AT THE FOREFRONT OF MANAGING AND TREATING AMD

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Follow these optometrists’ leads to become your patients’ go-to source for AMD.

The threshold sensitivity analysis software in Ellex’s MAIA evaluates macular function as compared with a reference database of normal subjects.

If you were to type “macular degeneration” into Google, approximately 1.9 million results would be found. The same search for macular degeneration treatments yields 1.1 million results. This illustrates the incredible wealth of information available with a few keystrokes to all of our patients.

But we optometrists need to be proactive with our patients by making sure they understand what macular degeneration is, what the risk factors are, and how they can take steps to lower their risk. Let them know what your recommendations are, whether it is supplementation, optical coherence tomography (OCT) instrument use, co-management with retinal specialists, or discussion of anti-VEGF treatments. Macular degeneration treatment and management is constantly changing, so we should be our patient’s go-to source for information, not Google.
To help with this discussion, I have asked leaders in our field how they manage age-related macular degeneration (AMD).

SUPPLEMENTATION
According to Jeffrey Anshel, OD, FAAO, president of the Ocular Nutrition Society, “emerging science to support the use of nutrition and

Distributed by Marco, the MacuScope measures MPPD while Macuhealth with LMZ3 has been shown to increase macular pigment to normal levels.

supplements to manage AMD continues to grow. One example is the Carotenoids in Age-Related Eye Disease Study (CAREDS), which evaluated the protective effect of carote-noid compounds against age-related ocular diseases in 1,313 women aged 55 to 74. The women whose diets scored in the highest quintile were 46% less likely to develop AMD than women with dietary scores in the lowest quintile.”

He continues, “we have already heard that nutrients such as lutein, zeaxanthin, the B-vitamins, and fish oils can have a positive effect on the development of AMD.”

Dr. Anshel urges optometrists to educate themselves on the different supplements available to make informed decisions on what to recommend patients. By selling these nutraceuticals in your office, he says it will increase your revenue stream and you’ll be able to monitor and track what your patients are taking.

There are many supplements on the market designed to support macular

Optovue’s iVue Spectral-Domain OCT now features the iHealthCheck scan to help doctors evaluate patients for macular degeneration.

health. AmeriSciences’ OS2 contains vitamins, minerals, carotenoids, and other antioxidants including lutein and zeaxanthin along with omega-3 fatty acids and a bioavailability enhancer.

Fortifeye Vitamins’ Fortifeye Complete Macular Defense has high levels of vitamins, minerals, phytonutrients, whole foods, enzymes, and omega-3 oils. According to the company, the Oxygen Radical Absorbance Capacity (ORAC) value is almost 13,000—equivalent to about 17 servings of fruits and vegetables a day.

Using a biochemically balanced full spectrum range of active ingredients, Biosyntrx, Inc.’s Macula Complete is presented in vegetable capsules to assure maximum absorption for the diagnosed macular degeneration patient.

With high levels of zinc, vitamins C and E, and copper, MedOp Inc.’s MAXIVISION® Macula Formula also contains the same concentrations of lutein and zeaxanthin being used in the AREDS2.

Focus Laboratories’ TOZAL® uses proprietary formulation of taurine, antioxidants, and omega-3 fatty acids to improve and stabilize vision in AMD patients.

And Macuhealth with LMZ3, distributed by Marco, contains all three pigments found in the macula: lutein, mesozeaxanthin, and zeaxanthin. According to the company, regular intake of Macuhealth has been shown to increase macular pigment to normal levels, up to a 40% increase over a six month period.

DIAGNOSTIC TECHNOLOGY
Joe Pizzimenti, OD, FAAO, associate professor at Nova Southeastern University College of Optometry in Ft. Lauderdale, FL, utilizes all of the newest tools and technology for diagnosing and managing AMD. He takes the team approach to management to include other systemic issues and lifestyle into the treatment protocol. His management structure combines “both traditional and emerging methods of patient evaluation, including structural (stereoscopic dilated macular evaluation, angiography, fundus photography) and functional (visual acuity, Amsler, contrast sensitivity, photostress, perimetry) testing at intervals to commensurate with the degree of pathophysiology. He also includes the newest in technology innovations, including fundus autofluorescence, preferential hyper- acuity perimetry (both in-office and in some cases with the home-based system), macular pigment optical density measurement, and microperimetry.

An example of a device offering microperimetry is Ellex’s MAIA™. It accurately measures macular sensitivity, fixation stability, and the point of fixation. MAIA also comes equipped with threshold sensitivity analysis software, enabling it to process the measured data and quickly evaluate macular function as compared with a reference database of normal subjects.

DON’T FORGET LOW VISION AIDS In order to support those patients with age-related macular degeneration (AMD) who are already experiencing some vision loss, be sure to offer low vision products (both high- and low-tech). For example, the new Mobilux Digital video magnifier from Eschenbach Optik features an AMOLED (active-matrix organic light-emitting diode) display, offering users a 1:10,000 contrast ratio with either 3x or 6x magnification. According to the company, its image processing speed is 1,000 times faster than ordinary video magnifier LCD screens so patients will appreciate the no “ghosting,” “smearing,” or fading of images.

Dr. Pizzimenti also utilizes and works closely with co-managing physicians of all disciplines. For dry AMD patients, he often integrates care with pharmacists, nutrition professionals, and internists, noting that many of his AMD patients also have cardiovascular disease. If a dry AMD patient is suspected of converting to the wet form, he initiates timely consultation with a vitreo-retinal specialist and then will provide much of the post-treatment follow-up care. Dr. Pizzimenti also uses a team approach to management if a patient has significant visual function deficits, which may include low vision rehabilitative optometric care (see “Don’t Forget Low Vision Aids,” below).

ANTI-VEGF
Leo Semes, OD, FAAO, professor at the University of Alabama at Birmingham School of Optometry, continues to be up on the latest research and technology, including anti-vascular endothelial growth factor (VEGF) treatments for his wet AMD patients. He considers “the anti-VEGF treatment via intraocular injection a revolution for patients harboring choroidal neovascular membrane (CNVM). It was the first management strategy that showed improvement in visual acuity. While there remain some remnants of earlier treatments (verteporfin, IVTA), the anti-VEGF injections have become mainstream.”

OCT AND OTHER TESTING
Sherry Bass OD, FAAO, teaching professor at the State University of New York State College of Optometry, finds Spectral Domain OCT to be “invaluable in the detection of disease not easily visualized by ophthalmoscopy and in the detection of early changes in disease.” These systems allows for more accurate and precise imaging of retinal structure and for early detection of drusen, geographic atrophy of the retinal pigment epithelium, and choroidal neovascularization (CNV). “Early detection of CNV is key,” says Dr. Bass, “because there are treatments clinically proven to decrease the risk of vision loss and improve visual acuity in patients treated early on in the course of their disease. With OCT, you can monitor and detect these changes, often before they become visually significant.”

One example of Spectral-Domain OCT is Optovue Inc.’s iVue,® which now features the iHealthCheck™ Program. One iHealthCheck scan of the macula reveals ocular anatomy and pathology with high-resolution, high-speed OCT imaging to help doctors evaluate patients for vision threatening diseases and conditions such as macular degeneration.

Early detection of AMD can establish the presence of risk factors, such as drusen diameter and size, which can determine if a patient needs other testing such as Macular Protective Pigment Density (MPPD) and Macula Risk® genetic testing. Distributed by Marco in the U.S., the Macu-Scope™ measures MPPD—low MPPD is a major, modifiable risk factor for macular degeneration. Macula Risk is a prognostic DNA test (a cheek swab) for patients diagnosed with early or intermediate AMD. By analyzing AMD genes and smoking history, Macula Risk identifies those most likely to progress to advanced AMD with vision loss. Macula Risk is reimbursed by most providers including Medicare. Go to “Instructions for Macula Risk” at OphthalmicOffice.com for complete instructions.

In addition, Ellex is currently pioneering a new laser therapy for the treatment of AMD. Retinal Regeneration Therapy (Ellex 2RT) is a laser therapy currently undergoing clinical trial for the treatment of dry AMD and Diabetic Macular Edema. A pilot study showed decreased drusen in 70% of treated eyes.

As these experts show, AMD diagnosis and management is usually a multistep approach. By being up-to-date and knowledgeable, we become the source of information for our patients, increase patient satisfaction, and continue to build the medical portion of our practice.

Jennifer L. Stewart is in private practice at Norwalk Eyecare in Norwalk, CT.

WHERE TO FIND IT:
AmeriSciences • 281-617-0100 • amerisciences.com

Biosyntrx, Inc. • 800-688-6815 • biosyntrx.com

Ellex • 800-824-7444 • ellex.com/usa

Eschenbach Optik of America, Inc. 800-487-5389 • eschenbach.com

Focus Laboratories • 866-752-6006 • tozalrx.com

Fortifeye Vitamins • 866-503-9746 • fortifeye.com

Macula Risk • 866-964-5182 • macularisk.com

Marco • 800-874-5274 • marco.com

MedOp Inc. • 727-943-9400 • medop.com

Optovue Inc. • 866-344-8948 • optovue.com

 

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