Woman With Macular Degeneration Is Able To Return To Driving

When she came to me for a low vision evaluation Laura Stanley's goals were:

1. To be able to read letters, newspapers, medicine labels

2. Return to driving
3. See the television picture better
4. Recognize peoples faces

As a result of her low vision evaluation I was able to help Mrs. Stanley achieve all of those goals.

Mrs. Stanley suffers from macular degeneration and with her glasses was able to see only 20/120 with her better eye. Not sufficient to drive in Virginia. She hoped to be able to obtain telescopic glasses and get a Virginia driver's permit allowing her to drive with   them.                                                            

Through testing her vision with various types of low vision glasses I determined that 1.7X bioptic telescopic glasses which included her eyeglass prescription allowed her to read 20/70 letters with each eye. That meets the DMV requirement to drive with bioptics. The same glasses help her recognize her friend's faces from a greater distance.

For television I prescribed wide angle telescopic glasses adjusted for the distance of her TV. A cap with a convex lens can be placed over the left telescopic lens and is used for reading.

Two months after receiving her telescopic glasses Mrs. Stanley returned to me for certification to apply for the special drivers permit. She passed that easily wearing the bioptics and was able to return to driving.

Mrs. Stanley told me, "These glasses are really worth the money. I can read and see TV better. I have used them at meetings and was able to see the person leading it better. I am looking forward to getting back to driving."

If your vision is keeping you from doing the things that you'd like to do give me a call. I'll talk it over with you and tell you on the phone if I can help you. I do not accept low vision patients unless I feel that I will be able to help them achieve their goals. Call me toll free at 1 866 321-2030.

Macular Degeneration: A New Risk Factor

Risk factors for macular degeneration are well known: family history, age greater than 60, smoking, sun exposure.  Now new research has found that in women with high dietary fat intake there is increased risk of developing macular degeneration.  The attached article from MedPage Today   also mentions the protective role of Omega 3.  If you have any of these risk factors it is important that you change those that you can (diet, smoking, sun exposure) and use appropriate dietary supplements which your eye doctor can recommend.

Complex Picture Emerges for Fat's Impact on the Eye

By Crystal Phend, Senior Staff Writer, MedPage Today
Published: November 11, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.


Action Points
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Explain to interested patients that the relationship between dietary fat and age-related macular degeneration in the study could not be determined as causal and may have been influenced by other related nutrient intakes and the proportion of different types of fat consumed.

A fat-filled diet may put younger women at risk for future age-related macular degeneration, although the effect varies by type of fat, researchers found.

Women younger than 75 with the highest total fat intake (about 43% of daily calories) had 70% higher odds of intermediate age-related macular degeneration than those in the lowest quintile (21% fat calories).

The multivariate adjusted odds ratio was 1.7, (95% CI 1.02 to 2.7, P=0.10 for trend), according to Julie A. Mares, PhD, of the University of Wisconsin in Madison, and colleagues.

The results in younger women, who made up the majority of the cohort, extend the "large body of evidence" for a link between macular degeneration and overall fat intake to earlier stages of the disease, they wrote in the November issue of the Archives of Ophthalmology.

"High-fat diets might be a marker for diets that are poor in many micronutrients that could protect against age-related macular degeneration," Mares' group said.

However, there were complex associations that differed by type of fat consumed and the population examined.

For example, women 75 and older actually saw a protective effect from higher total fat intake (multivariate adjusted OR 0.5 for highest versus lowest quintile, 95% CI 0.3 to 1.0, P=0.02 for trend).

This inverse association could reflect selective mortality bias, the researchers suggested: women who survived likely had healthier diets and lifestyles -- but developing age-related macular degeneration increases mortality risk.

"Thus, potentially adverse relationships between diets high in fat and age-related macular degeneration could be masked in older segments of the sample," they wrote.

Inconsistencies in the relationships between specific fats and age-related macular degeneration may also have reflected other dietary characteristics for which fat intake is a marker, the researchers noted.

The researchers analyzed dietary fat intake measured in 1,787 women participating in the Carotenoids in Age-Related Eye Disease Study (CAREDS), an ancillary of the Women's Health Initiative Observational Study.

CAREDS included only women ages 50 to 79 who had high or low intake of the antioxidant carotenoid lutein (above the 78th or below the 28th percentile), and who had been recruited from three of the 40 Women's Health Initiative study sites.

Photographic assessment for age-related macular degeneration revealed that 4% of the women had intermediate disease -- defined by extensive drusen deposits on the retina or optic nerve head as well as pigmentary abnormalities.

Advanced disease occurred in too few participants to analyze by fat intake.

Among the individual types of fat measured on food frequency questionnaires four to seven years prior to eye examination, saturated fat showed a higher risk with increasing intake among women overall (multivariate OR 1.6 for quintile five versus one, 95% CI 0.7 to 3.6), but not among older women (multivariate OR 0.9, 95% CI 0.3 to 2.6, P=0.01 for age interaction).

Monounsaturated fat, such as that found in nuts and olive oil, appeared to reduce risk with at least average intake overall, after adjustment for saturated and omega-6 fat and lutein intake (OR 0.9 to 0.5 for quintiles three to five versus the lowest quintile, P=0.12 for trend).

Polyunsaturated omega-3 fatty acids (most commonly from fish intake) have generally been found to reduce risk of age-related macular degeneration in prior studies (See Fish and Vitamin D Linked to Lower Risk of Macular Degeneration and Fish, Nuts Protective Against Macular Degeneration)

But in CAREDS, higher intake of this heart-healthy fat was linked to greater risk of intermediate macular degeneration (multivariate OR 1.8 for quintile five versus one, 95% CI 1.2 to 2.6, P=0.003 for trend).

Another polyunsaturated fat, omega-6 fatty acid, which comes largely from vegetable oils such as those in margarine and salad dressing, has been recommended by the American Heart Association to reduce coronary risk.

But as in some prior studies, macular degeneration risk rose with omega-6 intake (OR 2.0 for high versus low quintiles, 95% CI 1.1 to 3.5) after adjustment for age, and other fat intakes. The same was true for younger and older women alike.

Discounting the effect of omega-6 intake, which was closely linked to omega-3 intake, appeared to eliminate the apparently negative impact of higher omega-3 consumption (OR 1.0 for those above the median for omega-6 versus 2.7 for those below the omega-6 median), though it was not a significant interaction (P=0.38 for interaction).

Omega-6 may promote inflammation, "which is thought to contribute to retinal damage that may promote age-related macular degeneration," the researchers said.

The researchers cautioned that the relative proportion, not just the absolute amount, of each type of fat consumed may be important to the effect on eye health. They noted that the associations found could not be pinpointed to the fat itself, rather than other compounds in the foods in which they are commonly found.

Also, generalizability to more racially and ethnically diverse population and to men may be limited, Mares' group noted.

The study was supported by a grant from the National Eye Institute, by the National Heart Lung Institute (for support of the Women's Health Initiative), and by Research to Prevent Blindness. The researchers reported no conflicts of interest.

Help is Available for Persons with Macular Degeneration

Macular degeneration is a very unfortunate eye disease that effects millions of Americans.  Due to damage to the macula, the part of the retina that provides the sharpest vision, these people often have to give up many activities that are important to them.  Reading, driving, recognizing faces, watching television, viewing photographs, hobbies are among the many things that they are no longer able to enjoy.

One of the very unfortunate facts related to low vision problems such as macular degeneration is that most of these people are not aware that there are ways that they can be helped to return to some of the activities that they have had to give up. Of course, there are no magic cures for macular degeneration, diabetic retinopathy and other diseases that rob people of clear sight. However, there is help available for many who suffer from these conditions.


A couple years ago the magazine, Eyecare Business reported on a survey of 60 patients who had been helped by a low vision doctor in the Western U.S. Their average age was 68. "Most said that they had visited and average of 3 other providers who did not help before finding one who did. In fact, 47 percent said they were previously told nothing could be done to help."

In my low vision practice I'd say that almost all of the patients have been told that there was no help available for them. Of the patients who I accept I am able to help over 90 percent. I am able to prescribe some form of low vision device which will allow them to achieve their goals.

It is true that there is no current treatment that restores the vision lost from macular degeneration. However, there are many ways that patients can be helped to perform those activities that are important to them. Careful srceening in advance of the low vision appointment will identify those who can be helped and those who cannot.

All of the above explains the reason for my beginning this blog. My intention is to give real life examples of patients with macular degeneration and other eye diseases and the ways that I have helped them. All of those patients have given me permission to use their information. They share my desire to spread the word to other persons with low vision. You do not have to give up your normal activities. A low vision evaluation, by an experienced low vision doctor, can reveal ways in which your vision can be enhanced and ways to assist you.

In addition to sharing real life success stories through this blog I'll be providing information on macular degeneration and other diseases that result in low vision. I'll also discuss types of low vision devices and how they can be applied to various everyday activities. My hope is that you find this information helpful and if you or someone you know has macular degeneration you will seek help. If you would like to discuss your situation with me please call toll free 1 866 321-2030. Just leave a message and your phone number. I'll be happy to call you back for a phone consultation at no charge