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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Good Guy Force

We could be a force. Really! According to ScienceDaily (4/27/17) we are up to an estimated 14 million AMD sufferers in the States alone. That is one big number of visually impaired older folks!

We already know knowledge is power. Numbers are power, too. It is hard to ignore that many people. That is slightly more than the populations of Buenos Aires or Istanbul. Wow.

So now that we realize we have so much power, we need to decide if we want to use it for good or evil. Silly question! We all know we are the Good Guys!

Good guys go out and rescue people; right? Well, it turns out there are a heck of a lot of people who need to be rescued!

What am I talking about? David Neely at the University of Alabama re-examined 644 people who had been given clean bills of macular health based on routine eye exams. Double that to get the number of eyeballs, 1288.

Neely found 320 eyes had AMD! That is 25%! There was not a whisper in medical records about any of these eyes having drusen. Undiagnosed AMD was associated with older patients, male gender and less than a high school education.

Maybe there is no treatment for those eyes now, but what about in five or ten years? By then such lapses in diagnosis may mean the difference between an easy fix and serious problems.

Hot Topics Small Talk (volume 2, number 5) also picked up on Neely’s work and make a nice, little summary sheet for us. This summary noted it is harder to visualize the retina during routine exams in older adults. Maybe ‘routine’ should become a bit more rigorous? The pathology was observed using fundus photography.

Other findings cited by Hot Topics? The presence of cataracts did not contribute to misdiagnosis. Also, it did not matter if the initial exam was done by an ophthalmologist or an optometrist.

Essentially, this research suggests we could be over 17 million strong (and I mean that word, strong) if these early cases were not being overlooked. Like I said, perhaps not essential now but possibly crucial in the future.

So, your mission, should you choose to accept it, is to encourage everyone, but especially older men, to have fundoscopic examinations of their eyes. As usual, should any of your AMD Good Guy force be caught doing this, we will be very proud of you. This page will self-destructive in ten, nine, right…… Continue reading “Good Guy Force”

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Shimmering

Albert Einstein once said “the more I learn, the more I realize what I don’t know.” Apparently I am in good company, because I feel the same way.

With no immediate crises in my life and no immediate reason to freak out – and even with geographic atrophy and permanent retina damage, this state of affairs is possible! – I have been trying to get caught up with some research. I keep running into things I have no knowledge or understanding of.

Lin suggested that after over a year we should know SOMETHING about these things. We don’t. For example, I am still clueless about what I can expect concerning the progression of density of my ‘blind spots’.

And speaking of disease progression, (was that a smooth segue or was that a smooth segue?😁), I do have a couple of things to say about disease progression from that last article I read. Remember the one on GA?

The article opined all the new interest and hoopla about dry AMD came from the success with treating wet. However it wasn’t why I would think. You know, we have scaled that mountain and are looking for new summits sort of thing? Nope, the reason was they discovered that even after severely limiting the development of neovascularization in eyes, the eyes just kept right on progressing with dry AMD! Sorry, darlings.😢 It seems a former wet AMD eye becomes a dry AMD eye.

And dry AMD – to my great chagrin – progresses. How much? I assume it can take the entire macula but I have not seen that definitely stated anywhere. I have seen it stated that it generally stops with the macula. Maybe not such a ‘small’ favor. Could be a lot worse.

The last thing I learned from that article is how best to document disease progression. That is with something called cSLO FAF. Isn’t that informative? Exciting even!

OK, OK, just ‘funning’ with you. I looked it up. Fundus autofluorescence is diagnostic imagery. It detects fluorophores in the retina. Fluorophores being chemicals that re-emit lights shone at them. Research quoted by Wu in Use of Fundus Autofluorescence in AMD said risk of wet AMD can be predicted by a patchy reflection pattern and lots of ‘shimmer’ (my word) at the edge of a patch of geographic atrophy is predictive of cell death and growth of the GA. The more ‘shimmer’ the worse the trouble you are in. [Lin/Linda: We hadn’t had a music reference for some time.  When I hear the word ‘shimmer’, I think of John Lennon’s song “Julia” which uses the word ‘shimmering’, hence this page’s title. ::smile::]

So if anyone throws a bunch of letters ending with FAF at you and says you are going to have that, it may be they are checking for disease progression. I cannot remember ever having one, but it is noninvasive so no biggie. Should not hurt. Just more pretty pictures. Hopefully they will find something good.

Pretty much it for now. Will probably write some more nonsense between now and then, but Wednesday I am going to another support group meeting. They are demonstrating an electronic monocular called a Mojo and I want to see it. Will let you know!

Chat with you later! Continue reading “Shimmering”

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Good Thought, Bad Thought

Back again in the same day. You do know I am ridiculously hard to get rid of; don’t you?😀

This is the page I was going to write before my ZoomText, inelegantly put, took a dump. Now I will write it.

I went to see my local retinologist Monday. Great guy. He is good. His kids are good. I feel I see him enough I get to inquire about the boys.

I also feel like I am becoming ‘friends’ with my tomography tech. We chat. I asked about the enhanced depth tomography. He had the capability with his machine and since it would not cost any extra, he ran it on me. The pictures were pretty. I saw my optic nerve and my ‘divot’, geographic atrophy, but did not have the training to see much else.

The tomography tech pointed out two veins in my choroid. They were old veins, not new ones. It is sort of bizarre to realize how relatively deep the hole is in my macula, but that is a part of the definition of geographic atrophy; the damage is choroid deep.

Neither my local retinologist nor I believe I will convert to wet AMD. He has put me back to twice yearly for my check-ups. It was my understanding, and my retinologist confirmed, that wet developed as an adaptation (sort of) to the dry form of AMD.

The way I understand it, when the RPEs and the photoreceptors are not getting enough oxygen and nutrients they send out the SOS . They need supplies! They are starving! The body responds by establishing new supply lines in the form of new blood vessels. The only problem is these vessels are inferior. They break and the bleed. Problem not solved. The fix does not work so well.

I got the impression I am back to twice yearly visits – and he does not think I am a candidate for wet AMD – because I don’t have a lot of macula left. Now he did not say that. It was an impression but I am usually pretty good at those. I don’t think there is much for my body to try to save anymore.

Good thought and bad thought. Or actually bad thought and good thought. Bad thought that I may have reached this level so quickly. Good thought: could the slide be over? Will I soon stop losing vision?

Now, cheating my sweet little patootie off and using eccentric viewing and guess work to the max, my vision tests as 20/50. Am I really 20/50? No, but I cheat well. And they know I cheat, by the way. I tell them every time.

If I can cheat and test at 20/50, that means I have decent functional vision. I can do a lot with that. Not so bad.

So why all the horror pictures of visual fields that are 90% bleach white with decent vision around the edge? If this is a ‘central vision loss’ problem, what is the definition of central vision?

No clue, but Lin and I are on the hunt. Let ya know. Continue reading “Good Thought, Bad Thought”

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Hyper What?

Morning! Yesterday I was picked up before 7 to get someplace 4 miles away before 8:30. Today they are picking me up after 8 to get 11 miles away before 8:30. You cannot win for losing!

Anyway, if I bounce up and leave you suddenly, forgive me. The van got here.

Looking at GuideMe again, I noticed one of the things they suggested is self monitoring with a hyperacuity chart. A what?

Acuity is sharpness or ‘goodness’ of a sense. Hyper as a prefix means it has been amp’ed up. That is a good try but it turns out I am not exactly right.

According to Wikipedia, spatial discrimination can be made on a finer scale than what we are capable of with visual acuity. The good folks writing for wiki say misalignments of borders can be detected with 10x more precision than recognition of figures can be made. We are better at lining things up than we are at seeing what they are. Very interesting. Let me read some more.

OK. Hyperacuity appears to be the ability to identify the location of individual things in space particularly as they relate to one another.

So far not exactly coming together here. Let’s check Scholarpedia. They say hyperacuity is used to judge curves and sharpness of edges. Also to judge small differences in depth.

Now that sounds useful. I use hyperacuity to keep from walking into walls on curves and to see if pavement is uneven or just broken. Sounds like a good thing to have.

Apparently though hyperacuity is something you really start to lose quickly when you develop wet AMD. On medblog a doctor posted he was using the preferential hyperacuity perimeter, a test, to detect the start of wet AMD when it was still highly treatable. According to Regillo right now about the best chance you folks with wet AMD have is fast detection and fast treatment. That is where regular testing for hyperacuity comes in.

And that is why the home testing market is starting to boom. If you are able to test twice or three times a week from home, changes can be noticed very quickly.

I heard of an app for self-monitoring of vision functioning in patients with AMD and diabetic retinopathy. There is supposed to be a smart-phone based system that incorporates 10 vision tests in one app. It is called myVisionTrack Vision Monitor.

Looking it up in the app store, I found it in among dozens of other vision measuring apps. I am in the process of downloading it onto my iPad for free. However, an article in Retina Today says the app won’t sound the alarm to you doctor without your paying a fee. Maybe $9 a month.

To actually use this thing and have any results shared at all, it appears you both have to pay the fee and have a prescription. (I just discovered that without the 10 digit code it won’t even allow you to ‘play’ the ‘games’!) The developers don’t want people getting the results and trying to diagnose themselves. All results go to your doctor.

Party poopers. Some of my most accurate diagnoses have come from myself and the ‘Mommies’ at school. (Want to know something about health? Ask a lunch table full of Mommies!)

The Retina Today article also said something about the app not having all the bugs out (nearly impossible when dealing with a variety of people using a variety of devices under a variety of conditions.) It has not been FDA approved. Translation? Don’t expect your insurance to pay the monthly fee.

So this has been my contribution to our understanding of hyperacuity. I have still not found a paper hyperacuity chart. Anyone find one, let us know. Continue reading “Hyper What?”

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Sometimes It Happens

Last page I talked about how one of the symptoms of AMD is driving me crazy. I hate not being proficient at matching my clothes. A couple of years back I realized I had on plum (that color seems to be my nemesis!) slacks with a red sweater. On my way to my next appointment I stopped at the store and bought other slacks! Being poorly color coordinated can make me self-conscious all day.

According to my ‘personal profile’ on GuideMe – and according to just about every other source- seeing contrast also becomes a real problem with AMD. This is probably why I missed that last step several months ago and why sometimes things just disappear in plain sight!

It’s magic! Now you see it and now you don’t.

There are some online tests available but the one I saw requires registration. Since I am leery of the words ‘free’ and ‘register’ in the same sentence, I found an article that talked about the Pelli Robson chart.  This chart is a series of letters of uniform size that you can read like the Snellen chart. The difference is the contrast between the letter and its background decreases from line to line.

www.psych.nyu.edu/pelli/pellirobson/ offers a link to a printable contrast chart for personal use. It is – here is one of my favorite words again – free. You can also get free scoring sheets online at https://www.scribd.com/mobile/doc/59085894/F.

A study in Finland suggested an average score for 60 year olds would be 1.68. 1.84 was an average score for their subjects in their 20s. These scores make the most sense when you look at the scoring sheets.

Topic next: GuideMe was reassuring for me in one way. It says I only have a 15% chance of developing wet AMD.

Progression to wet AMD is not a guaranteed thing so if you have dry, you are allowed a sigh of relief at least on that point.

They still say dry AMD progresses so slowly 50% of sufferers die before experiencing significant loss.

Not a lot of comfort when you are the one ‘sometimes it happens’ to. However, the rest of you may have another sigh.

Of course, after reading dry AMD is so slow it doesn’t really negatively impact many people, I would like to know why, when I went to the self-help guide and clicked on writing, the first method mentioned was Braille! So sorry, but there is no way at 63 years old I am learning Braille.

Be that as it may, the self-examination of independent living skills has some really great suggestions. I would suggest looking at them!

Gonna end here. 5:45 came early this morning. Still trying to figure out why I got picked up at 6:56 when I wanted to be at work at 8:30. Life does have its mysteries. Catch up with you later! Continue reading “Sometimes It Happens”

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I Have Macular Degeneration…Now What?

If you aren’t familiar with how to move around on our website pages, click here

Where can I quickly find information about AMD?

One of the best resources available is from the Prevent Blindness organization’s website called Guide Me.  You answer a few questions and you will get a personalized guide with important aspects of AMD based on your answers.  Click here to go to Guide Me.

What other websites are helpful?

Here are some of our favorites:

  • Click here for a video that covers important information about AMD
  • Click here for a description of dry vs. wet AMD (we are not recommending any products in this article)
  • Click here for an article about depression after diagnosis (which is common)
  • Click here for some answers to common questions about depression after diagnosis
  • Click here for an article about how vision rehabilitation helps prevent long-term depression
  • Click here for a very comprehensive page about wet AMD
  • Click here for a very comprehensive page about dry AMD
  • Click here for an article about how fast AMD progresses
  • Click here for 10 questions to ask your doctor
  • Click here to find a support group
  • Click here to find out should I take the AREDS or AREDS2 supplements?
  • Click here read about the role of nutrition in AMD
  • Click here for eye healthy foods including a Healthy Vision Grocery List
  • Click here for a January 2017 scientific review article“Nutritional and Lifestyle Interventions for Age-Related Macular Degeneration: A Review”
  • Click here to find out what vision changes/symptoms to look for
  • Click here to find out about the people who can help you (what are the differences between the types of eye doctors, do I need to see a specialist, etc)
  • Click here for tips on how to make the most of the vision you have
  • Click here for a FAQ (Frequently Asked Questions) that answers a long list of questions such as ‘will resting help my eyes?’, ‘Can I see for myself if my retina or macula shows any signs of damage before I have symptoms?’, ‘why don’t new eye glasses help?’, ‘what is meant by degeneration?’, ‘is a macular hole the same as macular degeneration’, ‘I have had dry MD for years. Does this mean I’m going to get wet MD too?’, ‘No one else in my family has MD. Why did I get it?’, ‘can drusen be treated?’, ‘I have changes on the Amsler Grid, does this mean I have MD’, ‘I have Wet MD but my Doctor says there is nothing he can do or no treatment available. Why is this?’

Where can I do more research?

Of course you can do searches on the Internet – there is a LOT of information there.  We have done a lot of research and here’s how you can find it.

  • through Sue’s Journal Pages. Sue became visually impaired early in 2016.  She is a psychologist trained in Dialectic Behavior Therapy (DBT), a cognitive behavioral therapy, and she writes about how she is using it to help her cope with this vision loss.
  • on our Resource page where there are links to many sources of information such as what is AMD, what is Stargardt’s Disease, organizations and websites with useful information, support groups, videos, books & reading materials, where to find vision services, where to find financial help especially for injections, personal stories, the science stuff, clinical trials & research (and how you can become part of one,  online newsletters, symptoms, possible causes/contributing factors, treatments, coping, how to take care of yourself…and more!
  • and in the posts in News/Highlights blog

There are more ways to get information from our website

Search or select CategoryYou can actually do research ON OUR WEBSITE!  You can find things such as in which of Sue’s journal pages does she talk about depression, where can I get more information about sunglasses or vitamins, etc.  If you are using a computer, for example a laptop, you may have seen the search box plus words under Categories and words under Tags/Keywords on the right side of each page. If you use a tablet or smartphone & the screen isn’t wide enough, unfortunately you have to go all the way down to the end of each page to see these sections.

Do you want to know in which pages Sue talks about depression? You can type the word depression (you can also type multiple words) in the search box or select the word depression under Tags/Keywords and you’ll get all of her pages where she talks about it plus you will get any of the News/Highlights posts as well as any matches in the Resources/Links or News/Highlights pages, too. If you want to find everything on our site about sunglasses, you could type the word into the search box or look for the word under Tags/Keywords and select it.

Tags/KeywordsIf you want a broader range of pages & posts such as ‘Tips for living with low vision’, you’ll see that under Categories.

 

 

 

 

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I’ve set up this page so that when you click on a link (words that are underlined & in blue or green), a NEW tab will open in your browser and this page STAYS WHERE IT IS.  When you are done with the new page you opened, just close it.  You do NOT need to use the back option.  If you click on a link and the new page replaces this one, I’VE MADE A MISTAKE so please let me know by sending me an email at light2sight5153@gmail.com.  Let me know exactly which link or links do not open a new tab or window.

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Linda & her dog Chase
Linda & her dog Chase

To find about more about me, about Sue, about our project, go to the menu at the top of the page for sections about each of those.

 

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