Silent Thief of Sight – Glaucoma

January is National Glaucoma Awareness Month. The National Eye Institute, through their education program NEHEP, have created this infographic to provide you with information you need to know about this blinding eye disease.

When adults reach their 40s, they often begin to notice small changes in their vision that can affect their daily lives and jobs. It could be difficulty in reading a book or working on a computer. This can be annoying, but it can often be addressed by seeing an eye care professional for comprehensive dilated eye exam. This allows the doctor to detect diseases and conditions that can cause vision loss and blindness and yet have no symptoms in their early stages.

Silent Thief of Sight – Glaucoma

Glaucoma is one of these age-related eye diseases that has no early symptoms, which is why it is called the silent thief of sight. It is actually a group of diseases that can damage the eye’s optic nerve and result in vision loss and blindness. Open-angle glaucoma is the most common form disease.

In addition to an eye exam, you can reduce your chances of losing your vision to glaucoma by also:

  1. Live a healthy lifestyle that includes maintaining a proper weight, eating healthy foods, and not smoking.
  2. Know your family history to determine if you are at a higher risk for some eye diseases.
  3. Protect your eyes against harmful UV rays from the sun or your computer by wearing sunglasses when you are outdoors or computer glasses when using the computer for extended periods of time.
Silent thief of sight glacoma
Courtesy of NEI/NEHEP

1/5/16


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Diabetic Eye Diseases

November is National Diabetes Month. Diabetes is a controllable condition that is growing in the US. In adults 20 and older more than one in 10 people have diabetes, while in seniors (65 and older) that number increases to more than one in four.

Diabetic Eye Diseases

One of the eye diseases that can result from diabetes is diabetic retinopathy, which will affect approximately 11 million people by 2030. Check the infographic below to learn more about diabetic eye diseases.

diabetic eye diseases

11/3/15

NEI LogoCourtesy of the National Eye Institute (NEI), a part of NIH.

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.
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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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).

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  • 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.

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  • 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.

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  • 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 DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

What You Need to Know About AMD

Age-related macular degeneration (AMD) is the leading cause of vision loss in people over 60. And as we continue to live longer, our chances of being affected, either by being diagnosed, or being a caregiver for someone close who is diagnosed, increases considerably. This infographic from the National Eye Institute clearly defines who is at risk, what the risk factors are and how to reduce your risk – what you need to know about AMD.

need to know about amd

9/3/15

NEI Logo

 

National Eye Institute
National Institute of Health

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.  

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