Diffy Cults

Just getting a quick page or two written before I am off. That is off as in off on vacation not as in “she is a little bit off.” That happened quite a while ago.?

Still hoping to get my loaner CCTV before we leave but I doubt it will happened. A friend of my husband’s is watching the house. He promised to take delivery and pack up my machine to send for repairs.

I am still hoping against logic that this will all be settled by the time we get back. Cockeyed optimist; so shoot me.

Of course, I have found several interesting web articles now I don’t have a lot of time to go over them and no CCTV. Since I don’t have my machine to put them on to read, I put one on NaturalReader. Let the iPad read to me. [Lin/Linda: to read all about NaturalReader, go to Sue’s page Let Me Read to You.]

Some of the pronunciations are a bit ‘off’ as well. D.O., doctor of optometry, comes out as ‘odd’. I guess she calls them as she sees ’em!? She? It is a female voice on my machine. Not sure if I could change it if I wanted. Never tried.

Found something called Practical Guidelines for Treatment of AMD. The pamphlet says with all of the rapid advances in potential treatments for AMD it makes it “diffy cult” for practitioners to know what will be “Benny Fish All” to their patients.? Gotta watch those “diffy cults”. Not to mention that Benny Fish All. OK, OK, so I am easily entertained.

The article suggests doctors are not proactive enough in the early stages of the disease. It suggested something like 78% of AMD patients have substantial, irreversible vision loss already at the time of the first treatment. This includes 37% who have become legally blind by the first treatment. Yikes! It goes on to state not all drusen are a result of AMD and doctors may hesitate to make the diagnosis on the criteria of drusen alone. There is also the patient variable involved. Will the patient believe she is losing her sight and do something if there is no acuity loss? Will she freak? Stay tuned….

The article suggests using dark adaptation problems to emphasize there is a real problem even when acuity seems just fine. It quotes statistics dark adaptation is an excellent predictor of age-related macular degeneration and is, indeed, 90% accurate!

In other words, if you know someone who has a lot of problems with dark adaptation, suggest they be checked for AMD. There is evidence problems with dark adaptation can be detected up to three years before the disease can be detected through clinical measures.

Later….There is a lot more in that article, but I have to sign off here. Too much over 500 words and I turn into a pumpkin. Watch out for those “Diffy Cults” and if you run into “Benny Fish All” say hello for me. After all, he is the kind sort. Me, I’m going to crank up my loaner CCTV. It came today!

Written October 27th, 2017 Continue reading “Diffy Cults”

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Studying the Study

Lin found the paper discussing results from the phase 2 study of lampalizumab. It is a little dense but I will try to pre-digest it a bit for you. [Lin/Linda: we’ve been calling it ‘lamp stuff’.]

The study design itself was somewhat basic. There were two independent variables and two controls or shams. Independent variables are the things the researchers are manipulating. In this case it was two dosage schedules. Shots of the drug were given every month and every other month.

Controls, or sham treatment groups, were given shots on the same schedules. However, their shots did not contain lampalizumab. They just thought they did.

Overall, when the every month dosage of lampalizumab people were compared to the every month fake treatment people (sham condition), their rate of degeneration was slowed by a fifth. That is where the 20% number comes from.

However, when the researchers looked at their raw scores, they made a discovery. Some of the subjects absolutely rocked it! They were showing decreases of 44% in rate of deterioration. Others did not differ at all from the controls. Their eyes just continued to get worse at the usual rate. What the hey?

Thinking the difference might be genetic, the researchers thought about which genes to consider. They ended up with the complement factor I at-risk allele as a possible suspect.

An allele is half a gene pair. Genes come in pairs; remember? One from Mom and one from Dad. Alleles can be matched or mismatched. Terms are homozygotes and heterozygotes, but that’s not important in this case. It wasn’t important to the researchers either. They decided to look at people with one and two ‘bad’ alleles of complement factor I.

When they put everyone with good CFI alleles in one pile and everyone with at least one bad one in another pile, they made another discovery. It was the people with the bad CFI alleles who had responded to the lampalizumab. There appeared to be something about that gene that interacted with the lampalizumab in a way that slowed things down.

Looking back at their numbers, the researchers decided all of the ‘work’ done in the initial, whole group was done by the bad CFI allele people. There was an overall difference of 20%; right? But remember we are talking arithmetic averages here. If half of your group ‘improves’ by 40% but the rest of the group improves by 0% when you add them together and divide by 2, you get 20%. 20% is sort of misleading. No research subject showed a 20% rate decrease. They were either at somewhere around 44% or somewhere around 0%.

There are some things that need to be further studied. The number of subjects was not large and they need to replicate things with lots more people, for example. However, for right now the takeaway message for us is this: as suspected, AMD is looking like not one disease but a family of diseases. It is created by several different genetic flaws. The lampalizumab phase 2 study results suggest this drug will only be good for the AMD ‘family member’ that is caused by complement factor I at-risk allele. Those of us – like me – who do not have bad CFI alleles will have to wait for another breakthrough.

Those of you with CFI at-risk allele can rejoice! It looks as if they have found the first real TREATMENT and it is for you! Congratulations! We are all happy for you and want to follow you very soon.

If you really want to look at the scientific paper from the study, click here.

written July 24th, 2017

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That Preachy Zealot

Here she is again, that preachy zealot for clean living! How are you all doing?

I was looking for new info on AMD and I found this article.

I know I harp on this topic ad nauseam but seeing this in the new releases I could not help myself. I am basically weak (and can be profoundly irritating?).

Anyway, a recent article on nature.com presented research suggesting AMD does not like clean-living folks. People working on the Blue Mountain Eye Study evaluated a group in the late 1990s and then again 15 years later. They looked at physical activity, diet, smoking and alcohol consumption as it relates to AMD. After all was said and done, the researchers decided it would be helpful if people could be encouraged to engage in good health habits.

They quoted data that women who eat well, are physically active and don’t smoke are three times less likely to develop AMD than women who do not have a healthy lifestyle. If you add the complement factor H at risk allele into the mix, the poor souls who eat crap, don’t exercise and smoke really don’t have much of a chance of dodging the disease at all.

What I just quoted was an older study, CAREDS. It used only women. The Blue Mountain people decided to replicate it but to include both genders. They also added alcohol consumption as a variable.

Blue Mountain concluded the combined effects of the four, healthy living variables were better than only one of the habits alone. They hypothesized each of the healthy habits helps to reduce oxidative stress and therefore reduce inflammation, generally thought to be a huge factor in the development of AMD.  [Lin/Linda: Sue talks explains what oxidative stress in her page Electron Rustlers.]

In addition, good health habits can affect the density of macular pigment. Thicker macular pigment can be protective. And BTW, levels of macular pigment can be negatively affected by obesity.

Since I always like to support our friends Down Under, I am making a pitch for healthy living just like the Blue Mountain people. Avoiding bad habits and developing good ones can decrease your chances of developing AMD. It can also reduce the rate of progression of the disease.

Hard to change habits? Absolutely. I am a carbs and salt girl. Horrible for me, but that is what I crave. I have never been a fruit eater.

However, since getting my diagnosis I am drinking a cup of fruit juice every morning. Enough of a change? I doubt it but at least I feel as if I am making the effort.

How long does it take to establish a habit? Google says 66 days. If you can change one thing in your lifestyle and stick with it for 66 days, you have dealt a blow against AMD. Lifestyle changes are one way we can take some of our power back from this disease. Worth a try. Continue reading “That Preachy Zealot”

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Rock On!

Over the past year I have developed a certain affection for Cheeseheads. Wisconsin seems to do a lot for people with visual impairment. However, I am starting to think the Beaver Dam researchers may be a bunch of killjoys!

Wisconsin? Beaver Dam? Yep. Beaver Dam is a town with between 16,000 and 17,000 people located along the Beaver Dam River and, yep, Beaver Dam Lake. I guess they ran out of catchy names. (Actually, that really DID happen in upstate New York. I got a giggle out of the fact they gave up and just started numbering lakes!)

But back to Wisconsin. The Beaver Dam study started in 1987. Since then they have regularly polled and tested the folks about all things vision. A big area of interest for them has been macular degeneration.

Lin sent me a 2004 article on how the Beaver Dam people found a correlation between sunburns in youth and macular degeneration. Problem was she sent it Friday evening. The evening before I was going to “Brigg’s”, an outdoor blues/music festival. Really???? Why now? [Lin/Linda: in all fairness, I did not know about Brigg’s until AFTER I sent Sue the article!]

To make a long story sort of short, I put on my ‘dancing shoes’, slathered on the sunscreen and went. The article said sunburn in your youth. Sixties are not youth; right? Had a great time.

I decided old rockers never die; they just go to music fests. I saw more gray ponytails – male and female – than I had ever seen in one place before in my life. Rock on!

Came home and I am looking into this sunburn and AMD stuff. After all, outside is one of my favorite places!

The article Lin sent me says people with 5 or more hours of sun exposure are more likely to have increased retinal pigment. Hats and sunglasses are associated with fewer soft drusen and RPE degeneration. 10 or more ‘severe’ sunburns in youth is more than twice as likely to be correlated with AMD later in life than two or fewer sunburns.

Something that was a relief to me was there was no correlation between time spent outdoors in winter sports and AMD. Apparently my day skiing right before I ‘lost’ my second eye had nothing to do with things. (Phew!)

The report kicks around several reasons for the sunburn/AMD correlation and finally decides more study is needed. Me, too. Khan, Shahid and Yates found a ‘suggestion’ of an association between sunburn prone skin and geographic atrophy. In 1998 the Blue Mountain Eye Study (hi, there, New South Wales!) found blue eyes can lead to AMD trouble. Sounds like the jury may still be out on sunburnt SKIN and AMD.

However, the jury has come in on sunburned eyes. The Southwest Eye Center reports photokeratitis, sunburn of the eye, can result in pterygium (a condition of the conjunctiva/cornea), cataracts and possibly cancer. AMD is listed on the page as a ‘maybe’.

Bottom line is this: wear sunglasses. Wear sunscreen. And, rock on! ?

written July 9th, 2017

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Hindsight is 20/20

Good evening! How are you all?

Lin has noticed I seem to have written soooo many pages they are overwhelming and confusing some people. She feels this is particularly true for some of the newbies who probably feel like they have walked in on the (boring and confusing) middle of a movie. [Lin/Linda: to be clear, those are Sue’s words! ::grin::]

Understood. Some of you are back in the shock and doom phrase and I am talking about getting newspapers on your phones and other trivial matters. Who wants to hear about that sort of thing while your world is unraveling?

In the interest of pointing you towards something that might actually be helpful, Lin is republishing some earlier pages for your attention and discussion. And I – always helpful – am going to add to the confusion by writing another page!?

This page will have a catchy title thanks to Lin, but right now I am going to call it “What I know now that I wish I had known a year and a half ago”.

First, you are not going everything black and dark blind.

It is not good but neither is it quite that bad. You are losing central vision. Things will not be good for anywhere from about 15 to 60 degrees of arc. Since normal visual fields are 170 or so degrees of arc, you have the potential to lose about a third of your vision. Not anything to cheer about but better than 100%.

You may not be doomed to progress to end stage AMD.

About 15% of patients become ‘wet’. About 15% progress to geographic atrophy. That means you – starting out with drusen and a diagnosis of early AMD – have a 85% chance of dodging the proverbial bullet for end stage AMD. You may very well not get as bad as I am and a year and a half after my second eye went to hell, I am still functional. [Lin/Linda: a person can have both wet AMD and geographic atrophy in the same eye.  I don’t what that does to the %, if anything.]

You did not cause this.

Yes, AMD is caused but it was not caused by anything you did or did not do. The causes are in your genes. This is a heritable disease. There are dozens if not hundreds of genes that are being investigated to try to figure out how AMD is created. It appears AMD may just be the result of a genetic ‘perfect storm’ and there is no one to blame.

There may come a time you are seeing things.

I saw some odd stuff when my brain was working overtime to assign meaning to the faulty images my eyes were sending it. You are not psychotic (I hope you are not psychotic). This is Charles Bonnet Syndrome. When your brain gives up trying to assign meaning to false signals you will stop seeing weird ‘stuff’. In the meantime, enjoy the fantasy.

Point number last: There is an amazing amount of hope for treatment and eventually a cure for AMD.

Research is going on everyday. New discoveries are announced with regularity. The medical community is hot on the trail of something that will arrest the progression and may even reverse this disease. All we have to do is hold on.

OK. Those were my biggie when I first lost my second eye. What are you worried about? Please share and we can discuss it. Continue reading “Hindsight is 20/20”

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Why NOT Me?

I am working on my lesson plan on radical acceptance for DBT. In order to truly be able to tolerate distress and build a life worth living – all in DBT parlance, of course – we sometimes have to radically accept a situation we do not approve of and that causes us pain. [Lin/Linda: Click here for another of Sue’s pages about radical acceptance.]

Why radical acceptance? Things termed ‘radical’ effect fundamental nature and have far-reaching effects. Some changes and distressing occurrences threaten us at the core. In order to deal with them we need to accept them at the deepest levels as well. Thus, radical acceptance.

Think integrating a new identity as someone with low vision into your sense of self. Now THAT is pretty radical.

Radical acceptance not only teaches “it is what it is”, no changing reality. It also teaches “everything has a cause”. When I first read that, I bristled a bit. I do NOT feel I did anything to deserve having this eyesight. Not my fault. Then I decided I would need to research it a bit more (after all, I am supposed to teach this stuff!)

Turns out the idea behind everything has a cause is not about assigning blame. It is, instead, to quiet that chorus of voices saying how things should be and how life is not fair.

Only when we get over feeling the Universe is out to get us can we eliminate some of our distress.

The plain and simple fact of the matter is I was a pretty logical candidate for developing AMD. I am female, white and of a certain age. My father had AMD. My diet runs toward fatty foods and I have high blood pressure. After I took another look at the risk factors I have I had to admit “why me?” was not the proper question. The more appropriate question would be “why not me?” What would make me so special I could have all those risk factors and not develop the condition?

The third tenet in radical acceptance says life is worth living in spite of the pain. (I try to live a full life in spite of my ‘blurries’. I also end up with muscle aches to prove it. Somebody remind me to act my age….later.)

In fact, DBT says pain has some very positive purposes. (Now let’s not get too crazy here.)

Nietzsche really did say “that which does not kill us makes us stronger”. I wasn’t there but I take it on good faith. Jane Juza said in The Positive of Experiencing Pain that pain tends to make us appreciate the good in our lives and to seek out meaning and purpose. Frankl said the meaning and purpose in your life may be in how you endure with grace.

So, there you have it, a preview of my lesson on radical acceptance. Hope it made sense. Going to bed a little early now. I think my pain is telling me I played too hard. Information, another benefit of pain. Night!

written April 30, 2017

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Preventative Maintenance

Last night I got up to go to the bathroom and I was dizzy, really dizzy. My husband suggested it was my blood pressure so when I got to school I had the nurse check it.

I may not be the gold standard of 120/80 but I was not bad. I hate taking medication but I take it for my blood pressure. As I get older there is not only the possibility of blowing a gasket but there is some (inconclusive) evidence of an association between hypertension and AMD. In any case, I don’t want to make things worse in the eye department.

After being harangued and harassed for years about my blood pressure (part of the reason I have white coat syndrome!) and now taking medication, I was a little dismayed by a medicalxpress.com article reporting there are preliminary findings suggesting some blood pressure meds are associated with much greater risk of developing AMD! What is up with that?

As part of the Beaver Dam studies, they have been collecting data on eyes since 1987. Their data indicated there is a correlation between the use of vasodilators such as some people take for blood pressure and the development of AMD.

Please remember correlation does not mean causality. In other words they could be running together but one is not causing the other. For example, Florida has the largest number of elderly of any state but living in Florida does not make you old.

There are other factors at work. Just the same, something is related between them and we should figure out what it is.

The researchers also found that beta blocker use was associated with increased risk of developing AMD. In particular it was associated with the development of wet AMD. Beta blockers are used for treating heart disease.

Now the article did not say whether the control group also had some form of circulatory system disorder for which they were receiving different treatments. Therefore it is hard to say if it is the medication doing the damage, the underlying, circulatory disease doing the damage or a third factor underlying both the circulatory disease AND the AMD doing the damage. Inquiring minds want to know but we don’t seem to have an answer to that yet.

Because we don’t know, if you are concerned, talk to your doctor and see what he or she has to say before doing anything. Don’t make any drastic changes based on one study. Your doctor is your expert and you should make informed decisions in concert with him.

Me? My high blood pressure meds are diuretics so I don’t need to worry about the meds. However, if I had to guess – and this is a guess from a layperson – my money would be on an underlying genetic snafu wreaking havoc with both our circulatory systems and our eyes.

And until they can lift the genetic hood and make the necessary repairs on that level? Preventive maintenance, my dears, preventive maintenance. Watch what you eat, get your exercise and, yes, take your medication as prescribed.

April 12th, 2017

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