Unleash the Power of Age

5/29/14

Employment Challenges Faced by Older Persons with Visual Impairments

Growth in Number of Older Persons with Vision Loss
May is designated as “Older Americans Month” and last year’s theme “Unleash the Power of Age” seemed an appropriate title for this article with the number of baby boomers who are coming down the pike. In fact, according to the U. S. Bureau of Labor Statistics, the annual growth rate of “boomers” (those 55 and older) is projected to be 4.1 percent, 4 times the rate of growth of the overall labor force. Indeed, the Governmental Accountability Office estimates that by 2015 (just next year!!), older workers will comprise one-fifth of the nation’s workforce.

At the same time, the number of older persons with vision loss are growing dramatically due to age-related eye conditions such as macular degeneration . The 2011 National Health Interview Survey (NHIS) Preliminary Report indicated that an estimated 21.2 million adult Americans (or more than 10% of all adult Americans) reported they either “have trouble” seeing, even when wearing glasses or contact lenses, or that they are blind or unable to see at all. The survey also indicated that 12.2% of Americans 65 to 74 years of age and 15.2% of Americans 75 years of age report having loss of vision. These estimates only include the non-institutionalized civilian population.

Economic Burden of Vision Loss and Aging
According to Prevent Blindness, disorders of the eye and resulting vision loss result in a major economic burden to society, for all ages, but most dramatically with people 65 years of age and older: 77.27 billion of direct and indirect costs . Loss of productivity is estimated to be almost $25 billion for the 65 plus population.

Older People Want to Continue to Work
The loss of productivity costs are of particular concern given the fact that older people, including those with vision loss, want to continue to work. In fact, older persons are staying in the labor market beyond the usual retirement age. This is due to many reasons: people are living longer and often are in good health; because of the downturn in the economy, some need to work beyond the usual retirement age to meet to supplement diminished retirement funds; and some are looking for social engagement through the workplace.

Assets Versus Perceptions
Experienced workers who are older offer many assets to employers such as: an understanding of the expectations of employers; respect for co-workers and supervisors; loyalty; and skills and knowledge based on prior work experience. However, a major dichotomy is occurring in our society regarding older workers: “…companies are struggling with the large numbers of older workers who are retiring, and that the brain drain is a matter of concern to many…While the loss of experienced staff is a challenge that all companies must address, technology has improved the workplace and the work environment by enabling workers of all ages to complete work from other locations…Evidence shows that ageism, stereotypes, and misinformation about mature persons continue to be issues across all segments of society, including the workplace. … studies revealed that the positive perceptions characteristic of older workers held by managers include their experience, knowledge, work habits, attitudes, commitment to quality, loyalty, punctuality, even-temperedness, and respect for authority. These same studies also reveal some negative perceptions held by managers about the mature worker: inflexibility, unwillingness or inability to adapt to new technology, lack of aggression, resistance to change, complacency….. While the results of these findings may appear confusing or contradictory, they clearly focus on the precise and delicate balance between positive and negative perceptions that, depending on the industry or work environment, may affect a manager’s decision to hire, retain or advance an older worker.”

Kathy Martinez, Assistant Secretary of the Office of Disability Employment Policy at the Department of Labor, feels that this dichotomy, as it relates to people with disabilities, will not really change until disability becomes more of an environmental issue than a personal issue and that workplace flexibility is critical in terms of time, place, and task. (“Public Policy and Disability: A Conversation about Impact”, Disability Management Employment Coalition conference, April 1, 2014).

Challenges of Obtaining and Retaining a Job for Older Persons with Vision Loss
In addition to the negative perceptions noted above, older persons who experience vision loss, have additional challenges: learning to live with vision loss, dealing with the workplace to retain or obtain a job, working with a disability including having to learn new skills such as speech access for a computer, getting transportation to and from work (if they keep or land a job), dealing with co-workers and even managers who often don’t know what to say or do. Those persons with low vision or no vision whose medical condition is stabilized and with appropriate reasonable accommodations as assured by the Americans with Disability Act (ADA), can continue to be productive members of the workforce thereby contributing to the profitability of the business and to their quality of life.

An informal review of the latest available data submitted by public vocational rehabilitation agencies indicates the following: In 2011, there were 9609 blind and visually impaired individuals who obtained jobs through the vocational rehabilitation agencies; of these 505 (or 5%), were 65 years of age and older. We truly need to “unleash” the power of age in this country!

Resources
These resources listed can help older individuals with vision loss, employers, and professionals working with individuals with vision loss. The American Foundation for the Blind (AFB) hosts a family of web sites with information that can help older persons with adjusting to and living with vision loss, information on how to find and apply for jobs, adaptations to the work environment and assistive technology and workplace accommodations, and mentors who are blind or visually impaired and are willing to assist others with career choices. These sites can help individuals interested in working or retaining employment as well as employers seeking to know what to do. AFB has a directory of services for each state, which includes state vocational rehabilitation agencies charged with helping people with vision loss with the adjustment and career needs.

AFB Links
Information related to living with vision loss:
Visionaware.org/gettingstarted
Information about working:
Visionaware.org/work
AFB.org/careerconnect
Data base on how to find public and private agencies:
AFB.org/directory
Online courses including “Employment of Older Persons”, technology, etc. (for professionals):
Elearn.afb.org

Other Resources
Department of Labor funded Job Accommodations Network
http://askjan.org/
JAN provides consultation to employers and job seekers about the wide range of accommodations which can help to select the appropriate technology and job restructuring accommodations.
Department of Labor Office of Disability Policy
http://www.dol.gov/odep/topics/OlderWorkers.htm
Section on research and reports on employment of older workers.

Gil Johnson
Contributing author to VisionAware ™
American Foundation for the Blind

Beyond Eating Green

Spinach and kale aren’t the only things to watch in your diet. Eating low glycemic foods may slow the development and progression of AMD. The glycemic index measures how quickly carbohydrates get glucose (sugar) into the blood stream. People with diabetes will find this familiar. High glycemic foods like potatoes, white rice, processed foods like cakes and crackers and cereal raise the blood glucose level. Low glycemic foods include vegetables and beans.

Several years ago researchers at Tufts University found that mice fed a low glycemic diet developed fewer and less severe age-related lesions in the retina than mice fed the higher GI diet. When lesions like this develop after age 60 in humans, they are the earliest warning sign of age-related macular degeneration. Earlier studies in humans resulted in similar observations.

*Here are some tips from Harvard University for low-glycemic eating.

1. Eat a lot of non-starchy vegetables, beans, and fruits such as apples, pears, peaches, and berries. Even tropical fruits like bananas, mangoes, and papayas tend to have a lower glycemic index than typical desserts.

2. Eat grains in the least-processed state possible: “unbroken,” such as whole-kernel bread, brown rice, and whole barley, millet, and wheat berries; or traditionally processed, such as stone-ground bread, steel-cut oats, and natural granola or muesli breakfast cereals.

3. Limit white potatoes and refined-grain products, such as white breads and white pasta, to small side dishes.

4. Limit concentrated sweets – including high-calorie foods with a low glycemic index, such as ice cream – to occasional treats. Reduce fruit juice to no more than one-half cup a day. Completely eliminate sugar-sweetened drinks.

5. Eat a healthful type of protein, such as beans, fish, or skinless chicken, at most meals.

6. Choose foods with healthful fats, such as olive oil, nuts (almonds, walnuts, pecans), and avocados, but stick to moderate amounts. Limit saturated fats from dairy and other animal products. Completely eliminate partially hydrogenated fats (trans fats), which are in fast food and many packaged foods.

7. Have three meals and one or two snacks each day, and don’t skip breakfast.

8. Eat slowly and stop when full.

*Adapted from Ending the Food Fight, by David Ludwig with Suzanne Rostler (Houghton Mifflin, 2008)

Judith Delgado
Executive Director
Macular Degeneration Partnership

When You See Things That Aren’t There

5/8/14

Charles Bonnet Syndrome

“Do you ever see anything you know is not there but looks real anyway?” I asked Sam Weinberg when he came to the Low Vision Living program.

“No.” he said, looking at his wife, Rachel, and fidgeting with his sweater.

“Oh”, I said casually, “I just asked because many people with macular degeneration see things they know are not there. I call it phantom vision, but the technical term is Charles Bonnet Syndrome.”

“Is this syndrome an early sign of Alzheimer’s?” Sam asked pointedly, still looking at Rachel. . .

“Absolutely not”, I said firmly. “Charles Bonnet Syndrome has nothing to do with mental agility or stability. When you have phantom vision, your mind is fine; it is your eyes that are playing tricks on you. It’s a side effect of low vision.”

“Well,” Sam admitted quickly, “I see little monkeys with red hats and blue coats playing in the front yard. I’ve seem them for eighteen months.”

“What!” Rachel’s eyes about popped out of her head. “Little monkeys in the front yard?”

“Well. . .um,” Sam continued, “sometimes I see them in the living room too.”

What is Charles Bonnet Syndrome (CBS)?
Charles Bonnet was an eighteenth century Swiss naturalist and philosopher. . . who described his grandfather’s curious experience of seeing men, women, birds and buildings that he knew were not there. Later in his life, Bonnet’s own vision deteriorated and he experienced phantom visions similar to his grandfather’s. . . .Charles Bonnet’s discovery didn’t capture medical attention at the time. But 150 years later, in the 1930’s, his files were dusted off, and he was credited with being the first person to describe the syndrome that came to be named for him.

How common is CBS?
This syndrome is very common. Studies place the number somewhere between 10 and 40 percent of people with low vision. Twenty percent of my low vision patients have Charles Bonnet Syndrome. . . To determine whether or not you are experiencing phantom vision: Do the images that appear to you have the following six characteristics?

They occur when you are fully conscious and wide awake, often during broad daylight

They do not deceive you; you are aware that they are not real.

They occur in combination with normal perception. For example, you may see a sidewalk clearly but find it covered with dots, flowers, or faces.

They are exclusively visual and do not appear in combination with any sounds or bizarre sensations.

They appear and disappear without obvious cause.

They are amusing or annoying but not grotesque.

What do people with CBS see?
My patients. . . have reported seeing cartoon characters, flowers in the bathroom sink, hands rubbing each other, waterfalls and mountains, tigers, maple trees in vibrant autumn foliage, yellow polka dots, row houses, a dinner party and brightly colored balloons. . . One of the most remarkable qualities of these figures is that they almost always wear pleasant expressions. . . Menacing behavior, grotesque shapes and scenes of violent conflict are not, to my knowledge, a part of this syndrome.

Usually the same image or set of images reappears to each person. Sam’s monkeys usually materialized around sunset. . .They stayed for 10 or 20 minutes several times a week for two years and then began to appear less frequently. Some times the images change of multiple images appear. . .

Dolly Kowalski’s Little Girls with Pink Bows
‘I see little girls with pink bows playing in my yard. At first, there was only one little girl. But after a while, she had several playmates. Now they come almost every evening for fifteen minutes. . .They are so delightful, so cheerful, so active. Their little white dresses and pink bows blow in the wind. I see them so incredibly clearly, much more clearly than I see anything else now. . . .I know they aren’t real, but you wouldn’t believe how realistic they seem. . . . I wish you could see them the way I do.’”

Further note by Lylas Mogk, MD
Fortunately, most people, like Dolly, find the images of CBS largely untroubling and many actually find them amusing or enjoyable, as they are usually pleasant and they are crystal clear. There is no drug treatment for CBS, but it is associated with sensory deprivation, so the more active and engaged one is the less likely it is to occur. That’s one reason why vision rehabilitation to empower individuals to accomplish their daily activities in spite of vision loss.

Excerpts were used from Macular Degeneration: The Complete Guide to Saving and Maximizing Your Sight, by Lylas G. Mogk, MD and Marja Mogk, PhD, New York: Ballantine Books, 2003, Chapter 8, pp. 236-252.

Lylas G. Mogk, MD
Director, Center for Vision Rehabilitation and Research
Henry Ford Health System

Four Tips For Buying Sunglasses

4/29/14

May will be here this week, and in Southern California we are looking at bright, sun-filled days with temperatures in the upper 80s and low 90s. This means that thousands will be heading to the beaches or their own backyards to enjoy the warm weather.

Now is the perfect time to review one of the biggest contributing factors to vision loss – sun exposure. And it’s not just about sunglasses, but also brimmed hats.

First let’s talk about sunglasses. There are three things to think about when selecting your sunglasses:
1. Lens tint
2. UV protection
3. Glare
4. Frames

Lens Tint
There is a misconception that the darker your sunglass lens, the better protection for your eyes. No true. The color or darkness of your lens is personal preference and often based on the activity you are doing while wearing sunglasses or the sun conditions. At the beach in bright sunlight you are subject to more reflective light and may prefer dark amber, copper or brown lens, if you are on the ski slopes when the skies are overcast you may prefer yellow or orange lens to increase contrast and fight “flat light.” If you are looking to increase contrast on a partially cloudy day, and if you don’t mind distorted color perception, you might prefer amber or rose lenses.

Other considerations include mirrored sun lenses that can block 10-15% more of the sun’s visible rays, or photochromic lenses that darken automatically when you go outside and then quickly become lighter when you come inside.

UV Protection
While darker lenses don’t offer better eye protection, controlling the UV exposure does. Research has found links that extended exposure to UVA and UVB rays can result in eye damage such as cataracts, photokeratitis and macular degeneration. By wearing sunglasses that block these harmful rays your eyes should remain healthier as you age. Also know that some parts of the country receive more UV rays than others – here is a wonderful chart from The Vision Council to let you see how your location rates.

Glare
Another problem when out in the sun, and especially driving, is glare. Making sure your lenses are polarized is a great help. They work by only letting in specific amounts of light at certain angles and reducing the brightness of that light.

Because I am light sensitive I find I use polarized lenses when I am reading outside is helpful. The reflected light from the page of a book can cause me to squint or fatigue my eyes if I read for a long period of time. The only other option is using a paper-ink e-reader which also helps cut down on glare.

Another way to deal with glare is the use of an anti-reflective (AR) coating on your lenses. It reduces eye stain by preventing light from reflecting off lens surfaces. When applied to the back of your lenses it can help with problems when the sun is behind you or to your side.

Frames
Not all light hits your eyes from directly in front. It can come through the top, sides and bottom of your frames. The smaller the frames, the more unfiltered light makes its way to your eyes. This is where a brimmed hat can help keep the sun coming in from the top while also providing protection for your face.

Fitovers - Auroa in Claret — Fitovers – Auroa in Claret

To provide you with the maximum protection, “fit-over” sunglasses, that you can wear over your regular prescription glasses, are a great idea and more economical. Cocoons Eyewear and Fitovers Eyewear are two of several companies that make them. They filter the light from the top, sides and even below to give you the maximum protection and come in a wide variety of lens colors. It is also nice not to have to get new sunglasses when your eyeglass prescription changes.

Whatever frames you choose make sure they fit properly and will not keep sliding down your nose or fall of when being active. You may even want to purchase a band-style foamed neoprene retainer that attaches at both temples, sometimes known as a gator.

Also remember, it is not just the direct sunlight you need to worry about. Water reflects up to 100% of the harmful UV rays, dry sand and concrete up to 25% and even grass reflects up to 3%.

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Following the Rainbow

4/15/14

Last week we reviewed the rainbow of fruits and vegetables you can eat to help with eye health. But you don’t need to limit yourself – enjoy a rainbow of nuts, whole grains and beans as well.

A reason some people avoid nuts is the number of calories found in nuts. However, a report published in the American Journal of Clinical Nutrition found that adults who incorporate nuts into their diets don’t have to limit their consumption. A review of 31 studies about eating nuts found that people who added nuts to their diets and who replaced other foods with nuts lost more weight, an average of almost one and half pounds. Nuts have also been shown to be beneficial for stress reduction, heart health, various cancers, cholesterol, brain health and eye health.

Eating more whole grains makes your diet healthier because they are filled with nutrients including protein, fiber, B vitamins, antioxidants, and trace minerals (iron, zinc, copper, and magnesium). A diet rich in whole grains has been shown to reduce the risk of heart disease, type 2 diabetes, obesity, and some forms of cancer.

Beans, lentils and other nutritious legumes are the best sources of lean vegetarian protein. They made up of high-quality carbohydrates that are rich in fiber, zinc, vitamin B6, folate, magnesium, iron, and potassium. These protein-packed, low-fat nutrients can help with osteoporosis; improve heart-health, colon and bowel health; reduce the risks of cancer and age-related macular degeneration; control blood sugars, fight free radicals and even help with weight loss.

RED

Red adzuki bean

Pinto beans

Kidney beans

Pecans

Buckwheat

Amaranth

Quinoa

Barley

ORANGE/YELLOW

Almonds

Cashews

Millet

Chickpeas
Butter beans

GREEN

Lentils

Mung beans

Pistachios

Pumpkin seeds

Lima beans

Edamame

Sunflower seeds

BLUE/PURPLE

Flaxseeds

Walnuts

Chestnuts

Black beans

Quinoa

Black and wild rice

WHITE

Soy beans

Garbanzo beans

Rice

Barley

Sesame seeds

Navy beans

Oats

Quinoa

To learn more about the benefits of specific nuts, whole grains and beans, go to The World’s Healthiest Foods. The site is filled with nutritional information, history and recipes for a wide variety of foods from around the world.

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Eat A Rainbow

4/8/14

When planning what to eat, think of a rainbow. Eating brightly colored fruits and vegetables helps to give your body the nutrients it needs. These same nutrients are the disease-fighting components that give fruits and vegetables their array of colors.

by Sarah DeRemer - rainbow — by Sarah DeRemer

Eating a variety of colors can help –

Strengthen your immune system

Lower risk for certain cancers

Help ward off type 2 diabetes

Maintain heart heath

Improve memory

Reduce the risk for some eye diseases

Red

The pigments that make some foods red are known as anthocyanins and lycopene. These are the compounds that fight free radicals and prevent oxidative damage to cells, important to preserving eye health, keeping our hearts healthy and helping to fight cancers. Heat concentrates lycopene levels so cooked tomatoes and tomatoe sauces have higher concentrations than raw fruit.

Add red to your meals by tossing a handful of raspberries, strawberries, goji berries or pomegranate seeds into your cereal, slicing roasted beets or red bell pepper into a salad, or adding cooked red adzuki or kidney beans to a rice dish.

Here are examples of red fruits and vegetables:

Red apples

Adzuki beans

Beets

Red cabbage

Cherries

Cranberries

Goji berries

Pink grapefruit

Red grapes

Red peppers

Pomegranates

Red potatoes

Radishes

Raspberries

Rhubarb

Strawberries

Tomatoes

Watermelon

For a recipe filled with lycopene, try a zesty Orange and Tomato Salsa, one of three salsa crudas using brightly colored fruits.

Orange & Yellow

Orange fruits and vegetables contain beta-carotene, a powerful antioxidant that promotes eye health, can delay cognitive aging and protect the skin from sun damage. Beta-carotene also converts to vitamin A, which is important for night vision and the health of your immune system. Orange foods also contain vitamin C, another antioxidant that boost the immune system, but also protects against cardiovascular disease. Yellow fruits and vegetables contain lutein, another nutrient important for healthy vision.

Some of the sources you can enjoy include:

Sweet potatoes

Carrots

Pumpkin

Apricots

Cantaloupes

Summer squash

Citrus fruit

Papayas

Peaches and nectarines

Sweet corn

Yellow peppers

Mangoes

Pineapple

Yellow tomatoes

To incorporate more orange/yellow foods into your diet, replace French fries with crisp, baked sweet potato slices, keep dried apricots, pineapple or mangoes handy for a ready-to-eat snack or add sweet potatoes to black beans or chili for a color and texture boost.

To get your day off to a great start, try an Apricot-Orange Breakfast Smoothie.

Green

Green fruits and vegetables are colored by natural plant pigment called “chlorophyll” and are rich in lutein and zeaxanthin, pigments that may help your eyes filter damaging light rays, thus protecting against macular degeneration, the leading cause of vision loss in people over 65. Green fruits and vegetables are also a good source of vitamins C & K, fiber, folate and magnesium which contain anti-cancer properties as well as helping promote strong bones and teeth.

Some examples of the green group include:

Green apples

Artichokes

Asparagus

Avocados

Green beans

Broccoli

Brussels sprouts

Green cabbage

Cucumbers

Green grapes

Celery

Green Pepper

Honeydew melon

Kiwi

Kale

Lettuce

Limes

Green onions

Peas

Green pepper

Spinach

Zucchini

A delicious way to eat your greens is a Summer-time Asparagus, Strawberry and Spinach Salad.

Blue & Purple

Blue and purple fruits and vegetables are rich anthocyanins, lutein, zeaxanthin, resveratrol and vitamin C. These nutrents help protect cells and heal your body. Research suggests they play active roles in promoting eye and heart health, preventing premature aging, reducing inflammation, decreasing cancer cell growth and improving memory.

Foods such as blueberries, figs, eggplants, plums and grapes get their gorgeous hue from the phytochemical anthocyanin (also found in red foods). Anthocyanins act as powerful antioxidants that protect cells from damage and may help reduce the risk of heart disease, stroke and cancer. Studies have even shown that eating more blueberries is linked with improved memory function and healthy aging.

Be sure to help yourself to plenty of blue/purple foods, such as

Blackberries

Blueberries

Eggplant

Figs

Juneberries

Plums

Prunes

Purple grapes

Raisins

Purple cabbage

Bilberries

Acai berries

Here is another easy yet eye-healthy dish from our Eye Cook webpage, Eggplant and Tomato Pasta .

White

White fruits and vegetables are colored by pigments called anthoxanthins, which may help lower cholesterol and blood pressure. Onions also have the flavonoid quercetin, known for its anti-inflammatory properties and cardiovascular health benefits. As we know, being heart-healthy is also being eye-healthy.

Some members of the white group, such as bananas and potatoes, are also a good source of potassium, while the hard-shelled coconut is considered a “superfood” because its natural water is loaded with vitamins, minerals, and electrolytes, while the raw coconut meat (flesh), which is found around the inside of a coconut shell contains high levels of lauric acid, for helping reduce cholesterol and promoting brain health.
Some examples of the white group include:

Bananas

Cauliflower

Coconut

Garlic

Ginger

Jicama

Mushrooms

Onions

Parsnips

Pears

Potatoes

Radishes

Shallots

Turnips

This recipe for Dark Chocolate Fondue, not only has cream of coconut, but is wonderful when dipping bananas!

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

What Are The Differences In The Immune System of An Age-related Macular Degeneration Patient?

A symposium was held in Bethesda, Maryland at the National Institutes of Health on March 6, 2014. The purpose was to bring together clinicians and researchers from a wide variety of background to discuss the recently discovered differences in the function of the immune system in patients with age-related macular degeneration (AMD) and how it relates to aging. These differences are important to understand because they may lead to new therapeutic approaches to treat people which are high risk for AMD.

Courtesy of National Eye Institute, National Institutes of Health - immune system — Courtesy of National Eye Institute, National Institutes of Health

Three researchers associated with the Discovery Eye Foundation attended the one-day conference. Cristina Kenney, MD, PhD, has worked in the field of AMD for over twelve years and is a leading expert on the genetics and molecular changes in the mitochondria as it related to the retinal cell death associated with AMD.
Lbachir BenMohamed, PhD, is an expert immunologist with a tremendous understanding of how the immune system responds to infections and stress.
Anthony Nesburn, MD, has been involved in AMD research at both the clinical and research levels.

By attending this meeting, all three researchers gained insight into the importance of the immune system with respect to maintaining a healthy retina and slowing the progression of AMD.

The highlights of the meeting were the following:

1. Emily Chew, MD (National Eye Institute) reviewed the clinical aspects of the disease stressing that there are many stages of AMD.

The early stage of AMD is diagnosed based upon the medium-size drusen (about the width of an average human hair) that can be seen underneath the retina. There may not be any visual changes in these patients.

The intermediate stage of AMD is when subjects have larger drusen and some degree of retinal pigment epithelial cell drop out. These patients may not have vision loss or other symptoms.

The late stages of AMD which can be categorized into the dry form (geographic atrophy) which has significant loss of the retinal pigment epithelial cells and overlying photoreceptor cells. Presently there in no treatment for this type of AMD.

These individuals can have changes that cause decreased vision. The second form of late AMD is the wet form (neovascular), which has growth of abnormal blood vessels beneath the retina that can cause significant loss of vision. The treatments for this type of AMD are anti-VEGF medications that block the growth of these vessels and help maintain good visual acuity.

2. Anand Swaroop, PhD (National Eye Institute) reviewed the genetics of AMD and summarized the work of numerous laboratories. It is now recognized that there are over 20 different genes associated with AMD. These genes fall into the categories of those involved with Complement Activation, Cholesterol Pathway, Angiogenesis, Extracellular Matrix and Signaling Pathways. Many of these genes have additive effects, meaning that if a patient has more than one high risk gene, then the likelihood of developing AMD increases. While we have learned a lot about the genes that are important, we still do not have any gene therapies that can be used to treat AMD.

3. Six different speakers presented their data related to animal models of AMD and it was agreed that there is not a “perfect” model because most of the animals do not have a macula, the region of the retina that is affected the most by AMD. However, there is still a lot to be learned by using the models that we do have because if we can better understand the basic pathways involved, then we can block or modify the pathways to prevent the damage.

4. Jayakrishna Ambati, PhD (University of Kentucky) presented data showing that there is a deficiency of an enzyme called DICER1 in the retinal pigment epithelial cells which leads to increased activation of inflammation via a protein complex called the inflammasome. He described some of the signaling pathways which are involved in the inflammasome activation. This is important because these pathways can become targets for treatment of the dry form of AMD.

5. Jae Jin Chae, PhD (National Human Genome Research Institute) also talked about the role that inflammation plays in the development of AMD. The data presented reviewed the pathways involved with activation of the inflammasomes which is the first step in a cascade of events that result in inflammatory diseases. They have identified a calcium-sensing receptor (CASR) which triggers the activation of the NLRP3, a key component of the inflammasome. Understanding how this series of events works allows researchers to develop medications to block or interfere with the pathway and therefore decrease the levels of inflammation.

M. Cristina Kenney, MD, PhD
Professor and Director of Ophthalmology Research
School of Medicine, Dept. of Ophthalmology
University of California, Irvine

Low Vision Resources

What to do when “There’s nothing more that can be done.”

“I’m sorry, but there’s nothing more that can be done. There is no cure for your eye condition.”

In your work as healthcare professionals and health educators, it’s likely you’ve encountered a significant number of adults and older adults who have been on the receiving end of this devastating news.

When an eye care provider says, “There’s nothing more that can be done,” what he or she likely means is, “There’s nothing more I can do for you surgically.” But instead of saying, “There’s nothing more that I can do,” the discouraging message delivered to the patient is, “There’s nothing more that can be done.”

Thus, in many cases, the discussion ends there. Patients will either exhaust their resources searching for an elusive cure or become resigned to a life that is restricted and defined by incurable vision loss.

When receiving a diagnosis of vision loss, many adults who have managed to overcome a host of obstacles in their lives may now believe they are facing an obstacle with no viable solution. A natural, and understandable, initial reaction is to focus instead on the devastating losses that are seen as an inevitable accompaniment to blindness and low vision such as:

Loss of independence: “How will I prepare meals, clean my home, or shop? Will I become a burden to my family and friends?”

Loss of confidence and self-worth: “All my life I’ve been physically active and self-reliant. Has my life as an independent person come to an end?”

Loss of privacy: “I won’t be able to handle my finances independently. Will I have to surrender control of my life to someone else?”

Loss of employment: “I’ll have to quit my job. How will I earn a living?”

It’s important to let your clients and patients know that there is indeed hope—and life—after vision loss. A wide range of vision rehabilitation services enable adults who are blind or have low vision to continue living independently. The term “vision rehabilitation” includes highly trained professionals and comprehensive services that can restore function after vision loss, just as physical therapy restores function after a stroke or other injury.

Patient working with a low vision therapist

Vision rehabilitation professionals include:

Low vision therapists, who teach the use of residual vision with optical devices, non-optical devices, and assistive technology, and help determine the need for environmental modifications in the home or workplace.

Vision rehabilitation therapists, who teach adaptive independent living skills that enable adults to perform a wide range of daily activities, including cooking, reading and writing, braille, home repair, personal self-care, financial management, and leisure activities.

Orientation and mobility specialists, who teach safe and independent indoor and outdoor travel skills, including the use of a long cane, electronic travel devices, public transportation, and sighted guide, human guide, and pre-cane skills.

Additional vision rehabilitation services can include:

Peer support and counseling: talking with peers, sharing common concerns and frustrations, and finding solutions to vision-related problems.

Vocational rehabilitation: vocational evaluation and training, job training, job modification and restructuring, and job placement.

Veterans’ services: vision rehabilitation and related support services for blinded veterans of all ages.

There are many resources available to help your patients and clients locate vision rehabilitation services. For example, the VisionAware Directory of Services allows you to browse by state and type of service, including counseling resources, support groups, low vision services, independent living skills, and orientation and mobility. The VisionAware “Getting Started” Kit provides tip sheets on specialized services and products that can assist with everyday life after vision loss.

The National Eye Institute’s National Eye Health Education Program (NEHEP) also has low vision education resources. The video, Living with Low Vision: Stories of Hope and Independence, explains how, as a health professional, you can help your patients make the most of their remaining vision and improve their quality of life by referring them for vision rehabilitation services. Share it with your colleagues, too. You can find additional resources and ideas for promoting vision rehabilitation on the NEHEP Low Vision Program page.

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

Implantable Miniature Telescope Update

The Macular Degeneration Partnership, a program of the Discovery Eye Foundation, has received numerous questions about the implantable miniature telescope (IMT) since it was approved by the FDA in 2010.

The IMT is becoming more widely available now. The IMT is a tiny telescope implanted inside the eye that may benefit older adults with advanced AMD. Smaller than a pea, this device is proven to restore sight and quality of life in eligible candidates. Unfortunately, the inclusion criteria to be eligible for the device are narrow. Most importantly, the IMT can only be implanted into an eye that has not had a cataract removed yet. We encourage you to review the below information to see if you or a loved one might be a candidate for this procedure. Approximately 2 million Americans have advanced forms of AMD, which is the leading cause of blindness in people over the age of 65. When an individual has severe wet macular degeneration, or dry AMD with geographic atrophy, it is sometimes called “end-stage AMD”. Patients with end-stage AMD have a central blind spot or missing area in their vision. But, despite the availability of drug treatments that slow the progression of AMD, the number of people with end-stage AMD is expected to double by the year 2050.

Specifically, the telescope implant uses micro-optical technology to magnify images which would normally be seen in your “straight ahead,” or central, vision. The images are projected onto the healthy portion of the retina not affected by the disease, making it possible for patients to see straight ahead. The procedure is performed on one eye only, and involves removing the eye’s natural lens and replacing it with the tiny telescope implant. This is similar to the surgery performed to remove a cataract, which is a clouding of the natural lens. The other eye remains as is to preserve peripheral vision, which is important for balance and orientation. The surgery is done in an outpatient setting by a specially-trained ophthalmologist called a cornea/cataract surgeon. The telescope implant is FDA approved and available through Medicare.

Although the telescope implant is not a cure for AMD, studies showed that in general patients were able to see 3 to 4 lines better on the eye test chart and demonstrated improved quality of life on the National Eye Institute Visual Functioning Questionnaire. Two multi-year clinical studies enrolled over 225 patients to evaluate the safety and efficacy of the telescope implant used in the CentraSight treatment program. To be considered a candidate for the telescope implant, an ophthalmologist must first confirm that you:

• Have irreversible, End-Stage AMD resulting from either dry or wet AMD
• Are no longer a candidate for drug treatment of your AMD
• Have not had cataract surgery in the eye in which the telescope will be implanted
• Meet age, vision, and cornea health requirements

Some people with end-stage AMD may not be a candidate for a telescope implant. Patients and their physicians will assess if the benefits of the procedure outweigh the potential risks to decide if this treatment option is right for them.

CentraSight is the program that guides people with end-stage AMD through the telescope implant evaluation, surgery and rehabilitation process. While the out-patient procedure is quick, patients also must commit to a comprehensive occupational therapy program to learn how to use their new vision (and way of seeing) in daily life. Click here to watch a video that shows how the implantable telescope works.

“After surgery, one of the most important aspects of the telescope implant procedure is the rehabilitation,” said Dr. Marjan Farid, Associate Clinical Professor of Ophthalmology at the University of California-Irvine School of Medicine. “Specially trained optometrists and occupational therapists work with patients to teach them how to use their new vision because there are different techniques involved when you are sitting still (for example, reading or watching TV) than when you are moving around, such as walking or cooking.”

The CentraSight treatment program is coordinated by retina specialists who treat macular degeneration and other back-of-the-eye disorders. Before deciding to have the surgery, a special vision test is given in the office. A device simulates what a person may expect to see once the telescope is implanted to determine if the potential improvement will meet the patient’s expectations. Once the telescope has been implanted by an eye surgeon, the patient will need to work with vision rehabilitation specialists (approximately 6 to 12 weeks) to learn how to use their new vision in their everyday activities. Risks include all those associated with cataract surgery, such as postoperative inflammation, raised intraocular pressure, corneal swelling, and the potential for comprised corneal health.

“The first patient whom I implanted with this telescope over a year and a half ago states that she can now recognize the faces of her children and grandchildren,” said Dr. Farid. “For patients with AMD, face recognition of loved ones is a major improvement in the overall quality of their life.”

CentraSight treatment centers are available across the nation. Patients can call 1-877-99-SIGHT to find one in their area.

Judith Delgado
Executive Director
Macular Degeneration Partnership

Help DEF Unlock$100,000Matching Gift

Employment Challenges Faced by Older Persons with Visual Impairments

Charles Bonnet Syndrome

Red

Orange & Yellow

Green

Blue & Purple

White

What to do when “There’s nothing more that can be done.”

Help DEF Unlock
$100,000
Matching Gift