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Vision

William Park

2012-08-01 13:38:53

Question- What is age-related macular degeneration (AMD) and how does it affect my life?

Answer- Age-related macular degeneration (AMD) is a disease associated with aging that gradually destroys sharp, central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as reading and driving, therefore affecting distance, intermediate (computer) and near-point tasks. AMD affects the macula, the part of the eye that allows you to see fine detail. In some cases, AMD advances so slowly that people notice little change in their vision. In other cases, the disease progresses faster and may lead to a loss of vision in both eyes. AMD is a leading cause of vision loss in Americans 60 years of age and older. Wet AMD, which accounts for roughly 15 percent of AMD cases, occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile and often leak blood and fluid. With wet AMD, loss of central vision can occur quickly. An early symptom of wet AMD is that straight lines appear wavy. If you notice this condition, contact your eye care professional immediately for a comprehensive dilated eye exam. Treatment options include laser treatment to the affected area, photodynamic therapy and injections to prevent growth of abnormal blood vessels. Dry AMD, which accounts for about 85 percent of AMD cases, occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. As dry AMD worsens, you may see a blurred spot in the center of your vision. Over time, as less of the macula functions, central vision is gradually lost in the affected eye. The most common symptom of dry AMD is slightly blurred vision. You may have difficulty recognizing faces, or need more light for reading and other tasks. Dry AMD generally affects both eyes, but vision can be lost in one eye while the other eye seems unaffected. It is also not uncommon for both eyes to be affected, though at different levels. There is currently no form of medical treatment for dry AMD. Appropriate diet, recommended anti-oxidants and vitamins, protection from UV rays and refraining from smoking are important lifestyle practices to prevent further progression of AMD. As a result of AMD, it is not uncommon to have changes in color perception, depth perception (due to the eyes having unequal acuity), difficulty identifying objects of low contrast and a multitude of activities of daily living that may seem nearly impossible. Low Vision Rehabilitation is paramount to resolving issues that compromise a person’s life and may be the only avenue to achieve the capability to perform tasks that were once easy to accomplish. This may include a change in an eyeglasses prescription, stronger reading glasses, or occasional to steady use of magnifiers or video magnification technology (desktop or portable). There are also avenues to continue using computers occupationally or avocationally. The visual system is one of the most important organ systems of the body and should be treated as such. Just like other organ systems, age is most likely to have an impact. Therefore, persons with macular degeneration should seek comprehensive low vision rehabilitation by an interdisciplinary team to reach the goals that they have to continue activities that are valuable to their quality of life.

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Vision

William Park

2012-02-27 13:55:21

Q: I have been visually impaired in my right eye since I was 3-years old due to a cataract. I am now 45-years old and my eye doctor told me that removing the cataract at my age would not help. I feel that any improvement would be beneficial in my everyday life. Can you give me your thoughts on what I should do?

A: As you know, the lens of the eye must be clear for the retina to receive a sharp image. If clouding occurs in the lens, it is referred to as a cataract and the image you see will be blurred. Identifying details, such as seeing a road sign while driving, reading the newspaper and even recognizing a family member’s face, may be difficult or impossible. While the majority of cataracts are age-related, cataracts can also be caused by hereditary factors. The most common symptoms of a cataract are blurred vision, color perception changes, glare from lights, decreased night vision, seeing multiple images and more frequent changes in spectacle prescriptions. The symptoms of early cataract may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, magnifying lenses or low vision devices. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens referred to as an IOL (intra-ocular lens implant). Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help delay further formation of the cataract. If you smoke, stop immediately. Researchers also believe good nutrition can help reduce the risk of age-related cataracts as well as other eye diseases, such as macular degeneration. They recommend eating green leafy vegetables, fruit and other foods with antioxidants. An eye examination should always involve a comprehensive dilated eye exam by your optometric or ophthalmological practitioner; this is the only way that the lens can be evaluated in its entirety, along with the retina and posterior portion of the eye. A cataract needs to be removed when vision loss interferes with your everyday activities, such as driving, reading or watching TV. Visual acuity is a number that may lead to speculation of visual function, but often does not correlate with personal satisfaction. Even if you have low vision, surgery may be beneficial to you. While it won’t correct your vision problem, surgical removal of the cataract may benefit you functionally and improve your daily life. You and your eye care professional can and should make this decision together. Two recent published sources further review cataract extraction for improved quality-of-life issues, in spite of other known reasons for the visual impairment such as macular degeneration. Park WL. So what if we go outside the box? An argument for cataract extraction of moderate to profound visually impaired persons. Visibility 2009; 3(3):12-13. Kou IC, Broman AT, Massof, RW, Park, WL. The impact of cataract surgery on patients from a low vision clinic. Can J Ophthalmol 2011; 46:391-398. For information or copies of these articles, you can contact my office at (316) 440-1690.

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Vision

William Park

2011-12-27 09:55:34

Q: My 42-year-old husband experienced a stroke seven weeks ago and was admitted and treated at a hospital, followed by further care at a rehabilitation hospital. However, he still has difficulty with compensating for double vision, loss of peripheral vision, reading, walking and performing simple tasks. He is extremely depressed, which is affecting our entire family. I feel totally helpless. What can I do?

A: First, you are not alone. Approximately 750,000 people suffer a stroke each year in the United States. The problems you express are about visual function, not necessarily visual acuity. This is due to the abruptness of loss of using both eyes and the inability of the brain to adapt. This type of vision loss can also severely affect recovery due to cognitive and motor dysfunction. Many patients do not express their decreased capability to perform normal activities of daily living to their family, friends or occupational associates, though they may be extremely frustrated and lack an understanding of why they are unable to perform these tasks as they did in the past. They may become more withdrawn or non-social. These individuals may benefit from social work or counseling. Double vision is common due to cranial nerve trauma as a result of a hemorrhage or a mass that leads to poor function of the muscles involved in movement of each eye. This can be corrected in many cases with prism lenses that compensate for the defect. A word of caution – these lenses may need to be changed over time and, in many cases, the double vision resolves. Loss of peripheral visual field is also not uncommon and can be resolved with prism lenses, temporally or permanently, or with vision therapy scanning techniques. Early rehabilitation intervention is critical and should be implemented with occupational and physical therapy as soon as possible to achieve the objectives desired by both professions. That would include enhancement of mobility, prevention of falls, improved speech and language skills, scanning and reading skills, along with enhancement of activities of daily living. If your husband is still having difficulty, you may want to talk to his neurologist, primary care physician or any other healthcare practitioner about referral for further neurological rehabilitation. An evaluation by a vision rehabilitation team, consisting of a vision rehabilitation practitioner (optometrist or an ophthalmologist), occupational and physical therapist, and orientation and mobility specialist in the same clinical environment, may dramatically and expeditiously improve visual function, while providing further patient education about resources, therapeutic interventions and environmental adaptations. The changes will enhance the patient’s overall quality of life. Because transportation and mobility are significant factors for those rehabilitating from a stroke, the goal of my practice is to participate as part of this team in one building, on one floor, with each healthcare practitioner providing expertise and patient care in their private suite and treatment rooms.

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Vision

William Park

2011-11-17 15:16:27

Q: My husband suffered a stroke one month ago and was hospitalized for one week. He is now at home and having difficulty seeing, speaking, walking and comprehending what he reads. What can I do to help him?

A: Your husband is not alone. Statistically he is quite fortunate. Each year, 750,000 people suffer a cerebrovascular accident (CVA) and 150,000 die as a result. In fact, stroke is the third leading cause of death. Your husband should consult his primary care physician concerning his pre-stroke lifestyle, such as hypertension, smoking, alcohol consumption, stress and results of his blood tests, which may indicate a multitude of contributing factors such as hypercholesterolemia, the presence of high levels of cholesterol in the blood. A stroke can result in cognitive, sensory or physical impairments. Because there is a close relationship between vision and the brain, it can disrupt the visual process, interfering with the flow and processing of information. The result is a vision problem along with other issues such as partial paralysis, memory loss, speech problems and potential falls. Following a CVA, a patient may experience symptoms such as loss of visual field, delayed visual processing, vertigo, dizziness, impaired eye movements, double vision, eyestrain and difficulty reading, to name a few. Hemianopia, the most notable loss of vision, occurs when patients lose vision in one side of their field of vision. Sometimes, patients are totally unaware of this shortfall, bumping into walls, ignoring food on one side of their plate or having difficulty reading. Due to the major impact of the visual system on cognitive and motor function, the vision rehabilitation needs of a person affected by a traumatic brain injury must be addressed as early as possible. Immediate intervention following a CVA is paramount to recovery of visual function and general well-being. With proper care and rehabilitation, CVA patients have the potential to regain quality of life, return to work and perform daily activities that are necessary for independence. The road to recovery should include a team of caring and skilled interdisciplinary healthcare providers who specialize in neurological rehabilitation. Many deficits can be improved or resolved through diligent vision rehabilitation or occupational therapy, speech and language therapy, physical therapy or orientation and mobility training. In most circumstances, lenses and prisms may result in elimination of double vision. Prism lenses may also assist in compensation of visual field loss. A vision rehabilitation specialist will also address magnification, contrast sensitivity, glare and management of the visual field loss. Achieving and maintaining independence for persons following a brain injury can be challenging. Many activities of daily living, such as safe travel, eating, speaking and self-care, can seem difficult or impossible. These issues may be resolved with guidance from appropriate healthcare providers. If your family member or loved one is affected by a brain injury, you may be one of the most important people in their life. You can help your husband by sharing your knowledge of how low vision and neurological rehabilitation can help.

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Vision

William Park

2011-10-24 14:45:07

Q: I was diagnosed with diabetes eight years ago and have been having difficulty with my vision, which has affected my driving, performance at work and reading. I have also had a feeling of great fatigue and, as a result, generally feel depressed. I do not know what to do.

A: Diabetes now affects approximately 26 million Americans, so you are not alone. Your immediate short-term goal is to normalize the blood glucose and control of your blood sugar level. Your A1C (hemoglobin), HDL/LDL (cholesterol) and blood pressure are extremely important to short and long term implications of your diabetic disease and vision. Having said that, you need to schedule an appointment immediately with your physician, emphasizing the chief concerns that you have expressed to me. If you do not see a Certified Diabetic Educator (CDE), I strongly advise that you see one in the very near future to assist you in making important lifestyle changes. Living well with diabetes requires active, diligent, effective self-management of the disease. Self-management is an important concept to emphasize because you need to make choices that positively affect your health on a regular and recurring basis. I would be happy to help you locate a CDE in your area, should you wish. Simultaneously, you should also schedule an appointment with your optometrist or ophthalmologist to determine the cause of your reduced vision. This is critical for you, due to your visual complaints and the duration of disease. Manifestations of diabetic retinopathy are most often asymptomatic until vision loss occurs. Diabetes is also a progressive disease with systemic risks that include increased risk of falls, impaired range of motion, neurological and cardiovascular disease, peripheral neuropathy, compromised wound healing and decreased blood flow, which can result in amputation. I have found that early referral for low vision rehabilitation, even with near normal to mild visual impairment, greatly assists in the educational and rehabilitative process of patients with progressive eye, neurological and systemic disease, both short-term and over time. Referral for low vision rehabilitation of the diabetic patient (and other visually impaired patients) is often poor and untimely, resulting in decreased quality of life, decreased job performance, lack of adequate diabetic management and depression. It can also have a significant negative socioeconomic impact to healthcare costs, both to you and society at large. Overcoming this dilemma can be accomplished by obtaining early education and seeking available resources. These resources include coordination of interdisciplinary care, training or therapy to aid you in maintaining the ability to perform occupational and avocational tasks, orientation in the use of assistive devices, and addressing psychosocial and psychological manifestations before they seriously impact your life. An evaluation by a low vision rehabilitation team consisting of a low vision practitioner (optometrist or an ophthalmologist) and/or an occupational/physical therapist in the same clinical environment, can dramatically and expeditiously initiate improvement in visual function and provide patient education about resources, therapeutic interventions and environmental adaptations along with enhancing overall quality of life. I have also found that meticulous refraction and change in prescriptive lenses may improve visual acuity and performance in most or all daily activities, such as driving, job-related tasks, reading and avocations important to that individual. If you have significant loss of vision, or reduced field of vision that affects your life, talk to your current eye care practitioner about referral to alleviate the concerns you have with your daily life.

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Vision

William Park

2011-10-24 14:43:35

Q: I have recently been told that I have multiple sclerosis and I am having trouble walking with occasional visual difficulties. What should I do?

A: Multiple sclerosis (MS) is an autoimmune disease where the body’s immune system attacks its own tissues. This process destroys myelin — the fatty substance that coats and protects nerve fibers in the brain and spinal cord. When myelin is damaged, the messages that travel along that nerve may be slowed or blocked. Although MS can occur at any age, it most commonly begins in people between the ages of 20 and 40. A combination of factors ranging from genetics to childhood infections may play a role. Women are almost twice as likely as men to develop multiple sclerosis. The risk of multiple sclerosis is higher for people who have a family history of the disease. Also, a variety of viruses have been linked to multiple sclerosis. Caucasians, particularly those whose families originated in northern Europe, are at highest risk of developing MS. Optic neuritis, an effect of MS, is an inflammation of the optic nerve, the bundle of nerve fibers in your eye that transmits visual information to your brain. Pain and temporary vision loss are common symptoms of optic neuritis. Most people who experience a single episode of optic neuritis eventually recover their vision. Treatment with steroid medications may speed up vision recovery. Visual disturbances may include eye pain, decreased vision, double vision, loss or impairment of color perception and depth perception, and decreased ability to see low-contrast objects. During this time, it is important to see your eye care practitioner for consultation concerning your vision difficulties. Currently, there is no cure for MS. However, there are treatments available that may slow the progression of the disease. Treatment typically focuses on combating the autoimmune response and managing the symptoms. Some people have such mild symptoms that no treatment is necessary. The most common treatment for multiple sclerosis is corticosteroids that reduce the inflammation that spikes during a relapse. Examples include oral prednisone and intravenous methylprednisolone. • Eat well. A low-fat, balanced diet can give you more strength, energy and confidence in managing your multiple sclerosis. Consult with your healthcare provider about changing your diet. • Quit smoking. Smoking strains your lungs, making fatigue worse and compounding the effects of MS. • Exercise. Many studies have shown benefits of exercise for people with multiple sclerosis include improved cardiovascular fitness, increased strength, less fatigue and better mental wellbeing. • Reduce stress. Everybody feels stressed out sometimes. Simplify your life. If you don’t have the strength or time to do something, it’s okay to say no. Save your energy for things you want and need to do. If you do experience visual impairment that does not resolve, consultation for interdisciplinary low vision rehabilitation may be appropriate for moderate to significant visual impairment. Because MS may affect the patient’s ability to perform self-care and other activities of daily living, treatment may also include referral to a low vision specialist, physical therapy and occupational therapy. The low vision specialist can address driving issues, difficulty with double vision, and all other occupational and avocational concerns, facilitating your capability to perform visual tasks that are important in your daily life. A physical or occupational therapist can teach you stretching and strengthening exercises, and how to use devices that can make it easier to perform daily tasks. The collaboration of these healthcare professionals can help prevent injury to yourself and enhance your capability to perform the daily tasks that are important to you.

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Vision

William Park

2011-07-01 08:32:00

Question: I have read about your practice being involved in the Low Vision Rehabilitation Outcome Study (LVROS). Would I be eligible and why should I enroll?

Answer: The patient enrollment and data collection portion with Johns Hopkins University has concluded. The data collection to determine whether the outcome of vision rehabilitation had a significant impact in addressing quality of life issues (QOL) is being analyzed, discussed at international and national conferences and prepared for publication in numerous peer review journals. Research involving vision and neurological impairment is becoming increasingly important because of the predominance of information exchanged in today’s world, which requires adequate vision to be able to read, perform an occupation, use iPhones or a computer and drive to a destination safely. In addition, this kind of research is significant because of the importance of vision in safe driving, fall prevention, performing activities of daily living and recovery from brain injury while maintaining quality of life issues. Visual field loss is a common consequence of several conditions and diseases affecting the neurological system, including stroke, traumatic brain injury and cerebral palsy, to name a few. When visual field loss is detected, the patient may be referred to an optometrist or ophthalmologist, depending on local availability – and in rare cases – may be referred to a low vision specialist. Common treatment for visual field loss is the prescription of and training in the use of prisms. Often, however, treatment for visual field loss, due to neurological event, stops here. While it is well documented that prisms can be effective tools in addressing visual field loss, patients will most likely not be able to take full advantage of their remaining vision or achieve as much independence as they possibly could without treatment beyond prism training. An alternative approach is to offer or refer to a facility that has the capability of providing a comprehensive treatment plan involving the vision specialist, occupational therapists, orientation and mobility specialists and, potentially, physical therapists. This option presents the challenges of a longer treatment time, increased number of visits to rehabilitation specialists and potential issues of geographic distance and travel. A comparison of these two strategies would provide measureable and quantifiable outcomes to be able to demonstrate which is more beneficial to patients and most effective in the long term. I have significant appreciation for the impact of research. Research can have a positive effect on patient care, epidemiological study, rehabilitation of neurologically and visually impaired individuals, and has the capability to influence policy and reimbursement for those persons that are affected by visual impairment. Needless to say, this research becomes even more important with the escalation of baby boomers.

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Vision

William Park

2011-06-01 10:02:00

Question: My husband has purchased fireworks for the upcoming holiday. They include many types and sizes of firecrackers, rockets and Roman candles. He feels my 15-year-old son is mature and responsible enough to participate in igniting these fireworks at our home during the holiday. I am concerned for his wellbeing. Can you give your thoughts?

Answer: The safest way to prevent firework-related injuries is to leave firework displays to trained professionals. Even sparklers which are often dismissed as having minimal risk, burn at 1800 degrees (hot enough to melt gold). The use of fireworks by non-professionals leads to a significant number of injuries each year, many of which go unreported. Firecracker use accounted for 32 percent of the injuries reported, with 42 percent of the injuries associated with illegal firecrackers. Sky rockets, or bottle rockets, accounted for 15 percent of the injuries. Injuries to the eye because of fireworks are most commonly due to bottle rockets and, as you might imagine, these injuries can be devastating and life changing. Data from the United States Eye Injury Registry shows that fireworks more often injure bystanders than the operators themselves. Each year, 33 percent of the injuries result in permanent eye damage and 25 percent suffer permanent vision loss or blindness. These six steps can help save your child’s sight: •Do not rub the eye. Rubbing the eye may increase bleeding or make the injury worse. •Do not attempt to rinse out the eye. This can be even more damaging than rubbing. •Do not apply pressure to the eye itself. Holding or taping a foam cup or napkin (gauze) loosely to the eye for protection is prudent. Protecting the eye from further contact with any item, including the child’s hand, is the goal. •Do not stop for medicine. Over- the-counter pain relievers will not do much to relieve pain. Aspirin should never be given to children and ibuprofen can thin the blood, increasing bleeding. Take the child or person to the emergency room at once. This is more important than stopping for a pain reliever. •Do not apply ointment. Ointment, which may not be sterile, makes the area around the eye slippery and harder for the doctor to examine. As a matter of my own life, I have never chosen to be directly involved with fireworks. I have always observed from afar and enjoyed the show. The risk of injuries from fireworks cannot be overstated. This has been reinforced on countless occasions in my career by individuals who have put themselves at risk, either recreationally (fireworks) or occupationally, by not adhering to safety standards meant to protect their eyes. These patients have paid the ultimate price of loss of vision in one or both eyes for the rest of their lives. A holiday is meant to be a time of relaxation and enjoyment. Watch from afar as a family and let others provide the show.

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Vision

William Park

2011-05-01 13:04:00

Question: My family has a history of poor vision that is not correctable to 20/20 due to something being wrong with the back of the eye. I have a 2-year-old daughter who seems to have difficulty seeing things that my other children could see at that age. What should I do?

Answer: A chronicle of your family’s history will be a valuable asset to the doctor while determining a diagnosis for your daughter. This history needs to include previous familial vision diagnoses, general health information, prenatal and postnatal conditions and at what age visual problems were first noticed. An appointment with a pediatric optometrist or ophthalmologist should be scheduled as soon as possible, since this is a very critical time of development for your child’s visual system. The initial eye examination should include visual acuity, fixation or attention pattern to contrast. The examination will involve a multitude of tests that will include pupil and external examination, a special cycloplegic retinoscopy, and/or refraction to determine the need for a correction for best visual acuity. This is necessary to determine the health of the eyes (including a dilated examination – to evaluate the inside of the eye) and should be completed as soon as possible. The question of whether both eyes are being used together is extremely critical at this age. Preference for one eye may result in strabismus, commonly referred to as a “lazy eye.” This initial work-up will most likely involve assessment by a multidisciplinary team. You can help if you have photographs of your daughter that demonstrate the size of the pupils of each eye and the presence of a red reflex that demonstrates any lack of brightness or clouding of one eye versus the other eye. If you have a camera with videotaping capability, record her ability to travel in the environment, reaching for objects, and posture used to play with toys or respond to that toy or object. Parents’ observations are valuable. Is your home cluttered or do you notice your daughter bumping into objects if it is cluttered? Do you notice strong contrast needs to be present for your child to see the things that are important to her? Does your child see objects placed within her field of vision? Do you need to have larger or smaller toys in order for your child see them and is the color of the toy important? An eye examination and vision assessment are vital for the detection of conditions that result in blindness, signify serious systemic disease, lead to problems with school performance, or, at worst, threaten the child’s life. Since vision is often difficult to measure in a young child, I recommend teaching children the four symbols we often use to measure their vision as soon as possible. The pictures we use are Lea symbols: Visual acuity is only part of the concern. Because children do not complain of visual difficulties, visual acuity measurement (vision screening) is an important part of complete pediatric eye care and, in your case, should be initiated now.

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Vision

Dr Chris Jacquinot

2011-04-01 13:55:00

Question: What is Glaucoma and how can it affect my eyes?

Answer: Glaucoma, as defined by the American Optometric Association is “a group of eye disorders leading to progressive damage of the optic nerve, and is characterized by loss of nerve tissue resulting in loss of vision”. Wow, that’s a mouthful and kind of confusing so let’s first start by breaking this definition down and making it a little more understandable. The initial portion of the definition mentions “a group of eye disorders” – because glaucoma comes in many different types. It can be caused by anything from eye trauma to anatomical abnormalities of the eye. However the most common form of Glaucoma is called Primary Open Angle Glaucoma, and often is associated with pressure inside the eye that damages the optic nerve. If Glaucoma causes “damage to the optic nerve” the next logical question would be “what is the optic nerve?” The optic nerve is the “cable” that connects the eye to the brain, and transmits visual signals back and forth between the two. In Glaucoma, the optic nerve is progressively damaged, and thus cannot transmit visual signals to or from the brain properly. The “loss of vision” that most patients with Glaucoma experience is caused by the optic nerve damage. It often starts with patient’s peripheral vision – and as the condition advances, moves more central. The frightening problem with Glaucoma is that in most cases, individuals have no idea they are losing their peripheral vision. Unfortunately, trying to “self-check” your own peripheral vision is not near specific or sensitive enough to catch the vision loss from Glaucoma, unless the condition is extremely advanced. Even though anyone can develop Glaucoma, some individuals are at a higher risk than others. Certain risk factors such as high internal eye pressure, a family history of Glaucoma, age over 60, vascular conditions such as Diabetes and Hypertension, as well as Corticosteroid use may increase chances of developing Glaucoma. The treatment for Glaucoma is aimed at reducing the pressure inside of the eye. The most common first line treatment of Glaucoma is usually prescription eye drops taken daily. However, in some cases systemic medications, laser treatment, or other surgery may be required. Glaucoma is the second leading cause of blindness in the United States, and in most cases develops slowly and with no symptoms. It cannot currently be prevented, but with yearly eye examinations it can be diagnosed and controlled without serious vision loss.

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Vision

William Park

2011-04-01 13:55:00

Question: I have experienced a sudden decrease in my vision due to a recent stroke. I have also had difficulty with my vision for the last year as a result of diabetes and am concerned about my safety. What can I do?

Answer: Vision impairment and blindness are among the 10 most common causes of disability in the United States. The incidence rates of stroke, cognitive impairments and other neurologic disorders increase sharply with age. The risk of stroke more than doubles for every decade after age 55. Thirty percent of all patients who have experienced a stroke have visual field deficits. Unless vision loss among patients with stroke is addressed through rehabilitation, their participation in activities of daily living may be reduced, while their risk for more long-term and severe disability increases. People who have vision impairments are twice as likely to have a fall in comparison to those persons who are not visually impaired. Falls are also a common reason for hospital admissions for trauma and account for 90 percent of fractures. Diabetes is a progressive disease with systemic risks that include increased risk of falls likely due to decreased vision, impaired contrast sensitivity (the ability to see a low contrast object, i.e. facial recognition, walking down stairs), delayed adaptation to changes in illumination, possible impaired range of motion, weakness of extremities and peripheral neuropathy—all of which may result in serious injury and prolonged healing. I have been following a diabetic patient’s rehabilitative course for two months. She has been in a boot for one year to assist in healing from a fracture and prevent further injury. During this time, she has gained 80 pounds due to her lack of mobility and inability to perform many daily tasks that we take for granted. For her, this has resulted in reduced physical functioning and impaired activities of daily living (ADLs), instrumental activities of daily living (IADLs) and safety in moving around in the environment. Affected ADLs include dressing, bathing, eating, transferring and toileting. Affected IADLs include more complex, but essential, daily tasks such as preparing meals, taking medications, using the telephone, self-health monitoring, using devices such as glucometers and administering wound care. In this case, rehabilitative care involves working with her optometrist and/or ophthalmologist. In my practice, it also involves referral to occupational therapy, physical therapy, orientation and mobility, behavioral health, various ophthalmic personnel and a patient coordinator to ensure all mutual goals for a productive life, overall well being and safety concerns are addressed. If you are experiencing a loss of vision due to stroke or diabetes, ask your doctor for referral to low vision rehabilitation professionals to improve your personal safety and maintain your independence. Good luck and best wishes.

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Vision

William Park

2011-03-01 11:31:00

Question: What is meant by “aging in place?”

Answer: Perhaps the best way to explain it is, “It’s what you would want and what you would do if you could.” How do we function as a society with baby boomers and the aging population who want to remain in their homes? How do we solve the problem of independent travel and activities of daily living without the ability to drive? What are the considerations for adult children and the toll on them when caring for aging parents? By the year 2025, senior citizens will outnumber school-age children. Having experienced four aging parents in the above predicament, I can say that every family with baby boomers needs to consider what they are going to do for their family and for their parents. While serving as a co-investigator in “Interventions for Visual Loss for Nursing Home Residents” (EY15812 NIH/NIA 1999-2003), I evaluated residents in nursing homes all along the eastern shore of Delaware and Maryland with a vision team of 30 or more. I have seen that there is a very real calling for addressing the issue of complacency and belief that “it will not happen to me.” Unless you are independently wealthy, you need to be concerned. The good news is there are mechanisms to buffer the dilemma. The first is that overall health is being monitored and maintained to the highest level by consistent evaluation of systemic health by personal medical practitioners and directed ancillary staff. At the same time, vision issues that are likely to be prevalent as a matter of aging, such as cataracts, glaucoma, macular degeneration, implications of diabetes, neurologic and chronic disease, are being addressed. In addition, greater emphasis is being placed on interdisciplinary vision rehabilitation being provided at the very forefront of vision loss. Independence may depend on rehabilitation provided by skilled, caring healthcare providers who specialize as a team in meeting those functional goals paramount to quality of life. Many of these deficits and concerns can be improved or resolved through diligent efforts and rehabilitation provided by a low vision rehabilitation specialist, occupational and/or physical therapist, speech and language therapist, behavioral health specialist, orientation and mobility specialist and a certified driving rehabilitation specialist, if appropriate. In my professional setting, all of this rehabilitation is accomplished in one building on the same floor, unlike in my previous university faculty positions, in which the team was sprawled throughout various buildings or, in many cases, throughout the city. Research to address the fear of loss of independence becomes even more important with the anticipation of the escalation of baby boomers, which will dramatically increase the number of persons in the United States who are affected by age-related macular degeneration and previously mentioned vision impairment issues resulting from aging. I am very pleased to announce the fourth year of participation by residents of Kansas in the Johns Hopkins Low Vision Rehabilitation Outcome Study (LVROS). Currently, my practice has enrolled and completed the second highest amount of participants (all in the state of Kansas) versus Johns Hopkins University of 28 sites in the study. This research may influence governmental agencies when determining whether to provide funding to cover rehabilitation services for people who are visually and neurologically impaired.

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Vision

Dr Chris Jacquinot

2011-03-01 10:26:00

Question: When should a child have their eyes examined?

Answer: This is a wonderful question, and one that I am asked quite often.Children use all of their senses to learn about their surroundings and obtain information from birth. This ability helps the child to develop and adapt to their environment as they are growing. Sight is, for obvious reasons, an extremely important sense - and any deficiency or loss of sight at an early age can hinder a child’s ability to develop (visually, educationally etc). Thus, catching any visual impairments in young children is extremely important because of the affect that it can have on long term development. In some cases, visual problems in children are identified rather easily (child is squinting, parent notices child has an eye turn etc). However, many times from an outward appearance a child seems to function fine but they have underlying visual impairments. One of the most common situations occurs when a child’s vision is good in one eye but poor in the other. While both eyes are open, the child seemingly has no outward problems - however, in reality the child is only relying on the good eye. Left untreated, this can have lasting effects on depth perception, reading ability, reading comfort and even overall school performance. Children can also be born with, or develop ocular pathology that may not initially affect vision or be identifiable from an outward appearance. In some cases the pathology, if left untreated, may eventually decrease vision permanently. In extreme cases, some pathology can be linked to conditions that cause morbidity as well as mortality. The above scenarios highlight the need for pediatric eye examinations, and the American Optometric Association has guidelines set up to help determine when your child should have his/her eyes examined. Newborns are typically screened at birth for congenital eye disorders and disease, and if a problem or risk factor is present they should have a full eye examination as soon as possible. If no specific problems or symptoms are noted at birth, the child should be seen at six months of age for an examination. In the absence of specific problems or symptoms at six months, re-examinations at age three and prior to entry into school are recommended. Studies have shown that roughly one in ten children under the age of eleven have either an eye muscle imbalance, a disease condition, or other abnormality in one or both eyes. This statistic alone makes it extremely important for all children to have their eyes examined on a regular basis. Examinations at a young age will help identify visual problems and/or pathology that could cause lasting issues as well as developmental delays.

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Vision

Dr Chris Jacquinot

2011-02-01 14:24:00

Question: I work in an office setting which requires looking at a computer screen daily. What is Computer Vision Syndrome?

Answer: Great question! Technology has certainly changed our lives over the past decade, and computers have played a large part in that change. More and more jobs depend on computers - which mean an increased number of people are using computers on a regular basis. This increased usage can often stress our visual systems in many different ways. The American Optometric Association defines Computer Vision Syndrome (CVS) as a group of eye and vision related problems that result from prolonged computer use. These problems can include eyestrain, headaches, blurred vision and dry eyes and even neck/shoulder pain. The extent and severity of the symptoms are often directly related to the amount of time spent looking at the computer screen as well as the strength of the individuals visual system. Factors such as poor lighting, glare from the computer screen, improper viewing distance, poor seating posture, uncorrected vision problems or a combination of the above can all trigger CVS. CVS can be diagnosed through a comprehensive eye examination by a licensed Optometrist. The examination may include special testing that emphasizes the visual requirements needed at the patient’s computer working distance. All of the information will be assessed by the Optometrist (symptoms from patient, visual acuity, visual health, ability of eyes to work together and focusing strength) to identify key problems as well as a treatment plan. Treatment for CVS depends on the underlying problem. In many cases of CVS, the symptoms are alleviated by discontinuing computer work. Unfortunately, for many individuals that work on computers, this is not an option. Some may need eyeglasses or contact lenses that help specifically at the computer - while others may only need an updated prescription. Focusing and eye movement problems can often lead to CVS. If the Optometrist finds that a patient has problems in either of these areas they may prescribe a vision therapy program. Vision therapy is a structured program to help strengthen the eyes focusing and/or movement capabilities. These eye exercises help the patient with any deficiencies they may have in regards to eye movement or focusing ability. The exercises also help to ensure that the eye and brain are working “as a team.” Other modifiable factors such as computer screen location, lighting, anti-glare screens/coatings and seating position can often be altered to help alleviate symptoms of CVS. Even simple changes such as blinking more often during computer use and taking short breaks to rest your eyes every couple of hours can help. Our jobs in the future will continue to rely on computer use - especially with technology advancing at the rate it is. Regular eye examinations, ergonomic posturing and proper viewing conditions can help reduce and even prevent the symptoms often associated with Computer Vision Syndrome.

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Vision

William Park

2011-01-01 10:18:00

Question: I was diagnosed with glaucoma 10-years ago. I have been using eye drops and my doctor tells me my eye pressure is under control. However, I am having difficulty traveling in reduced lighting and at night, and am concerned with my safety. What can I do to be more confident and independent?

Answer: Glaucoma leads to blindness by damaging the optic nerve. Elevated pressure in the eye is a risk factor, but even people with normal pressure can lose vision to glaucoma. Although eye drops can lower your pressure, they do not cure the disease. The drops merely treat the glaucoma to slow the progression of the disease, so you may still experience difficulties in many activities. Adverse effects of long-term uncontrolled glaucoma can compromise enjoyment of many daily tasks. Glaucoma is the leading cause of blindness among African Americans, and is six to eight times more common in African Americans than in Caucasians. Glaucoma is much more common among older people and you are six times more likely to be diagnosed with glaucoma if you are over 60-years-old. The most common type of glaucoma, primary open-angle glaucoma, is hereditary. If members of your immediate family have glaucoma, you are at a much higher risk than the rest of the population. The unfortunate reality is that many patients do not express their decreased capability to perform normal activities of daily living to their families, friends or colleagues because of their frustration, fear or lack of knowledge. This can often lead to withdrawal from common social activities and a diminished quality of life. Your concern may be due to the slowly decreasing peripheral and/or central vision, resulting in the inability to see normal print, function well in poorly lit conditions or environments, travel safely in a known or unknown location or drive with confidence. There is no magic number relating to visual acuity that applies when the level of vision may be a compromising factor in performing any everyday task. It is important to understand that with today’s technology and an interdisciplinary vision rehabilitation team, most goals are possible and vision rehabilitation should be sought when difficulties arise. If you are having difficulty, you may want to talk to your practitioner about a referral for low vision rehabilitation. An evaluation by a vision rehabilitation team consisting of a vision rehabilitation practitioner (optometrist or an ophthalmologist), an occupational therapist and an orientation & mobility specialist in the same clinical environment may dramatically and expeditiously accomplish improvement in visual function, while providing patient education about resources, therapeutic interventions and environmental adaptations along with enhancing quality of life. It is very likely that filters would help you with contrast issues, glare and night vision. Other optical devices may assist you in basic activities of your daily life. I encourage you to talk with your eye doctor and ask for a referral for low vision rehabilitation with a team who can work together to help you remain as independent as possible.

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Vision

William Park

2011-01-01 10:18:00

Question: My four-year-old son has been diagnosed with possible cortical visual impairment. I am at a loss as to whom I should see for guidance.

Answer: For medical purposes, cortical visual impairment (CVI) may be defined as visual impairment in both eyes caused by damage to the occipital lobes and/or to a specific visual pathway. CVI is almost invariably associated with an inefficient, disturbed visual process due to widespread brain disturbance. For educational concerns, CVI is a neurological disorder, which results in unique visual responses to people, printed materials and the environment. CVI is one of the most frequent causes of visual impairment in children of developed countries. CVI can be congenital or acquired and may also exist with optic nerve disease, or retinopathy of prematurity. A few causes of CVI are asphyxia, cytomegalovirus, premature birth, metabolic and seizure disorder, hydrocephalus, brain bleeds, periventricular leukomalacia, shaken baby syndrome and exposure to toxins and drugs. Most children with CVI improve in functional behaviors, with the poorest prognosis for recovery in children with periventricular leukomalacia and children who suffer shaken baby syndrome that present with retinal bleeding. The objective of working with children with CVI is to help them create visual memory and to use their remaining functional vision. Children with CVI usually have some level of vision that can improve over time. However, this requires a team of health care professionals with very specific backgrounds to ensure that your son has maximum potential to meet the goals necessary to improve his learning process. This team would include, but not be limited to; vision rehabilitation practitioner, psychologist, pediatric occupational therapist, teacher of the visually impaired and patient coordinator. Common characteristics include aspects such as non-purposeful gaze, light gazing behavior and difficulty with novelty and/or complexity (too much auditory, visual or tactile information). There is a preference for the colors red and yellow. Ninety percent of children affected by CVI have visual field deficits that may have an impact on mobility. It is also common to have an atypical or absent response to visual threats of objects in their visual space. The child will, however, tend to bring the object close to block out irrelevant background. Atypical motor behavior will result in a child looking at a person or object and then looking away from the person or object as they reach for that object. Ocular and ocular motor issues need to be evaluated so that maximum correction is provided for any of these problems. The computer is an excellent tool to use with children who have CVI. It provides high contrast, two dimensions and fills the child’s visual field to eliminate the effects of figure-ground. There are excellent computer programs for children that are simple and educational that use bright colors, eliminating visual clutter and providing movement. Simple and consistent teaching approaches are optimal to the overall goal of improving visual function. This is just a brief answer to address areas of concern and the necessity for interdisciplinary rehabilitation for your son.

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Vision

Dr Chris Jacquinot

2011-01-01 10:00:00

Question: Why do I need to have my eyes checked if I don’t wear glasses or contact lenses?

Answer: Excellent question! I often wonder how many individuals bypass yearly eye examinations because they have clear vision. Optometrists (eye doctors), for some time, were primarily associated with eyeglasses and contact lenses. While they are still considered the “optical specialists,” Optometrists can also uncover many systemic problems by giving a comprehensive eye examination. The examination most often includes a vision test that determines if the patient needs glasses or contact lenses. Once a visual correction has been made, the doctor will check the outer portion of the eyes for any problems. During this process, they will also collect information about the pressure in the patient’s eyes. Finally, some individuals may need to have their eyes dilated. These patients may include those who are new to the practice, have visual symptoms that warrant dilation, and those who have a history or family history of ocular/systemic health problems. Dilating a patient’s eyes not only allows the doctor to adjust the prescription if necessary, but also allows them to view the interior portion of the eye, also known as the Retina. Usually one to two dilating drops are placed in each eye, and the patient is asked to wait anywhere from 10 to 20 minutes as his/her eyes dilate. When the eyes are dilated, the doctor uses a few lights and magnifying lenses to view the nerves, blood vessels and other portions of the interior eye. This process enables the doctor to monitor for any problems relating to the overall health of the patient. Many systemic health problems are vascular based, and the eye has numerous blood vessels that can be observed during the examination. Systemic conditions such as Diabetes and Hypertension can sometimes be diagnosed by examining the blood vessels in the eye. Frequently, patients with these disorders will have no indication that anything is wrong – and their vision is often excellent. Unfortunately, diabetes is the leading cause of new cases of blindness among adults from 20 to 74 years of age. This statistic alone makes it incredibly important for patients to have yearly eye examinations, especially those who have, or are at risk for developing diabetes and/or hypertension. If diagnosed early enough – patients can work with their primary care physician to control and sometimes even eradicate these conditions. Glaucoma is another condition that most often causes no visual symptoms until it is too late. Patients are at risk to develop the primary form of Glaucoma when the internal pressure of the eye is elevated. Unfortunately, in most cases of Glaucoma, the patient cannot feel the increased pressure, and visual changes are usually not detected until the late stages of the disease. As the condition progresses, the patient’s peripheral vision decreases, and if not managed properly, the patient is at risk for blindness. Optometrists are licensed in most states to diagnose and treat Glaucoma. The diagnosis process often involves testing to determine the risk factors assigned to the patient. The doctor then analyzes the tests and determines if a patient has Glaucoma, and how severe the disease is at the time of examination. Treatment usually consists of either instilling pressure lowering drops in the eyes or in other cases, surgical methods. Glaucoma, if diagnosed and treated early enough, can often be managed without further loss of vision for the patient. In addition to those mentioned above, there are many other sight threatening conditions that cause no outward visual signs or symptoms. Always remember that clear vision does not equate to “healthy” vision, and that yearly eye examinations are the key to early diagnosis and treatment.

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Vision

William Park

2010-12-01 11:33:00

Question: My loved one suffered a brain injury in a car accident and is having difficulty seeing, speaking, walking and comprehending what he reads. What can I do to help?

Answer: Traumatic brain injury (TBI) yields similar results to vision as a stroke. There are approximately 8 million head injuries reported each year. Of those, 1.5 million are deemed serious. With TBI, a patient may experience symptoms such as loss of visual field, visual processing, vertigo, dizziness, impaired eye movements, double vision, eyestrain and difficulty reading, to name a few. The injury can produce cognitive, sensory or physical impairments. Because there is a close relationship between vision and the brain, TBI can disrupt the visual process, interfering with the flow and processing of information. The result is a vision problem along with other issues such as partial paralysis, memory loss, speech problems and potential falls. Expressive aphasia is one category of a larger family of disorders known collectively as aphasia, which is characterized by inability to produce language (spoken or written). This differs from dysarthria, which is a motor speech disorder characterized by a patient’s inability to properly move the muscles of the tongue and mouth to produce speech. Expressive aphasia contrasts with receptive aphasia, which is characterized by a patient’s inability to comprehend language or speak with appropriately meaningful words. Hemianopia, the most notable loss of vision, occurs when patients lose vision in one side of their field of vision. Sometimes, patients are totally unaware of this shortfall, bumping into walls, ignoring food on one side of their plate or having difficulty reading. Due to the major impact of the visual system on cognitive and motor function, the vision rehabilitation needs of a person affected by a traumatic brain injury must be addressed as early as possible. Immediate intervention following a TBI is paramount to recovery of visual function and general well-being. With proper care and rehabilitation, TBI patients have a chance to regain quality of life, return to work and perform daily activities that are necessary for independence. The road to recovery should include a team of caring and skilled healthcare providers who specialize in TBI and low vision or neurological rehabilitation. Many deficits can be improved or resolved through diligent low vision rehabilitation or occupational therapy, speech and language therapy, physical therapy or orientation and mobility training. In most circumstances, lenses and prisms may result in elimination of double vision. Prism lenses may also assist in compensation of visual field loss. A low vision specialist will also address magnification, contrast sensitivity, glare and management of the visual field loss. Achieving and maintaining independence for persons following a brain injury can be challenging. Many activities of daily living, such as safe travel, eating, speaking and self-care, can seem difficult or impossible. These issues may be resolved with guidance from appropriate healthcare providers. If your family member or loved one is affected by a brain injury, you may be one of the most important people in their life. Share your knowledge of how low vision and neurological rehabilitation can help.

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Vision

William Park

2010-11-01 13:31:00

Question: I am a 45-year-old male who was diagnosed with diabetes six years ago. I have been told that I am 30 pounds overweight and I seldom feel well or positive about life because of my health. My vision fluctuates from day to day, resulting in difficulty with driving, reading and working. What can I do to improve my situation?

Answer: Visual impairment can significantly reduce one’s functional status. Diabetes and depression are intimately related and also contribute to poor compliance to medication, dietary regimens and glycemic control, potentially resulting in reduced quality-of-life issues and overall wellness. It is extremely important that you consult with your primary care practitioner about all of your concerns. You should also consult with your primary eye care practitioner (optometrist or ophthalmologist) concerning the visual difficulties that you are experiencing. Type 2 diabetes is far more common than type 1, making up the majority of diabetes cases. With type 2 diabetes, the pancreas does not make enough insulin to keep blood glucose levels normal. Type 2 diabetes usually occurs in adulthood, but young people are increasingly being diagnosed with this disease. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to increasing obesity and failure to exercise. This appears to be an area of your life that you need to address. Just as important as managing your diabetes is managing your visual system. You should strictly adhere to the advice of your medical and eye care practitioners. If your vision cannot be corrected to normal acuity levels, you should seek further consultation and vision rehabilitation. Vision rehabilitation may include new optical prescriptions, visual assistive devices, visual-spatial retraining, occupational therapy, orientation & mobility training, social work consultation and diabetic management. To assist in daily living and vocational issues associated with vision loss, your plan of care could also include onsite occupational ergonomic and environmental assessments, home activities of daily living evaluations, community participation assessments, vocational training and driving. An evaluation by a vision rehabilitation team in the same clinical environment can dramatically and expeditiously initiate improvement in visual function and provide information about resources, therapeutic interventions and environmental adaptations to enhance your quality of life. The vision rehabilitation team should consist of a low vision practitioner (optometrist or an ophthalmologist), a certified low vision therapist and/or an occupational therapist, social worker and orientation & mobility specialist. In addition to vision rehabilitation, a meticulous refraction and change in prescriptive lenses (validated with more than one visit if blood sugar levels are not controlled), may improve visual acuity and performance in many daily activities such as job-related tasks, reading, and perhaps driving, depending on visual acuity and the extent of your field of vision. The emphasis in your life should be related to eliminating barriers to effective therapy, promoting effective self-management, improving psychological status, and enhancing communication and coordination between your healthcare providers and yourself. If you have significant loss of vision that adversely affects your life, talk to your current eye care practitioner about a referral for vision rehabilitation to alleviate the concerns you have with your daily life.

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Vision

William Park

2010-10-01 10:11:00

Question: I have recently been told that I have multiple sclerosis and I am having trouble walking with occasional visual difficulties. What should I do?

Answer: Multiple sclerosis (MS) is an autoimmune disease where the body’s immune system attacks its own tissues. This process destroys myelin — the fatty substance that coats and protects nerve fibers in the brain and spinal cord. When myelin is damaged, the messages that travel along that nerve may be slowed or blocked. Although MS can occur at any age, it most commonly begins in people between the ages of 20 and 40. A combination of factors ranging from genetics to childhood infections may play a role. Women are almost twice as likely as men to develop multiple sclerosis. The risk of multiple sclerosis is higher for people who have a family history of the disease. Also, a variety of viruses have been linked to multiple sclerosis. Caucasians, particularly those whose families originated in northern Europe, are at highest risk of developing MS. Currently, there is no cure for MS. However, there are treatments available that may slow the disease process. Treatment typically focuses on combating the autoimmune response and managing the symptoms. Some people have such mild symptoms that no treatment is necessary. The most common treatment for multiple sclerosis is corticosteroids that reduce the inflammation that spikes during a relapse. Examples include, oral prednisone and intravenous methylprednisolone. Optic neuritis, an effect of MS, is an inflammation of the optic nerve, the bundle of nerve fibers in your eye that transmits visual information to your brain. Pain and temporary vision loss are common symptoms of optic neuritis. Most people who experience a single episode of optic neuritis eventually recover their vision. Treatment with steroid medications may speed up vision recovery. Visual disturbances may include eye pain, decreased vision, double vision, loss or impairment of color perception and depth perception, and decreased ability to see low contrast objects. During this time, it is important to see your eye care practitioner for consultation concerning your vision difficulties. If you do experience visual impairment that does not resolve, consultation for interdisciplinary low vision rehabilitation may be appropriate for moderate to significant visual impairment. Because MS may affect the patient’s ability to perform self-care and other activities of daily living, treatment may also include referral to a low vision specialist, physical therapy and occupational therapy. The low vision specialist can address driving issues, difficulty with double vision, and all other occupational and avocational concerns, facilitating your capability to perform visual tasks that are important in your daily life. A physical or occupational therapist can teach you stretching and strengthening exercises, and how to use devices that can make it easier to perform daily tasks. The collaboration of these healthcare professionals can help prevent injury to yourself and enhance your capability to perform the daily tasks that are important to you.

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Vision

William Park

2010-09-01 13:38:00

Question: I am 62 years old, live alone and need to continue driving to maintain independence and feel good about my life. I have had cataract surgery on my right eye and have been told I have a cataract in the other eye, with beginning macular degeneration in both eyes. What can I do to make sure I am safe?

Answer: First, I assume you have been counseled on your ability to drive by your optometrist and/or ophthalmologist and are still legal to drive. You should be aware of what level of visual acuity you currently have – in each eye separately and with both eyes together. Your depth perception has likely been affected by the difference between your two eyes’ visual capability due to the cataract in your left eye. Also, the macular degeneration could be more involved in one eye than the other. Other factors to consider are your ability to: detect low contrast objects such as shading on pavement, read signs, see traffic lights or a pedestrian crossing the street, and your reaction time to the unexpected, as these factors are perhaps even more important than your visual acuity. All of these factors may result in difficulty judging distance and closing rates of other vehicles. You may also ask yourself: • Can you identify signs and interpret roadway markings? • Do you look ahead into the center of your projected path? • Do you have awareness of your field of vision peripherally and in front, behind and around you as you are driving, or are you often surprised by a threatening incident? • Do you feel you react to potential threats in a timely manner to prevent an accident? These are concerns that any safe driver should have. Actions such as driving when most alert, limiting overall drive time, limiting driving to daylight hours, and limiting your routes may also increase your safety. Other safe, self-imposed habits may include avoiding driving during sunrise and sunset, choosing familiar and less challenging routes and driving when traffic is light. It is also very important to consider yellow filters that reduce glare. Yellow filters are advantageous for anyone driving at night – especially for those over 50 years of age due to changes of the lens in the eye as a matter of aging. Brown amber lenses are also of significant assistance in enhancing contrast and the red/green color spectrum, while reducing glare. This serves to improve your capability to see and identify traffic lights while driving. Lenses such as “Drivewear” could be considered depending on the advice of your optometrist, ophthalmologist or optician. Finally, you may want to ask your eye care professional if you should consult a low vision practitioner and driving program for constructive assessment of your driving skills as a matter of safety and continued independence. I wish you good luck and applaud your personal concern with safety.

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Vision

William Park

2010-08-01 13:01:00

Question: My 6-year-old son was recently diagnosed with juvenile optic nerve atrophy and is having difficulty performing schoolwork and seeing colors correctly. What can I do to help him?

Answer: There are multiple causes of hereditary optic neuropathies. From what you have stated, it appears your son has Kjier’s, or juvenile optic nerve atrophy, which is the most common hereditary optic neuropathy. Another common hereditary optic nerve disorder is Leber’s Optic Neuropathy (LHON), a mitochondrial disorder that is inherited through the mother. Hopefully, there have been multiple tests performed by more than one eye care practitioner, including a neuro-ophthalmologist. Continue to maintain follow-up care as directed. It is critical that your child receive guidance and resolution to the difficulties in school, now and in the future. This must include guidance from your optometrist and/or ophthalmologist along with vision rehabilitation professionals. If there is a significant need for glasses, they should be instituted as quickly as possible. However, your child may not need a prescription to correct for being near or far-sighted and/or having astigmatism. Rather, vision loss could be solely due to the optic atrophy for which conventional prescriptive glasses will not resolve. In that case, vision rehabilitation is imperative to prevent a lack of learning due to impaired vision. Therefore, I would recommend that you discuss with your optometrist and/or ophthalmologist whether referral for vision rehabilitation is needed. Vision rehabilitation seeks to maintain or improve visual function to ensure performance of all visual tasks, regardless of vision impairment. The vision rehabilitation process involves an interdisciplinary rehabilitation team. This may include a low vision rehabilitation practitioner, occupational therapist, certified low vision therapist, orientation & mobility specialist and a teacher of the visually impaired (TVI) to oversee your son’s present and future academic achievements and to ensure that activities of daily life are not compromised. It is imperative that you consult with your child’s primary teacher to establish a relationship with a teacher who specializes in working with individuals that are visually impaired (TVI). Your son’s TVI can help oversee his educational curriculum and learning process throughout his academic career. There are countless reasons for visual impairment. The good news is that healthcare professionals are being educated and choosing to practice solely or significantly in the area of vision rehabilitation. There are also many companies emerging that develop technology and assistive devices to help visually impaired individuals perform nearly all avocational, educational and many occupational requirements. For your son, the emphasis at this time would be to ensure that he has all the tools and resources needed to see the blackboard, perform in the classroom, complete academic requirements, participate in extracurricular activities of his choosing and enjoy life to its fullest, regardless of his visual impairment. William L. Park, OD, FAAO is in private practice in Wichita, KS. He works exclusively with patients referred for low vision evaluation, low vision rehabilitation and neurological vision loss. He is a past Director of Low Vision Services, Lions Research & Rehabilitation Center, Wilmer Eye Institute-Johns Hopkins University. Dr. Park can be reached at William L. Park, OD, LLC, www.parklowvision.com, 610 N. Main, Suite 201, Wichita, KS 67203, (316) 440-1690 or drpark@parklowvision.com.

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Vision

William Park

2010-07-01 12:04:00

My son recently suffered a traumatic brain injury as a result of a car accident and he complains of loss of peripheral vision, lack of concentration and difficulty reading. Is this common?

Answer: Unfortunately, the answer is yes. However, the good news is that it can be rectified in many cases by healthcare professionals who are trained in providing neurological rehabilitation. Emphasis on recovery requires a team effort to fully accomplish the task.

The problem is beyond the needs of sight (visual acuity), but about visual function due to the abruptness of the inability to use the eyes and other sensory modalities together. This may result in poor capability for adaptation, due to cognitive and motor dysfunction that cannot interact with past vision and motor processes. This severely affects recovery of visual processing, making early intervention critical. Common visual manifestations of difficulty after acquired or traumatic brain injury include staring, decreased comprehension, lack of concentration and attention during near activities, spatial disorientation and visual field loss, to name a few. In studies of patients seen by the Veterans Administration as a result of head injury and neurological trauma, 84% had reading problems. Seventy-five percent had visual problems, which included eye movement. These included convergence insufficiency, pursuit and saccadic eye movements (46% and 25%) along with accommodation and focusing of the lens inside in the eye (21%). Convergence insufficiency occurs when your eyes don’t turn inward properly while you’re focusing on a nearby object. When you read or look at a close object, your eyes should converge, turn inward together to focus so that they provide binocular vision and you see a single image. But if you have convergence insufficiency, eyes do not move inward to focus normally. Persons with a Traumatic Brain Injury (TBI) or Cerebral Vascular Accident (CVA) will frequently experience symptoms of double vision, movement of print or stationary objects, eye strain, visual fatigue, headaches and problems with balance, to name several. Frequently, people will report problems with their vision to rehabilitation professionals and be referred for eye examination. Unfortunately, many will be told that there is nothing wrong with their eye and that it is the effects of their TBI or CVA. Others will be told that their symptoms are not related to their vision. Visual problems are among the most common conditions following a TBI or CVA. It is essential that those individuals affected by visual dysfunction as mentioned above, as well as visual field loss due to injury to a region of the brain (which is very common), be seen by a rehabilitation team skilled in providing care for that person until dysfunction has been alleviated. This should involve an interdisciplinary rehabilitative team involving a neuro-optometrist and/or ophthalmologist, occupational, speech and/or physical therapist as indicated. Collaboration of these individuals will address the sensory and motor components of vision as well as the vestibular and kinesthetic process. Hopefully this will lead to your son obtaining improvement in all his activities of daily living. William L. Park, OD, FAAO is in private practice in Wichita, KS. He works exclusively with patients referred for low vision evaluation, low vision rehabilitation and neurological vision loss. He is a past Director of Low Vision Services, Lions Research & Rehabilitation Center, Wilmer Eye Institute-Johns Hopkins University. Dr. Park can be reached at William L. Park, OD, LLC, www.parklowvision.com, 610 N. Main, Suite 201, Wichita, KS 67203, (316) 440-1690 or drpark@parklowvision.com.

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Vision

William Park

2010-05-01 14:25:00

My husband and I recently noticed that our 2-year-old son’s pupil was not clear and looked white. We took him to an ophthalmologist who diagnosed him with a cataract in that eye. What should we do, as surgery is planned in the near future?

Answer: Due to your son’s age, it is very important he have the best correction possible, as soon as possible, for long-term maximum visual potential of both eyes. Otherwise, amblyopia, or "lazy eye" may develop due to deprivation or lack of stimulus to the retina, specifically the macula (responsible for central detailed visual acuity). This may affect other skills such as fine and gross motor skills, along with development of the visual system – all intertwined.

If there is a cataract in one eye only, the correction for your son will be in the form of an intraocular lens implantation or contact lens that will correct his vision maximally. Interestingly, the Infant Aphakia Treatment Study was recently completed scrutinizing different forms of treatment to resolve the issue. Aphakia refers to the condition where the natural crystalline lens has been removed from the eye, most often during cataract surgery. The study was designed to provide empirical evidence of whether optical treatment with an intraocular lens (IOL) or a contact lens after unilateral cataract surgery during infancy is associated with a better visual outcome. In a randomized, multicenter (12 sites) clinical trial, 114 infants with unilateral congenital cataracts were assigned to undergo cataract surgery with or without IOL implantation. The optimal optical treatment of aphakia in infants is unknown. Opinions vary about when cataract surgery should be performed on an infant. On the other hand, cataract surgery may need to be performed as soon as possible to ensure that the lens is clear enough to allow normal development of the baby’s visual system. Some experts say the optimal time to intervene and remove a visually significant congenital cataract from an infant’s eye is between the age of 6 weeks and 3 months. I currently have four young patients wearing contact lenses due to aphakia as a result of removal of the lens or lenses in one or both eyes due to retinopathy of prematurity and surgical intervention, congenital cataracts and microphthalmia (short eye) and cataracts. The youngest infant was fit with contact lenses at 52 days old and all four are doing well, with the longest contact lens treatment time of nearly two years. A critical aspect for these children in consideration of long-term outcomes is the collaboration and co-management with the optometrist, retina and pediatric ophthalmologists and a low vision eye doctor. My strong advice would be to consult your ophthalmologist or optometrist in the very near future for the appropriate short and long-term direction to ensure the best possible vision for the rest of your son’s life. William L. Park, OD, FAAO is in private practice in Wichita, KS. He works exclusively with patients referred for low vision evaluation, low vision rehabilitation and neurological vision loss. He is a past Director of Low Vision Services, Lions Research & Rehabilitation Center, Wilmer Eye Institute-Johns Hopkins University. Dr. Park can be reached at William L. Park, OD, LLC, www.parklowvision.com, 610 N. Main, Suite 201, Wichita, KS 67203, (316) 440-1690 or drpark@parklowvision.com.

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Vision

William Park

2010-04-01 12:04:00

Question: Because of a recent stroke and my diabetes, I am experiencing some vision loss and am concerned about my safety. What should I do?

Answer: Diabetes is a progressive disease with systemic risks, including increased risk of falls likely due to decreased vision, impaired contrast sensitivity, possible impaired range of motion, weakness of extremities and peripheral neuropathy. Since you have also suffered a stroke, you may have a loss of peripheral field of vision that impacts safe mobility and travel, either because you are not aware of your field loss or have not learned how to compensate for that loss. Fellow colleagues, Crew, Jones and Kim, have found in their study that 65 percent of older adults with vision loss and stroke reported difficulty walking, 54 percent reported difficulty climbing stairs and 41 percent reported difficulty with shopping. More than one third of adults 65 and older fall each year in the United States. Among older adults, falls are the leading cause of injury deaths. Falls are also a common reason for hospital admissions for trauma and account for 90 percent of fractures. People who have a visual impairment are twice as likely to experience a fall as individuals who are not visually impaired. If you have trouble seeing in your home, review the lighting both for enhancing your environment and also the contrast of objects located in the room, while making sure not to create unnecessary glare that might make travel unsafe. Older adults can prevent falls and protect their independence in several ways: • Exercise regularly • Ask your doctor or pharmacist to review your prescription and over-the counter medications to reduce side effects • Have your eyes checked by an eye doctor at least once a year • Improve the lighting in your home • Reduce hazards in your home that can lead to falls Most importantly, if your vision limits you from activities that you enjoy and makes it difficult to identify faces, prepare meals, read or safely walk, you should see your optometrist or ophthalmologist. Your doctor may recommend referral to low vision rehabilitation professionals who can help improve your personal safety and help you maintain your independence.

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Vision

William Park

2010-02-01 08:42:00

Question: Because my daughter was born at 24 weeks, she has retinopathy of prematurity and other eye problems, which resulted in multiple surgeries including removal of the lens in her right eye. She is now 3 months old and her retina specialist says that I can return to my eye care practitioner for a prescription to correct the vision. What should I do?

Answer: Retinopathy of Prematurity (ROP), also known as Retrolental Fibroplasia, is an eye disease that occurs in some premature babies. ROP is the growth of abnormal blood vessels in the retina that generally begins during the first few days of life and may progress rapidly to blindness over a period of weeks. This happens because the eye rapidly develops during gestational weeks 28-40. When a baby is born prematurely, this normal vessel growth ends and new abnormal vessels begin to grow. Over time, the vessel growth produces a fibrous scar tissue which attaches to the retina and the vitreous gel that gives the eyeball its shape. This ring may extend 360 degrees around the inside of the eye. If enough scar tissue forms, it can begin to pull the retina, detaching it and, in some cases, causing blindness. It sounds like your daughter experienced some of these complications that resulted in a lensectomy, or removal of the lens in the right eye. Based on the limited history, I would assume there is a significant correction necessary to provide a focus of light to the retina of your baby for maximum visual acuity. Due to your daughter’s age, it is very important that your baby has the best correction possible, as soon as possible, for maximum visual potential of the right eye long-term. Otherwise, amblyopia or a lazy eye may develop due to deprivation or lack of stimulus to the retina, specifically the macula (responsible for central vision). Because your daughter had her lens removed, the prescription in glasses would be of a thickness that would be problematic in numerous ways, starting with a thick lens on the right eye as compared to the left eye (assuming there is no need for a correction). My strong advice would be to consult your ophthalmologist or optometrist in the very near future for the appropriate short and long-term direction to ensure the best possible vision for the rest of her life. Time is of the essence for all the reasons previously mentioned. I strongly encourage that the correction for your daughter be in the form of a contact lens that would correct her vision maximally, and eliminate problems that would occur with wearing glasses. Contact lenses solve some of these problems nicely and infants adapt very well. I recently fit an infant that was 52 days old for the same concerns but for a different problem, which was cataracts at birth. I would be happy to send you a copy of a paper that is nearing publication discussing infants with ROP that were fit with contact lenses for the same reason that you may now have to consider, for your daughter’s well-being.

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Vision

William Park

2010-02-01 08:42:00

Question: I have read that your practice is involved in the Low Vision Rehabilitation Outcome Study. What does the study involve, and why should I enroll?

Answer: Research into vision impairment is becoming increasingly important with the aging of the Baby Boomer generation, and the subsequent increase in the number of people affected by age-related vision conditions. These impairments may include macular degeneration, diabetic eye disease and vision loss due to stroke or other neurological issues. This kind of research and development is significant because of the importance of vision in activities such as working, driving, reading, utilizing technology, self care and overall quality of life. My practice, located in Wichita, KS, is one of 26 sites across the country involved in the Low Vision Rehabilitation Outcome Study. The sites include University of Iowa, Harvard, Michigan, Oregon Health & Science and others, including hospital-based practices along with numerous private practices. Each of the participating centers has identified a clinic staff member who is responsible for subject recruitment and a staff member responsible for entry of the clinical data for each subject. After a new low vision examination appointment is scheduled, a staff representative will contact a patient, describe the study and send the patient a consent form and HIPAA waiver. It is the patient’s responsibility to sign and mail the waiver to Johns Hopkins University (JHU). Upon receipt of the waiver, a JHU study interviewer will call the patient, explain the study, answer questions and read the consent form to the patient. At that time, the patient can then choose to give verbal consent or simply let the interviewer know that he or she is not interested. After obtaining verbal consent over the phone, the interviewer administers an intake history, which usually takes an hour. Upon completion of the patient’s first visit to the clinic, the clinician will complete an online visual analog scale through a secure website answering three questions estimating rehabilitation potential of the patient. After the low vision rehabilitation process is complete, a clinic staff member, in collaboration with the clinician, enters the subject’s clinical examination data (e.g., visual acuity, disorder diagnoses, etc.) and information about the plan of treatment (e.g., recommended and obtained devices and/or services) into the study database through the secure website. The patient will be contacted by JHU several times following the completed vision rehabilitation to assess outcomes. Having practiced in several academic university environments prior to coming to Kansas, I have a significant appreciation for the positive impact of research on patient care, epidemiological study, rehabilitation of neurologically and visually impaired individuals and, perhaps most significantly, the capability to influence policy and reimbursement for those affected by visual impairment. If you have an interest in participating in this study, please call (316) 440-1690 and join in this important endeavor.

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Vision

William Park

2010-01-01 15:32:00

Question: I have had glaucoma for five years. I have been taking eye drops and my doctor tells me my pressure and control of my glaucoma are good. I recently acquired new glasses, but I am still having difficulty with reading and I bump into objects when I walk, especially at night. What can I do?

Answer: First of all, I commend your desire to seek solutions. The unfortunate reality is that many patients do not express their decreased capability to perform normal activities of daily living to their families, friends or colleagues because of their frustration or lack of knowledge. This can often lead to withdrawal from common social activities and a diminished quality of life. Because of this, it is essential to understand the implications of glaucoma and the importance of control of the disease. Adverse affects of long-term uncontrolled glaucoma (several types of glaucoma including normal or low tension glaucoma, open angle glaucoma or angle closure glaucoma) can compromise enjoyment in many daily tasks such as reading, hobbies, work, sports and driving. The negative impact of glaucoma on everyday life can occur, even if your pressure is considered “good” by your doctor. Although eye drops can lower your pressure, they do not cure the disease. The drops merely treat the glaucoma to slow the progression of the disease, so you may still experience difficulties in many activities. This may be due to the slowly decreasing peripheral and/or central vision, resulting in the inability to see normal print, function well in poorly lit conditions or environments, travel safely in a known or unknown location or drive with confidence. There is no magical number relating to visual acuity that applies when the level of vision may be a compromising factor in performing any everyday task. It is important to understand that with today’s technology and an interdisciplinary vision rehabilitation team, most goals are possible and vision rehabilitation should be sought when difficulties arise. First and foremost, you need to clearly understand the treatment and management status provided by your eye care practitioner and if you do not, you need to discuss what their goal is for you. Having said that, if you are still having difficulty, you may want to talk to your practitioner about referral for vision rehabilitation. An evaluation by a vision rehabilitation team consisting of a vision rehabilitation practitioner (optometrist or an ophthalmologist), an occupational therapist and an orientation & mobility specialist in the same clinical environment, may dramatically and expeditiously accomplish improvement in visual function while providing patient education about resources, therapeutic interventions and environmental adaptations along with enhancing quality of life. It is very likely that filters would help you with contrast issues, glare and night vision. Other optical devices may assist you in basic activities of your daily life. I encourage you to talk with your eye doctor and ask for a referral for low vision rehabilitation with a team who can work together to help you remain as independent as possible in everyday life.

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Vision

William Park

2009-12-01 08:24:00

Question: How do I help a loved one who has vision loss following a traumatic brain injury?

Answer: Traumatic brain injury (TBI) yields similar results to vision as a stroke. There are approximately 8 million head injuries reported each year. Of those, 1.5 million are deemed serious. With TBI, a patient may experience loss of visual field, visual neglect, vertigo, dizziness, impaired eye movements, double vision, eyestrain and difficulty reading, sensitivity to light, dry eyes, visual hallucinations and impaired visual memory. Maintaining independence for persons following a brain injury can be challenging. Many activities of daily living, such as, safe travel, eating, speaking and self-care, can seem difficult or impossible. Essentially, traumatic brain injury is an insult to the brain such as a blow to the head or neurological dysfunction. The injury can produce cognitive, sensory or physical impairments. Because there is a close relationship between vision and the brain, TBI can disrupt the visual process, interfering with the flow and processing of information. The result is a vision problem along with other issues such as partial paralysis, memory and speech problems. Hemianopia, the most notable loss of vision, occurs when patients lose vision in one side of their field of vision. Sometimes, patients are totally unaware of this shortfall, bumping into walls or ignoring food on one side of their plate. This visual neglect is a perceptual loss of vision. The person is unaware of their lack of sight on the affected side and is unable to complete a visual picture based on seeing only some of the parts. This makes it difficult to recognize faces and environmental dangers that may put the person at risk for falls. Due to the major impact of the visual system on cognitive and motor function, the vision rehabilitative needs of a person affected by a traumatic brain injury must be addressed as early as possible. Early intervention following a TBI is paramount to recovery of visual function and general well-being. With proper care and rehabilitation, TBI patients have a chance to regain quality of life, return to work and perform daily activities that are necessary for independence. The road to recovery should include a team of caring and skilled health care providers who specialize in TBI and low vision rehabilitation. Many deficits can be improved or resolved through diligent efforts and rehabilitation provided by a low vision rehabilitation specialist, occupational therapist, speech and language therapist, orientation and mobility specialist, and a certified driving rehabilitation specialist, if appropriate. In most circumstances, lenses and prisms may result in elimination of double vision and prism lenses may assist in compensation of visual field loss. Magnification, contrast sensitivity, control of glare and management of the visual field loss will also be addressed by a low vision specialist. If your family member or loved one is affected by a brain injury, you may be one of the most important people in their life. Share your knowledge of how low vision rehabilitation can help them regain their independence. William L. Park, OD, FAAO is in private practice in Wichita, KS. He works exclusively with patients referred for low vision evaluation, low vision rehabilitation and neurological vision loss. He is a past Director of Low Vision Services, Lions Research & Rehabilitation Center, Wilmer Eye Institute-Johns Hopkins University. Dr. Park can be reached at William L. Park, OD, LLC, www.parklowvision.com, 610 N. Main, Suite 201, Wichita, KS 67203, (316) 440-1690 or drpark@parklowvision.com.

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Vision

William Park

2009-11-01 15:55:00

Question: I was diagnosed with diabetes five years ago and have been having difficulty with my vision, which has affected my driving, performance at work and reading. What should I do?

Answer: If you have diabetes, management of your blood sugar, cholesterol and blood pressure is important to lessen the negative impact the disease can have on your life. Diabetes is a progressive disease with systemic risks that include increased risk of falls, impaired range of motion, neurological and cardiovascular disease, peripheral neuropathy, compromised wound healing, decreased blood flow and amputation. Several factors have been identified that contribute to the increasing problem, including obesity, calorie-rich diets, sedentary lifestyles, depression and lack of general well being. If you experience vision loss and have diabetes, you should immediately make an appointment with your optometrist or ophthalmologist to determine the cause of your reduced vision. You may have diabetic retinopathy. Diabetic retinopathy causes small blood vessels that line your retina to weaken, eventually rupturing, blurring your vision and causing swelling. There are usually no early symptoms of diabetic retinopathy. You may not know anything is wrong until vision loss occurs. If diabetic retinopathy is untreated, about half of all cases will result in blindness. The severity of diabetic retinopathy can be minimized significantly with proper diagnosis and care. Meticulous diabetes care, managing a healthy lifestyle, quitting smoking, and appropriate management by an ophthalmologist and retina specialist can stabilize the disease and reduce vision loss. For the two most common complications, macular edema and proliferative retinopathy, laser and local drug therapy can improve short and long-term outcomes. Laser treatment for proliferative retinopathy can prevent blindness, though peripheral vision may be reduced. Pharmacological therapy directly to the eye may also be used to stabilize diabetic retinopathy. Early referral for low vision rehabilitation, even for patients with near normal vision to mild visual impairment, greatly increases chances of an independent and healthy life. An evaluation by a low vision rehabilitation team consisting of a low vision practitioner (optometrist or an ophthalmologist), a certified low vision therapist, an occupational therapist and/or orientation & mobility specialist can dramatically improve visual function, while providing patient education, resources, therapeutic interventions and environmental adaptations, resulting in enhanced quality of life. Prescription changes can also improve visual acuity and performance in most daily activities such as driving, working, reading and self-care. If you have diabetes and have vision loss that affects your life, talk to your eye doctor about a referral for a low vision evaluation and rehabilitation. Low vision rehabilitation can improve your visual function and restore your independence.

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Vision

William Park

2009-10-01 09:07:00

Question: I have recently been told that I have multiple sclerosis and I am having visual difficulties. What should I do?

Answer: Multiple sclerosis (MS) is a chronic neurological disorder that affects the central nervous system (brain and spinal cord). The disease process results in inflammation and damage to myelin insulation of the nerve fibers and other cells within the nervous system. Because myelin aids the conduction of nerve signals, damage to myelin results in impaired nerve signaling and may impair normal sensation, movement and thinking. Multiple sclerosis is an autoimmune disease where the body’s immune system attacks its own tissues. In multiple sclerosis, this process destroys myelin — the fatty substance that coats and protects nerve fibers in the brain and spinal cord. When myelin is damaged, the messages that travel along that nerve may be slowed or blocked. Although multiple sclerosis can occur at any age, it most commonly begins in people between the ages of 20 and 40. A combination of factors ranging from genetics to childhood infections may play a role. Women are almost twice as likely as men to develop multiple sclerosis. The risk of multiple sclerosis is higher for people who have a family history of the disease. Also, a variety of viruses have been linked to multiple sclerosis. Caucasians, particularly those whose families originated in northern Europe, are at highest risk of developing multiple sclerosis. Currently, there is no cure for MS. However, there are treatments available that may slow the disease process. Treatment typically focuses on combating the autoimmune response and managing the symptoms. Some people have such mild symptoms that no treatment is necessary. The most common treatment for multiple sclerosis is corticosteroids that reduce the inflammation that spikes during a relapse. Examples include oral prednisone and intravenous methylprednisolone. Optic neuritis is an inflammation of the optic nerve, the bundle of nerve fibers in your eye that transmits visual information to your brain. Pain and temporary vision loss are common symptoms of optic neuritis. Most people who experience a single episode of optic neuritis eventually recover their vision. Treatment with steroid medications may speed up vision recovery. Visual disturbances, which may include eye pain, distortion or loss of vision in one eye, double vision, loss of or impairment of color perception and depth perception, and decreased ability to see low contrast objects, can occur. During this time, it is important to see your eye care practitioner for consultation concerning your vision difficulties. If you do experience visual impairment that does not resolve, consultation for interdisciplinary low vision rehabilitation may be appropriate for moderate to significant visual impairment. Because MS may affect the patient’s ability to perform self-care and other activities of daily living, treatment may also include referral to a low vision specialist, physical therapy and occupational therapy. The low vision specialist can address driving issues, difficulty with double vision, and all other occupational and avocational concerns, facilitating your capability to perform visual tasks that are important in your daily life. A physical or occupational therapist can teach you stretching and strengthening exercises, and how to use devices that can make it easier to perform daily tasks.

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Vision

William Park

2009-08-01 13:52:00

Question: What is age-related macular degeneration (AMD) and how does it affect my life?

Answer: Age-related macular degeneration (AMD) is a disease associated with aging that gradually destroys sharp, central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as reading and driving, therefore affecting distance, intermediate (computer) and near-point tasks. AMD affects the macula, the part of the eye that allows you to see fine detail. In some cases, AMD advances so slowly that people notice little change in their vision. In other cases, the disease progresses faster and may lead to a loss of vision in both eyes. AMD is a leading cause of vision loss in Americans 60 years of age and older. Wet AMD, which accounts for roughly 15 percent of AMD cases, occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile and often leak blood and fluid. With wet AMD, loss of central vision can occur quickly. An early symptom of wet AMD is that straight lines appear wavy. If you notice this condition, contact your eye care professional immediately for a comprehensive dilated eye exam. Treatment options include laser treatment to the affected area, photodynamic therapy and injections to prevent growth of abnormal blood vessels. Dry AMD, which accounts for about 85 percent of AMD cases, occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. As dry AMD worsens, you may see a blurred spot in the center of your vision. Over time, as less of the macula functions, central vision is gradually lost in the affected eye. The most common symptom of dry AMD is slightly blurred vision. You may have difficulty recognizing faces, or need more light for reading and other tasks. Dry AMD generally affects both eyes, but vision can be lost in one eye while the other eye seems unaffected. It is also not uncommon for both eyes to be affected, though at different levels. There is currently no form of medical treatment for dry AMD. Appropriate diet, recommended anti-oxidants and vitamins, protection from UV rays and refraining from smoking are important lifestyle practices to prevent further progression of AMD. As a result of AMD, it is not uncommon to have changes in color perception, depth perception (due to the eyes having unequal acuity), difficulty identifying objects of low contrast and a multitude of activities of daily living that may seem nearly impossible. Low Vision Rehabilitation is paramount to resolving issues that compromise a person’s life and may be the only avenue to achieve the capability to perform tasks that were once easy to accomplish. This may include a change in an eyeglasses prescription, stronger reading glasses, or occasional to steady use of magnifiers or video magnification technology (desktop or portable). There are also avenues to continue using computers occupationally or avocationally. The visual system is one of the most important organ systems of the body and should be treated as such. Just like other organ systems, age is most likely to have an impact. Therefore, persons with macular degeneration should seek comprehensive low vision rehabilitation by an interdisciplinary team to reach the goals that they have to continue activities that are valuable to their quality of life.

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Vision

William Park

2009-08-01 12:16:00

Question: Can people who are visually impaired wear contact lenses?

Answer: When I suggest contact lenses as the first step in providing low vision rehabilitation, many low vision patients wonder how they could possibly wear contact lenses successfully. Contact lenses are often ignored as a component of low vision rehabilitation, though they can be a viable treatment modality for many ocular diseases that result in visual impairment. This is in spite of clear implications that optical theory predicts improved best-corrected visual acuity in high prescriptions versus glasses and therefore, probable enhancement of the individual’s functional vision. Contact lenses should be an important consideration for best-corrected visual acuity (BCVA) for high refractive errors and/or ocular disease manifestations as a component of low vision rehabilitation for visually impaired patients. This is even more important with infants who have significant prescriptions due to complications of retinopathy of prematurity or aphakia (where the lens is removed in their eye) due to resultant surgical management and treatment. In my career, I have prescribed contact lenses for patients as young as 11 weeks of age with extremely high prescriptions, with excellent outcomes in visual acuity and comfort decades later. Therefore, in my opinion, age is not a factor. My preference is for soft contact lenses for the ocular disease manifestations of cone retinal dystrophy, albinism and nystagmus (involuntary eye movement) where the eye is almost never looking through the critical location in glasses. Prosthetic soft contact lenses are also implemented for aniridia (born without the iris or colored part of the eye) creating an artificial pupil and iris. Soft contact lenses are also the lenses of choice for high refractive error due to ease of adaptation, performing activities of daily living and participation in sports. Patients with disorders of cone photoreceptors often have debilitating photophobia, over and above their decreased visual acuity. This prevents them from optimal visual functioning in the daytime and even in ordinary indoor illumination. Patients often need to wear a baseball cap or visor in addition to light-absorbing glasses, even indoors. Therefore, contact lenses, with the ease of adding tints and the availability of high astigmatic corrections, may be the answer. In a paper published in the American Journal of Ophthalmology (2004), Janet Sunness and I reported marked improvement in symptoms and in effective visual function using red contact lenses in 23 patients with cone disorders. One other important benefit of the lenses is in affording some of these patients the opportunity to drive based on significant improvement in visual acuity. Nine patients (39 percent) became legally eligible for driver’s licenses in Michigan or Maryland. While the answer to this question has been, for the most part, directed to the pediatric population, throughout my career, literally hundreds of patients of mine were fit in their mid- ‘20s to ‘50s, when they could have experienced dramatic changes in their life (employment, avocations and quality of life) much earlier due to wearing contact lenses as opposed to glasses. Unfortunately, many of those persons were already compromised in areas of life discussed above. For this reason, contacts should be the first step to improving visual function for many patients with low vision.

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Vision

William Park

2009-06-01 10:29:00

Question: What is a cataract?

Answer: The lens, which is located behind the iris, works much like the lens of a camera. The lens is a transparent, biconvex structure of the eye that helps to focus light, or an image, onto the retina, the light-sensitive tissue at the back of the eye. The lens also adjusts the eye’s focus (accommodation), letting us see things clearly both up close and far away. The lens must be clear for the retina to receive a sharp image. The lens is made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and allows light to pass through it. A change in the internal protein and water content of the eye, or clumping of the proteins, leads to cataract formation. A cataract is a clouding of the lens that affects vision. Most cataracts are related to aging and can occur in one or both eyes. Symptoms The most common symptoms of a cataract are blurry vision, color perception changes, glare from lights, decreased night vision, double vision and more frequent changes in spectacle prescriptions. Prevention Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataract progression. If you smoke, stop. Researchers also believe good nutrition can help reduce the risk of age-related cataracts as well as other eye diseases, such as macular degeneration. They recommend eating green leafy vegetables, fruit, and other foods with antioxidants. Diagnosis and Treatment An eye examination should always involve a comprehensive dilated eye exam by your optometric or ophthalmological practitioner. This is the only way that the lens can be evaluated in its entirety, along with the retina and posterior portion of the eye. The symptoms of early cataract formation may decrease with new eyeglasses, brighter lighting, anti-glare sunglasses, magnifying lenses or low vision devices. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens referred to as an IOL (intra-ocular lens implant). A cataract should be removed when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. Visual acuity may lead to speculation of visual function, but very often does not correlate with personal satisfaction. Even if you have low vision from other eye conditions, surgery may benefit you functionally and in your daily life. Low Vision Rehabilitation If you have vision loss from cataracts, or have residual vision loss after cataract surgery due to other eye diseases, low vision rehabilitation can help you maximize your remaining vision, making activities like reading and self-care less frustrating. This process begins with a low vision optometric exam to determine the nature of your vision impairment. When this assessment is completed, your doctor will suggest a plan of care that may include use of optical devices, adaptive aids and a referral for individualized low vision rehabilitation. If you have questions about low vision rehabilitation, visit www.parklowvision.com or call (316) 440-1690.

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Vision

William Park

2009-05-01 11:45:00

Question: How can bioptic telescopes help me drive with vision loss?

Answer: The ability to drive is the ultimate form of independence in today’s society. However, it is important to remember that driving is a privilege, not a right. First and foremost, it is important to ensure that visually impaired individuals have obtained maximal correction for their eyes and that best corrected visual acuity has been achieved. Many issues affect those with vision loss, including: poor depth perception and recognition of low contrast objects, reduced night vision, decreased field of view, slow reaction time, and sensitivity to glare. There are, however, many people who are visually impaired who can drive safely with the use of bioptics. A bioptic telescope is a miniature telescope mounted in normal distance corrective lenses, usually above a person’s line of sight, and is used to magnify distant objects. However, driving with a bioptic telescope requires significant training in the general use as well as behind-the-wheel driver’s training. Only a low vision optometrist or ophthalmologist should prescribe the bioptic telescope. While the use of bioptic telescopes for activities of daily living and driving has been around for decades, they are not without controversy. If vision loss is affecting your vision, ask your doctor for a comprehensive low vision evaluation, as you may benefit from a bioptic telescope-mounted lens. An initial two-hour evaluation is performed to see if you are an appropriate candidate. You are then assessed and educated using a bioptic for all activities of daily living, including driving. As a result of this, a referral is sent to an occupational therapist and an orientation and mobility specialist. A week-long loan and home environment assessment with the bioptic is then scheduled with follow up from the low vision team on the success and skillful use during the loan period. Proper use and understanding of the bioptic can assist your ability to see and drive safely. For further information, see published papers concerning the visually impaired driver at www.parklowvision.com. Kansas Law In order to obtain a driver’s license in Kansas, the driver must demonstrate a visual acuity of 20/40 in the better eye with or without corrective lenses. Vision worse than 20/40 in the better eye requires a Department of Motor Vehicles (DMV) vision form filled out by an eye care specialist. For drivers with less than 20/60 visual acuity, a DMV vision form is required and the driver must demonstrate an ability to operate a vehicle safely and have a safe record for three years. Visual fields of less than 110 degrees (binocular), less than 55 degrees (monocular), require a test drive. For bioptic users, a vision form is required, accompanied by an annual report and a drive test based on acuity through carrier lenses. A doctor must certify that the applicant is safe enough to attempt the driving test.

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Vision

William Park

2009-05-01 11:45:00

Question: What is low vision optometry and what is low vision rehabilitation?

Answer: Low vision optometrists examine patients with severe vision loss, vision that cannot be corrected by traditional clinical means. Patients are usually referred by their optometrist, ophthalmologist or family physician. Low vision optometry is a process of examination, determination of functional vision, and coordination between the optometrist and other low vision professionals including ophthalmologists, low vision therapists, orientation and mobility specialists, occupational therapists and teachers of the visually impaired. The goals of low vision optometric care are: •To evaluate the functional status of the eye and visual system •To assess ocular health and related systemic health conditions and the impact of disease or abnormal conditions on visual functioning •To provide appropriate optometric rehabilitation intervention to improve the patient’s visual functioning •To counsel and educate patients regarding their visual impairment, including recommendations for treatment management and future care •To provide appropriate referral for services which are outside the expertise of the optometric low vision practitioner Your appointment and low vision examination can last between one and two hours. The examination may include a visual acuity test, refraction test, ocular motility and binocular vision assessment, visual field assessment and/or an ocular health assessment. Additional testing beyond this may be necessary depending on your vision problems. During your low vision examination, your low vision eye doctor will ask you for your medical and eye health history in addition to discussing your functional vision problems. Be prepared to discuss how your vision loss is impacting your daily activities. This may include problems with reading, watching TV, mobility, playing cards, sewing, knitting, woodworking, or other social and recreational activities. Think about the things that you would like to see and do better. Visual impairments can result in significantly lowered vision, affecting a person’s ability to complete simple daily tasks such as reading, driving or finances. Because of the decreased ability to carry out activities of daily living, your low vision eye doctor may refer you for low vision rehabilitation. -Low Vision Rehabilitation- Low vision rehabilitation is a collaborative, multidisciplinary process involving a low vision optometrist or ophthalmologist and a team of other low vision professionals including vision rehabilitation therapists, orientation and mobility specialists, occupational therapists and teachers of the visually impaired. The goal is to provide patients with maximum functionality through treatment and education. This increases independence and confidence, resulting in a higher quality of life. A low vision rehabilitation plan is individualized to meet each patient’s needs through clinical treatments and training in activities of daily living. Because many causes of low vision cannot be cured or treated clinically, low vision rehabilitation is necessary to train patients how to correctly use optical devices and other adaptive strategies to make the most of their remaining eyesight. If you or someone you love is experiencing vision loss, don’t wait to get help. Early intervention through low vision optometry and low vision rehabilitation is the key to ensuring that vision loss doesn’t result in the loss of independence.

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Vision

William Park

2009-04-01 14:39:00

Question: How do I help a loved one who has vision loss following a stroke?

Answer: Maintaining independence for persons following a stroke can be challenging. Many activities of daily living, such as reading, safe travel, eating, speaking and self-care, can seem difficult or nearly impossible. The most common deficits following a stroke or CVA (cerebral vascular accident) include difficulties with visual function. These difficulties may include double vision, poor focusing for tasks such as reading, loss of depth perception, or a loss of visual field. Vision problems after a stroke stem from damage to the brain or optic nerve, and can range from slight to severe. Vision loss often occurs along with other problems such as partial paralysis, memory, and speech problems. The most notable loss of vision, hemianopia, occurs when patients lose vision in one side of their field of vision. Sometimes, patients can be totally unaware of this shortfall, bumping into walls or ignoring food on one side of their plate. This visual neglect is a perceptual loss of vision. The person is unaware of their sight or lack of sight on the affected side, and is unable to complete a visual picture based on seeing only some of the parts. This makes it difficult to recognize faces and environmental dangers that may put the person at risk for falls. Only an experienced medical professional can definitively diagnose a stroke using various imaging tests. However, strokes have several characteristic symptoms, including sudden numbness or weakness (especially on one side of the face or body), sudden confusion or inability to speak or walk, and sudden vision changes. If you experience any of these symptoms, contact your doctor or emergency personnel immediately. Due to the major impact of the visual system on cognitive and motor function, the vision rehabilitative needs of a person affected by a stroke must be addressed as early as possible. Early intervention following a stroke is paramount to recovery of visual function and general well being. With proper care and rehabilitation, stroke patients have a chance to regain quality of life, return to work and perform daily activities that are necessary for independence. The road to recovery should include a team of caring and skilled healthcare providers who specialize in stroke and low vision rehabilitation. Many deficits can be improved or resolved through diligent efforts and rehabilitation provided by a low vision rehabilitation specialist, occupational therapist, speech and language therapist, orientation and mobility specialist, and a certified driving rehabilitation specialist, if appropriate. In most circumstances, lenses and prisms may result in elimination of double vision and prism lenses may assist in compensation of visual field loss. Magnification, contrast sensitivity, control of glare, and management of the visual field loss will also be addressed by a low vision specialist. If a family member or loved one is affected by a stroke, you may be one of the most important people in their life. Share your knowledge of how rehabilitation can help them regain their independence.

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Vision

Dr Bruce A Kater

2005-01-01 09:20:00

QUESTION: My aunt has been diagnosed with glaucoma. What can you tell me about the disease?

ANSWER: Glaucoma is known as the "sneak thief of sight" because it has no symptoms, yet if untreated can cause blindness. Glaucoma is a family of eye diseases that share one characteristic: increased pressure in the eye. Think of your eye as a sink, and glaucoma as having a clogged drain. As fluid is added to the eye, it builds up, causing increased pressure. As the pressure increases on the optic nerve, it kills nerve cells that transmit visual information to the brain.People with glaucoma typically report no symptoms at first. Eventually, they lose their side or peripheral vision, and then central vision.But most glaucoma can be managed and people can avoid vision loss. The keys are early diagnosis and proper management.Like some other diseases, glaucoma can be age-related. People older than 45 are considered to be at higher risk than the general population. Genetics also plays a role. If your family has a history of glaucoma, you should consider yourself at risk.One group that is at particularly high risk for glaucoma is African-Americans, who not only get the disease more often than other groups, but also get it earlier in life and in more severe forms. Glaucoma is the leading cause of blindness for African-Americans.Other risk factors for glaucoma include diabetes, extreme myopia (nearsightedness), previous eye injury or regular use of steroids, such as Cortisone. If you belong to any of these groups you should have a regular eye exam.You should be tested for glaucoma as part of a normal eye exam. If you're in doubt about being tested, just ask your eye doctor.There are three main ways your eye doctor tests for glaucoma. The most common is tonometry. In applanation tonometry, your doctor gives you eye drops with a mild anesthetic, and then gently touches your eye with a plastic prism in order to measure your intraocular pressure, the pressure inside your eye. In air tonometry, a puff of air is used to take the measurement. Since no objects actually touch your eye, no anesthetic is needed. In the visual field test, your doctor tests your peripheral vision. You place your chin in a stand and look at a computerized screen. When you see a flash of light, you push a button. At the end of the test your doctor gets a graphic printout of how well you see across the visual field.In ophthalmosocopy, your eye doctor uses a specialized instrument to look directly through your pupil at the optic nerve, where damage from glaucoma may be visually apparent.Glaucoma is one of the most treatable eye diseases. If you have the disease, chances are good you can manage it with medicine and have no further vision loss. The key to treatment is keeping your intraocular pressure under control. Your doctor has several tools available to achieve this goal.Eye drops are the most common solution. The advantage of eye drops is that the medicine is delivered right where it is needed. If your doctor prescribes eye drops, remember to tell him about other medicines you take. There are several categories of eye drops. Miotics help open the "drain" in the eye, increasing the flow of fluid from the eye. Beta-blockers slow down the rate of fluid into the eye. There are other, newer formulations that are also available that may be used in selective cases. If eye drops don't control your intraocular pressure, your doctor may also prescribe pills. Carbonic Anhydrase inhibitors are taken orally and reduce the production of fluid into the eye. Surgery can also be helpful in treating glaucoma. According to the National Eye Institute, glaucoma affects more than 2.2 million Americans age 40 and older, including more than 21,000 Kansans.

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Vision

Dr Bruce A Kater

2004-12-01 10:02:00

QUESTION: My mother has macular degeneration and is losing her vision. What can I do to help her? The doctor said there is no cure.

ANSWER:  Unfortunately, your mother's doctor is correct. There is no cure for macular degeneration. Some kinds of wet macular degeneration may be stabilized through medical treatment, but there's no proven "miracle cure" for most people with the disease.But that doesn't mean that medical science can't help her. She can benefit from vision rehabilitation, which has the goal of helping her make the most of her remaining vision. This process begins with a low vision assessment, in which the eye doctor identifies exactly what parts of her vision are giving her problems. We can usually identify some optical solu-tions to improving her function. These may include a new refraction (eyeglass prescription), use of a prism built in to the lens, filters or magnification. Patients with vision loss can also generally benefit from learning rehabilitation skills. These may include learning new viewing techniques, which help the patient better use their "good" vision. Patients can also learn orientation and mobility skills so they can move about more safely, learn how to use a "reading machine" or use other forms of electronic magnification, and learn independent living skills so they can continue to live safely and effectively at home.Patients who take advantage of vision rehabilitation services often report a big improvement in their ability to do daily tasks. With that, they often resume other activities that they may have given up on. If you have impaired vision from any cause, you should definitely ask your eye doctor about vision rehabilitation.Since the holidays will soon be upon us, you might also want to think about some gifts that can help your mother with daily activities. Since there are now so many people with vision loss, there is a wide range of household products that are low vision friendly.For someone with moderate low vision, we usually recommend products that enhance vision. These may include a large-print and high contrast watch, measuring cups with large print, or games with large, high contrast cards and playing pieces.If magnification is of limited help, then we recommend products that help replace vision. For example, if you can't see your watch, you can get a talking watch or one with a flip-up crystal so you can feel the time. With modern microelectronics there are many talking products, including telephones and caller ID boxes. Another approach is to solve a visual problem with your sense of touch. One of the most effective adaptive aids, bump dots, is also one of the cheapest. Place an adhesive dot on your favorite button on your VCR, your microwave or oven, and you'll always find it with ease.The great thing about an adaptive aid is that it is useful to everyone, even those who don't have low vision. Everyone benefits from larger print and tactile features. Hopefully in the future we'll see more products like these.

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Vision

Dr Bruce A Kater

2004-10-01 15:07:00

QUESTION: I have heard I could lose my eyesight and become blind because of diabetes. What can I do to save my vision and my independence?

ANSWER: Yes. It is true that diabetes can cause blindness. Diabetes is the leading cause of blindness in the United States, causing up to 24,000 people, mostly older Americans, to lose their vision every year. The good news is that with careful management, ill effects can be minimized.The greatest threat to vision from diabetes is diabetic retinopathy. It causes small blood vessels that line your retina to weaken from excessive blood sugar, eventually rupturing, blurring your vision and causing swelling. The retina is the light-sensitive nerve tissue that lines the back of your eye, transmitting visual information to your brain. If diabetic retinopathy is untreated, about half of all cases will result in blindness.People with diabetes are twice as likely as the general population to get cataracts and glaucoma, both can cause blindness. The most important thing any diabetic can do is properly manage their blood sugar. The most extensive study to date about diabetes and vision found that people who properly manage their blood sugar were able to reduce their risk of vision loss by 75 percent.It is also important for all diabetics to have an annual dilated eye exam. Dilation allows your eye doctor to look for signs of damaged blood vessels. Early detection of any eye disease, including diabetic retinopathy, is vital to slowing the progression and saving vision.There are other ways to reduce the risk from diabetic retinopathy. If you have diabetes, it is important that you:• Manage high blood pressure.• Keep cholesterol low through a combination of diet and exercise.• Avoid smoking.• See your regular eye doctor annually.While no treatment can cure diabetic retinopathy, there are treatment options that an ophthalmologist can employ to reduce vision loss. Laser surgery may be used to either shrink or destroy leaking or abnormal blood vessels on the retina. Another treatment option is a vitrectomy, which removes cloudy vitreous fluid and replaces it with a clear saline solution.Don't let diabetic eye disease take control of your life. If you are living with vision loss, you can take advantage of vision rehabilitation, which can include a low vision assessment, orientation & mobility training, assistive technology (computer classes for individuals who are blind or low vision) and independent living training.Through vision rehabilitation you can learn to live safely and independently with vision loss.

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Vision

Dr Bruce A Kater

2004-08-01 11:51:00

QUESTION:  Lately I have been hearing the term "low vision." What does this mean, and how is someone helped with this condition?

ANSWER:  Low vision means that an individual has trouble doing everyday tasks due to uncorrectable vision loss. A person whose vision can be corrected with eyeglasses to 20/20 does not have low vision.The term "low vision" does not have a precise definition, but "legally blind" does. According to the U.S. Government, "legally blind" means a visual acuity with best correction in the better eye worse than or equal to 20/200 or a visual field extent of less than 20 degrees in diameter. About 1.3 million Americans are legally blind.The term "vision im-paired" generally means having 20/40 or worse vision in the better eye, even with eyeglasses.All told, there are about 3.5 million Americans - including 39,000 Kansans - who are blind or vision-impaired.The incidence of vision loss is expected to increase dramatically in the next 15 years, as the baby boomer generation becomes the largest group of seniors in history. Many kinds of vision loss, such as macular degeneration, glaucoma and diabetic eye disease, are age related.The key to getting the best possible ocular health is regular eye exams. For most people, this should be done every two years. If you're a senior, or at risk for eye disease, you should see your eye doctor every year. These visits are not just for getting a new prescription. Your eye doctor will give you a complete medical exam and check for eye diseases such as glaucoma. Early detection can help your doctor treat most eye diseases. Glaucoma, for example, presents no symptoms until it has damaged your sight. But if identified early, you can manage the disease and avoid vision loss.If you have low vision, you can take advantage of vision rehabilitation services. This process begins with a comprehensive evaluation to assess your vision loss. Once the source of your vision loss is identified, there are often optical strategies that can improve a patient's functional vision. A low vision therapist can also teach you techniques to make the most of your available vision. Today there are many tools at our disposal to improve functional vision, including special lighting, filters, optical aids, electronic aids and tools to adapt your computer.Relatively few people with vision loss know about or receive vision rehabilitation services. A study by the Lighthouse International found that only three percent of people with low vision actually received these services.While many forms of vision loss have no cure, my patients report that they live safer, more independent and satisfying lives after they receive a low vision assessment and vision rehabilitation services. Getting access to these services can help a senior remain in their own home, help them avoid injuries from falling, and keep them better connected to families and loved ones.If you'd like to learn more about vision rehabilitation, visit visionconnection.org, an outstanding web site that explains how people can benefit from these services.

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Vision

Dr Bruce A Kater

2004-07-01 09:50:00

QUESTION:  I have heard that vitamins can prevent macular degeneration. Which vitamins should I be taking?

ANSWER:  It seems like every day you hear a new claim for some breakthrough treatment for macular degeneration (AMD). You should be wary when you hear these claims. There is no cure for macular degeneration. There are, however, some promising developments that can slow development of the disease and may offer you some protection from vision loss.The Age Related Eye Study, or AREDS, was a rigorously conducted large sample scientific study. It found that people who are at risk for advanced stages of AMD lowered their risk by 25 percent by taking high levels of antioxidants and zinc. The nutrients also reduced the effect of vision loss caused by AMD by 19 percent.The nutrients examined in the study included a daily dose of:• 500 milligrams of Vitamin C• 400 international units of vitamin E• 15 milligrams of beta-carotene• 80 milligrams of zinc (as zinc oxide)• 2 milligrams of copper (as cupric oxide)If you're at risk for AMD, this is definitely worth discussing with your eye doctor at your next exam.Another nutrient that has shown some promise is lutein. While not addressed by AREDS, other studies have found it useful in maintenance of your eyes' health. There appears to be no major risk associated with adding some lutein to your diet.Recent studies have found daily use of aspirin and statin drugs to be of some protection against AMD. These substances prevent choroidal neovascularization (CNV), a process that leads to wet macular degeneration. Statin drugs are widely prescribed to reduce cholesterol for individuals at risk for heart disease. Popular brand names are Zocor and Lipitor. Use of these drugs was associated with a 49 percent reduction in the risk of CNV.Many people with high blood pressure also take enteric or "baby" aspirin as a way to reduce the risk of heart attacks. These aspirin are typically a reduced dosage, such as 81 milligrams, compared to the more common 300 mg tablets people take for headaches. In the study, people who took an aspirin every day reduced their risk of CNV by 37 percent.These studies illuminate a basic relationship that I can't stress enough. People with good cardiovascular health are more likely to have healthy vision. While statins and aspirins may indeed be helpful to someone with AMD, you should also take full advantage of other things that are related to good cardiovascular health. You should get moderate physical exercise. Don't smoke. Eat a balanced diet with lots of fruits and vegetables and not too much fat. Maintain proper body weight.The AREDS vitamin regimen far exceeds recommended daily requirements and may have negative effects for some individuals. Please check with your doctor before taking new vitamins or drugs, or engaging in an exercise program.We all eagerly await medical breakthroughs that will help people with AMD. But until then, your healthy lifestyle is your best protection from macular degeneration.

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Vision

Dr Bruce A Kater

2004-06-01 16:14:00

QUESTION:  My mother is 79 years old and was recently diagnosed with macular degeneration. What can we do for her?

ANSWER:  Age-related macular degeneration (AMD) is a condition in which the patient loses central vision and the ability to see fine details. It affects almost two million older Americans. There is no cure for AMD, but through vision rehabilitation, affected individuals can learn to get the most from their vision. Macular degeneration is a retinal disorder. The retina is at the back of your eye and functions like film in a camera. It is here that visual information is collected and then sent on to the brain for processing. At the center of the retina lies the macula. This is where central vision and fine detail are resolved.Many people with vision loss have blank spots, or scotomas, on their retinas. With macular degeneration, the scotomas are over the macula, creating the frustrating loss of central vision that characterizes the disease. It's difficult for the patient to describe this loss of vision because the brain "fills in" the missing information, resulting in distortion.The first step in managing macular degeneration is identifying the scotomas. This is done with a diagnostic tool called the scanning laser ophthalmoscope. It takes a picture of the retina, and the patient responds to a series of stimuli from a laser light to identify exactly where they can - and can't - see. Once this map of the retina is created, the doctor can begin to teach you where the vision loss resides, and can create a vision rehabilitation plan. This may involve a new eyeglass prescription, use of other optical devices and magnifiers, lighting, filters, contrast enhancement and new viewing techniques.Dry macular degeneration accounts for 90% of all cases of AMD. It occurs when small deposits of drusen, a yellowish material, accumulate in the macula. The accumulation interferes with the macula's ability to sense light, which leads to distortion and loss of central vision. This accumulation may begin as many as 10 years before you notice any vision loss, and its progression is subtle and painless.Wet macular degeneration is caused when tiny, abnormal blood vessels begin to grow behind the retina near the macula. These vessels can leak and damage the macula, leading to rapid and sometimes severe vision loss. Wet macular degeneration almost always occurs in people who already have dry macular degeneration. If you ever experience sudden changes in your vision, you should see your eye doctor immediately. Your eye doctor may be able to treat wet macular degeneration. There are different technologies available that use lasers to destroy leaking blood vessels. This treatment is typically done on an outpatient basis and may require follow-up visits.Age is the largest predictor of getting macular degeneration. While it is rare in middle age, almost a third of those older than 75 have it. Additionally, women are at greater risk than men, and whites are more likely to get it than other ethnic groups. If others in your family have had macular degeneration, you have slightly increased odds of getting it yourself.Prevention is mostly a matter of living a healthy lifestyle. Some studies have shown that taking vitamins and eating a diet rich in fruits and leafy green vegetables can offer some protection from the disease. You should limit fat intake, keep your blood pressure down and avoid excessive alcohol use. And you should wear sunglasses or eyeglasses with ultraviolet light protection and wear a brimmed hat while outside.