Vision Loss and Depression

On Tuesday, September 29, 2015, the National Eye Institute (NEI) hosted a Twitter chat on vision loss and depression. Here are some highlights of that discussion, along with some great resources to learn more about dealing with vision loss and depression.

Many studies show that people with vision loss or low vision are at risk for depression, although not everyone with vision loss gets depressed.

A person with low vision is defined as someone who finds it difficult to do daily tasks even with regular glasses, contacts, medications or surgery.

The number of Americans with low vision will increase over 70% by 2030. Broken down by ethnicity, African Americans with low vision will increase 93% and Hispanics with low vision will increase 190% during the same period. This is due to the rapidly aging Boomer population. 88% of Americans with low vision are age 65 and older.

Symptoms of depression include persistent feelings of sadness, anxiety, irritability and fatigue. It is a common and serious illness that interferes with daily life. Each year, about 6.7% of American adults experience major depressive disorder. Women and men experience depression differently, with women 70% more likely to experience depression than men.

People 65 and older are at particular risk for developing serious depression related to vision loss and yet it is often underdiagnosed and undertreated. Older adults may have other, less obvious symptoms of depression or they may not be willing to talk about their feelings. Many overlooked because sadness is not their main symptom. It is important to remember that while depression is a common problem among older adults, it is not a normal part of aging.

An estimated 29-58% of those who suffer significant vision loss have major depressive disorder one year later. People with vision loss are 2x more likely to be depressed than someone without vision loss. Depression can be very disabling and may reduce the effectiveness of low vision rehabilitation interventions.

A recent study confirmed age-related macular degeneration (AMD) is a big contributor to depression risk, as it accounts for about 45% of low vision cases.

Older adults w/ vision loss are also 3X more likely to report difficulty in 1) walking, 2) managing medications, and 3) preparing meals. In fact about 39% of people with severe vision loss experience activities of daily living ADL limitations, compared to 7% of those with better vision. ADLs include eating, bathing, dressing, toileting, walking and continence.

A link between depression and vision loss was also found in people as young as 20 according to a recent study. It looked at over 10,000 adults in the US and found they were approximately 2x more likely to be depressed.

A decline in vision can also be associated with lower emotional, physical, and social functioning. To help those with low vision avoid depression it is important that they remain active and engaged in the world around them. And while people may become depressed because of vision loss, other causes of depression may also be present.

An integrated approach to depression management in older adults with impaired vision may be the best course of action. Behavioral activation helps people recognize that loss of the activities they enjoyed that have led to depression and encourages them to find ways to re-engage with these activities. After 4 months, behavioral activation reduced the risk of depression by 50% compared to the control group. Behavioral activation can be used alone, or as part of psychotherapy called cognitive-behavioral therapy (CBT).

Cognitive behavioral therapy (CBT) helps people with depression restructure negative thought patterns and to correct distorted thinking that is often part of depression. But it is important to remember that the best approach to treating depression is to personalize it for each individual.

Often, the combination of pharmacotherapy and psychotherapy is a very effective option for depression treatment. Other time-limited psychotherapies, including interpersonal therapy (IPT) are effective in treating depression in people of all ages.

Collaboration between eye care and mental health professionals can help people with vision loss improve their quality of life.

Resources
Understanding depression

How to live with low vision

Living with Low vision – How you can help webinar

Update on depression and AMD

Association of vison loss and depression in those over 20

Sadness impairs color perception

Rehab helps prevent depression from age-related vision loss

10/6/15

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Using Andragogy to Help People with AMD

Adults and children do not learn in the same way. The concept of “andragogy” was widely introduced to the world of educational theory by Malcolm Knowles, PhD, in the latter part of the 20th century. He contrasted “pedagogy,” which is generally used to describe the method or practice of teaching — and comes from the Greek for “child learning” — with the practice of “andragogy,” which applies specifically to adult learning. While Knowles did not invent the term, he advanced the argument that andragogy should be very different from pedagogy.

Maureen Duffy, CVRT, LVT, an editor for Journal of Visual Impairment & Blindness, a writer and blog editor for VisionAware, and author of Making Life More Livable: Simple Adaptations for Living at Home After Vision Loss, relies heavily on andragogy in her work with vision-impaired adults. Loved ones — especially adult children of older people — have a tendency to push care and “help” on grown-ups as if they were children, she says. Not surprisingly, this method seldom works.

Using Andragogy to Help People with AMD

From her work as a certified vision-rehabilitation therapist (CVRT) and low-vision therapist (LVT), Duffy calls out three concepts of andragogy to keep in mind when trying to help an adult who is coping with vision loss:

1. Adults have life experience.
Children don’t have a lot of life experience. And while adults have an incredible amount of life experience, we don’t always treat them as if they do. They already know how to problem-solve. If they have been cooking for their entire lives, they don’t need to learn to learn how to cook all over again; they just need to make adaptations.

“We treat adults as if they have to forget everything they’ve learned, and try to teach them something new,” Duffy says. “That doesn’t usually work. I say, ‘Show me how you’ve always done this. There’s probably just a little adaptation you need to make, and you can keep doing things the way you’ve always done them.’ You can’t just go in, and tell someone you’re going to change everything they do. Just figure out an adaptation.”

2. Adults are reactive learners.
Children are ready to learn when they are told they are ready to learn: We send them to school, and they know it’s time to learn. Adults are ready to learn when they decide they need to know or do something to improve their daily lives — not before. You cannot make an adult learn until they are ready to learn. That’s a big difference.

“Adults tend not to say, ‘I’m going to learn this now because I might need it later.’ They say, ‘I have this problem right now; I need to learn this thing right now,’” Duffy says. “It’s common for family members to tell a person with macular degeneration, ‘You need to learn braille in preparation for when you go blind in the future.’ That’s not true. They can read larger and larger print for as long as they are able to do so. It creates additional anxiety to tell an adult they have to start now to prepare for when they can’t see. You can’t prepare for that. It’s a process, and you make changes as you go.”

3. Adults are self-directed.
Adults want to be independent and determine, for themselves, what it is they need to learn. And that won’t necessarily match what family members think or want.

“Adults will decide what they want to learn, usually based on a hierarchy of needs and what they really need to know now,” Duffy says. “That hierarchy starts with survival needs: making food, getting food, reading medications, etc. And the only way to know what an adult wants and needs to learn is to ask them.”

At the heart of andragogy, it seems, is respect for the fact that an adult is an adult — and should be treated as such. “Andragogy is more focused on teaching problem-solving skills, which can be used over and over again by the adult in a variety of situations,” Duffy says.

Another difference between the way children and adults learn is the need for adults to maintain a sense of autonomy, points out Judi Delgado, director of the Macular Degeneration Partnership (MDP). “People with AMD may need to adjust the way they do some things, but they can still do them,” she says. “It doesn’t help them if others try to take over or do things for them. It’s important to understand that the person is already losing so much; if loved ones try to take over their lives, it just adds to the loss of independence.”

9/10/15

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

3 Tips for Caregivers Helping People With Low Vision

Receiving a diagnosis of age-related macular degeneration (AMD), diabetic retinopathy or glaucoma can be a shock. Loved ones naturally want to help, but they don’t always know what to do or how to do it. Here are 3 tips for caregivers helping people with low vision.

We asked vision-rehabilitation expert Maureen Duffy, CVRT, for advice. She suggests turning to local low-vision agencies, trained low-vision professionals and online resources, such as the Macular Degeneration Partnership and the VisionAware services guide. Perhaps most importantly, she says, look for a support group.

“I have found that most adults with whom I’ve worked turn to their peers, and they get the most guidance and help in vision-loss support groups,” says Duffy, an editor for Journal of Visual Impairment & Blindness, a writer and blog editor for VisionAware, and author of Making Life More Livable: Simple Adaptations for Living at Home After Vision Loss.

Duffy shared the three most important things to ask a loved one after they find out they have AMD:

1. What do you understand about what the doctor said and about what’s going on with your vision? What don’t you understand? What do we need to clear up?
If they don’t understand completely, ask if you can go to doctor with them to be a note-taker and information-gatherer. Ask the doctor for explanations. Be clear and concrete about the information you need — and ask the doctor for next steps.

The Macular Degeneration Partnership website has a downloadable list of questions to take along, as well as suggestions on how to be an advocate during a visit to the doctor on its “Be an Advocate” page.

2. What is the one thing you are most afraid of RIGHT NOW?
At first, their biggest fear is of going totally blind: “I won’t be able to do anything; I’ll be all alone; I’ll be totally helpless.” With AMD, they won’t go totally blind, and they can learn to make the most of their peripheral vision. There are services that can help, but it’s tough in the beginning: Go slowly.

Vision-rehabilitation services can help teach them to function safely and independently in critical day-today activities, such as:

• Independent movement and travel:

getting around indoors
walking with a guide
using a long white cane
crossing streets
using public transportation
using electronic travel devices

• Independent living and personal management:

preparing meals
managing money
labeling medications
making home repairs
enjoying crafts and hobbies
shopping

• Communication and technology:

telling time with an adapted clock or watch
signing their name
using tablets and smartphones
using computers with speech or screen magnification
learning braille

3. What is the ONE thing you are most afraid you can’t do?
Don’t start talking about everything that may need to go on; it’s just too much and is overwhelming. Start with the one thing. “I can’t aim for the toilet”; “I can’t keep food on the fork”; “I can’t make my coffee in the morning.” Help them find solutions for simple things. Figure out alternatives. That little bit of accomplishment encourages self-analysis.

“Many people have difficulty telling currency bills apart,” Duffy says. She shares a simple, effective way to do this by folding each bill differently:

Keep the $1 bill flat and unfolded.
Fold the $5 bill in half crosswise (with the short ends together).
Fold the $10 bill in half lengthwise (with the long sides together).
Fold the $20 bill like a $10 bill lengthwise, and then in half again crosswise, like the $5 bill.

It’s important to remember that no matter how much you may want to help, your loved one may not be ready to accept assistance. Pushing too much too soon isn’t helpful. Once you ascertain that your loved one is ready to be receptive, offer your help gently, slowly and with empathy.

9/8/15

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

Print and Web Design for Older Adults

How to Design for Older Adults

Reading the small print can be very challenging as you age. Your eyes lose their elasticity due to a hardening of the lens inside your eye. This condition is called presbyopia and begins to affect many people after the age of 40, continuing to advance as you age. Readers glasses or a single prescription is no longer the best solution. You may find that you need one pair of eyeglasses for reading a book that you hold in your lap, while a different strength may be needed to use a computer at your desk, because it is further away. But it is not just the font size that can affect how easily you can read. Font shape, spacing and color all contribute to readability. Here are some helpful hints if you are producing printed materials for people over 40.

Print Size
Ideal size will vary depending on the font you choose as not all fonts are the same size. A 14 point type size in New Times Roman is smaller than a 14 point Verdana font. Therefore smaller fonts should not be less than 14 points and you may find they are easier to read at 16 points.

Font Type
Decorative fonts are difficult to read and should be used sparingly. For the body of text stick to a regular font that is bolder, with thick lines that are more legible.

Some people prefer a serif font, such as Times New Roman, as they say it is easier to read because of the “tails” at the end of the letters that create an illusionary line, helping to guide the eye along the line. However, others prefer a sans serif font, such as Ariel. It can be easier to read because of the simplicity of the lines. It is a personal choice.

Regardless of the font you select, use both upper and lower case letters in your body text. All capitals letters can be difficult to read. Save them for headlines or to emphasize a word or two.

Avoid using italicized text as the letters appear squeezed together, increasing the reading difficulty.

Presentation Style
Allow for white space as it provides natural places for the eyes to relax and can help you focus on what you are reading.

Align text to the left, as it is easier to read. And don’t wrap text around graphics.

Keep normal spacing between letters, neither expanding nor condensing them which make it more difficult to read the words. Space lines of text at 1.5 instead of single space, to make the lines of text much easier to follow.

Contrast & Color
As you get older, yellow, blue and green become increasing difficult to differentiate from each other if they are used in close proximity to each other, especially if you have cataracts. Yellow can almost disappear.

To make it easier for reading, stick with very dark type on a white background. Avoid patterned backgrounds.

Avoid using very glossy paper as it creates glare that can make reading hard. Also make sure your paper is thick enough so print form the other side of the page cannot be seen.

Websites & Blogs
Most of the rules listed above for printed materials also apply to websites and blogs (expect the glossy paper rule). But here are a few additional suggestions for online communications.

Use design templates that are one column (or one and a sidebar) to make it easier read. This is especially true for viewing on mobile devices, even if your web design is mobile responsive.

Allow enough space around clickable items, such as word links and buttons, so they are easy to target and click separately. Make sure the linked text is clearly defined with a color that is easy to differentiate for the surrounding text. Bright royal blue is the most common color used.

Provide a space between paragraphs.

Online a sans serif font is much easier to read, but keep the size at 12 -14 points. Ariel is common font, but Tahoma and Verdana are often used and were specifically designed for online usage. Verdana is a naturally large font, so a 12 point can work well.

Offer a feature where you can easily change the size of the font directly from the screen. An example is the Discovery Eye Foundation site where the control is located at the top right of the page. You can even offer on-screen contrast settings like on the Macular Degeneration Partnership page, at the top center of the page.

Avoid layering shades of the same color, such as dark blue type on a light blue background. Also avoid layering colors that clash such as red type in a purple block. These make reading the text more difficult.

These are just a few of the ways to make text easier to read, both in print and online. Do you have any other tips to share below in the comments?

7/28/15

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Toric Intraocular Lenses after Cataract Surgery

Toric Intraocular Lenses for Post-Transplant Astigmatism

Corneal transplants can be very successful at replacing diseased or damaged corneas. However, vision after a corneal transplant is often limited by high amounts of astigmatism. Treating this astigmatism is often difficult. Typically the amount of astigmatism is higher than can be corrected with glasses. Rigid contact lenses are often required. LASIK, PRK and astigmatic incisions in the cornea (astigmatic keratotomy) have all been tried with varying success.

This month, doctors at the Gavin Herbert Eye Institute at the University of California, Irvine, published a paper describing the use of commercially available, FDA approved toric (astigmatism correcting) intraocular lenses (IOL) during cataract surgery in patients with previous corneal transplant surgery.

Good candidates for this procedure are those who have had all transplant sutures removed and had corneal astigmatism that was stable, and for the most part symmetric and regular. (Image 1A shows topography that is both regular and symmetric. Image 1B is regular but not symmetric and image 1C is irregular.)

The study showed improvement in uncorrected vision (post-treatment average 20/40) and vision corrected with glasses only (post-treatment average 20/25). The images below, 1D and 1F, illustrate how toric intraocular lenses are positioned along the axis of corneal astigmatism.

While any intraocular surgery after corneal transplant can decrease the life expectancy of the graft, no complications or graft failures were seen during the course of the study. Not all types of astigmatism can be treated with this procedure.

This study highlights an effective treatment for regular symmetric corneal astigmatism after corneal transplant in patients needing cataract surgery.

7/24/15

Matthew Wade, MD
Assistant Professor of Ophthalmology
Gavin Herbert Eye Institute
University of California, Irvine

Eye Issues For Every Age Recap

Vision is something we take for granted, but when we start to have trouble seeing it is easy to panic. This blog has covered a variety of eye issues for every age, from children through older adults. Here are a few articles from leading doctors and specialists that you may have missed and might be of interest.

Bill Takeshita, OD, FAAO – Visual Aids and Techniques When Traveling

Michelle Moore, CHHC – The Best Nutrition for Older Adults

Arthur B. Epstein, OD, FAAO – Understanding and Treating Corneal Scratches and Abrasions

The National Eye Health Education Program (NEHEP) – Low Vision Awareness
Maintaining Healthy Vision

Sandra Young, OD – GMO and the Nutritional Content of Food

S. Barry Eiden, OD, FAAO – Selecting Your Best Vision Correction Options

Suber S. Huang, MD, MBA – It’s All About ME – What to Know About Macular Edema

Jun Lin, MD, PhD and James Tsai, MD, MBA – The Optic Nerve And Its Visual Link To The Brain

Ronald N. Gaster, MD FACS – Do You Have a Pterygium?

Anthony B. Nesburn, MD, FACS – Three Generations of Saving Vision

Chantal Boisvert, OD, MD – Vision and Special Needs Children

Judith Delgado – Driving and Age-Related Macular Degeneration

David L. Kading OD, FAAO and Charissa Young – Itchy Eyes? It Must Be Allergy Season

Lauren Hauptman – Traveling With Low Or No Vision / Must Love Dogs, Traveling with Guide Dogs / Coping With Retinitis Pigmentosa

Kate Steit – Living Well With Low Vision Online Courses

Bezalel Schendowich, OD – What Are Scleral Contact Lenses?

In addition here are few other topics you might find of interest, including some infographics and delicious recipes.

Pupils Respond to More Than Light

Watery, Red, Itchy Eyes

10 Tips for Healthy Eyes (infographic)

The Need For Medical Research Funding

Protective Eyewear for Home, Garden & Sports

7 Spring Fruits and Vegetables (with some great recipes)

6 Ways Women Can Stop Vision Loss

6 Signs of Eye Disease (infographic)

Do I Need Vision Insurance?

How to Help a Blind or Visually Impaired Person with Mobility

Your Comprehensive Eye Exam (infographic)

Famous People with Vision Loss – Part I

Famous People with Vision Loss – Part II

Development of Eyeglasses Timeline (infographic)

What eye topics do you want to learn about? Please let us know in the comments section below.

7/21/15

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Driving With Vision Loss

Challenges Faced by Individuals Driving With Vision Loss

Overview
People of all ages often view driving as the key to independence. Individuals with vision loss are no exception. Three groups of people with vision loss who wish to acquire or maintain the privilege of driving include teenagers with a congenital or acquired visual impairment who have never driven, adults with the same who have never driven, and adults with an acquired visual impairment who have driven in the past but may lose their license because of their vision loss. However, vision standards for driving vary from state to state, and this variation persists despite decades of research demonstrating that there is no absolute cutoff criteria in visual acuity or peripheral vision for safe versus unsafe driving. The fact that states have variable standards results in people with visual impairments not being able to be licensed in some states, including perhaps their own, while being able to be licensed in a neighboring state. Clearly, the ability of these individuals to safely operate a motor vehicle does not change when they cross a state line. Yet, to maintain at least some driving privileges, they may find themselves having to move to a different state.

It is well known that many older drivers modify their driving norms to help keep themselves and others safe. For example, many older drivers voluntarily reduce or stop driving at night, in hazardous weather conditions, or on super highways. By limiting their driving, older drivers, particularly those with visual impairments, are able to continue operating their automobiles safely and efficiently in spite of reduced vision. This is important, considering the vast majority of older adults live in the suburbs or in rural areas where automobiles are required for transportation.

Maximizing Visual Capabilities
It is important for all individuals, but particularly for drivers who are visually impaired, to make sure their spectacle correction is up-to-date. Contrast enhancement and glare control with filtering lenses can also be of great benefit. Most drivers have experienced driving into the glare of the sun, while looking through a dirty windshield. Although wearing sunglasses and keeping windshields clean is not mandatory, they certainly help drivers see more easily and feel more comfortable when driving.

Maximizing Visual Attention
Human factors research has found that inattention blindness and the cost of switching contribute to or directly cause automobile mishaps. Inattention blindness refers to when a person’s attention to one activity undermines his or her attention to other activities. For example, when drivers focus on directional signs, their attention is not on what is happening on the road in front of them. The cost of switching refers to the time it takes a person to switch attention between different activities. A common example that causes driving mishaps is when drivers text while driving. When people focus on texting while driving, their response to the traffic around them is delayed.

Useful Field of View testing research has shown that the time it takes a person to process visual information, especially the complicated visual environment experienced each time a person drives, increases with age. With this in mind, decreasing or eliminating the time it takes older drivers or drivers with visual impairments to look for and visually process signage should help them maintain their concentration on the road ahead and the traffic around them.

A simple way to reduce or eliminate the need to look for directional signage is with the use of a Global Positioning System (GPS) device that uses spoken directions. Older drivers and drivers with visual impairments in particular should consider using a GPS device with spoken directions so that they are freed from the distraction of looking for/at road signs and can keep their attention on the traffic around them.

Finally, with the technology, such as adaptive cruise control and lane alert warnings, currently available in cars, it is expected that all drivers will be safer behind the wheel.

Final Considerations
A good driver is someone who has the ability to perceive change in a rapidly changing environment; the mental ability to judge and react to this information quickly and appropriately; and the motor ability to execute these decisions, along with the compensatory skills to compensate for some loss of ability in the other areas. Additionally, a driver’s familiarity with the driving environment and his or her past driving record should be taken into account when considering limiting driving activities or retiring from driving altogether.

For many drivers with vision loss, a limited driver’s license that allows them to drive during daylight hours, within a restricted radius of their home, and at lower rates of speed may be all they desire. However, there are times when an individual will need to retire from driving altogether because of vision loss or a combination of vision and cognitive changes. When this time comes, the individual needs to understand that retiring from driving is for his or her safety and the safety of others.

Finally, it is well known that vision loss in general, as well as the loss of driving privileges, can lead to feelings of hopelessness and depression. Fortunately, there are many things that can enhance the functional abilities of individuals with vision loss. To learn about available resources for individuals with vision loss, visit the National Eye Health Education Program low vision program page at www.nei.nih.gov/nehep/programs/lowvision.

7/9/15

Mark Wilkinson, OD
University of Iowa Carver College of Medicine
Chair of the National Eye Health Education Program Low Vision Subcommittee

LA Story – A Life of Vision and AMD

Growing up in Los Angeles, Leah Bernstein always loved movies and made it her goal to work in the entertainment industry. She took typing, shorthand and bookkeeping in school, and when she was turned 16, her sister’s friend got her a job working from 5 pm to midnight at MGM Studios.

“I remember Judy Garland and Mickey Rooney playing outside the window, and Katharine Hepburn was always trying to get me to play tennis,” recalls Bernstein, now 93 years old.

“I made enough money at MGM to go to Woodbury’s Business College and become an executive secretary,” she says. She spent the rest of her career working with entertainment-industry executives, including Irving Fein, who managed Jack Benny; renowned animator Ralph Bakshi; and producer/director Stanley Kramer, who was best known for The Defiant Ones, Judgment at Nuremberg, Guess Who’s Coming to Dinner and It’s a Mad, Mad, Mad, Mad World. She worked with Kramer on 28 films, counting luminaries such as Sidney Poitier, Bobby Darin and Vivien Leigh among her friends, before she retired at age 69.

Vision and AMD

Since then, Bernstein spends time with her eight great-great nieces and nephews and has been a dedicated volunteer for organizations such as Cedars-Sinai Medical Center, the Los Angeles County Museum of Art and the Beverly Hills Public Library, where she regularly attends the Macular Degeneration Partnership’s monthly support group.

“I go to the meetings every month; I like to hear what other people are going through,” she says. “Mostly, though, I love hearing about the latest research. I would like to improve my eyesight, and I’m hoping they will come up with eye drops for my dry eyes.”

Bernstein started wearing glasses in her early 40s, and since being diagnosed with age-related macular degeneration, she’s had cataract surgery in both eyes. “That didn’t help, but I do take the vitamins given to me by my retina doctor twice a day. I’m hoping those might be keeping my macular degeneration from getting worse,” she says.

She’s given up driving and now lives in an assisted-living facility, where she really hates the food. She has a little computer “for looking things up,” and she gets by with two pairs of glasses and a magnifier for reading.

“I wish I could read better. I really wish my eyes were better,” Bernstein says. “I do watch television. I see it — not as you see it — but I can see it with my distance glasses. And of course, I watch movies on my DVD player.”

7/7/15

Lauren Hauptman
Lauren Hauptman INK

Vision Recap Of Previous Articles of Interest

Besides the comments that we get, one of the best parts of putting together this blog is the wonderful group of guests who share their expertise and personal stories. I want to thank all of the eye care professionals and friends that have contributed to make this blog a success.

Here is a quick vision recap of some of the articles we had in the past that you may have missed.

Jullia A. Rosdahl, MD, PhD – Coffee and Glaucoma and Taking Control of Glaucoma

David Liao, MD, PhD – What Are A Macular Pucker and Macular Hole?

Kooshay Malek – Being A Blind Artist

Dan Roberts – 15 Things Doctors Might Like Us To Know

Jennifer Villeneuve – Living With KC Isn’t Easy

Daniel D. Esmaili, MD – Posterior Vitreous Detachment

Donna Cole – Living With Dry Age-Related Macular Degeneration

Pouya N. Dayani, MD – Diabetes And The Potential For Diabetic Retinopathy

Robin Heinz Bratslavsky – Adjustments Can Help With Depression

Judith Delgado – Drugs to Treat Dry AMD and Inflammation

Kate Streit – Hadley’s Online Education for the Blind and Visually Impaired

Catherine Warren, RN – Can Keratoconus Progression Be Predicted?

Richard H. Roe, MD, MHS – Uveitis Explained

Sumit (Sam) Garg, MD – Cataract Surgery and Keratoconus

Howard J. Kaplan, MD – Spotlight Text – A New Way to Read

Gerry Trickle – Imagination and KC

In addition to the topics above, here are few more articles that cover a variety of vision issues:

If you have any topics that you would like to read about, please let us know in the comments section below.

6/23/15

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

When Is The Best Time For Cataract Surgery?

As you age, cataracts become a concern prompting the question – when is the best time for cataract surgery?

There are decades worth of old wives tales floating around regarding cataracts that often lead to unnecessary fear and apprehension for many patients. These myths involve concepts such as “ripeness”, having to wear eye patches afterwards, danger in “waiting too long, etc. Just as the techniques of cataract extraction have changed over the decades, so have the indications to proceed to surgery.

Firstly, cataracts are a normal part of the aging process. Patients should not be alarmed if they are told that they are developing cataracts, even as early as their fifties. As we age, the natural clear lens inside the eye becomes progressively harder, darker, and cloudier. This dark, cloudy lens is what is referred to as a cataract. Cataracts develop at different rates for different people, and even between the two eyes of the same person. It typically takes many years for the lens to become cloudy enough to impact the clarity of vision. There are many different types of cataracts depending of what area of the lens becomes cloudy, but the typical cataract related to normal aging results in a relatively uniform cloudiness with a denser central core, and is referred to as “Nuclear Sclerosis”. Other varieties of cataracts tend to grow more quickly, are relatively uncommon, and often result from certain conditions other than typical aging.

Regardless of what type of cataract the patient has, the treatment is the same: cataract extraction with an implant of an intraocular lens. There have been great advances in lens design over the years, and they now result in excellent, stable, predictable vision for the remainder of the patient’s lifetime and do not typically need to be changed once implanted.

Cataracts result in different symptoms that may be more of less relevant to a specific person’s needs, such as:

Glare with bright lights
Difficulty with fine print
Difficulty following the golf or tennis ball
Impairment in night driving
Difficulty with seeing street signs
Seeing the score or small print on the television
Fine visual tasks such as threading a needle, etc.

Although cataract surgery is an incredibly successful procedure with only about a 1-2% risk of complications, it still DOES have some risk. Therefore, cataract surgery should only be undertaken when there is something to gain. In other words, the BENEFITS MUST OUTWEIGH THE RISKS. This means that if your symptoms are mild and are not interfering with your activities of daily living, it is not time to accept the risks of surgery. Once your visual impairment progresses to the point that YOU feel your activities of daily living and enjoyment are impaired, this is the time to proceed to surgery. This threshold is very different between people. Some people feel impaired with vision of 20/25, and others still function within their scope of usual activities until they are 20/100! The best first-step in determining if it is time for your surgery is to get an up-to date refraction. This means a detailed check for new glasses. Often, cataract development will change a person’s glasses prescription, and updating this can improve the visual symptoms for months to years. When a new glasses prescription no longer improves the sight adequately, this is when surgery is indicated.

For the most part, putting off cataract surgery does not impact the final outcome. It will not harm you or your eye to leave the cataract alone until you are ready. There are of course certain exceptions to this rule, such as in Fuchs’ dystrophy, pseudoexfolation, untreated narrow-angle glaucoma, and some others. However, these are relatively rare conditions that your doctor will speak to you about if you have any of these diagnoses.

In summary, the time to proceed to cataract surgery is something that you as the patient determine. YOU assess your lifestyle needs and your vision performance within your scope of activities. When you feel you are impaired in these activities, the benefits will outweigh the risks, and it’s time to take them out. You should not feel any pressure to urgency in this process.

Once you have determined you are ready to have cataract surgery, your surgeon will discuss with you your options for intraocular lens implantation including astigmatism neutralizing lenses, standard distance or near-vision lenses, multiple focal distance lenses, accommodating lenses, and others. The current standard approach for cataract surgery is called “phacoemulsification” and uses ultrasound technology to remove the cataract. There are also laser devices that assist in making the incisions and breaking up the lens, which many surgeons now employ in addition to the phacoemulsification. In general cataract surgery only takes a few minutes, is performed with topical anesthesia, is pain-free, and has a very short recovery time. No pirate-patches are used these days! Most patients are very happy with the results, but this requires adequate discussion with the surgeon prior to the procedure to best assess the needs of the individual patient. A well- informed patient who participates in their care results in the best outcomes!

6/18/15

Sameh Mosaed, MD
Director of Glaucoma Services, Gavin Herbert Eye Institute, UC Irvine
Associate Professor, Cataract and Glaucoma Surgery, UC Irvine School of Medicine

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