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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.

AMD Awareness Could Save Your Vision

It’s that time of the year again. Each February, the optometric community bands together to create awareness about age-related macular degeneration (AMD). AMD is a leading cause of vision loss for people 50 years and older; early detection plays a key role in the outcome of the disease. That’s why bringing awareness to the disease and its risk factors is so important.

Macular degeneration is a disease that damages the macula, which is a small area in the center of the retina responsible for sharp, clear central vision. The disease comes in two forms, wet AMD and dry AMD. The most common form, dry AMD, which affects around 80% of AMD patients, is when the macula gradually thins, and small clusters of protein called drusen begin to grow. Drusen result from cells in the macula that cannot rid themselves of metabolic waste called lipofuscin. The lipofuscin accumulates as drusen which causes a gradual vision decline.

Dry AMD can turn into wet AMD when abnormal new blood vessels grow through breaks in a membrane layer of the thinning macula. The fragile blood vessels leak fluid into the macula, causing rapid decrease in central vision.The wet form is less common, yet it can cause a faster and more drastic vision loss. If a person has dry AMD which turns into wet AMD, this should be treated as soon as possible, as within days this can cause permanent scarring. Fortunately, there is effective treatment for wet AMD if detected before scarring arises.

Both forms of AMD result in a loss of central vision, while peripheral vision stays intact. Symptoms can present as difficulty focusing on objects in front of you, or a blurred or dulled area in the central visual field which leads to having trouble reading, doing close work, driving or even recognizing faces. With time, the size of the blurred area can grow and eventually develop into black spots in central vision. Oftentimes patients don’t even notice symptoms until a significant amount of damage has been done. This is why regular eye exams are critical, especially if you are at risk.

While AMD alone won’t cause complete blindness, it can cause a permanent, total loss of central vision if not treated. Vision loss can lead to a condition called low vision which can have a very serious impact on daily living and require a lot of assistance both by vision devices and the help of others.

Are You at Risk?

As it is an age-related disease, age is a significant risk factor for AMD, specifically once you reach 60. However, age is not the only risk factor. While some risk factors for AMD cannot be controlled there are lifestyle factors that you can change to prevent AMD.

Other than age, risk factors include:

  • Family history: If you have a family history of AMD, you are more at risk. Research has identified at least 20 genes that are associated with AMD, showing there is a genetic factor.
  • Race: Caucasian descent is a higher risk factor for AMD, and in fact, Caucasians with light irises have an increased risk from age 50.
  • Smoking: Smoking doubles your risk of developing AMD.
  • Overweight/Obesity: Research shows that being overweight is a risk factor for AMD.
  • Having heart disease, high blood pressure and high cholesterol increase your risks.
  • Diet: An unhealthy diet rich in saturated fats is a significant risk factor.
  • Early exposure to UV light and blue hazard light (especially with the younger generation having increased exposure to digital devices) can cause early onset AMD.

Here are some lifestyle steps you can take to reduce your risk of AMD:

  • Stop smoking
  • Eat a healthy diet rich in omega 3 fatty acids, (from fatty fish or flax seeds), leafy greens and colorful fruits and vegetables.
  • Know your family history.
  • Exercise regularly.
  • Protect your eyes using UV protection and blue blocker coatings on eyeglasses.
  • Get regular eye exams.

In addition to a comprehensive eye exam, your doctor may be able to test for certain risk factors. For example, there is now technology available that can test for lutein levels via technology such as QuantifEye and Macuscope, (low lutein can indicate increased risk). In addition, genetic testing is also now available through a simple cheek swab to determine an individual’s risk for developing AMD.

Treatment

There is no known cure for AMD, however there are treatments available that may slow the progression of the disease. For dry AMD, studies (AREDS and AREDS2) have concluded that a particular high-dose combination of nutritional supplements taken daily can slow the disease. The combo includes vitamins C and E, Lutein, Zeaxanthin, Zinc and Copper. For wet AMD, the goal is to reduce the growth of abnormal blood vessels and the leakage that takes place and this is done through certain medications called anti-VEGFs which are injected into the eye or with laser surgery.

Untreated macular degeneration can have devastating effects on your independence and quality of life. If you are 50 or over, speak to your eye doctor about your risk factors and what you can do to prevent AMD.

IALVS Advice Americans about Increasing Dangers of UV and Blue Light on the Eye.

As Summer Approaches, members of International Academy of Low Vision Specialists Advice Americans about Increasing Dangers of UV and Blue Light on the Eye.

While everyone acknowledges that UV and Blue Light are dangerous for their eyes, members of International Academy of Low Vision Specialists, are acutely aware that the risks are not taken seriously enough, especially for seniors and those suffering with Macular Degeneration. With summer almost here and the sun at its brightest, IALVS is urging all Americans to protect their eyes and the future of their vision.

For Immediate Release

Corona, CA. – While most sunglasses claim to provide “UV Protection”, statistics show that UV and Blue Light are increasingly damaging the vision of Americans across the country. To respond to this growing epidemic, Doctors of the International Academy of Low Vision Specialists are today urging everyone to acknowledge the risks and take appropriate preventative measures.

Ultra-Violet light is a portion of the spectrum of invisible light primarily produced by the sun. The main risk comes to the Macula, an oval-shaped highly pigmented yellow spot near the center of the retina. UV and Blue Light are directly linked to retinal damage.

“Few know about Blue Light, which has caused such an epidemic that researchers are now starting look at it more closely. What they have discovered, through actual studies with live animal retinal cells, is that much of the blue – violet spectrum can be harmful to the eye and actually amplifies cell damage to the retinal cells,” says Dr. Palmer an IALVS Optometrist.

Everyone is urged to follow these simple steps:

– Always wear sunglasses when outside, and make sure that they conform to rapidly-changing UV protection standards

– Don’t be fooled by the presence of clouds; UV and Blue Light are can still be present in dangerously-high levels

– Never look directly at the sun, without exception

– Take special care to ensure children and older family members are always protected with proper sunglasses and brimmed hats

– If you feel your sight has been damaged by prolonged exposure to UV or Blue Light, contact an IALVS Doctor today for a free consultation

“Blue -violet exposure can be damaging to everyone, but especially damaging to high risk patients, like those with wet or dry macular degeneration ( AMD), retinitis pigmentosa (RP) and other associated retinal pathologies. These individuals especially should be wearing protective blue – violet and UV filtering lenses or coatings, not for simple symptomatic photosensitivity, but more specifically for the UV protective benefits provided by the introduction of the newer selective wavelength filtering lenses,” Dr. Palmer adds.

If an individual feels they are at risk, contact the nearest IALVS-accredited Doctor for a free phone consultation today, at: http://www.ialvs.com.

About IALVS:

The International Academy of Low Vision Specialists (IALVS) believes in LIFE AFTER VISION LOSS. The IALVS brings new hope and sight to those with Macular Degeneration and other vision limiting-conditions. The IALVS can bring back the enjoyment of retirement.

If someone is having problems seeing and doing the things they enjoy, an IALVS eye doctor can help. If they have been told by their eye doctor that a change in their eyeglass prescription will not help them see any better, call an IALVS doctor who is trained to design special glasses that can make a difference.

When a doctor says, “Sorry, I cannot get you to see any better,” an IALVS doctor often says, “It may not be perfect, but it definitely is better!”

Age Related Macular Degeneration and Your Central Vision

Did you know that age-related macular degeneration (AMD) is one of the leading causes of vision loss and blindness among adults aged 50 and above?

AMD occurs when the part of the retina responsible for your sharp central vision, the macula, begins to deteriorate. Central vision is the visual field that you rely on to focus on objects clearly, to read or to drive. As AMD affects your macula, the condition often results in gradual central vision loss. AMD does not cause complete blindness, as those affected by the condition are able to see by relying on their peripheral or side vision.

AMD is usually diagnosed as either dry or wet. The dry form is more common than wet macular degeneration. In dry AMD, light-sensitive cells in the macula gradually break down and slowly begin to blur central vision in the affected eye. Over time, central vision in the affected eye can be slowly lost as the macula begins to further deteriorate.

In its wet form, macular degeneration can lead to more severe vision loss, as the more advanced stage of the disease causes new blood vessels to grow beneath the retina. These new blood vessels are delicate and can leak blood and fluid, causing damage and scarring of the retina, leading to further vision loss.

The early and intermediate stages of AMD usually occur without symptoms. Only a comprehensive dilated eye exam can detect AMD. The eye exam includes a visual acuity test that measures how well you see, a dilated eye exam and the use of an Amsler grid. An Amsler grid consists of a grid of straight lines with a central focus point in the center. Someone with AMD may see the central area darkened or will report that the lines are wavy. This is a very effective and easy way for you and your eye practitioner to monitor changes in your central vision.

Aside from age, other risk factors that can increase your chances of developing AMD include smoking, high blood pressure, UV exposure and family history of the disease. It is important to maintain a healthy lifestyle, which includes quitting smoking, exercising regularly and maintaining normal blood pressure and cholesterol levels. Eating a diet rich in colorful vegetables and fish can boost the vitamins that naturally protect the eyes from AMD. We may recommend vitamin and mineral supplements based on your risk factors and level of developing macular degeneration.

Early detection of AMD is the best way to control the condition and reduce damage to your eyesight. That’s just one of the reasons why it’s so important to get a comprehensive eye exam from an eye care professional at least once a year.

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