VISION ACCESS, Volume 9, Number 1, 2002, Copyright 2001 by the Council of Citizens with Low Vision International.

 

VISION ACCESS is a journal by, for, and about people with low vision.  VISION ACCESS is published quarterly in three formats (cassette, large print, and computer disk) by the Council of Citizens with Low Vision International (CCLVI), a not-for-profit affiliate of the American Council of the Blind.  Views expressed in VISION ACCESS are those of the individual contributors and do not necessarily reflect the views of the editor or of CCLVI.  All rights revert to individual contributors upon publication.

 

VISION ACCESS welcomes submissions from people with low vision, from professionals such as ophthalmologists, optometrists, and low vision specialists, and from everyone with something substantive to contribute to the ongoing discussion of low vision and all of its ramifications.  Submissions are best made on 3.5" disk in a format compatible with Microsoft Word. Submissions may also be made in clear typescript.  All submissions should include a self-addressed stamped envelope.  VISION ACCESS cannot assume responsibility for lost manuscripts.  Submissions may be mailed to Joyce Kleiber, 6 Hillside Rd., Wayne, PA 19087.

 

VISION ACCESS is a free publication to all members of the Council of Citizens with Low Vision International.  Subscription and membership inquiries can be made to Janis Stanger, CCLVI Membership, 1239 North American Beauty Drive, Salt Lake City, Utah, 84116.  Call CCLVI toll free at 1-800-733-2258.

 

Editor:  Joyce Kleiber

 

CCLVI OFFICERS: 

Ken Stewart, President,

Carl Foley, 1st Vice President,

Janis Stanger, 2nd Vice President,

Barbara Kron, Secretary,

Bill Burgunder Jr., Treasurer,

Coletta Davis, Past President

 

CCLVI BOARD MEMBERS:

Patricia Beattie

Charles Glaser

Herb Guggenheim

Bernice Kandarian

Jane Kardas

Joyce Kleiber

Fred Scheigert

Mercedes Schott

Robyn Wallen

Contents

From the Editor…………………………………………………………….2

Organization News

   President’s Message……………………………………………………3

   Best Convention Ever!………………………………………………….5

   Reports from CCLVI Chapters…………………………………………6

   Project Insight Update…………………………………………………10

Health and Vision Rehabilitation

   NEI Promotes Referrals to Low Vision Services……………………11

   Eye Drops to Treat Childhood Eye Disorder Work As Well As

      Patching the Eye…………………………………………………….12

   Medicare Now Covers Glaucoma Detection Eye Exam…………15

   As Glaucoma Treatment Advances Vision Is Saved….

                By Julie Bain…………………………………………………16

   Eating for Eye Health—New Research Sharpens the Focus…20  

   Eli Lilly Offers $12 Flat Fee Per Prescription for Millions of Needy

      Seniors & People With Disabilities Without Coverage………….24
   Some Notes from Optometrist Dr. Marc Gannon…………………25  

   Montgomery County Association for the Blind—An Agency with

      Heart, By Curt Woolford…………………………………………..26

   The Theft of Useful Vision, By Bill Chapman…………………….30

Features

   Member to Member, By Charles Gourgey…….. ………………..39

   Write Now!  Starting a Personal Journal, By Mike Vogl…………41

People

   Meet Joseph J. Neff—Shedding Light on Glaucoma,

      by Joseph Neff……………………………………………………..45

Gifts and Bequests to CCLVI………………………………………….50

Resources……………………………………………………………….50

CCLVI New, Renewal, and Donor Application………………………51

 

 

From the Editor

 

     I am grateful to everyone who contributed articles and suggestions to this issue of VISION ACCESS.

     You will find several articles about new developments in the treatment of glaucoma.

     I invite you to respond to topics covered in articles in VISION ACCESS or to share your own questions and coping strategies with our readers. 

     In this issue our “Member to Member” column addresses the topic of dating and low vision—when and how to tell your date that your vision is not 20/20.  What are your thoughts and feelings on this sensitive topic?

     Bill Chapman, one of our contributors, has strong feelings about the use of blindfolds in rehabilitation programs.  He resents that consumers are not taught to make full use of whatever vision they have.  What did you experience in vision rehab?  Were you required to use a blindfolded at any time?  Were you encouraged to use your vision?  Or were you trained as a person who is blind?  How do you feel about this?

     In contrast to the problems described by Bill Chapman, Curt Woolford writes about a training center that is a shining example—the Montgomery County Association for the Blind.  This agency offers training that should be a standard for vision rehabilitation practice everywhere.

     Mike Vogl writes about the benefits of “Journaling” for people with low vision?  Do you journal?  How has this practice helped you?  What other ways have you found helpful in coping with your stress?  Do you have a hobby?  Would you like to share your interest in this hobby with us?

     CCLVI is YOUR organization.  VISION ACCESS is YOUR magazine.  Let us hear from you!!

JMK,3/02

 

Organization News

President’s Message

 

     I am “putting thumbs to keyboard” (nowadays no one “puts pen to paper” any more) just after getting off a telephone conference call with almost half of our Board of Directors.  The discussion topic was planning for our next convention’s program sessions.  It was heartening to witness great enthusiasm among members of our Board.  There were proposals for sessions presenting medical experts, surveying the latest in adaptive devices, airing controversial federal legislation on expanded Medicare coverage of rehab services, explanations of attitudes about maximizing the use of remaining vision, and exchanges of feelings and ideas about being visually impaired.  Novel evening social events were also blossoming during the conference call.

     Those Board members had stepped forward at our recent mid-year meeting in Houston to help put together the program that will be offered at the same venue from June 29th through July 3rd.  It warrants note also that our mid-year Board of Directors meeting was very well attended in spite of the reality that the organization was unable to offer any financial assistance with hotel and travel expenses.  Eleven of our fifteen Board members spent nine heavy-duty hours focusing on CCLVI’s highest priorities—membership services, balancing the budget, advocacy initiatives, as well as our upcoming convention.

     Immediately after the Houston Board of Directors journey I flew off to Portland for a three-day meeting of the federal Access Board’s Advisory Committee on public rights of way.  This body continues to meet frequently all around the country and it continues to present precious opportunities to educate key transportation decision-makers about the travel needs of pedestrian with low vision.  This on going role is personally costly both in time and dollars (our organization has very limited funds for these activities, too), but can, I am convinced, yield great and long-term benefits for us all.

     While in Portland I had the chance to meet that city’s very enlightened public transit ADA Compliance staffer.  As we glided along beside each other during a field trip on their light rail system, I offered several observations—how the audible station calls could be more listenable, how to conspicuously mark stair treads, how to better time route announcements for a person waiting on a station platform.  The staffer received each of my comment thoughtfully and noted them on her clipboard.

     There are so many ways each of us can spread the word about the little things that can be done just a bit differently, and often at no additional cost, to make it easier for people with low vision to continue to function independently.

KLS 3/02 

 

 

Best Convention Ever!

 

     Where can you go this summer in Houston to enjoy a good horse race, learn about the latest research in genetic eye conditions, have a glass of wine and mingle with friends, or dance to the best music in town?  Try the Council of Citizens with Low Vision International.  This year’s convention program, mixer, dances, and Wednesday Game Night promise to be the best ever planned. 

     This year’s events begin Sunday morning.  Join Patricia Beattie and her guests to learn more about genetic eye conditions, the role of the low vision therapist in the vision rehabilitation team, and learn about low vision services at the Houston Lighthouse.  That afternoon, enjoy a sneak preview of what’s new inside and outside of the exhibit hall with Janis Stanger, Low Vision Advisor for Utah State Services for the Blind and Visually Impaired, Noelia Dillingham of Houston Lighthouse and vendors of technology which can be seen in the exhibit hall this year.

     That evening, just before the opening session of the American Council of the Blind, ACB, Annual Convention, attend the best mixer CCLVI has ever hosted.  But find some time in the day for a little nap so you can stay up for the highlight of the day: dancing and listening to music the way you like it with Gordon Kent taking requests. 

     Sunday’s activities are just a sampling of what will be available throughout the week.  Of particular interest will be the program sessions scheduled for Monday afternoon.  Patricia Beattie, of National Industries for the Blind, and member of the board of directors of CCLVI will lead a discussion on issues in rehabilitation for people with low vision.  Later, she and others will participate in a panel discussion on different philosophical approaches to training for those who are blind and visually impaired.  Particular emphasis will be placed on the impact these different approaches may have on individuals seeking training.  The session will conclude with an update on proposed legislation to provide Medicare coverage of vision rehabilitation services.  

     New this year will be the Wednesday Game Night.  Charles Glaser and Barbara Kron are busily planning the social event of the convention:  an exciting night of horse racing, The Newlywed Game, team trivia, Name That Tune and the Dating Game.  Anyone looking for a lot of laughs and great times will be there Wednesday night to cheer on their favorite horse, or root for their chosen jockey.  Between races, laugh at the antics of our Dating Game contestants, and enjoy finding out how much our newlywed’s actually know about each other.  And of course there will be plenty of team trivia and Name that Tune with pianist, Janiece Petersen. 

     Friday night, after the banquet, top off your convention week with the CCLVI Texas Farewell Dance with Gordon Kent providing the best dance music in town.   

     CCLVI invites everyone to join with us this summer in Houston for some of the best programming and activities we have ever planned. 

 

 

Reports from CCLVI Chapters

 

Delaware Valley Council

     Dr. Larry Goldberg, attorney and medical doctor, spoke at the February 2002 meeting of the Delaware Valley Council of Citizens with Low Vision.  His topic was the Americans with Disabilities Act (ADA).  Here is a summary of his remarks.

     The ADA is an offspring of rehabilitation and civil rights legislation.  Important areas affected by the ADA are the workplace, education, and travel.  The ADA from its beginning was not a strong piece of legislation.  In employment, the application process for obtaining jobs has not changed with the ADA.  It is hard to determine discrimination at the time a person applies for a job.  Also the number of people with disabilities who have been hired since the passage of the ADA has not increased significantly.  The ADA has had

 

a strong impact in the area of accommodations that employers are now required to

provide for their employees with disabilities.

     Recent Court decisions have shown that it is more difficult for people to be classified as “disabled” and thus get protection under the ADA.  Cases have been ruled in favor of employers.  Two of these rulings involved public safety.  In a third case, a person with a mental health disability was denied protection; the Court said this disability could be lessened through medical intervention.  In another case a worker was denied protection because other protective options are available.  These include workmen’s’ compensation, private disability insurance, Social Security Disability Insurance, or light duty on the job.  Therefore her appeal to the ADA was deemed inappropriate.

     With the ADA, people who are visually impaired find it easier to get accommodations to help them do their jobs.  Prior to employment, they are more able to get the educational opportunities they want. 

     Our chapter is happy to report that some of our members supported a workshop held in Philadelphia in February to train audio describers who will work to make local theatre offerings accessible to theatergoers who are visually impaired.

     Members of our chapter take every opportunity to speak to people in our community about low vision.  In March Joyce Kleiber spoke to a group of patients at Ophthalmic Subspecialty Consultants.  Her topic was “Coping with Vision Loss.”  Members of this group also appreciated the chance to share their experiences with each other.

     For more information about our chapter call us at 215-735-5888.

 

Florida Council of Citizens with Low Vision

     The Florida Council of the Blind, along with the Florida Council of Citizens with Low Vision gladly invites all of you to share in our 2002 State convention.  This will take place from Thursday, May 30, through Sunday, June 2 at the Double Tree Hotel Tampa - Westshore located at 4500 West Cypress Street; Tampa, FL 33607.  Room rates are:  single, double, triple and quad, $65 per night and junior suites are available for $69 per night.  Phone (813) 879-4800 or (800) 355-0524 to make your room reservation, being sure to state that you are attending the convention of the Florida Council of the Blind.  The cut off date is May 17, 2002.  Remember, however, that your chance to make a reservation at these rates is based on room availability; so call soon!
     On Thursday, May 30, for your enjoyment and by popular demand, there will be a tour of Busch Gardens.  For those who are thrilled simply by shopping, Burdines, as well as other local merchants will be offering a discount to all convention attendees for the entire weekend.  The hotel will provide complementary shuttle service to the mall.  
     On Friday, May 31, members will have the opportunity to participate in FCB's annual legislative seminar, the Library Users' Focus Group, our annual awards banquet and the welcome to Tampa party.  On Saturday, June 1,the general session program will be devoted to how each of us can play a role in making the voting experience in our communities an accessible and positive one for all individuals who are blind and visually impaired.  Kathy Dent, Supervisor of Elections for Sarasota County, will demonstrate their accessible voting system and will speak about the training program for poll workers in that county.  Representatives from other counties will also speak.  Melanie Brunson, Director of Advocacy and Governmental Affairs for the American Council of the Blind, will speak about the nation's accessible voting agenda.
     Following that presentation, there will be two workshop choices.  Choice one, “How to Learn about and Take Full Advantage of Municipal Programs and Services”, will be hosted by Melanie Brunson and Gayle Krause.   Choice two: ACB Immediate Past President, Paul Edwards, will host “Chapter Revival, Fitting the Bill, Making the Grade.”
     The afternoon will include an additional meeting with members of the Division of Blind Services.  The annual business meeting for FCCLV will take place on Saturday June 1st, from 3-5 PM.  Cocktail hour will begin at 6:30 PM followed by the banquet and dance.
     Sunday programming gives you the opportunity to participate in the business of the organization and to elect the officers that will serve FCB for the next two years.
     FCCLV is a very important part of the Florida Council of the Blind.  The issues being addressed at the convention will help enlighten and educate all, and the social aspect will include some very fine Southern Hospitality.
     For any additional information, please call our Project Insight Line at 1800 26 SIGHT (1 800 267-4448) and Bobbie will gladly help answer any questions.
Rosanna Lippen, FCCLV President

 

Metropolitan Council of Low Vision Individuals

     Our Metro Chapter is looking for issues!  We ask that any CCLVI member in the metropolitan New York, upstate New York, or New England area, a Chapter member or not, get back to us with your issues, your concerns. 

     Our Chapter has had some success in advocacy efforts.  We want to learn more from people with low vision what “bugs” them about the actions or inactions of governmental agencies and other public organizations.  We want to get involved and try to help out.

     Recently our Chapter heard from a museum that we had contacted about the inaccessibility of an exhibit’s informational displays.  Previously, the agency that operates New York City’s subways had been very responsive to Chapter input regarding the visibility of station elements.

     Our Chapter can be reached via email at lsanborn@rr.nyc.com; by mail at MCLVI, Suite #1F, 357 West 55th Street, New York, NY 10019-4525; and by phone through the CCLVI toll free number, 800-733-2258.

     Our Metro Chapter’s bimonthly meetings are held from 6-8pm on Wednesday evenings at Alternate Solutions, 110 William Street, in the Financial District of Lower Manhattan, less than a block from many subway lines.

 
National Capital Citizens with Low Vision.  Our Chapter has had a great year with interesting speakers who generated stimulating discussions among our group members.
     In September, Matt Ater from AccessAbility Inc., a company selling assistive technology, brought various CCTV's, electronic Braille and voice output notetakers, and the more conventional magnifiers and telescopes for our members to try out.  He gave us some idea about the future of certain technologies.
     Our own Laurie Gregorio, at our October meeting, told us about the consulting work that she does with the Smithsonian museums to help them make their exhibits and publications more accessible to people with low vision.  
     In November, Phillip Strong, an intern with American Council of the Blind, ACB, told the group about what ACB is doing concerning the issue of pedestrian safety.
     We took a holiday break in December and had our usual holiday bash with the other local affiliates of ACB organized by our own Skip Sharpe.
     At our January meeting, Herb Guggenheim led a support group on how to be an authentic person while dealing with various difficulties presented by having low vision.  
     Dr. Sulieman Alibhai, a low vision specialist, talked with the group in February about what he does in a low vision exam and answered a diverse range of questions from the future of assistive technology to possible directions for breakthroughs in medical research.
     Here are our plans for future meetings.  In March, Heather McDaniel, a visually impaired aerobics and water aerobics instructor and personal trainer will talk to the group about fitness in the workplace.  In April, Janina Sajka from the American Foundation for the Blind will give us an update and demonstration of digital books and will also talk about what to do to get more accessible cell phones.  In May, we will have a speaker from a local store that sells assistive technology, and she will also talk about ways to make office workstations more user friendly to those of us with low vision.
     Anyone wanting to join our group should send their form and check to our treasurer, Bella S Guggenheim, 413 Torrington Place, Silver Spring, MD 20901
     Email requests for information can be sent to Sarah Presley at ncclv@yahoo.com.

 
 
Project Insight Update

    

     Bernice Kandarian answers CCLVI’s 800 line, 800-733-2258.  She refers callers to Project Insight volunteers who might be of help.  We are looking for ways to reach out to more people who are challenged by vision loss.  We are planning to print brochures about Project Insight.  The title on these brochures is “You Have Lost Your Sight—Not Your Vision”.  We will ask our volunteers to strategically distribute these brochures in their communities.  We hope more people will learn about Project Insight. 

     Project Insight is listed on the website of the National Eye Institute.  Please make your suggestions to any of the members of our Project Insight Committee:  Bernice Kandarian, Jane Kardas, Barbara Kron, and Joyce Kleiber.  We want everyone to benefit from the information and support that has been so important to us in coming to terms with our own vision loss.

     At this summer’s CCLVI convention in Houston, we will offer a workshop for everyone who is interested in Project Insight.  We look forward to hearing your ideas, experiences, and suggestions for how to reach more people through this project.

 

 

Health and Vision Rehabilitation

 

NEI Promotes Referrals to Low Vision Services

 

     The National Eye Institute, NEI, assumed the leadership of a pilot project to determine effective strategies for increasing the number of referrals to vision rehabilitation services.  NEI will be funding the design, conduct, and evaluation of this project.  Elements of this pilot will incorporate findings from the NEI focus groups conducted last spring.  (This focus group explored what ophthalmologists, optometrists, and eye care staff across the country know about low vision and its system of care.)  A key element of the pilot project will be the promotion of the Lighthouse toll-free number.  Last week, Cynthia Stuen of the Lighthouse and Rosemary Janisewski of NEI met with the leadership in the Low Vision Council.  The Low Vision Council pledged "$10,000 to the pilot project under the NEI leadership.  It was agreed that the $10,000 would be used for the cost of printing .

     NEI is directing the project and assembling  a committee with representatives from the National Eye Health Education Partnership Planning Committee and Partnership; Ed Bettinardi, representing the Low Vision Council; Bryan Gerritsen, representing Goal 2; and Cynthia Stuen, representing the Lighthouse.

     Based on the results of the pilot project, the Low Vision Council expressed cautious interest in developing a national program.

     The time frame for this project will be approximately one year, with implementation taking place sometime in the fall.      


 

 Eye Drops to Treat Childhood Eye Disorder

        Work As Well as Patching the Eye

 

News Release from National Eye Institute

     Atropine eye drops given once a day to treat amblyopia, or lazy eye, the most common cause of visual impairment in children, work as well as the standard treatment of patching one eye.  This research finding may lead to better compliance with treatment and improved quality of life in children with this eye disorder. These results appear

In the March issue of Archives of Ophthalmology.

     After six months of treatment, researchers found that the drug atropine, when placed in the unaffected eye once a day, works as well as eye patching and may encourage better compliance. Compliance is an important factor in the success of amblyopia therapy. Treatment should be started when the child is young, since amblyopia is more effectively treated in children under seven years of age. Timely and successful treatment for amblyopia in childhood can prevent lifelong visual impairment.

      "These results are important because they provide an effective alternative treatment that helps prevent permanent vision impairment for children with amblyopia," said Paul A. Sieving, M.D., Ph.D., director of the National Eye Institute, one of the Federal government's National Institutes of Health and the agency that sponsored the study. "Amblyopia is currently treated by wearing an eye patch over one eye for weeks to months. Children usually do not like this treatment approach because of quality of life issues, such as irritation of the skin and teasing by other children. This new study found that atropine eye drops had a higher acceptance rate and better compliance by children and their parents than did patching. This may well become a new standard form of treatment for some forms of amblyopia.

     Amblyopia, or lazy eye, is a condition of poor vision in an otherwise healthy eye because the brain has learned to favor the other eye. Although the eye with amblyopia looks normal, there is interference with normal visual processing, that limits the development of a portion of the brain responsible for vision. The most common causes of amblyopia are misalignment of the eyes (crossed eyes) or significant differences in refractive error, such as farsightedness or nearsightedness, between the two eyes. Amblyopia usually begins in infancy or childhood. It is estimated that as many as three percent of children in the U.S. have some degree of vision impairment due to amblyopia.

     Treatment for amblyopia is most effective when started in young children less than seven years old. Response to treatment in older children is much less effective. Most eye care professionals treat amblyopia by placing an opaque adhesive patch, or "eye bandage," on the skin to cover the unaffected eye. This forces the child to use the eye with amblyopia, which stimulates vision in the eye with amblyopia and helps the part of the brain that manages vision to develop more completely. However, many children do not like the appearance of the eye patch and the accompanying social and psychological stigma and will not fully cooperate, which can lead to treatment failure. Also, patching forces a child to use an eye that has poor vision, often making compliance difficult for active children. Unless it is successfully treated in early childhood, amblyopia usually persists into adulthood, and is the most common cause of monocular (one eye) visual impairment among children and young and middle-aged adults. Consequently, it is crucial for children to comply with treatment.

     The atropine eye drop works by temporarily blurring vision in the unaffected eye, thereby forcing the eye with amblyopia to be used. This strengthens it and improves vision. The advantage of atropine treatment is that the parent simply places a drop in the child's eye once a day. With patching, the parent must monitor the child wearing the patch for six or more hours each day for many weeks or months.

     In the Amblyopia Treatment Study, 215 children were randomly assigned to receive patching, and 204 were assigned to receive atropine eye drops. Researchers found that 79 percent of those receiving the eye patch were treated successfully, and that 74 percent of those receiving the atropine were treated successfully. This difference is clinically insignificant. Although researchers found that vision in the amblyopic eye improved faster in the patching group, the difference in the two groups at six months was small and not significant.

     "The daily burden to administer treatment for amblyopia falls on the parent," said study chairman Michael Repka, M.D., professor of ophthalmology and pediatrics at the Wilmer Eye Institute of Johns Hopkins University School of Medicine in Baltimore. "This study shows that one drop a day of atropine works as well as patching the eye for some children with amblyopia. Since both patching and atropine work equally well, the choice of treatment can be made by the eye care professional in consultation with the parent.”

     The children who were treated in this study will continue to be followed until April 2003, allowing researchers to learn whether there is any longer term advantage to treating amblyopia with either patching or atropine.

     The study was conducted by the Pediatric Eye Disease Investigator Group at 47 clinical sites throughout North America. The study was funded by the National Eye Institute and coordinated by the Jaeb Center for Health Research in Tampa, Florida and the Wilmer Eye Institute of Johns Hopkins University in Baltimore.

 

 

Medicare Now Covers Glaucoma Detection Eye Exam

 

News Release from National Eye Institute

New Coverage to Benefit At Risk Populations

     Medicare now covers an annual dilated eye examination for all people at high risk for glaucoma.  This important new preventive benefit will safeguard the vision of millions of Americans enrolled in the Medicare program.

     This new coverage, effective January 1, 2002, is consistent with recommendations from the National Eye Institute, one of the Federal government's National Institutes of Health, as well as from eye care professional organizations and consumer groups.

     Glaucoma, a leading cause of blindness, affects about three million Americans half of whom don’t know they have this eye disease.

     The new benefit defines high-risk Medicare beneficiaries as those with diabetes; those with a family history of glaucoma; and African Americans aged 50 and older.  Glaucoma is five times more likely to occur in African Americans than in whites and about four times more likely to cause blindness in African Americans than in whites.  "Preventive benefits, such as this new glaucoma coverage, help keep people enrolled in Medicare healthy and improve their quality of life,"

said HHS Secretary Tommy G. Thompson.  "An eye exam now can prevent serious problems later, even blindness.  It is important that we make taking care of our eyes a part of our overall health maintenance program.”

     "Glaucoma, and the risk of vision loss, remains unrecognized for millions of Americans," said Paul A. Sieving, M.D., Ph.D., director of the National Eye Institute.  "The expanded Medicare coverage will help people keep their vision, especially those at high risk for eye disease.  "Once vision is lost from glaucoma, it cannot be restored -- the damage is irreversible," said Dr. Sieving.  "Studies have shown that the early detection and treatment of glaucoma, before it causes major vision loss, is the best way to control the disease.”

     The "air puff" test, which measures eye pressure, is one part of a glaucoma examination but this test by itself cannot detect glaucoma.  Glaucoma is found most often during an eye examination through dilated pupils, which means drops are put into the eyes to enlarge the pupils.  The eye care professional then can see more of the inside of the eye to check for signs of glaucoma.”

     For more information on glaucoma, write Glaucoma, 2020 Vision Place, Bethesda, MD 20892-3655 or visit www.nei.hih.gov.

 

As Glaucoma Treatment Advances, Vision Is Saved
 By Julie Bain

 

Reprinted with permission from The New York Times.  Thanks to Charles Gourgey for directing VISION ACCESS to this article.

     Roger Martin of Milford, Conn., watched his grandmother go blind from glaucoma. His mother lost mo

st of her sight in her 40's from the same condition and had to give up the successful catering business that she loved. Four years ago, when Mr. Martin, then 51, found out that he too had open-angle glaucoma, the most common form of the disease in the United States, he was determined to have a better outcome.  Three million Americans have glaucoma, and it is the second leading cause of blindness in the United States, after macular degeneration.  But doctors' understanding of the disease has advanced in recent years, and so have the treatments, including eyedrops, laser procedures and surgery.
     Dr. Robert Ritch, a professor and chief of glaucoma services at the New York Eye and Ear Infirmary, said that when he was training 25 years ago, "Professors then said, `What do you want to go into glaucoma for?  You just put drops in until they go blind.'  That's all changed. With proper treatment, and if patients do their part, they should be able to see for the rest of their lives."
     One of the biggest misperceptions about glaucoma is that the disease is simply elevated eye pressure. "Elevated intraocular pressure is not the disease," said Dr. Ritch, "but it is the most important risk factor."
     Doctors have redefined glaucoma. "It's a progressive disorder of the optic nerve, characterized by a specific pattern of visual field damage and optic nerve damage that we can see with an ophthalmoscope," Dr. Ritch said.  "This is caused by a number of different diseases that affect the eye."
     In open-angle glaucoma, the fluid in the front of the eye drains too slowly or not at all, backing up like a clogged sink.  This raises the pressure in the eye; the resulting stress on the optic nerve can kill nerve fibers and destroy vision.  Peripheral vision is usually affected first.
     Blacks are four times as likely as whites to have open-angle glaucoma and often begin developing it in their 40's.  Also at high risk are people who have relatives with glaucoma, the elderly, those with high blood pressure and those who are quite nearsighted or farsighted.  Other factors may include poor blood flow to the eye, diabetes, cardiovascular disease and sleep apnea, a breathing disorder also linked to high blood pressure, heart attacks and strokes.
     People at risk for glaucoma should have yearly eye examinations once they turn 40, doctors say. Others should be tested every two to four years between the ages of 40 and 64, and every one to two years after that.
     It is not clear whether glaucoma can be prevented. But Dr. Harry Quigley, director of glaucoma services at the Wilmer Eye Institute at Johns Hopkins, where he is a professor of ophthalmology, said aerobic exercise like walking had been shown to lower eye pressure temporarily in people at risk for the disease. But exercises that involve hanging upside down or standing on one's head can cause very high eye pressure, and people with glaucoma are warned to avoid them.
     About 50 percent of Americans with glaucoma do not know they have it.  Most forms of the disease have no symptoms until it is too late to reverse the damage, said Dr. Quigley, who is a founding member of the American Glaucoma Society.  "It's rare for people to notice they've lost vision from glaucoma until they're blind in one eye," Dr. Quigley said.  "Even doctors have discovered their own glaucoma that way.  It's a very slow eating away of your vision."
     A common misunderstanding is that elevated eye pressure equals glaucoma.  That is not the case; some people have elevated pressure and yet no damage to the optic nerve.  Moreover, some people with normal pressure do have glaucoma.  For that reason, careful screenings are important.  Doctors should look at the optic nerve and test its function, Dr. Quigley said.
     "We can prevent vision loss in more than 90 percent of the people with glaucoma, but only if we've got our hands on them and they play the game," Dr. Quigley said.
     Mr. Martin said: "My prognosis is very cheerful. I follow my doctor's directions religiously, and I have very little field-of- vision loss."
     When he found out that he had the disease, he closed his Italian seafood restaurant in Milford and devoted himself to glaucoma awareness and education.  He organized a national glaucoma screening program through Lions clubs and other organizations.  The program has tested over 34,000 people in the last three and a half years.

     Lowering pressure within the eye is still the main goal of open-angle glaucoma treatment.  Prescription eyedrops are where most doctors begin.  Beta blocker drugs, similar to those used to treat high blood pressure and some heart problems, were the standard pressure-lowering eyedrop for more than 20 years, but they often had negative side effects.
     Newer drugs, including ones based on prostaglandins, are generally more effective at lowering pressure, and they tend to bring on fewer side effects.  Different drugs work for different patients.
     "I still start with medications," Dr. Ritch said.  "If you look at the eye as a sink, you give medications to open the drain and turn down the faucets.  If a couple of different types of eyedrops don't control the pressure, I go on to laser."
     Laser treatment is now regarded as a kind of second medication for open-angle glaucoma.  The laser is used to burn tiny openings in the drainage system in the front of the eye, to help drain fluid out and lower pressure.  But the results are not permanent.  "A study showed that laser and eyedrops come out at about the same rate of effectiveness after five years," Dr. Quigley said.
     For some patients who have not had good results with eyedrops, or who have trouble remembering to use the drops every day, a good option is an operation called a trabeculectomy, which creates a new drainage system for the eye.
     "When I was starting out," said Dr. Ritch, "surgery was the last resort.  There were all kinds of complications, and the success rate was about 50 percent.  But now the success rate from surgery is about 95 percent."
     Several British studies in the mid-1990's found that glaucoma surgery was more effective than eyedrops, lowered the pressure more and preserved patients' vision better.  But a major American study based at the University of Michigan and recently presented at a conference of the American Academy of Ophthalmology found otherwise.  In the American study, new glaucoma patients were treated either with eyedrops or trabeculectomy in both eyes.  After five years, vision was the same whether patients had eyedrops or surgery.  But the surgery group reported slightly more side effects.
     Dr. Quigley said: "Conclusion: the British were not necessarily right when they said we should be doing a lot more surgery.  But we should offer surgery to patients who can't or don't want to remember to take eyedrops.  It's a reasonable choice."
     New glaucoma treatments are being developed.  A number of studies are looking for ways to protect the cells of the optic nerve.  The immune system may have a role to play, and drugs similar to those used to treat multiple sclerosis, which also involves the immune system, may prove effective.
     In a related approach, Dr. Michal Schwartz, a professor of neuroimmunology at the Weizmann Institute of Science in Rehovot, Israel, is developing a glaucoma vaccine, which researchers may begin testing in people in the next year or two.  In rats, the vaccine works by stimulating the production of certain immune system cells that protect the optic nerve.
     Dr. Quigley said: "We want to do preventive medicine, so the ultimate aim is vaccine.  She is highly regarded and an innovative scientist.  We need to see more, but there's too much there to dismiss it."
     Optic nerve regeneration is also being considered. Stem cells from nerves, which can develop into new nerve fibers, are being tested in animals to see whether they can repair damaged optic nerves.
     In people, eventually, a way to achieve this may be to take cells from within a blind person's eye and treat them to turn them into progenitor cells that will grow nerve fibers and reconnect to cells in the brain, allowing the person to see again.  The studies look promising, Dr. Quigley said, adding, "Before you and I retire, I expect somebody will have seen light again from a blind eye."

 

Eating for Eye Health

New Research Sharpens the Focus

 

Reprinted with permission from the Tufts University Health and Nutrition Letter.  For further information, on the web go to www.healthletter.tufts.edu or tel: 1-800-274-7581.  Reported to VISION ACCESS by Patricia Beattie.

 

    Normally, the results of a single study don't lead researchers to make recommendations on whether people should change their habits.  But a new study on macular degeneration, the leading cause of irreversible blindness in older Americans, has proven so promising that its authors are advising certain people to start taking high doses of vitamins C and E, beta-carotene, and zinc in hopes of slowing the advance of the disease.

     In an enormous effort coordinated by the National Institutes of Health, researchers at 11 eye centers around the country tested various combinations of those nutrients on some 3,600 people ages 55 to 80 for 6 years.  The study, called the Age-Related Eye Disease Study, or AREDs, found that certain people with macular degeneration who swallowed one particular combination reduced their odds of the disease worsening by 25 percent.

     The AREDs results were compelling enough that the study's authors recommend that everyone over 55 have an eye exam to check for the presence of eye abnormalities that indicate risk for macular degeneration.  Those whose doctors determine that they're in the intermediate stages of the disease should consider following the study regimen:  500 milligrams of vitamin C daily, 400 International Units of vitamin E, 15 milligrams of beta-carotene, 80 milligrams of zinc, and 2 milligrams of copper--the last of which is to prevent the high doses of zinc from interfering with copper absorption.  (Smokers are advised not to take beta-carotene because earlier research has suggested that large doses of supplemental beta-carotene may be harmful to them.)

     Vitamins C and E and beta-carotene, all antioxidant nutrients, are thought to play a role in protecting the body against the advance of macular degeneration by neutralizing destructive substances called free radicals that can damage delicate tissue in the retina.  As for zinc, more than a decade ago, a small study suggested that the mineral might also help prevent macular degeneration.  Zinc is involved in metabolism in the retina.

     To be sure, supplements are by no means a cure.  But they provide a ray of hope for people who have macular degeneration, because they could slow its advance.

     For prevention, research still points to foods.

     The AREDs study didn't provide any word on whether taking supplements might help to prevent macular degeneration in pe