My grandmother had a dear friend of many years whom I always knew as “Aunt” Reba. She was quite the remarkable woman during her approximately 104 years. She worked in a sweater factory starting at age 14 to help support her family; raised thousands of dollars for a charity that helped women, children and families; and helped play matchmaker to a number of couples, including my grandparents. Even well into her 90s, she could entertain the family with her stories, make known her strong political opinions, and bake incredible knishes.
While she could make knishes based on years of doing so, she had trouble with such visual tasks as signing her name to a check or identifying people in a photo. I had edited enough articles about age-related macular degeneration and seen pictures simulating how the world appears to an individual with AMD. Still, I had a whole new perspective as I watched her struggle, even with the help of a magnifier, to make sure she signed on the line, to pick out people from a group photo and even to see letters on the Snellen chart when she visited her eyecare practitioner.
Whatever complaints she expressed about other maladies of old age or loneliness from having outlived friends and family, I don’t recall her complaining about her vision loss. Still, I can only begin to imagine how it felt.
Numerous studies have shown that vision loss due to AMD is associated with increased risk of depression and anxiety. To show how important vision is to individuals, in one study, an average person with 20/40 vision was willing to trade two of every 10 remaining years of life in return for perfect vision, while the average person with counting fingers vision in the better eye was willing to trade about five of every 10 remaining years.
The good news is that AMD does not need to be an automatic sentence to blindness. In this month’s issue, Leo P. Semes, OD, FAAO, discusses technology to measure dark adaptation that may enable you to detect AMD almost three years before other signs such as drusen can be observed on clinical exam (page 8). This gives you time to monitor the patient and suggest strategies, such as quitting smoking, making dietary changes and taking supplements, to prevent, or at least delay, vision loss.
For patients whose conditions progress, injectable medications can treat neovascularization, offering hope not only to patients with AMD but those with diabetic retinopathy and diabetic macular edema. We offer a review of two such agents.
Though not AMD related, Robert A. Ryan brought greatly improved visual acuity and increased comfort to an individual who experienced 20/100 vision, lagophthalmos, exposure keratopathy and dry eye following tumor resection. Read more about this case, his outside-the-box approach, and some tips for keeping patients in contact lenses despite dry eye.
Semes points out how having advanced technology will help differentiate your practice. What also helps differentiate your practice is the patient who, for many years, is still able to read a novel, sign a check, follow a recipe, or enjoy viewing family pictures.
Jeffrey Eisenberg | Editor-In-Chief | JEisenberg@FVMG.com