Technologyhasmadearealdifferenceforthosewithlowvision.Handheldmagnifiershaveadvancedfromglasstoelectronic.Cellphonesnowoffersophisticatedreadingapplications.Specialglassesaregivingthevisuallyimpairednewmobility.
byDanRoberts,MDFDirectorofResources
Mindfulnessmeansbeingfullypresent,awareofwhereweareandwhatwe’redoing,andnotoverlyreactingorbecomingoverwhelmedbywhat’sgoingonaroundus.A2018studyconjecturedthatreliefofchronicstressmightbeaneffectivetreatmentforvisionloss.Practicingmindfulness,therefore,maybeimportanttoourclinicalandhomecare.
Theauthorsofthestudywrote:“Thelossofvisionafterdamagetotheretina,opticnerve,orbrainhasoftengraveconsequencesineverydaylifesuchasproblemswithrecognizingfaces,reading,ormobility.Becausevisionlossisconsideredtobeirreversibleandoftenprogressive,patientsexperiencecontinuousmentalstressduetoworries,anxiety,orsuchasdepressionandsocialisolation.Whileprolongedmentalstressisclearlyaconsequenceofvisionloss,itmayalsoaggravatethesituation.Infact,continuousstressandelevatedcortisollevelsnegativelyimpacttheeyeandbrainduetoautonomousnervoussystem(sympathetic)imbalanceandvasculardysregulation;hencestressmayalsobeoneofthemajorcausesofvisualsystemdiseasessuchasglaucomaandopticneuropathy.”
Afterreviewingrecentresearch,theauthorsconcludedthat“stressisboththeconsequenceandcauseofvisionloss.Thiscreatesaviciouscycleofadownwardspiral,inwhichinitialvisionlosscreatesstresswhichfurtheracceleratesvisionloss,creatingevenmorestressandsoforth.”
Doctorsandpatients,therefore,shouldbeawareofthebenefitsofstressreductionandrelaxationtechniquesforvisualhealth.
Whilephysicianshavedrugstotreatmaculardegenerationandareawareofthemanyriskfactors(suchasageandfamilyhistory),thereisstillalotabouttheunderlyingcausesandhowthediseaseprogressesthatisstillunknown.OneofthemajorhurdlesthatAMDresearchscientistsfaceistheydonothaveanimalorcellularmodelsthatfullyrepresentthecomplexityofthediseaseinhumans.
TheDeAngelisResearchLab,locatedattheUniversityofBuffalo,approachesthisproblembystudyingactualhumantissue.Dr.MargaretDeAngelisisresponsiblefordevelopingtheUtahProtocolwherebydonatedeyesofalltypesarecollectedandpreservedwithinsixhoursofautopsy.Theeyesarethencarefullyclassifiedandmeticulouslydissectedtoisolatejustthemacula.FurtherDNAanalysisallowsthemtostudytheretinaatthelevelofsinglecells.That,inturn,ishelpingthescientistsattheDeAngelislabtobetterunderstandhowAMDdevelopsinhumansandtocreatetargetedtreatments.
DimitraSkondraMDPhDUniversityofChicago
Wehaveabigstudyregardingmacularholerepair.Amacularholeisaverycommondisorderaffectingolderpatientsthatmayalreadyhavemaculardegeneration.Surgerywouldbeneededtorepairthehole.Thiscancausemoreeyetraumaifthepatienthasaneyedisease.
Wehavepioneeredanewtreatmentalgorithmusingdropstoclosethemacularhole.Wehavesixyearsofdatafrommorethan100patientsthatweregiventhedrops.Wefoundthatinpatientswithsmallholeslessthan200micrometerthedropsclosedtheholein70%ofthepatientsandtheydidnotneedsurgery.Thepatientpopulationwithlargerholesdidnotrespondandneededsurgery.Thesuccessonthesmallerholessuggesttheclinicaltrialsshouldcontinuetobringasafertreatmentoptiontofruition
Dr.DimitraSkondraisthedirectorandleaderoftheretinamicrobiometeamattheUniversityofChicago.HerteamisinvestigatingthepossibleprotectivepropertiesofMetformininrelationshiptoage-relatedmaculardegeneration.Metforminhasbeenusedasanoralmedicationfortype2diabetesformorethan30years.DatawascollectedfrompatientsthathavebeenonmetforminfordiabetesorotherindicationstoseeiftheyhavelessincidenceofAMDversuspeoplethatdon’ttakemetformin.TheyfoundthatpatientsthattakemetforminhavesignificantlydecreasedrisksforAMD.Theresearchledtothehypothesisthatmetforminwasimproving“guthealth”bysuppressinginflammatorypathways.Thisprovidedaprotectiveelementinneovascularization,thecauseofwetAMD.Studiessuggestedmanyofthepropertiesofmetforminforpromotinghealthyagingandhealthisbypromotinghealthymicrobiome.Dr.Skondrastates,“thebesttoolwehavenowtopromotehealthymicrobiomeisahealthydiet.
MywifewasdiagnosedwithwetAMDinoneeyeabout4yearsago.Shecrumbledafterthediagnosis.Sheexpectedherrighteyetogothesamewayalmostimmediatelyandbegantogrieveforherlostsightevenbeforeitactuallyhappened.Ididn’tgotopiecesimmediately,butoverthecourseofthenextfewmonthsIcopedlessandlesswellwiththeideaofhavinga“blind”spouse.EventhoughIreadaboutallthereadingaids,etc.,Icouldseehowdifficultourlifewasgoingtobeandforalongtimecouldconcentrateonlyonthedownside.
Eventually,IwascopingsobadlythatafriendofminesuggestedIaskforcounselingattheuniversitywhereIworked.Thiswasaconfidentialservicewhichhespokehighlyof,havingusedithimselfwhenhesufferedabereavement.WhatIwasgoingthroughwasalsoabereavementofsorts:thelossofasecurefuture,howbadthiscouldbeonourmarriage,themanylossestocome,etc.Thecounselingcamethrough,andIslippedawayfrommyofficedeskforanhour.
IsatdownwithmycounselorandpouredmyheartoutabouthowlowIfelt,howbadoursituationwas.Atthestartofthesecondsession,mycounselortoldmethatshehadStargardt’sdisease.Shesaidshehadnocentralvisionandreliedonspecialbinocularstotraveltowork.However,onceatworkshegotaroundnicely,thankyou.Shehadstudiedforhercounselingdiplomawitheveryoneelse,buthadhertextbookstranscribedontoaudiotapes.Shewasmarriedandhadthreechildrenandsomegrandchildren.SheandherhusbandhadjustcomebackfromaholidayinEurope,whichtheyhadthoroughlyenjoyed.
Wakeupcall!Ihadnoideafromthefirstsessionthattherewasanythingdifferentaboutheratall.Irealizedthiswasnotadeathsentenceandnotaboutlivingindarkroomsanddoingnothingwithyourlife.Itwasaboutmakingthemostofthings,beinggladyouwerealive,andgettingonwithit.
Intheearlydaysaftermydiagnosis,Iexperiencedanunexpectedsymptomofmychronicvisionlossthatwasn’tmentionedinanythingIwasreadingaboutthesubject.
Mywife,Christina,hadbeentryingtogetmetofixourrefrigerator’sicemakerformonths.Thiswouldnormallyhavebeenawelcomechallenge,butafterafeebleattemptwhichtookmuchtoolong,Igaveup.
Ourporchlightdevelopedanelectricalshort.Aprojectwhichusedtotakemeonlyafewminutestooknearlyanhour,andmyhalfheartedrepairwouldprobablynotlast.ThensomethinghappenedthatforcedmetoadmitthatIwasstartingtogiveintomyslowly-decreasingvision.Iwaslosingmyself-confidence.
ItstartedwhenIdrovetothecomputerstoretogetaharddriveforChristina’scomputer.Ihadnotbeenthereinquiteawhile,andtheplacelookedslightlydifferenttome.Everythingseemedmoreaskewandunfamiliar,andIhadtroublereadingtheinformationontheracks.Myfrustrationturnedintosurliness,andChristina(blessherheart)chosetonottakeitpersonally.
Thestorewasoutofstock,soweneededtogotoaplaceontheothersideoftown.WhenIgotbackintothedriver’sseat,Iwasfeelingalittleshaky.Christinahadotherthingstodo,soIsaidIwoulddropheroffathome.Sheofferedtogowithme,butItoldheritwasunnecessaryandcontinuedonmyown.
AsIdroveaway,Isoonbecamedisoriented.Thismadenosense,becauseIknewthearea.SoIdrovecarefullyandpaidextra-closeattentiontomysurroundings.
Afterawhile,IbegantowonderifIwasgoingtherightway,soIdecidedtopullintoagasstationfordirections.Iturnedleftatthenextintersection,intothewrongsideofthemedian,andendedupfacingoncomingtraffic.TheotherdriversshooktheirheadsandrolledtheireyeswhileIinchedmywayalong,and–thankstoonesympatheticlady–Iwasabletoturnacrossherlaneintoaparkinglottogetmybearings.
IconsideredphoningChristina–somethingIhadalwayspromisedtodoinanemergency.ButIjustwasn’treadyforthatyet.Shewouldneverfeelsaferidingwithmeagain,andshewouldworryevenmorethanusualwheneverIwouldgooffalone.
Finally,Ifoundthestore.TheyhadwhatIwaslookingfor,butasIpaidforit,Ithought,“HowamIevergoingtoinstallthisthing”Ayearbefore,thatwouldneverhavecrossedmymind.Butsomethingwashappeningtome,anditwasworseafterthepasthourofevents.Ihatedthat.
Well,ittookagoodhalfofthenextday,buttheinstallationwasaqualifiedsuccess,andChristinafinallyhadhercomputerback.SoonMondaymyconfidencehadfaltered,andonWednesdayitrecovered.That’sallIknow.Ihavenowgivenupdriving,butI’mstillridinganemotionalrollercoaster.Ijustwantyoutoknow,sothatifyouareonthissameride,itmighthelptorememberthatyouhavecompany.
OnethingIlearned:thereissomethingaboutthisnewmethatwillwanttogiveupwhenthingsgettough.ButsomethingalsogivesmethestrengthtokeeptryingtobethehusbandIpromisedtobe.NowI’mgoingtohaveanothershotatthaticemaker.
Thesciencemaybedifficultformostofustounderstand,butthebottomlineisclear.Thisresearchidentifiesthegenesandpathwaysthatdrivemaculardegeneration.Withthisessentialunderstanding,theeffortstofindeffectivetreatmentsandonedaypreventmaculardegenerationhavereceivedasignificantboost.
Supportissomethingweallneedatonetimeoranother.Humanbeingsaresocialbynatureandsocializationisnecessaryforgoodmentalhealth.
Likewise,tryingtokeepaproblemlockedwithinourselvesisdifficult.Itismucheasierandhealthierto“getitout”bytalkingwithothers,especiallyiftheyhavebeenthroughthesameexperience.Itmayalsoresultingaininginformationthatwillfurnishsolutionsandrelievefears.
Supportgroupsarepeoplewhomeetface-to-face,bytelephoneoron-linetoshareexperiences,discusscommonproblemsandseeksolutions.SupportgroupshavehelpedmanyworktheirwaythroughthechallengesoflivingwithAMD.Theyareusuallyfree,meetatconvenienttimes,andwelcomenewmembers.
WhatgroupisbestformeThesupportgroupbestforyoudependsonyourpreferences.Someprefersimple,one-on-oneconversations.Othersenjoyinteractingwithagroup.Ifyouarecomputerliterate,“Skype”,“Zoom”and“ChatRooms”maybeforyou.
AnantidepressantbestknownasProzaccouldofferthefirsttreatmentformaculardegenerationaccordingtonewresearchfromtheUniversityofVirginiaSchoolofMedicine.
UVA’sBradleyD.Gelfand,PhD,andcollaboratorshavefoundearlyevidencethatthedrugfluoxetine(Prozac)maybeeffectiveagainstdryage-relatedmaculardegeneration.Thedrughasshownpromiseinlabtestsandanimalmodels.Inaddition,theresearcherswereencouragedbytheresultsofexaminingtwohugeinsurancedatabasesencompassingmorethan100millionAmericans.Thatanalysisconcludedthatpatientstakingfluoxetine(Prozac)werelesslikelytodevelopdrymaculardegeneration.
Basedontheirfindings,theresearchersareurgingclinicaltrialstotestthedruginpatientswithAMD.Ifsuccessful,theybelievethedrugcouldbeadministeredeitherorallyorviaalong-lastingimplantintheeye.
MicrocurrentStimulationistheapplicationofasmallelectricalcurrenttotissuesusingelectrodesplacedontheskin.IthasbeenusedforyearswithFDAapprovalfortherepairofinjuredsofttissuesandfortreatingmuscular-skeletalpain.
Severalsmallstudieshaveappliedmicrocurrentstimulationtomaculardegeneration.Theyconsideredvariouslevelsofstimulation,frequencies,pulseratesandwaysofapplyingthestimulationtotheareaaroundtheeyes.Manyhaveshownpromisingresultswithnoadverseaffects.
AnewstudyinKorea,attheKoreaUniversityAnsanHospitalinSeoul,iscurrentlyunderway.Studysubjectswillparticipateinthetrialfor16weeks.Ifdeterminedtobesafeandeffective,microcurrentstimulationwouldbeone-stepclosertoofficialapprovalbymedicalauthorities.
Afeweasyadjustmentstothelivingareasofapersonwithlowvisioncanimprovevisibilityandreducetheriskofaninjury.Dr.StewartShofnerofNashville,TNshareswithus5practicaltipstoassistthosewithlowvision.
Lights
Makesuretheirhomeiswelllitandbrightwithadditionallampsortasklighting.Lightswitchesthataresprayedwith“glowpaint”showupinthedarkprovidinganextrameasureofprotectionandconvenience.Outdoorwalkways,kitchen,bathroomandworkareasallshouldbefullyandevenlyilluminated.Haveflashlightsnearbyincasethepowergoesout.
Stairs
Markstairsorslopeswithbrightlycoloredtape.Brightcolorsthatcontrastwiththeflooringworkbest.Handrailsareimperative,evenifonlyforacoupleofsteps.
DeclutterRemoveunnecessaryhouseholdclutterandbesurefloorsareclearandsafe.Offertohelpwithorganizingimportantitemsandpackingupotherstoensureitemsuseddailyareeasilyaccessible.
EmergencyNumbers
Createalistofimportantphonenumbersinlargeprintonbold-linedpaperandprogramautomaticdialingoptionsifavailable.Includeemergencycontacts,doctors,family,andclosestneighbor’sinformationneareachphoneandintheconsoleorabovethevisorineveryvehicle.
Upgrades
Suggestpurchasingalarge-screentelevisionthatproduceshigh-contrastimages.EnsurefurnitureisplacedclosertotheTVifupgradingisnotinthebudget.
Weallknowthatourbodieshaveanimmunesystemthatprotectsusfrominfections.Aspecialpartofthisprotectioniscalledthecomplementsystem,orjustcomplement.
Itwasfirstidentifiedinthelate1800’sassomethinginthebloodofsheepthatcouldbeusedinhumanstotreatanthrax.
Today,researchersdescribeitasahighlycomplexsystemthatcirculatesinourbloodwaitingtobeactivated.Whentriggered,complementstartsachainreaction(knownasacomplementcascade)thatattacksforeignanddamagedcellsbyeatingthem,blowingthemup,andhaulingthemawayaswaste(notaprecisedescription,buttheimagerycomesclose).
That’sverygoodnewsbecausewerelyoniteverydaytostayhealthy.Unfortunately,researchershavediscoveredthatthecomplementsystem,whichismeantto“complete”or“enhance”theimmunesystem,hasthepotentialtodousgreatharm.
HowtheComplementSystemCanHurtUs
Itisthoughtthatthecomplementsystemmayactuallyplayadetrimentalroleinmanydiseasesthatinvolvetheimmunesystem.Theseincludeasthma,lupus,arthritis,heartdisease,multiplesclerosis,therejectionoftransplantedorgans,Alzheimer’sandmaculardegeneration.
Poorregulationofthecomplementsystemseemstobetheproblem.Scientistshavegoodreasontobelievethattwoofitsingredientsnamed“factorH”and“C3”cangetout-of-whackanddousharm.
Summary
Themainroleofcomplementistorecognizeandfacilitatetheremovalofwasteproducts(likeDruseninthecaseofmaculardegeneration),deadcells,andbadthingsthatinvadethebodyandcausedisease.
Thecomplementsystemneedstobetightlyregulatedtoavoidexcessiveactivation.
Stronggeneticlinkshavebeenmadebetweenpoorregulationofcomplementactivationinthebackoftheeyeandmaculardegeneration.Scientistsaroundtheworldareworkinghardtodevelopeffectivedrugsanddeliverysystemstoregulatethecomplementsystem.ApellisPharmaceuticals,forexample,hasjustsubmittedaNewDrugApplicationtotheUSFoodandDrugAdministrationforintravitrealpegcetacoplan,atargetedC3therapyforthetreatmentofmaculardegeneration.Accordingtotheirwebsite,recentstudieshaveprovidedevidencethatpegcetacoplanmeaningfullyslowsdiseaseprogressionandhasthepotentialtopreservevisionlonger.
Usingroundworms,theUniversityofMarylandSchoolofMedicineresearchersbelievetheyhaveidentifiedanewanddistinctcauseofmaculardegeneration.Thediscoveryoffersthepotentialtoidentifynewwaystotreatthedisease.
“Inordertofindacureforadisease,youhavetofullyunderstandwhatcausesit,andweidentifiedpotentialnewcontributorsthatwerenotknownbefore,”saysBruceVogel,PhD,AssistantProfessorofPhysiologyandScientistattheUMSOM’sCenterforBiomedicalEngineeringandTechnology(BioMET).
“OurfindingssuggestthatcomplementfactorHplaysaroleinmaintainingtheorganizationofphotoreceptorcilia,andthisprocessmaybedefectiveinage-relatedmaculardegeneration,”saysVogel.“Weplantocontinuethisworktodeterminehowthisstructuraldisruptionaffectsvisionandtodeterminewhetherwecanreversethedisruptionandrestorephotoreceptorfunction.”
“Itisexcitingtoseethesepositivedatawithpegcetacoplan,whichshowedcontinuousandpotentiallyimprovingeffectsovertime.These18-monthresultsprovidefurtherevidencethatpegcetacoplanmeaningfullyslowsdiseaseprogressionandhasthepotentialtopreservevisionlonger,”saidJeffreyS.Heier,M.D.,principalinvestigatoroftheDERBYstudyanddirector,retinaserviceanddirector,retinalresearch,OphthalmicConsultantsofBoston.“Inmypractice,IhaveseenhowdevastatingitcanbeforpeoplelivingwithGAtolosemoreoftheirvisionyearafteryear.ThereisanurgentunmetneedinGA,andtheseresultsreinforcethepotentialofpegcetacoplantobecomethefirst-evertreatmentforpatientswiththisdebilitatingdisease.”
TheFDAhasapprovedRoche’sSusvimo(ranibizumab),along-lastinginjectabledrugfortreatingpeoplewith“wet”age-relatedmaculardegeneration.
Susvimo,whichcontinuouslydeliverstherapyviaarefillableocularimplant,canbeadministeredjusttwiceayear,providinganalternativetootherinjectionsthatareoftengivenmonthly.
Thedrug’sapprovalwassupportedbyphase3datademonstratingthatpatientstreatedwithSusvimoexperiencedvisionincreasesequivalenttothosereceivingmonthlyranibizumabinjections.Rochenotedthat98percentofpatientswereabletogosixmonthsbeforeneedingtheirfirstrefillofSusvimo.
AdditionalInformation
Inrecentyearsatleasttwostudiesdemonstratedthebenefitsofflavonoid-richdarkchocolateovermilkchocolateastoimprovedvision.Thatwasgoodnewsforchocolatelovers.
Inanewdouble-blindrandomizedclinicaltrial(DepartmentofOphthalmologyLudwig-Maximilians-University,Munich,Germany),theshort-termbenefitsofdarkchocolatewereonceagainputtothetest.Unfortunately,thistimetheysawnobenefittovisualfunctionofeitherdarkormilkchocolate.Researchersadmitsamplesizewassmall(22participants)andfurthertrialswouldbeneededtoruleinoroutpossiblelongtermbenefits.
Conclusion:Chocolatetastesgood!
“Tom”,a73-year-oldmale,complainedofseveredryeyesyn-dromeandlossofacuityafteroneinjectionofananti-VEGFdrugfortreatmentofwetmaculardegeneration.Tomhadpreviouslyundergonefourmonthsoftreatmentwithasimilardrug,buthisphysicianrecommendedchangingtothenewerandlessexpensiveone.
Bothdrugshadbeenclinically-testedandFDA-approvedforophthalmicuse.Dryeyesyndromewasnotreportedinthetrialsasanadverseeventforanti-VEGFdrugs,sothephysiciandidnotsuspectittoberelated.Instead,heprescribedmedicationtotreatTom’snewsymptom.Tomrefusedthemedication,sayinghefeltthathisconditionmaybeanadverseeventsorarethatitwasnotreportedinthetrialresults.Hedidnotagreewithhisphysician’sopinionthatthebenefitsofthenewdrugoutweighedtheriskinthiscase,andheinsistedthathebereturnedtotheoriginaltreatment.Afterdoingso,Tom’sconditionimproved,andhisvisionreturnedtobaseline.
AgenciessuchastheFDAareresponsibleforapprovingdrugsandformonitoringtheirsafetyafterreachingthemarket.Timelyandaccuratereportingofsideeffectsandseriousadverseevents(SAE’s)bypharmaceuticalsandphysiciansisimportant,especiallyinthecaseofnewlymarketeddrugs.Physiciansareexpectedtoreporttothepharmaceuticalcompanies,andthecompaniesareexpectedtotakeappropriateactionwhennecessary.Thesafetyofthepublicdependsuponcompliancewithreportingprocedures.UnreportedSAE’s,however,arestilltoocommon,andcanleadtopublichealthdisasters.Physiciansandpharmaceuticalcompaniesareobligedtocomplywiththereportingprocess,andpatientsplayanimportantroleaswell.Everypatientshouldbeawarenotonlyofthepre-marketdiscoveryofsideeffectsandSAE’sofaparticulardrug,butofthepotentialfornewandunexpectedevents.
Patientsshouldbeencouragedtoreportallphysiologicalandpsychologicalchangesduringtreatment,whetherornotsuchchangesarereportedinthetrialresultsanddiscussedintheprescribinginformation.Suchreportsshouldbemadetothephysicians,butintheeventthatareportgoesnofurther,patientsneedtohavetheopportunitytocommunicatedirectlywiththedrugcompaniesandgoverningagencies,andtoshareinformationwithoneanother.
Throughaprogramofdiet,sleep,exercise,andrelaxationtechniques,combinedwithsupplementalprobioticsandphytonutrients,ateamof3internationalscientistshavedescribedaplanthatmayactuallyreverseaginganditsresultanteffectondisease.
Intheirstudy,thedietandlifestyletreatmentgroupdecreasedinbiologicalageby3.23yearscomparedtothecontrolgroup.Thedataalsoshowedthatthoseinthetreatmentgroupdecreasedinbiologicalageby1.96yearsovertheeightweeks.
Someoftheimportantlife-stylechanges:
Smartphonesareusedbyamajority,possiblymorethan75%,oftheUSpopulation.Thereareliterallythousandsof“Apps”orApplicationsfortheblindandvisuallyimpaired.Moreandmorearemultifunctionalandmanyarefree.Fortheblindandvisuallyimpaired,thesmartphoneisthebestthingsinceLouisBraille’stactilealphabet.Itallowsthemtocommunicateeffortlessly,doresearchandhaveahand-heldcomputer.Moreappsarebeingdevelopedeveryday,andthousandsarenowavailable.Manyareusefulforthevisuallyimpaired,andsomearespecificallyforthem.
Therearemanydifferentmakesandvarietiesofsmartphones,andsomearesimplifiedandadvertisedasdesignedforeasyusebythevisuallyimpaired.Atthistimein2021,theiPhoneisthemostpopularintheUS,includingintheblind/visuallyimpairedpopulation.Insomeothercountries,theAndroidmaybemorepopular.Phonecostsvary,andatthistimeintheUS,theIPhoneisusuallyafewhundreddollarsmoreexpensivethantheAndroidmodels.
TheiPhoneSincebeingintroducedin2007,theIPhonebyApplehasbeenregardedbymanyasthebestsmartphoneforthevisuallyimpaired.Thisisprimarilybecauseithasmanybuilt-inaccessibilityfeatures,whichsimplyneedtobeturnedoninSettingssuchas“Voiceover”whichwillreadthescreendisplay,and“Zoom”andothermagnificationoptions.
AppsfortheVisuallyImpairedInadditiontotheinherentaccessibilityoptionsintheIPhoneandtheAndroid,therearenowamyriadofapps.Thesewillmagnify,contacthelpfromasightedvolunteer,countmoney,recognizefaces,etc.Thevarietyandusefulnessofappshassteadilyandprogressivelyimproved,andtheredoesnotseemtobeanendinsight.
Asanexample,wecanlookatappsforreadingtext.In2007atextreaderapp,theKurzweilNFBreaderappwasintroducedatacostof$99.SubsequentlytheAfewyearslater,anothertextreaderapp,Envisionreaderwasavailableat$20.In2020theAppleSeeingA1,whichinadditiontoreadingtextwillcountmoney,hasabarcodescannerandidentifiesimageswasreleasedanditisfreeforiPhoneusers.Thissortofincreasingfunctionanddecreasingcostistypicalofappdevelopmentforthevisuallyimpaired,andwehopewillcontinue.
Allwithvisionlossshouldusesmartphonestotheirmaximumandwillbecomemoreindependent,functionalandhappybecausetheydoso.
SummaryThesmartphoneisacommunicationandcomputingdeviceofgreathelptoall,especiallyforthevisuallyimpaired.Itisrapidlyimproving,andmoreappsthatarespecificallyforthevisuallyimpairedarebecomingavailablealmostweekly.
MostpeoplefoundtohaveAMDare:
DryAMDSomeoftheinitialchangestotheeyecausedbyAMDaremildanddonotrequiretreatment.Yourdoctorwillseesmallyellowareasof“drusen”,aGermanwordfor“bump”,inoneorbotheyes.Thisisknownas“DryMacularDegeneration”.Symptomsmayincludevisualdistortions,theneedformorelightwhenreadingandablurryorblindspotinyourcentralfieldofvision.Side(peripheral)visionisnotaffected.
WetAMDThe“Wet”typeofmaculardegenerationischaracterizedbythegrowthofabnormalbloodvesselsthatleakfluidorbloodintothemacula(theareaoftheretinaresponsibleforcentralvision).Symptomsofwetmaculardegenerationarethesameasthedryformbutusuallyappearsuddenlyandgetworserapidly.
WhattoDo!Askyoureyedoctorifyoushouldseeanophthalmologistwhospecializesinthetreatmentofmaculardegenerationoraretinaspecialist.Retinaspecialistsarebestqualifiedtodecideifactivetreatmentisneededandwhentobegintherapy.
Don’tStop!DONOTPANICorstopdoingallthatyouneedorwanttodo.Continueyourjobandhobbies!VisionRehabilitationhastraining,techniquesanddevicesthatalloweventhosewithseverevisionlosstocontinuetofunctionastheyalwayshave.Fromsimplestrongerglassestoadvancedelectronicdevices,muchhelpisavailable.Developmentsintechnologyinthelastfewdecadeshavemadethiseasierthanever.Askyourdoctorforareferraltoalowvisionrehabilitationclinic.Youwillbegladthatyoudid!
Summary…“WhatDoIDo”
NewestSustained-ReleaseAnti-VEGFDruginTrials
EyePointPharmaceuticals,Inc.announcedonJanuary28,2021thatthefirstpatienthasbeendosedintheirPhase1clinicaltrialofEYP-1901.EYP-1901isapotentialtwice-yearlysustaineddeliveryintravitrealanti-VEGFtreatmentforwetage-relatedmaculardegeneration(wAMD).Itisthenewestofseveralsustaineddeliverydrugsunderstudy,thisonepromisingtoextendtreatmentsfrom4-6weekstoonlytwiceayear.
FaricimabforWetAMDEffectiveat16-weekIntervals
GenentechhasannouncedpositivetoplineresultsfromitsPhaseIIIstudies,TENAYAandLUCERNE,evaluatingitsnewdrugfaricimabforpeoplewithwet(neovascular)age-relatedmaculardegeneration(nAMD).Bothstudieshaveshownthatpeoplereceivingfaricimabinjectionsatfixedintervalsofuptoevery16weeksachievedvisualacuityoutcomesaseffectiveasthosereceivinginjectionsevery4-6weeks.
ZimuraShowsSignificantSuppressionofGA(latestagedrymaculardegeneration)
IVERICbio,Inc.hasannouncedpositivePhase3resultsfromitsGATHER1clinicaltrialwithZimura(avacincaptadpegol).ZimurainhibitscomplementfactorC5,whichisbelievedtobeinvolvedinthedevelopmentofAMD.Thereductioninthemeanrateofgeographicatrophy(GA)growthover12monthswasbetterthan27%groupascomparedtoshamcontrolgroups.Thedatawasstatisticallysignificant,andthedrugwasgenerallywelltolerated.GATHER2iscurrentlyunderwaytofurtherevaluatetheefficacyandsafetyofZimurainpatientswithGA.
LucentisSubstituteInPhase3Trials
SamsungBioepisisreportingfirstyearresultsfromtheirphase3studyofaproposedlucentisbiosimilar(SB11).Abiosimilarisabiologicalproduct(derivedfromalivingorganism)thatshowsnoclinicallymeaningfuldifferencesfromanotherbiologic(eg.Lucentis).Thisstudyhasshownthat,at52weeks,primaryendpointsweremetforvisualacuityandretinalhealth,suggestingthatitcouldbecomeasubstituteforGenentech’sLucentis(ranabizumab).Thiswouldbethefirstbiosimilarforananti-VEGFdrug,whichcouldleadtosignificantcostsavingsfortheU.S.healthsystemandconsumers.
APL-2SlowsProgressionofEarlyDiseaseinPatientswithGeographicAtrophy
ApellisPharmaceuticals,Inc.announcedtheiranalysisofthePhase2FILLYstudyinvestigatingintravitrealpegcetacoplan(APL-2)forthetreatmentofgeographicatrophy(GA),alsoknownasadvanceddrymaculardegeneration.TheposthocanalysisfoundthatthemonthlytreatmentreducedtherateofprogressiontoGAby39percentinareasoftheretinaoutsideofexistingGAlesions.
APL-2istheonlytargetedC3therapyinPhase3clinicaltrialsforGA,whichaffectsapproximatelyfivemillionpeoplegloballyandhasnoapprovedtreatment.AccordingtoSriniVasSadda,M.D.,President&ChiefScientificOfficeroftheDohenyEyeInstituteandleadinvestigator,“ThisstudyprovidesexcitingevidencetosupportfurtherexplorationofthepotentialofpegcetacoplanforearlierinterventioninthecourseofGA.”
Theintraocularinflammationthatmayoccurafterintravitrealtherapywithbrolucizumab(Beovu)canalsobeaccompaniedbyretinalvasculitissevereenoughtocauseprofoundlossofvision,researchershavefound.
Source:AmericanAcademyofOphthalmology(AAO).LindaRoach:EyeNetMagazineJuly2020
Real-worldoutcomes.Thisretro-spectiveanalysisofretinalvasculitisin15eyesof12patientsfrom10U.S.centerswasthefirstcaseseriespub-lishedinapeer-reviewedjournalsinceisolatedreportsofbrolucizumab-asso-ciatedproblemsbeganemergingearlierthisyear.
Thepatients’meanvisualacuity(VA)beforetreatmentwithbroluci-zumabwas20/53.Bythetimeretinalvasculitiswasdiagnosed,itwas20/191(range,20/25to20/1,600).Andatameanof25daysfollowingdiagnosisandtreatment,itwas20/136.Nineeyes(60%)lost3linesormore,andfiveeyes(33%)hadVAoflessthan20/200.
Thevasculitisandintraocularin-flammationnotedintheseeyesrangedfrom“peripheralvasculitistoocclusionoflargeretinalarteriesaroundtheopticnerveormaculawithseverevisionloss,”theresearcherssaid.All12affectedpatientswerewomen,whichsuggeststhatautoimmunitymaybeafactor,saidcoauthorScottD.WalterMD,MSc,atRetinaConsultantsinHartford,Connecticut.
Insidiousonset.Theseadverseoutcomesoccurredinapatterndistinctfromanythingeverseenwithotherapprovedanti-VEGFdrugs,saidDr.Walter,alsoattheUniversityofConnecticutSchoolofMedicineinFarmington.Specifically,theinflam-mationassociatedwithbrolucizumab“tendstobemilderinitsearlystagesandmoreinsidiousinonset,”hesaid.“Thepatientmightnotbecomesymptomaticforseveralweeksaftertheinjection,andtheinflammationmaybemildenoughthatpatientwouldn’tthinktocalltheoffice.”
Insomepatients,“theinflammationwaspickedupwhentheyreturnedforascheduledinjection,”Dr.Walternoted.Inothers,hesaid,“Itwasoverlookedbecausetherewasnointensevitritisorhypopyon.”Thesearetypicalsignsofintraocularinflammationassociatedwithotheranti-VEGFdrugs,withonsettypicallyinthefirstweekafterinjection,hesaid.
Additionally,“Thereweremultipleexposurestothedruginsomecases,andadelayofweeks,asopposedtodays,beforetheonsetofclinicallyapparentintraocularinflammationandretinalvasculitis,”Dr.Waltersaid.“Andifyoumisscatchingthis,thenitcanreallygetyouintotrouble.”
Ifyouusebrolucizumab.Retinaspecialistsshouldbealertforinflam-mationandothereventswhenusingbrolucizumab,thestudyauthorssaid.Andwhileresearcherstrytodiscoverthemechanismbehindtheproblems,Dr.Waltersaidthathehasdecidedagainststartinghispatientswithage-relatedmaculardegenerationonbrolu-cizumab,andthatheisencouragingthosealreadyonittoswitchtoanotheranti-VEGFagent.
Butforthoseclinicianswhodousethedrug,Dr.Walteradvisesacompleteexaminationofboththeanteriorandposteriorsegmentstoevaluateforsubtlesignsofinflammation—evenforappar-entlyasymptomaticpatients—beforeeachsubsequentinjection.“Themostimportantthingforanyonetreatingthesepatientsistonotreinjectaneyethathasactiveinflammationwithbrolucizumaboranyotheranti-VEGFdrug.”
WhatisanAMSLERGRID
TheAmslerGridisbasicallyasquareofhorizontalandverticallines.Accordingtoonesource,asimilardesignmayhavebeenusedinthelate1800’s.ButtheAmslerGridweknowtodaygetsitsnamefromMarcAmsler,aSwissophthalmologistwhobeganpromotingitsusein1947.
Whenusedproperly,itcanhelptheusertodetectvisualdistortionsandlossofvisioncausedbysuchdiseasesasmacularedema,centralserouschorioretinopathy(CSC)andage-relatedmaculardegeneration(AMD).
Earlydetectionofmaculardisordersisveryimportant…especiallytodaywheneffectivetreatmentsareavailablewhencaughtearlyintheprocess.TheAmslerGridhashelpedpeoplewithmaculardiseasetoidentifychangesintheirconditionandreportittotheireyedoctorforevaluation.
WhatFormsDoAmslerGridsTake
1.AmslerGridsonpaperarethemostcommonformandareavailablefromyourdoctorandmanysourcesovertheInternet.Inanattempttoimproveaccuracy,someusecoloredbackgroundsandlines,whileothersuseaspecialnumberoflinesandlinespacing.
3.Portableviewer:Weevaluatedaportablekeychain“viewer”.Itisanovelapproach,butwefoundittobeimpreciseandsubjecttomisinterpretation.
HowtoUsetheAmsler(AmericanAcademyofOphthalmology)
LimitationsoftheAMSLERGRID
BecausetheAmslerGridhaslimitations,someeyecareprofessionalsdonotrecommendeditasawayto“self-assess”diseaseprogression.Herearesomeofthereasonswhy:
1.Itrequiresreasonablygoodnearvisiontodiscernthegridlines.
2.Poorpatientcompliance.Meaning,noteveryoneiswillingorabletomaintainagoodroutineofself-assessment.
3.Itisa“subjective”testandpronetomisinterpretation.
4.Whencomparedtothetoolsavailabletoeyedoctors,theAmserGriddetectsonlyaboutone-halfoftheareasinthevisualfieldwherevisionisabsentordeficient.
5.Theeyesandbraincanplaytricksonyou.Oneoftheseiscalled“PerceptualCompletion”.Thisiswhenthebrainfillsinorcompletesgapsinthevisualfieldofeacheye.Anotherchallengeiscalled“CentralFixation”,whichcausesvisualconfusionwhenlookingatmultiplelines.PerceptualcompletionandcentralfixationcanmaketheAmslerGridunreliable.
SpecializedAmslerGrids
AsearchoftheInternetwillfindreferencestotheselesscommon,high-techAmslerGrids.
*ThresholdAmslerGrid(TAG)
*AcceleratedAmslerGrid
*DeformableAmslerGrid
*Three-dimensionalComputer-automatedThresholdAmslerGrid(3D-CTAG)
These(andother)modifiedAmslerGridsareattemptstoimprovethetestforuseathomebetweenroutineeyeexaminations.Progressisbeingmadeintheareaofcomputerandtabletbasedsoftwaretoidentifymaculardisorders.All,however,havelimitationsthatmakeregularvisitstoyouroptometrist,ophthalmologistand/orretinalspecialistthebestwaytomonitoryourvision.
1.Firstandforemost,haveyoureyesexaminedonaregularbasis.Howoftendependsonyourage,riskfactorsandwhetheryoucurrentlyweareyeglassesorcontactlenses.Mosteyecareprofessionalsrecommendacomprehensivetesteveryyearortwo.
2.Ifyounoticeachangeinyourvision,contactaneyecareprofessionalimmediately.
3.Ifyouhaveadiagnosisofmaculardegeneration,anAMSLERGRIDmaybeusefulasa“follow-up”toolformonitoringchangesinyourcentralvisionbetweeneyeexams.However,itshouldneverbeusedtoscreenyourselfformaculardisease.Leavethattoatrainedprofessional.
Thefollowingvideo,producedinNovemberof2019bytheCanadianBroadcastingCorporation,interviewsDr.SunirGarg,aneyesurgeonandspokesmanfortheAmericanAcademyofOphthalmology.
Statisticshaveshownthatonly1outof5smokersactuallyareawareoftherisksmokinghasontheireyehealth.Thefollowinginformationmayconvincefolksthatbreakingthehabitisimperativetoinsurealongandhealthylife!
2.Smokingcanmakediabetes-relatedsightproblemsworsebydamagingbloodvesselsatthebackoftheeye(theretina).
4.Smokersare16timesmorelikelythannon-smokerstodevelopsuddenlossofvisioncausedbyopticneuropathy,wherethebloodsupplytotheeyebecomesblocked.