Cataracts and AMD

Hunting around for a good topic and AMD and cataracts popped up in the search. Daddy had both and I would suspect some of you have both, too. Is there a relationship between AMD and cataracts? If so, what is it?

Turns out those are excellent questions. The experts are falling on different sides of the fence as to whether or not there may be a relationship between them.

Back in the earlier years of this century (2002) the good folks in Wisconsin, the Beaver Dam Eye Study people, again looked at their subjects after ten years had passed. Statistically, there was an indication that cataracts alone are associated with early AMD. There was also a statistical correlation between cataract surgery and late AMD.

Once again, we are looking at correlation. Correlation does not assume causality. Want a giggle over crazy correlations? Go to the website Spurious Correlations for some fun graphs. You will quickly see how just because things correlate they may not cause one another.

Anyway, like I said, they are still casting around to try to get some definitive answers on this question. The Chesapeake Watermen Study found a correlation between having cataracts and AMD but the Framingham Eye Study and some early Blue Mountain work did not.

But what about a correlation between cataract surgery and late AMD? Beaver Dam found cataract surgery before baseline (initially study measures) was associated with increased risk of late AMD. In fact, eyes that had cataract surgery were four times as likely to develop geographic atrophy and three times as likely to develop wet AMD! Holy freakin’ moley! How do you like that for being between a rock and a hard place?

Of course, like, I said, there is no certainty in any of this yet. In AREDS Report 25, Chew et al reported no correlation between cataract surgery and ARM. Hard to know who to believe.

So, what to do? No one is saying to go blind with cataract now rather than wait and go blind with AMD later. Do what you have to do to see.

FYI Blue Mountain, fortunately or unfortunately, flipped over to the significant correlation camp in reviewing results of a 2006 study. While that may not be great news for those with cataracts, Blue Mountain also shared yet another point they agree on with Beaver Dam. They discovered nonphakic eyes had a three times greater risk of developing late stage AMD as opposed to phakic eyes.

I know. I know. Don’t get your panties in a bunch.  Here is the explanation: in phakic cataract surgery, there is a small incision made in the front of the eye and the artificial lens is implanted. The natural lens is not removed. In nonphakic cataract surgery, the lens is removed.

Talk to your doctor, but as it stands now, given the choice, take the phakic procedure. Might decrease your chances of advanced AMD.

Written August 7th, 2017

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Worldwide Warriors

Some of this is a repeat of information I shared a few months back, but a little review is not a bad thing. I know we have readers in low and middle-income countries and I started to wonder about the state of things where these readers are.

Even though most of our readers are in the US, UK and Canada, we should not ignore people just because they don’t make up large numbers; right? Right!

Found the WHO site on vision and blindness. That is as in World Health Organization and not Doctor Who, although over the years I have been partial to Tom Baker and Matt Smith. Bless the BBC. But I digress AGAIN.

The World Health Organization says there are 285 million visually impaired in the world. 39 million of that number are blind. This is two million more than a population estimate I found for Tokyo. 90% of the world’s visually impaired live in low-income settings. 82% of the people with blindness are over age 50.

To repeat, most of the vision problems in the world could be solved with glasses. That’s 43% of that 285 million or….let me get the calculator, 122,550,025 needed pairs of glasses. Unoperated cataracts come in second at 33% and glaucoma comes in third at 2%. Age-related Macular degeneration comes in down the list.

WHO is in the coordination role for fighting world blindness. Among other initiatives WHO has partnered with Lions Club International to establish a global network of 45 childhood blindness centers in 35 countries. (Actually, the number may be greater than that because the article was written in 2014).

And talking about the Lions Club, the Lions Club doesn’t just dabble in vision support, they are into it up to their own eyeballs around the world. Need a vision hospital in Nepal? Try Butwal. The Lions are there. How about the state of Telengana in India? The Sunyaet Lions have their own hospital.( I think. I need work on my knowledge of Indian geography!) Kenya? SightFirst eye hospital is in Nairobi.

The Lions have dozens and dozens of sites, most of them in developing nations. If you are in need of sight services, contact the Lions Club. The chances are good you can find help.

And once again…is there hope? Are these warriors against blindness fighting a losing battle? In order, yep and nope. The battle is being won. In the last 20 years there has been a decrease in visual impairment worldwide. This is in spite of the aging of the population. The decrease has been primarily due to efforts to eradicate infections causing blindness but other efforts have bearing fruit as well.

So, there you go. WHO and the Lions Club may not own that all around wonder tool, a sonic screwdriver like Doctor Who but they are still managing to do great things for people with vision loss. If you are living in a developing nations, WHO and the Lions Club may represent your hope. Continue reading “Worldwide Warriors”

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Not Created Equal

We heard from a reader who has vitelliform macular dystrophy. I had never heard of it. Therefore you can image my surprise when I picked up an article I had downloaded last week and – guess what! – the article talked about vitelliform dystrophy! Sometimes the synchronicity in the Universe is scary.

Anyway, it appears the Universe has declared we are to learn about vitelliform dystrophy. Here we go!

I have discovered all macular diseases are not created equal. There are dozens of them and researchers are discovering more on a regular basis.

Vitelliform dystrophy may look like age-related macular degeneration and act like macular degeneration but it is not macular degeneration. (Don’t worry. We are not throwing you out of the group!)

Vitelliform dystrophy is a pattern dystrophy. They are so called because the damage tends to ‘draw’ things on the retina. For example, one manifestation of the disease looks like a butterfly (photo to the right is a fundus photograph of butterfly pattern).

Vitelliform 2 is called Best disease. This is not because it is the best disease to have nor is it because Dr. Best hijacked the disease and named it for himself. It is because the disease comes as a result of a mutation on the BEST1 gene. (Apparently that means we all have BEST genes and there are at least two of them. How about that.)

Best disease is a pattern dystrophy because – all together now! – it makes a PATTERN on your retina. The pattern is a sunny-side-up egg. The yolk is centered on the fovea.

One of the nice things about Best disease is you may never know you have it.  According to the Hereditary Ocular Disease site 7 to 9 percent of those with Best disease are asymptomatic. Others may experience vision loss but recover most of their function. A much smaller percentage may proceed to neovascularization and serious loss. Of course, the older we get the better chance we have of having some really serious problems. And by the way, children can have this one.

That is because, once again, it is genetic. Best disease is an autosomal dominant condition. That means it is on a body-forming chromosome – not the chromosome that has the x or the y and makes you a boy or a girl.  It is also dominant and can express itself whether or not its partner gene wants it to. You only need one of these babies to be in trouble.

Of course there are all sorts of things that may or will affect whether or not this gene does actually express. However, this is not a place to discuss epigenetics. Nor am I the one to explain THAT baby! Suffice it to say, you should warn everyone you are related to by blood that it has expressed in the family and they need to have regular eye exams.

Like AMD there is absolutely no treatment and no cure. (I get so tired of typing that). If you have Best disease and progress to CNV you may profit from shots.

And that, my dears, is that. Continue reading “Not Created Equal”

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Cheap Entertainment

Just back from a walk with the Beastie Baby. This time I got to smell the honeysuckle and listen to the bees buzz. Spring in Central Pennsylvania. “Enjoy! Enjoy!” (Thank you to Manny Gordon for that quote!)

Lin got me another article on geographic atrophy and scotomata. I have not read it yet. I will let you know but right now I want to talk about floaters.

We had a yoga class outside in the middle of the afternoon. When I was in savasana (corpse pose or final rest in English. I like the Sanskrit much better!), I was watching my floater swim around in my eyeball. Hey, what can I say? I take my entertainment where I can find it!😋

I have been told that eventually most floaters settle to the bottom and just hang out there. However, when I am in yoga and doing all sorts of poses, mine gets riled up and ‘swims’, my floater is in my right eye and looks like a mosquito larva.

Or at least, after some deliberation, that is what I decided. Cheap entertainment. Sort of like lying in the grass and deciding what the clouds look like.

Floaters are one more delightful thing we develop as we get older. The gel in our eyes – the vitreous – separates. I had a chocolate pudding analogy before. Know how pudding separates into fluid and clumps of pudding when it has been in the fridge too long? Same basic idea. The floaters are the clumps.

I have had this particular floater for years. You probably have some ‘old friends’ in your eyes as well. However, if those old friends suddenly have a lot of company from other floaters, if you get flashes, if you get a curtain-like shadow (see photo to the left) or if peripheral vision starts going dark, get to your eye doctor stat. These are signs of serious retinal damage and need to be dealt with as soon as possible.

The Mayo Clinic page on eye floaters lists a series of questions for which you might want to have answers when you go to your doctor. They also list some possible treatments for floaters. Laser surgery is used infrequently due to the serious risks involved. The other possible treatment is a vitrectomy. That is not fun and games either.

If possible, the best and safest thing to do is to just put up with the floaters. Shake your head. Watch them float. Think what they remind you of. If nothing else, they are cheap entertainment.

written April 29th, 2017

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Mr. Magoo!

Here we go with the crazy, preconceived notions again. I told you I was at my third job. First time in months but I understand. It is a major event to get me there and get me home. Anyway, a colleague there looked at me with my glasses and looked perplexed. She wanted to know where my big, thick glasses were!

Now this is an intelligent woman with advanced degrees. If she is thinking this, what are other people thinking?

Basic tutorial, just in case: corrective lenses, especially the big, thick ones, are for errors of refraction. Refractive errors occur in the front of the eye. There is a malformation of the lenses that causes the light to bend ‘wrong’ and focus either in front or behind the retina. The same thing can happen if you have an eyeball with the ‘wrong’ shape. Some eyeballs are long and ‘skinny’ and others are short and ‘fat’. In either case the light does not focus on the retina and things are out of focus.

Corrective lenses bend the light. They do it in such a way that the light will fall properly on the retina and we can see clearly.

There are two, main types of refractive errors. Myopia, or nearsightedness, makes it hard for us to see things far away. Hyperopia, or farsightedness, makes it hard for us to see close up. There are also astigmatisms. I don’t know a lot about these but I think they distort things because of imperfections in the lens. They can also be corrected with glasses.

Age-related macular degeneration, as most of our readers know, is a problem at the back of the eye. Bluntly put, our maculas are dying. Maculas are parts of the retina, located at the back of the eye. The only type of ‘corrective lenses’ that may help AMD are prisms. They relocate the image off the macula and on to a part of the peripheral retina, a part that should still be functional. [Lin/Linda: prismatic glasses don’t work for everyone with AMD. Click here for an article about them.]

So that is pretty much that. AMD is not a refractive error and is not going to be helped with ‘coke bottle bottom’ glasses. We are not all Mr. Magoo!

There are many, many different types of eye disorders. Most of them are not correctable with glasses, but the average person does not appear to know that. Once again it appears it is up to us to go out and educate people.

We are not all Mr. Magoo! Continue reading “Mr. Magoo!”

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I Promise

Greetings! Beautiful day. Sunny but cold. 37 degrees Fahrenheit. My friend who is ever concerned about my welfare knew my husband had pumped up my bike tires and thought today would be perfect for me to join her in a bike ride. Yes, I want to ride, but it is 37 degrees! Whoa.

New washer came bright and early this morning. I am actually very glad to be able to get some laundry done. Classic example of not appreciating something until it is no longer there.

Which brings me to our vision and a problem I heard about the other week. At least one member has retinal scarring. If one person has it, I suspect others do as well. I tried to look it up online and there was surprisingly little. Everything I found turned me around to macular puckers and holes. They are obviously all related, but what I was looking for was scarring in particular. If you find any good info, please share. Maybe write a page😀.

According to WiseGeek, retinal scarring is exactly that, scar tissue on and under the retina. Small scars are not that big a deal. Our wonderful brains just sort of erase them. However, big ones make problems by giving us visual distortions and loss.

What types of distortions? According to WiseGeek the Amsler Grid may curve and/or parts of it may pull out of position. Reading can be just about impossible for people with large retinal scars.

Cause of retinal scarring can be pretty much anything that causes the retina to become inflamed. That would include injury, illness and wet AMD. Repeated inflammation leads to the potential of bigger scars and more vision loss.  [Lin/Linda here: I found an article that says “People can develop retinal scarring from severe myopia, ocular histoplasmosis syndrome, and wet age-related macular degeneration (AMD). Scarring results from inflammation, caused by irritation of the retina. Severe occurrences  can cause swelling of the retina, wrinkling of the surface tissue, or even retinal detachment.” The article also talks about research into a compound that may prevent scarring in the first place.]

You hear the cautionary note there? For you folks with wet, very few things are more important than keeping up with your treatments and preventing irritation to your retinas.

Repeat after me: “I promise I will get my treatments in a timely fashion. So help me God.” Now spit in your hand and virtually shake….yuck. Who came up with that spit in your hand business? Obviously knew nothing about viruses and bacteria.

Treatments for retinal scarring appear to be limited at this time, of course. Because the available treatments are invasive, often the first ‘treatment’ is watch and wait. Other treatments are vitrectomy and something called a membrane peel.

We talked about vitrectomies in the past. In that procedure the gel like substance in your eye is drained. That substance, the vitreous, has string-like things in it that can adhere to the macula and tug. These ‘tugs’ create puckers, holes and scars.

Epiretinal membrane peeling is described in an article by Hampton Roy. The title is, aptly, Epiretinal Membrane Treatment Management. My interpretation is that in a peel, the surgeon teases off the upper layer of the retina. Maybe like trying to take off just one cell layer of an onion? Roy goes into explanations on a few different types of peels. My assumption is their assumption is the scar will be mostly in the top layer and can be removed this way.

So now you know everything I think I know about retinal scarring and its treatment. Remember, I am not a doctor and you should assume I know nothing when it comes to pretty much anything. The great majority of what I think I know has come off the web. Always check with your doctor. Continue reading “I Promise”

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