Mark Levengood, VRC’s Insight host is joined by Dr. Nicole Johnson from Kutztown University to discuss Braille. Check it out here on BCTV’s Insight…
Mark Levengood, VRC’s Insight host is joined by Dr. Nicole Johnson from Kutztown University to discuss Braille. Check it out here on BCTV’s Insight…
The puppy raising process for The Seeing Eye is discussed by Shannon Rager, area coordinator for The Seeing Eye, Dennis Dietrich, long-time Seeing Eye puppy raiser, and host Mark Levengood. Check it out here on BCTV’s Insight…
Mark Levengood is joined by Joyce Morgan and Frank Paull to talk about transportation services and volunteer driving. Check it out here on BCTV’s Insight…
A great way to keep up with all the good things Vision Resource Center of Berks County is doing in our community is by staying informed through our newsletters. Please enjoy our Spring 2018 In-Sight Newsletter in print format below.
print version: Spring Newsletter, 2018
Mark Levengood and Terri Nyce discuss working with visually impaired students. Check it out here on BCTV’s Insight…
Mark Levengood is joined by Maureen Taylor and Jamie Pressmann to discuss The Bureau of Blindness and Visual Services. Check it out here on BCTV’s Insight…
Perhaps you have just learned that you or a loved one has age-related macular degeneration, also known as AMD. If you are like many people, you probably do not know a lot about the condition or understand what is going on inside your eyes.
This PAGE will give you a general overview of AMD. You will learn about the following:
The aim is to answer your questions and to help relieve some of the anxiety you may be feeling.
AMD is a common eye condition and a leading cause of vision loss among people age 50 and older. It causes damage to the macula, a small spot near the center of the retina and the part of the eye needed for sharp, central vision, which lets us see objects that are straight ahead.
In some people, AMD advances so slowly that vision loss does not occur for a long time. In others, the disease progresses faster and may lead to a loss of vision in one or both eyes. As AMD progresses, a blurred area near the center of vision is a common symptom. Over time, the blurred area may grow larger or you may develop blank spots in your central vision. Objects also may not appear to be as bright as they used to be.
AMD by itself does not lead to complete blindness, with no ability to see. However, the loss of central vision in AMD can interfere with simple everyday activities, such as the ability to see faces, drive, read, write, or do close work, such as cooking or fixing things around the house.
The Macula
The macula is made up of millions of light-sensing cells that provide sharp, central vision. It is the most sensitive part of the retina, which is located at the back of the eye. The retina turns light into electrical signals and then sends these electrical signals through the optic nerve to the brain, where they are translated into the images we see. When the macula is damaged, the center of your field of view may appear blurry, distorted, or dark.
Age is a major risk factor for AMD. The disease is most likely to occur after age 60, but it can occur earlier. Other risk factors for AMD include:
Does lifestyle make a difference?
Researchers have found links between AMD and some lifestyle choices, such as smoking. You might be able to reduce your risk of AMD or slow its progression by making these healthy choices:
The early and intermediate stages of AMD usually start without symptoms. Only a comprehensive dilated eye exam can detect AMD. The eye exam may include the following:
During the exam, your eye care professional will look for drusen, which are yellow deposits beneath the retina. Most people develop some very small drusen as a normal part of aging. The presence of medium-to-large drusen may indicate that you have AMD.
Another sign of AMD is the appearance of pigmentary changes under the retina. In addition to the pigmented cells in the iris (the colored part of the eye), there are pigmented cells beneath the retina. As these cells break down and release their pigment, your eye care professional may see dark clumps of released pigment and later, areas that are less pigmented. These changes will not affect your eye color.
Questions to ask your eye care Professional
Below are a few questions you may want to ask your eye care professional to help you understand your diagnosis and treatment. If you do not understand your eye care professional’s responses, ask questions until you do understand.
There are three stages of AMD defined in part by the size and number of drusen under the retina. It is possible to have AMD in one eye only, or to have one eye with a later stage of AMD than the other.
AMD has few symptoms in the early stages, so it is important to have your eyes examined regularly. If you are at risk for AMD because of age, family history, lifestyle, or some combination of these factors, you should not wait to experience changes in vision before getting checked for AMD.
Not everyone with early AMD will develop late AMD. For people who have early AMD in one eye and no signs of AMD in the other eye, about five percent will develop advanced AMD after 10 years. For people who have early AMD in both eyes, about 14 percent will develop late AMD in at least one eye after 10 years. With prompt detection of AMD, there are steps you can take to further reduce your risk of vision loss from late AMD.
If you have late AMD in one eye only, you may not notice any changes in your overall vision. With the other eye seeing clearly, you may still be able to drive, read, and see fine details. However, having late AMD in one eye means you are at increased risk for late AMD in your other eye. If you notice distortion or blurred vision, even if it doesn’t have much effect on your daily life, consult an eye care professional.
Currently, no treatment exists for early AMD, which in many people shows no symptoms or loss of vision. Your eye care professional may recommend that you get a comprehensive dilated eye exam at least once a year. The exam will help determine if your condition is advancing.
As for prevention, AMD occurs less often in people who exercise, avoid smoking, and eat nutritious foods including green leafy vegetables and fish. If you already have AMD, adopting some of these habits may help you keep your vision longer.
Researchers at the National Eye Institute tested whether taking nutritional supplements could protect against AMD in the Age-Related Eye Disease Studies (AREDS and AREDS2). They found that daily intake of certain high-dose vitamins and minerals can slow progression of the disease in people who have intermediate AMD, and those who have late AMD in one eye.
The first AREDS trial showed that a combination of vitamin C, vitamin E, beta-carotene, zinc, and copper can reduce the risk of late AMD by 25 percent. The AREDS2 trial tested whether this formulation could be improved by adding lutein, zeaxanthin or omega-3 fatty acids. Omega-3 fatty acids are nutrients enriched in fish oils. Lutein, zeaxanthin and beta-carotene all belong to the same family of vitamins, and are abundant in green leafy vegetables.
The AREDS2 trial found that adding lutein and zeaxanthin or omega-three fatty acids to the original AREDS formulation (with beta-carotene) had no overall effect on the risk of late AMD. However, the trial also found that replacing beta-carotene with a 5-to-1 mixture of lutein and zeaxanthin may help further reduce the risk of late AMD. Moreover, while beta-carotene has been linked to an increased risk of lung cancer in current and former smokers, lutein and zeaxanthin appear to be safe regardless of smoking status.
Here are the ingredients based on AREDS and AREDS2 research:
If you have intermediate or late AMD, you might benefit from taking supplements containing these ingredients. But first, be sure to review and compare the labels. Many supplements have different ingredients, or different doses, from those tested in the AREDS trials. Also, consult your doctor or eye care professional about which supplement, if any, is right for you. For example, if you smoke regularly, or used to, your doctor may recommend that you avoid supplements containing beta-carotene.
Even if you take a daily multivitamin, you should consider taking an AREDS supplement if you are at risk for late AMD. The formulations tested in the AREDS trials contain much higher doses of vitamins and minerals than what is found in multivitamins. Tell your doctor or eye care professional about any multivitamins you are taking when you are discussing possible AREDS formulations.
You may see claims that your specific genetic makeup (genotype) can influence how you will respond to AREDS supplements. Some recent studies have claimed that, depending on genotype, some patients will benefit from AREDS supplements and others could be harmed. These claims are based on a portion of data from the AREDS research. NEI investigators have done comprehensive analyses of the complete AREDS data. Their findings to date indicate that AREDS supplements are beneficial for patients of all tested genotypes. Based on the overall data, the American Academy of Ophthalmology (link is external) does not support the use of genetic testing to guide treatment for AMD.
Finally, remember that the AREDS formulation is not a cure. It does not help people with early AMD, and will not restore vision already lost from AMD. But it may delay the onset of late AMD. It also may help slow vision loss in people who already have late AMD.
Neovascular AMD typically results in severe vision loss. However, eye care professionals can try different therapies to stop further vision loss. You should remember that the therapies described below are not a cure. The condition may progress even with treatment.
Coping with AMD and vision loss can be a traumatic experience. This is especially true if you have just begun to lose your vision or have low vision. Having low vision means that even with regular glasses, contact lenses, medicine, or surgery, you find everyday tasks difficult to do. Reading the mail, shopping, cooking, and writing can all seem challenging.
However, help is available. You may not be able to restore your vision, but low vision services can help you make the most of what is remaining. You can continue enjoying friends, family, hobbies, and other interests just as you always have. The key is to not delay use of these services.
To cope with vision loss, you must first have an excellent support team. This team should include you, your primary eye care professional, and an optometrist or ophthalmologist specializing in low vision. Occupational therapists, orientation and mobility specialists, certified low vision therapists, counselors, and social workers are also available to help. Together, the low vision team can help you make the most of your remaining vision and maintain your independence.
Second, talk with your eye care professional about your vision problems. Ask about vision rehabilitation, even if your eye care professional says that “nothing more can be done for your vision.” Vision rehabilitation programs offer a wide range of services, including training for magnifying and adaptive devices, ways to complete daily living skills safely and independently, guidance on modifying your home, and information on where to locate resources and support to help you cope with your vision loss.
Medicare may cover part or all of a patient’s occupational therapy, but the therapy must be ordered by a doctor and provided by a Medicare—approved healthcare provider. To see if you are eligible for Medicare—funded occupational therapy, call 1—800—MEDICARE or 1—800—633—4227.
Low vision services can take place in different locations, including:
Because low vision varies from person to person, specialists have different tools to help patients deal with vision loss. They include:
For some patients with end-stage AMD, an Implantable Miniature Telescope (IMT) may be an option. This FDA-approved device can help restore some lost vision by refocusing images onto a healthier part of the retina. After the surgery to implant the IMT, patients participate in an extensive vision rehabilitation program.
Keep in mind that low vision aids without proper diagnosis, evaluation, and training may not work for you. It is important that you work closely with your low vision team to get the best device or combination of aids to help improve your ability to see.
People with impaired vision sometimes see things that are not there, called visual hallucinations. They may see simple patterns of colors or shapes, or detailed pictures of people, animals, buildings, or landscapes. Sometimes these images fit logically into a visual scene, but they often do not.
This condition can be alarming, but don’t worry—it is not a sign of mental illness. It is called Charles Bonnet syndrome, and it is similar to what happens to some people who have lost an arm or leg. Even though the limb is gone, these people still feel their toes or fingers or experience itching. Similarly, when the brain loses input from the eyes, it may fill the void by generating visual images on its own.
Charles Bonnet syndrome is a common side effect of vision loss in people with AMD. However, it often goes away a year to 18 months after it begins. In the meantime, there are things you can do to reduce hallucinations. Many people find the hallucinations occur more frequently in evening or dim light. Turning on a light or television may help. It may also help to blink, close your eyes, or focus on a real object for a few moments.
AMD and vision loss can profoundly affect your life. This is especially true if you lose your vision rapidly.
Even if you experience gradual vision loss, you may not be able to live your life the way you used to. You may need to cut back on working, volunteering, and recreational activities. Your relationships may change, and you may need more help from family and friends than you are used to. These changes can lead to feelings of loss, lowered self-esteem, isolation, and depression.
In addition to getting medical treatment for AMD, there are things you can do to cope:
Shock, disbelief, depression, and anger are common reactions among people who are diagnosed with AMD. These feelings can subside after a few days or weeks, or they may last longer. This can be upsetting to family members and caregivers who are trying to be as caring and supportive as possible.
Following are some ideas family members might consider:
NEI conducts and supports research in labs and clinical centers across the country to better prevent, detect, and treat AMD.
NEI-funded research over the past decade has revealed new insight into the genetics of AMD. By screening the DNA of thousands of people with and without AMD, scientists have identified differences in genes that affect AMD risk. Armed with this knowledge, researchers are identifying key biochemical pathways involved in the disease and are exploring therapies that could interrupt these pathways. It might also be possible to develop drug therapies for AMD that are targeted specifically to a person’s unique genetic risk factors.
Scientists are also exploring ways to regenerate tissues destroyed by AMD. One approach is to make stem cells from a patient’s own skin or blood. In a lab, these stem cells can be specially treated to form sheets of retinal pigment epithelium (RPE)—the pigmented layer of tissue that supports the light-sensitive cells of the retina. The goal is to generate layers of RPE that can be implanted into the patient’s eye to preserve vision.
The NEI Audacious Goals Initiative (AGI) is taking on one of the biggest challenges in medicine: the regeneration of nerve cells in the retina and brain. In humans, once brain and retinal neurons are gone—due to injury or diseases like AMD—they are typically gone for good. However, lessons from nature suggest that it may possible to overcome this limitation. For example, in some fish and amphibians, if the retina is damaged, it can grow back. Through targeted research, the NEI AGI aims to unlock these secrets and utilize them in humans—to develop new therapies to regenerate neurons and neural connections in the eye and visual system.
About NEI: As part of the federal government’s National Institutes of Health (NIH), the National Eye Institute’s mission is to “conduct and support research, training, health information dissemination, and other programs with respect to blinding eye diseases, visual disorders, mechanisms of visual function, preservation of sight, and the special health problems and requirements of the blind.” For more information, please visit NEI’s homepage HERE.
Steve Bobick talks about Vision Resource Center of Berks County’s board of directors with Mark Levengood. Check it out here on BCTV’s Insight…
by Mark Levengood
A common struggle among visually impaired individuals is the emphasis on pictures as a means of capturing a moment or experience. Certainly we will participate in the picture and position ourselves according to instruction from the individual with the camera or smart phone, but inevitably we will never be able to enjoy those pictures. However, I inadvertently stumbled across a solution to at least some of these situations. While exploring my iPhone I discovered an app called Voice Memos. I never downloaded this app, so I can only assume it came as a standard app already installed on the iPhone at purchase. Essentially, this app is a preinstalled digital recorder on the phone. Many visually impaired people will pursue a digital recorder as a means of quickly recording appointment dates and times when at a doctor’s office or even phone numbers of people they encounter in public, both of these situations occurring away from their normal means of noting this information in a form that is accessible to them. Naturally a paper and pencil will not work, but a digital recorder suffices. The Voice Memos app will successfully accomplish this same task.
My primary use for the Voice Memos app at this time in my life actually concerns my nieces. As previously mentioned, visually impaired people cannot appreciate pictures, and there are certainly many pictures to be taken of all children, but especially when infants and toddlers in an effort to capture and preserve that stage of life. I began using my Voice Memos app in early 2017 before my nieces even turned a year old to record their cute sounds, laughter, and early attempts at words, which has since evolved into recording them say my name and that of my Seeing Eye dog as well as some of our earliest conversations and songs. Every time they do something adorable, which is frequent, I am trying to record it with my Voice Memos app to relive and experience later, either that week or in the years to come. Therefore, the Voice Memos app has offered me and other visually impaired people with a way of replacing cameras and pictures by providing an alternate means of capturing those special moments in life. A picture might be worth a thousand words, but as a visually impaired individual I can now record those thousand words to appreciate and value just as a sighted person treasures a picture.
If you are visually impaired and you have a digital recorder, then by all means use it, but if you do not have a digital recorder and do own an iPhone, then start accessing this Voice Memos app. I cannot comment on other smart phones having a Voice Memos app or something similar as I am an iPhone user, but hopefully something is available as I have recorded not only special interactions with my nieces, but also important presentations and other family events.
A great way to keep up with all the good things Vision Resource Center of Berks County is doing in our community is by staying informed through our newsletters. Please enjoy our Winter 2018 In-Sight Newsletter in print format below.
print version: Winter Newsletter, 2018