“I Just Learned My Mother Has Macular Degeneration. How Can I Help Her?” – Part 1
By Dr. Jared L. Cooper
If you are wondering how you can help a parent diagnosed with macular degeneration, you are not alone. Age-Related Macular Degeneration is the leading cause of blindness in people over the age of 60. There are currently 15 million Americans who suffer from this condition and the National Institute of Health reports the numbers will double by 2020.
Understanding the eye disease and its treatment is the most important thing you can do to help not only your loved ones, but also yourself-- Macular Degeneration is caused by many things, but studies indicate a strong genetic link, which means that you could also be at risk. That’s why it’s important for you to know as much as you can about the disease, its symptoms and its treatment.
Step 1: Learn about the disease and treatment options.
What is Age-Related Macular Degeneration?
Age-Related Macular Degeneration (ARMD) is a progressive, sight-limiting condition in which the delicate nerves in the back of the inside of eye begin to deteriorate. This leads to reduced central vision, but spares all of a person’s peripheral or side vision. Because your parent still has good peripheral vision, you may notice that they can sometimes see small things, like a coin dropped on the floor, but they cannot see a person’s face when looking directly at them. Often, people with ARMD will turn their heads or look to the side when gazing at someone, to make the most of their side vision capabilities
There are two main types of ARMD: Dry and Wet.
Dry Macular Degeneration
Also known as non-exudative macular degeneration, Dry ARMD is characterized by development of drusen, an abnormal accumulation of macular waste products that are naturally produced by the eye’s specialized nerve cells. Drusen, which can be seen by an eye doctor during a dilated eye examination, is normally removed by special types of cells located just below the retina, known as retinal pigment epithelium. But if these cells fail to keep the macula clean, waste products will begin to collect and accumulate.
One theory about how drusen impacts vision is that it may form a barrier against the blood supply to the macula, leading to degeneration of rod and cone cells, causing progressive visual loss. Although drusen is present in Dry Macular Degeneration, the macula is not leaking fluid, proteins, cellular debris or blood, hence the term "dry."
Wet Macular Degeneration
Wet ARMD is a progression of the dry type of the disease. It has many of the characteristics of Dry ARMD, but it also includes the development of new abnormal blood vessels below the macula, as well as the accumulation of fluid and cellular debris called exudates.
These new blood vessels are very fragile and can rupture spontaneously, leading to bleeding below the macula, or even inside or on the retina and macula itself. This rupture of blood vessels can cause profound visual loss. The treatment of wet macular degeneration aims to stop the leaky blood vessels in the eye through a series of eye injections. In many cases, vision does not improve from the injections, but the injections can prevent vision from worsening.
Treatments for ARMD
Although macular degeneration causes severe central vision loss and there is no complete cure, many people are able to continue to do the things they love to do without surgery or medication, with the help of a highly skilled low-vision physician who can prescribe specialized vision aids. There are three common optical aids that can greatly improve vision for ARMD sufferers:
- Telescopic eyeglasses
- Microscopic magnifying glasses
- Electronic devices
In general, if someone can read with a magnifying glass, they can also read with prescribed magnifying prism eyeglasses or prescription microscopic eyeglasses. During a low-vision evaluation, the patient is taught how to hold reading material or projects at the proper distance for each of the different prescribed lenses.
Telescopic eyeglasses can be loosely thought of as miniaturized prescription-based binoculars placed into eyeglass frames. They can be monocular, meaning for just one eye, or binocular, for both eyes. The miniature binoculars are placed in different positions according to the patient’s needs.
Microscopic magnifying eyeglasses combine a patient’s regular eyeglass prescription for common conditions, like astigmatism and myopia, with the magnification needed to see things up close and engage in activities like reading, writing, knitting, sewing and even tying fishing flies. Microscopic eyeglasses look somewhat different from regular glasses, and may include several lenses on each side to provide the adequate correction for patients with severe vision loss.
Electronic devices can enlarge the size of reading material, but because these devices can be expensive and are not always portable, specialized eyeglasses are typically the primary course of treatment. An experienced, knowledgeable low-vision specialist will prescribe the right solution for each patient’s individual needs, so they can confidently handle their daily activities in a variety of different settings.
There are many products that help those with vision problems handle everyday tasks and activities, by using other senses to assist, and by making things easier to see. Audio options include talking clocks, calculators, watches, navigation tools and books. Telephones are available with large dials or buttons, and computers offer large print, large screens and special keyboards for the visually-impaired. Because the market for visual aids is only growing as the population ages, there are always new, ingenious devices coming to market to help the vision-impaired lead better lives, so if there’s not a solution for a particular challenge yet, there just might be soon!
Orientation & Mobility Training
To make getting around as worry-free as possible for those with ARMD, special techniques to stay oriented and mobile, known as Orientation and Mobility Training, have been developed by vision rehabilitation specialists. Techniques that work include listening more carefully while moving around (people are able to gauge more than you might think about their surroundings using their other senses!) and using a white cane. Another good option, when it’s available, is for the patient to use a sighted guide who holds their arm just above the elbow while walking a half step in front of them. The guide can tell the patient in advance about anything that could cause falls, like cracks or holes in the sidewalk, steps or ledges,visions problems to keep the patient from tripping or losing their balance.
Educating yourself about the disease and treatment options is the first and most important step to supporting your loved one as they learn to live with the disease. Armed with the facts, you can better help them cope with the emotional aspects and help them adapt their lives to their changing vision.
Next in Part 2: The emotional aspects of a diagnosis of Macular Degeneration-- What to expect and how to handle the feelings you and your family member may experience.vision problems
Dr. Jared L. Cooper is a Low Vision specialist who treats patients with Macular Degeneration throughout Utah, Southern Idaho, Montana and Wyoming. For more information on how specialized eyeglasses with advanced optics can greatly improve the vision of Macular Degeneration and Low Vision sufferers, please visit www.drjaredcooper.com, call 1-800-451-2015 or email firstname.lastname@example.org.