of them is the familiarity that helps calm the patient’s anxieties. Furthermore, even if a patient’s memory is intact, they rarely remember all the suggestions and recommendations discussed during the doctor’s visit — something a support person can help with.

The support person may be able to fill in any missing information regarding the patient’s visual needs and medical history if the patient isn’t able to do so.

Accompanying the patient to exams can give the support person a deeper understanding of the patient’s visual capabilities and limitations. They may be dismayed at the patient’s poor vision during the eye chart testing or elated to discover that the patient has usable vision that can be enhanced with the use of low vision aids and devices.

The “3rd person” can act as a cheerleader, encouraging the patient to try activities they thought were beyond their visual abilities. They can encourage the patient to try telescope glasses or read small print using a microscopic lens.

The support person can also help and remind the patient to correctly follow the instructions when using the low vision aids by, for example, ensuring the patient is holding the reading material at the correct reading distance and situating the desk lamp for maximum benefit and brightness.

Bring a Support Person to Your Next Low Vision Consultation

To ensure the best outcome, we highly recommend that patients invite a support person to join them for their vision evaluations and consultations with .

To learn more about how can help low vision patients make the most of their vision, please contact today.

We serve low vision patients from , , ,, all throughout ***state.

Reading Tips For Those With Macular Degeneration

Woman 1.7FD w Cap.KinkadeThe most serious symptom of macular degeneration (AMD) is the loss of central vision, with those in the more advanced stages of AMD experiencing a smudge or black spot in the center of their vision. This makes it difficult to read and causes many people to give up on reading.

It doesn’t have to be this way.

Below you will find a list of low vision devices and strategies that can help people with AMD read more easily and comfortably.

Members of The International Academy of Low Vision Specialists are experts in determining which low vision devices will work best for you for reading.

Low Vision Devices for Reading

Reading Magnifier

Hand-held magnifiers are the most commonly used visual aids for spot reading among those with AMD and other low vision conditions. In the correct power, they are useful for reading medicine bottles, prices, labels, oven dials, etc. While you can find small pocket magnifiers, full-page illuminated magnifiers, and magnifiers that are mounted on adjustable stands, only your low vision doctor can determine exactly what power you need.

Portable Electronic Magnifiers

A portable electronic magnifier resembles an iPad or a tablet. By holding this device in front of your reading material, you can view the magnified version on its LED screen.

High-Power Reading Glasses

Strong magnifying reading eyeglasses enable a person with severe visual impairment to read the fine print. Your low vision eye doctor will determine the correct near prescription and demonstrate how they work.

Video Magnifier

Although traditional optical magnifiers, such as magnifying glasses, are generally very helpful, some people benefit more from a video magnifier. A video magnifier, or closed-circuit television (CCTV), has a camera that transmits magnified images (up to 50x or higher) and displays them on a large monitor or TV screen. You can sit as close to the screen as you like and adjust the magnification, brightness, and contrast for reading clarity.

Tele-Microscopic Glasses

Tele-microscopic lenses are mounted on the eyeglass lenses and may be prescribed for one or both eyes. They allow people with low vision to read, use a computer, write, and perform other tasks at a comfortable distance.

Certain low vision devices require a prescription from an eye doctor as they are custom-made for your specific needs. Consult , who will help determine which vision aids are best for your needs, based on your lifestyle and level of vision impairment.

Other Strategies To Help You Read With Macular Degeneration

Increase in Contrast

It’s important to ensure a stark contrast between the text being read and its background. Newspapers don’t offer much contrast because the grey letters sit on an off-white background.

Many electronic screens allow you to tailor the contrast to your needs: black lettering on a white background; white lettering on a black background; black lettering on a yellow background; and yellow lettering on a dark black background. Try the different color combinations and settle on the color contrast combination that offers the best contrast for the most comfortable reading experience.

Increase Lighting

Increasing the amount and type of lighting can greatly improve reading ability in those with AMD.

Direct light. A standard table lamp usually won’t provide sufficient light for reading a book. Consider getting an adjustable gooseneck lamp that allows you to focus the light directly onto the reading material.

Sunlight. Because natural sunlight is the ideal lighting for reading, try to arrange your furniture in such a way that you can sit near a window for comfortable daytime reading.

Lightbulbs. Use the brightest light bulbs for each light fixture in the house. These include LED, halogen, and full-spectrum light bulbs (which mimics natural sunlight more than incandescent bulbs). Be careful with halogen, however, as they may create excessive heat. Replace any fluorescent lighting in the house, as it can cause glare, particularly for those with low vision. For reading, however, the best option is to use lower strength light bulbs and bring the lamp closer.

E-reader. Kindles and other e-readers conveniently include a built-in light that allows you to adjust brightness for more comfortable reading.

Large Print Books or Larger Fonts

Consider purchasing large print books online or in book shops, as they include larger fonts, more spacing and better contrast. If you opt for electronic books, you can conveniently increase the font size, rendering it easier and more enjoyable to read.

Adjust Spacing

Your electronic reading device allows you to adjust the spacing between the lines as needed. By widening the space between lines, you will find reading easier and will experience less eye strain.

Speak with for more advice on reading with macular degeneration or to get low vision aids and devices.

serves low vision patients in , , , and , throughout ***state.

 

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