Learning-Related Vision Problems

7/29/14

Next month is Children’s Eye Health Month, and to kick it off a little early we are taking a look at learning-related vision problems. Next month children start heading back to school, so now is the perfect time to make sure you child has had a recent comprehensive eye exam.

Vision and learning are closely related. About 80% of what a child learns in school is presented visually, and 25% of school-aged children already have vision problems (5-10%of preschoolers do). By scheduling a comprehensive eye exam for your child before school starts, you will help your child be more successful and happier in school.

When children have difficulty in school, from being able to see what is written on the whiteboard to learning to read, it not only makes the learning difficult, but it also makes the child frustrated and can affect their love of learning as well. While most schools perform a quick eye check at some point during the school year to determine simple refractive errors such as nearsightedness, farsightedness and astigmatism, there are other visual disorders that can make learning difficult.

Vision is a complex process that involves the eyes working well with the brain. Specific learning-related vision problems can be classified as one of three types. The first two types primarily affect visual input. The third primarily affects visual processing and integration.

Refractive vision problems. Your child holds a book close to their face when reading or they have difficulty seeing things that are far away. These are generally refractive issues and include nearsightedness, farsightedness and astigmatism, but could also include more subtle optical errors called higher-order aberrations.
Functional vision problems. This type of problem refers to a variety of specific functions of the eye and the brain’s control of these functions, such as eye teaming (using the eyes together), fine eye movements, and focusing skills, peripheral awareness and eye-hand coordination. These issues can cause blurred or double vision, eye strain and headaches.
Perceptual vision problems. Visual perception includes understanding what you see, identifying it, judging its importance and relating it to previously stored information in the brain. Examples would include recognizing words that you have seen before and being able to form a mental picture of the words you see.

Because most routine school and pediatrician eye exams evaluate only the refractive vision problems, it is wise to see optometrist who specializes in children’s vision problems to evaluate functional vision problems and perceptual vision problems that may affect learning.

Color blindness is not considered a learning-related vision problem, but it can cause problems for very young children if color-matching or identifying specific colors are part of the classroom activities. For this reason, make sure your child’s eye exam includes a color blind test prior to starting school.

Symptoms of Learning-Related Vision Problems:

Headaches, eye strain, excessive blinking or rubbing the eyes
Blurred vision or double vision
Crossed eyes or if the eyes move independently of each other
Holding a book very close to their face for reading
Bending way over a table to get closer to what they are drawing or writing
Using only one eye by tilting the head or covering the other eye
Losing their place while reading, or needing to use a finger to stay on line
Slow reading speed or poor reading comprehension
Omitting or repeating words, or confusing similar words
Persistent reversal of words or letters (after second grade)
Difficulty remembering, identifying or reproducing shapes
Poor eye-hand coordination
Distracted in class

If your child shows one or more of these symptoms, they could indicate a learning-related vision problem. To find out see an eye doctor who specializes in children’s vision for a comprehensive evaluation. If no vision problem is detected, your child’s problems could be caused by a non-visual issues, such as dyslexia or a learning disability, in which case you would need to contact an educational specialist for an evaluation.

Treatment of Learning-Related Vision Problems

If your child is diagnosed with a learning-related vision problem, treatment generally consists of an individualized and doctor-supervised program of vision therapy. Special eyeglasses also may be prescribed for either full-time wear or for specific tasks such as reading.

Remember that when children have a difficult time learning, especially while other classroom friends have no visual issues to impair learning, they may experience emotional problems as well, such as anxiety, depression and low self-esteem.

Reassure your child that learning-related vision problems do not relate to how smart they are and with the proper treatment and/or eyeglasses, things will become easier.

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Children Can Wear Contact Lenses Too

7/24/14

Several studies have shown that children as young as eight years are able to wear gas permeable,^[1-3] corneal reshaping,^[4-8] and soft contact lenses.^[9-12] Gas permeable (hard) contact lenses were originally thought to slow the progression of nearsightedness, but two randomized clinical trials have shown that they do not slow the growth of the eye,^{[1, 3]} so they are primarily fit on children who have difficulty handling soft contact lenses or who have highly irregular corneas (the clear window on the front of the eye) possibly from trauma or eye problems such as keratoconus. Corneal reshaping contact lenses are worn during sleep only. They temporarily flatten the cornea so that a nearsighted child can see clearly throughout the day with glasses or contact lenses. These contact lenses have been shown to slow eye growth in children.^[4-7] Typical soft contact lenses have no effect on the progression of nearsightedness,^[13] but soft bifocal contact lenses (typically worn by adults over the age of 40 who otherwise have difficulty seeing clearly at near) have been shown to slow the growth of the eye.^[14-17]

Children also benefit from contact lens wear other than slowing the progression of nearsightedness. Children feel better about their athletic abilities, their appearance, and their peer interactions when they wear contact lenses than when they wear spectacles.^[11] They even feel smarter if they wear contact lenses than if they wear spectacles, but only if they originally didn’t like to wear spectacles. Children also report that they prefer to participate in activities while wearing contact lenses more than while wearing spectacles, and the most-preferred vision correction is contact lens wear.

It has even been shown that most children (8-12 years of age) require only about five extra minutes to learn how to insert, remove, and care for their contact lenses when compared to teenagers (13-17 years of age). They also show similar benefits as the older group. In fact, children between the ages of 8 and 18 years of age are less likely to require discontinuation of contact lens wear due to problems encountered and also less likely due to experience irritation of the eye due to contact lens wear than college students between the ages of 19 and 25 years.^{[18, 19]} After wearing soft contact lenses for 10 years, those fit as children (7 to 12 years of age) reported similar rates of painful red eyes that required visits to the eye doctor than those fit as teenagers (13 to 17 years of age), and those fit as children as exhibited similar eye health as those fit as teenagers.^[20]

Personal experience, backed up by scientific evidence, shows that children as young as eight years can routinely wear contact lenses. When considering contact lens wear for your child, determine the primary reason you would like your child to wear contact lenses. If it is to slow the progression of nearsightedness, then corneal reshaping and soft bifocal contact lenses are the most effective methods. Unfortunately, neither of these contact lenses comes in a daily disposable modality. If your child doesn’t like to wear glasses or finds it difficult to participate in recreational activities with glasses, then daily disposable contact lenses may be best for your child. Contact lenses that are thrown away daily eliminate the need to clean and care for the lenses, reducing care of the lenses to insertion in the morning and removal at bedtime.

Some doctors believe that children should not be fit with contact lenses until they are teenagers. However, there is considerable evidence that indicates children are very capable of contact lens wear, and they experience significant benefits, visually and socially. Talk to your eye doctor about contact lens wear for your child, and if your doctor says that children should not be fit with contact lenses, consider a second opinion.

References
^[1] Katz J, Schein OD, Levy B, et al. A randomized trial of rigid gas permeable contact lenses to reduce progression of children’s myopia. Am J Ophthalmol 2003;136:82-90. (Go Back)
^[2] Khoo CY, Chong J, Rajan U. A 3-year study on the effect of RGP contact lenses on myopic children. Singapore Med J 1999;40:230-7. (Go Back)
^[3] Walline JJ, Jones LA, Mutti DO, et al. A randomized trial of the effects of rigid contact lenses on myopia progression. Arch Ophthalmol 2004;122:1760-6. (Go Back)
^[4] Cho P, Cheung SW. Retardation of Myopia in Orthokeratology (ROMIO) Study: A 2-Year Randomized Clinical Trial. Invest Ophthalmol Vis Sci 2012;53:7077-85. (Go Back)
^[5] Cho P, Cheung SW, Edwards M. The longitudinal orthokeratology research in children (LORIC) in Hong Kong: a pilot study on refractive changes and myopic control. Curr Eye Res 2005;30:71-80. (Go Back)
^[6] Santodomingo-Rubido J, Villa-Collar C, Gilmartin B, et al. Myopia Control with Orthokeratology Contact Lenses in Spain (MCOS): Refractive and Biometric Changes. Invest Ophthalmol Vis Sci 2012. (Go Back)
^[7] Walline JJ, Jones LA, Sinnott LT. Corneal reshaping and myopia progression. Br J Ophthalmol 2009;93:1181-5. (Go Back)
^[8] Walline JJ, Rah MJ, Jones LA. The Children’s Overnight Orthokeratology Investigation (COOKI) pilot study. Optom Vis Sci 2004;81:407-13. (Go Back)
^[9] Rah MJ, Walline JJ, Jones-Jordan LA, et al. Vision specific quality of life of pediatric contact lens wearers. Optom Vis Sci 2010;87:560-6. (Go Back)
^[10] Walline JJ, Gaume A, Jones LA, et al. Benefits of Contact Lens Wear for Children and Teens. Eye Contact Lens 2007;33:317-21. (Go Back)
^[11] Walline JJ, Jones LA, Sinnott L, et al. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci 2009;86:222-32. (Go Back)
^[12] Walline JJ, Long S, Zadnik K. Daily disposable contact lens wear in myopic children. Optom Vis Sci 2004;81:255-9. (Go Back)
^[13] Walline JJ, Jones LA, Sinnott L, et al. A randomized trial of the effect of soft contact lenses on myopia progression in children. Invest Ophthalmol Vis Sci 2008;49:4702-6. (Go Back)
^[14] Anstice NS, Phillips JR. Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmology 2011;118:1152-61. (Go Back)
^[15] Lam CS, Tang WC, Tse DY, et al. Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. Br J Ophthalmol 2014;98:40-5. (Go Back)
^[16] Sankaridurg P, Holden B, Smith E, 3rd, et al. Decrease in rate of myopia progression with a contact lens designed to reduce relative peripheral hyperopia: one-year results. Invest Ophthalmol Vis Sci 2011;52:9362-7. (Go Back)
^[17] Walline JJ, Greiner KL, McVey ME, et al. Multifocal contact lens myopia control. Optom Vis Sci 2013;90:1207-14. (Go Back)
^[18] Wagner H, Chalmers RL, Mitchell GL, et al. Risk Factors for Interruption to Soft Contact Lens Wear in Children and Young Adults. Optom Vis Sci 2011;88:973-80. (Go Back)
^[19] Wagner H, Richdale K, Mitchell GL, et al. Age, behavior, environment, and health factors in the soft contact lens risk survey. Optom Vis Sci 2014;91:252-61. (Go Back)
^[20] Walline JJ, Lorenz KO, Nichols JJ. Long-term contact lens wear of children and teens. Eye Contact Lens 2013;39:283-9. (Go Back)

Jeffrey J. Walline, OD, PhD
Associate Professor
Chair, Research and Graduate Studies
The Ohio State University College of Optometry

The Habit of Seeing

7/22/14

We often take our vision for granted – and if you lose it, your life is turned upside down. I met Kooshay Malek at a Pacific Palisades Lions Club meeting and was amazed by her story. She has agreed to share with you how she “gave up seeing.” This three-part series will explore losing her vision, how it affected her career choice and how she expresses her creative nature.

My eyes are what brought me to the US. I was 16 when my father and I came here from Tehran, Iran, for eye treatment. My case was an unusual case: We still, to this day, don’t have a name for it, but it’s retinal tumors of some sort. My case had been through Europe, Russia, Israel, to different conferences, and they sent me to the US as a final recourse. During that time, in 1982, it was the Iran-Iraq war, and the airports were not open. My dad and I had to get special permits to get out for medical reasons. Then to get American visas, we were stuck in Frankfurt for a couple of months waiting. It was a very challenging time. Long story short, we got to Boston, and I started receiving treatments on my left eye. It didn’t respond well, and I became totally blind on the left side. Meanwhile, I could still see 20/20 on my right side. We moved to LA, where we had friends for support, and my mother and sister joined us. I was 18 when my right eye started going bad, and I started going to UCLA/Jules Stein for treatment. I went blind in that eye when I was 22.

My father passed away two years after I lost my sight. I finished college and went through independence training at Foundation for the Junior Blind in LA. I eventually decided to go back to school to get a master’s degree in psychology, because I realized I’m a good listener and I’m always wanting to help people, so I thought it would be a good way to channel that. And as a blind person, I didn’t think I had too many career choices.

I’ve been licensed as a marriage and family therapist for the past five years. I have a part-time practice, I do volunteer work at the clinic where I did my internship, and I help train up-and-coming therapists. I think one of the reasons I was so drawn to this field is the fact that when I became totally blind while I was in college, I was able to receive free counseling through school. But once I got out, I was looking for support groups and the camaraderie I had found during independence training — being around other blind people and helping each other emotionally. I couldn’t find anything like that. The only support groups I found were for seniors, so I just found a low-fee therapist to get some support. I’d lost my dad, lost my eyes, lost my country. I was dealing with so many losses. I think that’s why I’m so passionate about doing volunteer work in this area. I tried to pull together a support group for some blind clients, but it didn’t work out, partially due to transportation and location and the same stuff blind people always run into, but I do offer low- or no-fee counseling to them. I also have good relationships with some rehab counselors who refer people to me. I think therapy is an important part of rehabilitation; you have to approach this holistically.

I’ve always been very proactive and resourceful. I’ve often thought, “If only there were a 12-step program for blind people.” I’ve always been able to relate to people in these types of programs: They have to give up a habit that’s no longer working for them, and they have to put their lives back together, step by step, day by day, one day at a time. I really related to that: I had to give up the habit of seeing.

Kooshay Malek
Marriage and Family Therapist
Los Angeles, CA

Ways to Reduce the Harmful Effects of Sun Glare

During the height of summer sunshine (and heat!), it’s helpful to discuss the importance of eye protection, including ways to reduce the harmful effects of sun glare.

Fundamentally, we need light to see. Approximately 80% of all information we take in is received through the sense of sight. However, too much light – and the wrong kind of light – can create glare, which can affect our ability to take in information, analyze it, and make sense of our surroundings.

Facts about Sunlight

Every type of light has advantages and disadvantages, and sunlight is no exception:

Advantages:

• Sunlight is the best, most natural light for most daily living needs.
• Sunlight is continuous and full-spectrum: the sun’s energy at all wavelengths is equal and it contains all wavelengths of light (explained below).

Disadvantages:

• It is difficult to control the brightness and intensity of sunlight.
• Sunlight can create glare, which can be problematic for many people who have low vision.
• Sunlight is not always consistent or reliable, such as on cloudy or overcast days.

Visible Light and Light Rays

An important factor to consider is the measurement of visible light and light rays, beginning with the definition of a nanometer:

• A nanometer (nm) is the measurement of a wavelength of light.
• A wavelength is the distance between two successive wave crests or troughs:

• A nanometer = 1/1,000,000,000 of a meter, or one-billionth of a meter. It’s very small!

The human visual system is not uniformly sensitive to all light rays. Visible light rays range from 400 nm (shorter, higher-energy wavelengths) ? 700 nm (longer, lower-energy wavelengths).

The visible light spectrum occupies just one portion of the electromagnetic spectrum, however:

• Below blue-violet (400 nm and below), is ultraviolet (UV) light.
• Above red (700 nm and above), is infrared (IR) light.
• Neither UV nor IR light is visible to the human eye.

Ultraviolet Light and Blue Light

Ultraviolet (UV) light has several components:

• Ultraviolet A, or UVA (320 nm to 400 nm): UVA rays age us.
• Ultraviolet B, or UVB (290 nm to 320 nm): UVB rays burn us.
• Ultraviolet C, or UVC (100 nm to 290 nm): UVC rays are filtered by the atmosphere before they reach us.

Blue light rays (400 nm to 470 nm) are adjacent to the invisible band of UV light rays:

• There is increasing evidence that blue light is harmful to the eye and can amplify damage to retinal cells.
• You can read more about the effects of blue light at Artificial Lighting and the Blue Light Hazard at Prevent Blindness.

A new study from the National Eye Institute confirms that sunlight can increase the risk of cataracts and establishes a link between ultraviolet (UV) rays and oxidative stress, the harmful chemical reactions that occur when cells consume oxygen and other fuels to produce energy.

Sunlight and Glare

Glare is light that does not help to create a clear image on the retina; instead, it has an adverse effect on visual comfort and clarity. Glare is sunlight that hinders instead of helps. There are two primary types of glare.

Disability glare

• Disability (or veiling) glare is sunlight that interferes with the clarity of a visual image and reduces contrast.
• Sources of disability glare include reflective surfaces (chrome fixtures, computer monitors, highly polished floors) and windows that are not covered with curtains or shades.

Discomfort glare

• Discomfort glare is sunlight that causes headaches and eye pain. It does not interfere with the clarity of a visual image.
• Sources of disability glare include the morning and evening positions of the sun; snow and ice; and large bodies of water, (including swimming pools).

Controlling Glare

You can protect your eyes from harmful sunlight and minimize the effects of glare by using a brimmed hat or visor in combination with absorptive lenses.

• Absorptive lenses are sunglasses that filter out ultraviolet and infrared light, reduce glare, and increase contrast. They are recommended for people who have low vision and are also helpful for people with regular vision.
• Lens colors include yellow, pink, plum, amber, green, gray, and brown. Ultra-dark lenses are not the only choice for sun protection.
• Lens tints in yellow or amber are recommended for controlling blue light.
• NoIR Medical Technologies: NoIR (No Infra-Red) filters absorb UVA/UVB radiation and also offer IR light protection.
• Solar Shields: Solar Shields absorb UVA/UVB radiation and are available in prescription lenses.
• You can find absorptive lenses at a specialty products store, an “aids and appliances store” at an agency for the visually impaired, or a low vision practice in your area. Before you purchase, it’s always best to try on several different tints and styles to determine what works best for you.

More Recommendations

• Always wear sunglasses outside, and make sure they conform to current UVA/UVB standards.
• Be aware that UV and blue light are still present even when it is cloudy or overcast.
• Make sure that children and older family members are always protected with UVA/UVB-blocking sunglasses and brimmed hats or visors.

Maureen A. Duffy, CVRT
Social Media Specialist, visionaware.org
Associate Editor, Journal of Visual Impairment & Blindness
Adjunct Faculty, Salus University/College of Education and Rehabilitation

20 Facts About Eye Color and Blinking

7/15/14

Eye color is one of the first things a person notices about another person, but blinking is so automatic we rarely think about it. Here are some intriguing facts about eye color and blinking:

1. The world’s most common eye color is brown.

2. Brown eyes are actually blue underneath.

3. Melanin affects the color of your eyes so brown eyes have more melanin than blue eyes.

4. Heterochromia is when you are born with two differently colored eyes.

5. Blue-eyed people share a common ancestor with every other blue-eyed person in the world.

6. We blink more when we talk.

7. It is impossible to sneeze with your eye open.

8. The average person blinks 12 times per minute or about 10,000 blinks per day.

9. The eye is the fastest muscle in the body – in the blink of an eye. They are also the most active muscles in the body.

10. A blink usually lasts 100 to 150 milliseconds making it possible to blink five times in a second.

11. You blink less when you’re reading.

12. Infants blink 10 times less than adults.

13. One blink isn’t always the same as the next.

14. Our eyes close automatically to protect us from perceived dangers.

15. The older we are the less tears we produce.

16. Tears are made of three main components – fat, mucous and water. This is so tears won’t evaporate.

17. Your nose gets runny when you cry as the tears drain into your nasal passages.

18. You blink on average 4,200,000 times a year.

19. Tears kill bacteria because they contain lysozyme, a fluid that can kill 90 to 95 percent of all bacteria.

20. A newborn baby will cry, but not produce any tears. Babies do not produce tears until they are around six weeks old.

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Lasers for Glaucoma

7/10/14

Many people have heard of Laser Vision Correction, where special lasers are used to change the shape of the cornea to help a person see without the need for glasses or contact lenses. Lasers can also be used to treat glaucoma. There are different types of glaucoma, and they all can cause irreversible blindness; early diagnosis and treatments aimed at lowering eye pressure can help prevent blindness from glaucoma. Laser treatments for glaucoma do not improve vision, but they can help prevent vision loss.

There are 3 main ways that lasers are used to treat glaucoma.

Laser Peripheral Iridotomy
Laser peripheral iridotomy involves making a hole in the iris, or colored part of the eye, to prevent angle closure glaucoma. Angle closure glaucoma happens when the drain of the eye is blocked by the iris. This type of glaucoma can come on very quickly, called “acute angle closure glaucoma”, or more slowly, called “chronic angle closure glaucoma”. When it comes on quickly, people will often have symptoms like eye pain and redness, blurry vision, and even nausea; the chronic form can have few or no symptoms. This laser can help prevent vision loss from angle closure glaucoma.

Laser Trabeculoplasty
Laser trabeculoplasty is used to treat open angle glaucoma. In open angle glaucoma, the drain of the eye is open, but not working well enough to keep the eye pressure controlled. During this procedure, the laser is focused on the drainage tissue itself (called the trabecular meshwork); it helps the drain to function better to lower the eye pressure. This laser procedure may be repeated after the effect wears off. This is not a cure for glaucoma; the disease still needs to be monitored regularly.

Gonio - lasers for glaucoma — Credit: Michael P. Kelly, FOPS Duke University Eye Center

Cyclophotocoagulation
Laser peripheral iridotomy and laser trabeculoplasty are both office-based procedures; cyclophotocoagulation, where lasers are used to treat the ciliary body (the part of the eye that makes the fluid), are frequently done in the operating room. Cyclophotocoagulation involves “coagulating” the ciliary body with a laser. After the procedure, the ciliary body makes less fluid, thereby lowering the eye pressure.

Laser treatments, along with eye medications and surgeries, are important components of the care of glaucoma patients. Early diagnosis and treatment can help prevent blindness from glaucoma. A comprehensive dilated eye exam by your eye care provider is the first step.

To learn more about glaucoma, visit www.nei.nih.gov/glaucoma.

Jullia A. Rosdahl, MD, PhD
National Eye Health Education Program Glaucoma Subcommittee
Duke Eye Center, Duke University

Caitlin Hernandez – Blind Actress and Playwright

7/8/14

Being a blind actress is many things: challenging and rewarding, cathartic and uplifting, fun and freeing. What most people don’t realize is that blindness, in and of itself, requires us to be actors every day. Of course, this is true of anyone and everyone, blind or not. We all wear masks, conceal truths, profess to feel things we don’t. But with a trait like blindness– something obvious and visible, which douses us daily in an eternal, inextinguishable spotlight — the play-acting invariably becomes more complex. Striving, constantly, to put others at ease, regardless of our own state-of-being, is an exhausting side-effect of blindness which few people recognize. In some ways, blind people are more accustomed to the pressures of acting than many sighted person will ever be.

If I could grant anyone with special needs one wish, it would be the chance to be part of a company like CRE Outreach. For me, CRE’s magic comes in two forms. First, there’s the singular sensitivity of the sighted members of CRE: the directors, the assistants, the sighted actors who join us on certain projects, the audience members who have attended so many of our shows that they’ve learned about blindness by osmosis. Back home, as I catch my breath between answering the public’s questions and negotiating the logistics of graduate school as the only totally blind student in my program, I replay each little L.A. moment. The guiding hands and detailed explanations, so much more beneficial than the ever-present, ineffectual pointing, gesturing, and “over theres” which the rest of the world uses in abundance. The implementation of sound cues–taps on chairs, doorways, and obstacles in our paths–which become second-nature to those who know us best. The easy way we walk together. The empathy that only develops when a sighted person makes the choice to truly live blindness alongside us, even when it’s hard. And, always, always, the way they’re able to open their eyes wide enough to let us see, too.

Alongside our sighted compatriots, our “honorary blind people,” as we affectionately call those of the CRE contingent who can see, we’re a team of blind actors. The blind cast members are different ages and backgrounds; we have different levels of vision, different pasts, different families, different lives, different dreams. But being visually impaired binds us inextricably, regardless of our stories. We’ve all lived through those ups and downs of blindness that can sometimes feel so overwhelmingly difficult to share or explain.

CRE casts never leave shows and move on. Contact remains constant, through phone calls and texts and e-mails, voice-chatting and video-chatting and Braille letters, playing and replaying treasured recordings of the laughs, the triumphs, the moments of growth and change. It’s about so much more than putting on a show. When the curtains part on opening night, our plays almost feel like bonuses: beautiful things we were able to produce as a team, chiefly because we’re so deeply invested in this family we’ve created along the way.

Caitlin Hernandez
CRE Outreach
Actress and Playwright

Theater Company Gives Blind Actors Confidence

7/3/14

In this two-part blog post, you will learn more about an amazing program at CRE Outreach, which uses theater to engage and improve confidence among the blind participants, which is how the program started, later helping at-risk youth and military veterans. In the second post on Tuesday, one of the blind actors, Caitlin, will share her experiences as a member of the CRE Outreach troop and what it has meant to her.

When twelve visually impaired kids, ranging in age from eight to thirteen, are busy creating characters for their original play, silence is a rarity. Here, in the safe space of an acting class where everyone is visually impaired. I glance around the circle to see whose turn it is to suggest a character … and then I understand the silence. Eric is ten years old, totally blind, and autistic. He’s almost completely nonverbal. If he has ideas, which I often sense that he does, we never hear them.

It’s highly unlikely that Eric’s going to speak, or share, or rise from his hunched, self-protective crouch among the other students. I prompt him anyway. “Eric, it’s your turn. Do you have an idea for a character?”

Without warning, he lights up. A burst of energy seems to lift him right out of his hunched position, and with more clarity and volume than I’ve ever heard from him before, he declares, “I want to be a human telephone!”

Eric went on to be the lead in our show and now interacts socially with other kids. Acting has helped him build up his confidence and find his voice. And he isn’t alone.

CRE Outreach aims to transform lives one show at a time. From inception to performance, these actors play a major role in all aspects of the production. Inclusivity is the cornerstone of CRE Outreach. Our productions are based on authentic stories and rarely-heard messages, conveyed by the very people who should be sharing them.

CRE Outreach works with three different populations–at-risk youth, military veterans, and the visually impaired–using theater as an empowerment tool. For all participants, stepping into another character allows them to forget about themselves for a while. They feel new emotions, take on new experiences, and live a life which they don’t have the opportunity to live every day.

For blind actors, visual impairment is their common thread, but it’s their will to define their disability which truly binds them. To cement that bond, we introduce each new blind actor to our theater group with an exercise called “The Run.” One by one, each visually impaired actor races from one side of the stage to the other: an experience that they have never had before. Learning to use sound cues, along with textured mats on the floor, the actors break through their fears of movement and learn to navigate the stage independently. They learn to trust themselves and each other. As they run, they realize that the unknown isn’t half as scary as you’d think, when you have a family all around you.

Greg Shane
CRE Outreach
Co-Founder

Breathing, Patience and Keratoconus

7/1/14

Besides hearing from eye care professionals and Discovery Eye Foundation staff, we also think it is important to hear from people with sight threatening eye diseases such as age-related macular degeneration, keratoconus, retinitis pigmentosa, etc. They can share their experiences with others that are newly diagnosed with eye disease, while providing insights to family members, friends and caregivers. What follows is the first of these occasional posts focusing on the experiences and insights gained from vision loss.

“The expression on my optometrist’s face was as if he was giving me a cancer sentence,” Jeanette Hasseman remembers. “I had never heard of keratoconus, but he told me it was an incurable vision disability. He said he was aware of some evolving technology, but he wanted to give me some time to absorb and research the disease.

“When I went back three months later, he told me a about a cross-linking study that was going on not-too-far from here, but I hadn’t fully absorbed all the information I was reading yet,” she recalls. I did not understand — even though it was plainly stated in the information I was looking at — that once you lose some vision, you don’t get it back.

“I kept thinking, ‘OK, this certainly can be fixed,” so instead of getting cross-linking in July, I waited until December. I regret not acting on my doctor’s suggestion of getting in the study in July, because I lost a tremendous amount of vision by December.”

Hasseman was tested and qualified for the clinical trial in December and had epi-on cross-linking in both eyes in January 2013. “The topography scans show the KC progression has been halted,” she says. “I rejoice in that.”

While her vision seemed better shortly after the procedures, she was diagnosed one week after crosslinking with a “gouge” (4 mm corneal abrasion) in her left cornea that resulted in severe hazing. While the severity of the corneal hazing has decreased in the past year, she is waiting to find out if it is permanent. If so, she may need to have a corneal transplant at some point to restore any visual acuity.

A registered nurse, Hasseman finished her BSN degree two years ago at age 54 — just months before she was diagnosed with KC. The native Ohioan has since stopped working as a nurse, and more recently, she had to give up teaching and doing tatting — lace-making — a hobby she had enjoyed for decades.

Hasseman found the National Keratoconus Foundation (NKCF) when she first Googled “kerotoconus.” “KC-Link has been a great blessing,” she says. “I’ve downloaded information; I signed up for KC-Link and asked questions of Catherine [Warren, director of NKCF] and the moderating doctors. I found great support for my own spirit, as well as information on the latest technologies.

“When people ask questions on KC-Link, if I can relate, I answer. Just the other day, someone who was just diagnosed asked, ‘Well, what should I do?’ I wrote: ‘First thing is: Breathe. Second thing is: Ask for information from your eye doctor and ask who is the best corneal specialist in your area who is really good for keratoconus. Most of all: Be patient.’

“It’s really hard to lose your vision. Even in your own heart, you can feel isolated. KC-Link gives you a body of other people who totally understand what you’re thinking, what you’re feeling, what frustrates you. There is so much advice you can get on KC-Link regarding contacts, how to keep eyes moist, how to handle low-light driving, what type of e-reader works best for people with keratoconus — you cannot exhaust the information that is shared; you cannot exhaust the different emotions that are shared.”

Jeanette Hasseman
Keratoconus Advocate

Food for Thought . . .

6/26/14

Can dinner really be delicious medicine for our eyes?

Recent studies have shown compelling evidence that specific nutrients support eye health.* When a vitamin or mineral is given as a supplement, are there the supporting micronutrients and enzymes required for optimal utilization of that supplement by our bodies? Is a nutrient more bioavailable and/or more beneficial to our health as a foodstuff than as a supplement? Are there unintended effects from supplements that are not present when the nutrient is derived from a food source?**

Despite the many thought provoking questions, I personally take supplements as I feel it is difficult to acquire the nutrients strictly through food. Dietary preferences and requirements influence our everyday food choices as well as the quality of food available at our local grocery stores. Thoughtfully designed, well-sourced supplements have been shown to enhance eye health and general well being.
Here are some key nutritional principles which should be kept in mind to maximize the nutrient availability to our eyes and bodies from the foods that we eat:

1. Bioavailability: Vitamins A, D, E and K are fat soluble; the vitamin B-complex and vitamin C are water soluble. Dietary fats aid in the transport of fat soluble vitamins. Of particular importance to eye health are the fat soluble carotenoids in the vitamin A family, lutein and zeaxanthin. Carotenoids are the red, orange and yellow pigments found in fruit and vegetables such as kale, spinach, corn, apricots and orange bell peppers. To maximize their nutritional benefit, combine foods rich in carotenoids with a healthy source of fat such as olive oil, avocados or walnuts. Egg yolk contains the most bioavailable source of lutein and zeaxanthin and is preferentially deposited in the macula.

2. Nutrient Synergy: Nutrient synergy is the interaction of two or more nutrients that work together to achieve a greater effect than a single nutrient alone could. Foods have a vast array of micronutrients. We know that spinach contains a high level of lutein; however, we don’t know precisely how all the nutrients in spinach work together to promote eye health. Epidemiological studies show people who eat spinach have a lower risk for developing Age-related Macular Degeneration (AMD). Levels of lutein and zeaxanthin in the macula can be measured and low levels are a predictor for the risk of developing AMD.

3. Growing and Feeding Practices: The growing and feeding practices of the agriculture industry affect the nutrient profile and nutrient density of our food. Grass-fed versus corn-based animal husbandry, and wild versus farm-raised fish, alters the fatty acid profile. The amount of omega-3 fatty acids found in eggs varies depending upon the chicken’s diet. Ketchup from organically grown tomatoes contains nearly 50% more lycopene than from conventionally grown tomatoes. Choose quality ingredients whenever possible.

4. Cooking Techniques: Steaming, sautéing or pureeing will break down the plant cell walls increasing the body’s access to the lutein found in dark leafy greens. Cooking tomatoes will increase the availability of lycopene. Heat, however, diminishes the amount of vitamin C present. To maximize lutein and vitamin C, consume both fresh and cooked vegetable sources. Excessive heat and lengthy cooking times diminish vitamin content (mineral content will remain intact, however).

5. Whole Foods: Whole foods have benefits such as soluble and insoluble fiber which help to regulate blood sugar. Foods high in fiber have been shown to decrease total cholesterol, triglycerides and VLDL levels. Fiber supports gut health which is integral to nutrient absorption.

6. Select Eye Nutrient Dense Foods: Studies have highlighted lutein+zeaxanthin, the omega-3 fatty acids balanced with omega-6 fatty acids, the vitamin A family, the antioxidant vitamins C and E, as well as the mineral zinc. There a number of other nutrients that play a role in eye health including B vitamins, selenium and other plant based antioxidants. Knowing the food sources of these important nutrients will help you to make better food choices for eye health.

How does this sound for dinner tonight? Grilled wild salmon on a bed of lightly sautéed spinach with caramelized onions!

* AREDS 1, 2; LAST: Lutein Antioxidant Supplement Trial; ZVF: Zeaxanthin and Visual Function
** CARET: Carotene and Retinal Efficacy Trial

Sandra Young, OD
Author of the award winning Visionary Kitchen: A Cookbook for Eye Health
www.visionarykitchen.com

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