Category Archives: Articles

Retinitis Pigmentosa

Retinitis Pigmentosa is an inherited disease that affects the photoreceptor cells of the retina. These are cells that process light and help us to see. The first symptom is usually night blindness. Other symptoms are decrease in color vision, and eventually peripheral vision. When peripheral vision is progressively lost, this ends up in what is referred to as tunnel vision. This is like looking through a keyhole.

Since this is hereditary, family members should be screened for the disease.

To date, there is still no treatment for Retinitis Pigmentosa. As this disease is progressive, vision rehabilitation can help you maximize your visual potential through devices and solutions.

Glaucoma

Glaucoma is a progressive disease characterized by damage to the optic nerve usually caused by increased pressure within the eye.

The optic nerve is like a cable that connects the eye to the brain and functions to transmit visual impulses from the eye to the brain enabling us to see what is directly in front of our eyes or what we are directly looking at (central vision) as well as what is around what we are directly looking at (peripheral vision). The central vision and peripheral vision are what comprise our entire field of vision or the entire area that we see.

This optic nerve, however, is a sensitive part of the eye that functions normally within an optimal range of eye pressure. Beyond this optimal eye pressure range, the optic nerve can get damaged as what happens with glaucoma. When damaged, the optic nerve’s ability to transmit visual impulses becomes impaired, thus causing the visual symptoms. What usually gets affected first is the peripheral vision and it usually occurs gradually. That is why persons with glaucoma may not notice the visual disturbance in the early part of the disease. Without proper control of the disease, the damage to the optic nerve may progress and cause progressive narrowing of the field of vision making the area the eye can see smaller until it is as if you are looking through a peephole. With further damage glaucoma can cause blindness.

Aside from narrowing of the field of vision, glaucoma has other symptoms depending on whether it is the open-angle type or closed-angle type of glaucoma. It will also depend on the severity of the disease.

With the open-angle glaucoma, there is no detectable symptom during the early part of the disease. It is only in the latter part when vision is significantly affected that patients begin to notice they are unable to see certain portions of their vision or that vision is not as clear as before.

Symptoms are usually noticed earlier with closed-angle glaucoma. There may be recurrent headaches or heaviness in the eyes in the late afternoon or when in dark places. This may be accompanied by seeing haloes around lights and blurring of vision or even slight eye redness. When the increase in eye pressure is sudden, all the symptoms of eye pain, headache, blurring of vision, and eye redness are more dramatic and severe. The severe pain usually prompts these patients to seek consultation and treatment.

Symptoms include cloudy vision. Sometimes there is glare, and double vision with one eye. Cataracts are usually caused by age. Our natural lens ages and changes in color, as we get older. There are however other causes of cataracts. These include those who have them at birth (congenital), those who develop them in young adulthood (developmental), those acquired from diseases like diabetes mellitus, and those that result as a complication of the intake of some medications like steroids.

halo-590
Haloes around light

 

Some forms of glaucoma have a hereditary factor but not everyone born to a parent with glaucoma would get the disease. However, it is advisable that people with a family history of glaucoma get screened and examined regularly, even in the absence of symptoms, because while there may be no symptoms in the early part of the disease, signs of glaucoma may be detected through a thorough eye examination. As with other diseases, the earlier glaucoma is detected and treated the greater the chances of preserving vision. Therefore, periodic eye examinations on people with a family history of glaucoma especially those over the age of 40 is recommended.

Glaucoma can also be a complication of trauma to the eye, overusing or misusing of steroids, or from inflammatory diseases of the eye.

To test for glaucoma, your pressure of the eye will be determined, the optic nerve will be examined in various ways, and your field of vision will be tested. Your glaucoma eye doctor can discuss the different tests needed.

Treatment of glaucoma would depend on how severe the damage has been, or how fast the disease is progressing. This consists of eye medications in the form of drops, laser to help maintain the pressure within the eye, and if medicines and laser do not prevent further damage, surgery may be needed to create a passageway for the fluid when the pressure is too high. When a patient has glaucoma, regular follow ups with the eye doctor is necessary to check if the disease is progressing or not.

The best way to deal with glaucoma is to prevent progression of damage to vision. However, glaucoma despite all efforts to control the disease can significantly damage sometimes vision. When glaucoma significantly damages vision, one’s activities and lifestyle may be affected. Many people with uncontrolled glaucoma are unable to do what they used to do because of they have been incapacitated by damage to their vision. The degree to which activities and lifestyle can be affected depends on which part they cannot see and the size of the non-seeing part of the visual field. For those who have lost their peripheral vision and can see only what is directly in front of them, crossing the street is a real challenge and driving becomes very dangerous. Many people with glaucoma have lost their jobs because they could no longer read. Depression is common among them too. Fortunately, while it is true that damage to vision caused by glaucoma is irreversible, there is hope for them. While it is true that damage to the visual field due to glaucoma is irreversible and that vision that has been lost cannot be regained, something can be done for them. The answer is maximizing what is left of the vision through visual rehabilitation. A Low Vision Specialist can evaluate these people and help find ways to help them cope with their difficulties.

Diabetic Retinopathy

Diabetic retinopathy is a complication of diabetes when the blood sugar goes up and causes the blood vessels of the retina to break and leak. The damage to the retinal blood vessels may appear as spots in the field of vision.

The blood vessels can get blocked which may cause a lack of oxygen, and this will make the retina swell. This is called the nonproliferative diabetic retinopathy. In the more advanced stages, the lack of oxygen will stimulate the growth of new blood vessels that are very friable and that easily break and bleed. This can cause additional hemorrhage that will decrease vision further. This is the proliferative diabetic retinopathy stage. Sometimes, scar tissue can form which can pull on the retina causing a detachment of the retina. Eventually, if left untreated, diabetic retinopathy can lead to blindness.

People with diabetes must have a regular eye check up. The key to not getting the complication of diabetes is still to maintain the proper blood sugar level. It is essential to have regular visits to their doctor, to maintain good diabetic management.

The treatment for diabetic retinopathy varies depending on the stage. For the nonproliferative stage, if the central portion of the retina or the macula is swollen, laser can be done to help reduce the swelling. In the proliferative stage, laser therapy can be done to prevent the growth of new vessels, and to stop the progress of the retinopathy. If bleeding has occurred in the gel of the eye called the vitreous, removal of the vitreous is done (vitrectomy). However, at this stage, the goal of treatment is not to cure the retinopathy, but to prevent further damage. Despite all these measures the disease can progress to blindness. Early detection and control of diabetes is important. If your vision loss has affected your quality of life, ask for a low vision specialist.

Vision rehabilitation can help people being treated with vision loss from diabetic retinopathy, by devices and solutions that enable them to do the activities they value in daily life.

Cataract

A cataract is an opacity or a clouding of the lens of the eye. It is one of the most common leading causes of visual impairment. This however can be treated by removal of the lens of the eye or cataract extraction, and then replacing the lens removed, with an intraocular lens. Many people suffer from blurred vision due to a cataract and if undetected, glasses or contact lenses cannot improve vision.

Symptoms include cloudy vision. Sometimes there is glare, and double vision with one eye. Cataracts are usually caused by age. Our natural lens ages and changes in color, as we get older. There are however other causes of cataracts. These include those who have them at birth (congenital), those who develop them in young adulthood (developmental), those acquired from diseases like diabetes mellitus, and those that result as a complication of the intake of some medications like steroids.

There is no medical treatment for a cataract. Once it affects your function in daily activities, it would be recommended to remove the lens surgically and replace it with an intraocular lens. Vision may then be restored.

To know more about cataracts and how they are removed, go to American Eye Center’s cataract page

Age-related Macular Degeneration

Age related macular degeneration (AMD) is a degenerative disease of the macula, which is the central portion of the retina. This causes progressive loss of central vision. Since the central vision is the one involved, many of the daily tasks are affected. These include reading, writing, sewing, and the like. Therefore if one has visual disturbances from AMD, the quality of life most likely will deteriorate.

Symptoms are described as having a blurred spot in the central vision, and this usually interferes with tasks that require using their central vision like reading, and writing, and driving. Other symptoms include distortion in the center of the image. Straight lines may appear wavy.

Symptoms include cloudy vision. Sometimes there is glare, and double vision with one eye. Cataracts are usually caused by age. Our natural lens ages and changes in color, as we get older. There are however other causes of cataracts. These include those who have them at birth (congenital), those who develop them in young adulthood (developmental), those acquired from diseases like diabetes mellitus, and those that result as a complication of the intake of some medications like steroids.

If you have been diagnosed with AMD, you are not alone. There are millions of people who have this disease, especially people above the age of 55.

The cause of macular degeneration is unknown but the risk increases with advancing age. Other risk factors are hypertension, smoking, and those with family histories of retinal diseases.

There are two forms of AMD, dry and wet AMD. Dry AMD consists of yellowish deposits called drusen, which accumulate under the central portion of the macula. In wet AMD, abnormal blood vessel growth forms under the central portion of the retina, and it leaks and damages the photoreceptor cells. This can progress rapidly and cause severe damage. But the damage is contained in the patient’s central vision. It can produce a scar, which causes visual impairment that limits the patient to engage in daily activities that require detailed central vision. But even if it may significantly reduce vision, it does not lead to total blindness. Some useable visual function will remain.

There is still no cure for AMD, but there are treatment options that include vitamin supplement for the dry type, and laser treatment or intravitreal injections for the wet type. Your retina specialist can advise you on the best treatment option for you to improve your vision, and to stop your vision loss from progressing. (link to AEC retina page)

Some lifestyle habits have to change like smoking, and diet. Discuss this with your doctor.

If your visual impairment affects your quality of life, then you should ask for consult with a low vision specialist. You can discuss how your vision has affected your quality of life, and the low vision specialist will help you with aids, and services to maximize your residual vision to its fullest potential, and get back to the life you want to lead.

Looking through the eyes…

When visual impairment develops from birth, more often than not, the parents are the ones that need counseling. They get depressed because they want the best for their
child. They want their child to see the world as they see the world. The child
on the other hand, sees the world as it is. He doesn’t know any better. He was
born this way. The child learns how to see with his impaired vision, he
develops visual clues in order to adapt to the vision he was given.

I recently had a patient, a young handsome man, on his late 20s who has
a rod cone dystrophy. What is rod-cone dystrophy? This is an inherited disease
that affects the rods and cones of the eye. There are two kinds of cells in the back
of the eye or the retina called rods and cones. The cones gather information
about details and color. They work best in bright light. They are located in the
center of the back of the eye. The rods are all around the rest of the back of the
eye. They gather information about things that move and things that are on
the sides, above and below the person. They work best in dim light. People
who have rod-cone dystrophy lose the use of the rods and cones. Aside from the dystrophy, he is also very nearsighted and wears very thick glasses. Despite the impairment, up until employment, he was leading a normal life. He went through elementary and high school with no problems. He continued to college and finished hotel and restaurant management. I asked him what his goal was. He wants to work in a hotel, but he keeps being rejected due to his vision or the fact that he wears very thick glasses. He has been trying to get a job in a hotel as a bellboy or at the housekeeping department. He always faced rejection. The reason? His vision!

This man is very independent. He can commute on his own, he does everything by himself, and he can even drive. While jobless, he continues to educate himself and look for opportunities where he can work through the internet. He is very driven and motivated. He said, actually doctor there is nothing wrong with him as far as functioning with my daily activities. The problem lies with people who can’t accept me for my thick glasses. It’s so difficult for visually impaired people to get a job, even if they are as capable. They have rights and it’s all in republic act no 7277 known as the magna carta for disabled persons. This is a law passed since 1991 but sadly has not been enforced.

Good things happen to people that patiently yearn

I saw a young lady a few months ago who had to stop school after she finished high school. It was just too difficult for her to handle the school work because of her vision. She has a condition that affects the nerves of the eye (optic nerve), which she developed as a child. As she grew up, her vision began to slowly deteriorate. For this impairment affecting the optic nerve, she was told that there was no medical or surgical treatment option for her. She came for low vision consultation, and when I asked her what she wanted to do, she said she wanted to go back to school. We tried several devices. She was happiest  with the bioptic telescope. With it, she was able to see 20/20 and although she knew there was a learning curve on how to use it properly, she was determined to learn and use the device. “I can see! I can see!. Dad, I want this telescope!”. Unfortunately, the telescope is very expensive. But she wanted it. She said it will be very useful for her because with it, she will be able to see the blackboard, and see her computer too. I saw the sad face of her father. His expression said it all. (She wants it so much and I want to give it to her, but I can’t). So they told me they would think about it and get back to me if they were going to order it.  Months passed and I would be checking on her but she kept postponing her return. She finally came back and said she wanted the bioptic telescope and she was ready to order. She even enrolled for the next school term. So she tried the device again and was really happy. Her parents were smiling now and they said they can get it for her now. I thought she had given up.  Then she told her story. She would go everyday to church and pray that she would be able to get the device so she can go back to school. Then one day, one of the church members donated an amount to her. Much to her surprise, she donated the whole amount needed!

 I was touched with her story. Her desire to go back to school and to learn was very inspiring. This is one student who will not rejoice when classes are suspended!  She is very eager to go to school. This girl wished, and she wished harder.  Her impairment was not an obstacle. Instead, her motivation and enthusiasm made her want and dream.  I know that her dreams will become a reality.

Bioptic telescope by Ocutech

 It is a telescope mounted into eyeglasses that are very light and portable. They are convenient to use as they leave your hands free! It improves your distance vision (watching tv, recognizing faces), and has an adjustable knob for intermediate vision like for computer work, playing cards, painting, and the like.

90 years old and back to work!

Yesterday I saw my 90-year-old patient, (turning 91 this year), who is blind in one eye but has some vision in his other eye. He first came to me last year and asked if I could help him. All he wanted to do was read. He had retired already because of his vision but ever since his wife died, he got really depressed and his former job was willing to take him in as a consultant. He thought it was a good idea as he would forget his loneliness. So he wanted to know if there was a way he could read documents. He has macular degeneration in that better eye.

He was very happy with an illuminated stand magnifier, and so he went home excited to read with this device. A few days later he called to say that his magnifier got stolen when he was in a drugstore. But since he was able to read using it, he had to get another one.

Yesterday he came back and I asked him if he was able to go back to work. And yes he was back. He started as a consultant, but they later on made him corporate secretary, and just recently they added treasurer responsibilities.

He still misses his wife until today, but definitely going back to work has made him happier man.

Another ‘aha’ moment

This week, I met a woman with ocular albinism. She has had a visual impairment since childhood. She is now on her late 50s and she owns a famous bakeshop in the province where she lives. She was not part of the appointment list but she decided to stay and wait for her turn. It was about 7 in the evening when I saw her and so after some time of getting to know her, her history, and what her goals are, she summarized what she wanted from me in one sentence. “Doc, I just want to be able to read”. She especially wants to be able to read her bible.

So after the evaluation I showed her some illuminated hand and stand magnifiers with the proper magnification for her. And with that, she was able to read until the smallest print! With it she could even read print as small as the labels in the medicines! She was so happy she then said, doc, what about karaoke? I love to sing but I can’t see the words! Her friend with her laughed and said that singing was her first passion. So I offered a spectacle binocular for her and let her stand the approximate distance of her tv and then I made her read the print as big as the karaoke print she reads and she could read!

She was very happy and said that fate brought us together. She had no intentions of coming to see me but her friend told her that since they were there they should just wait since they live so far. She said she had lost all hope to read and was so ecstatic she could!!!!

Being able to help patients like her make it truly worthy to be in this subspecialty. It’s knowing that with just
making people aware that there may be hope, many people can be helped to improve their lives, or at least be happy with
the life they have now.

Why didn’t I know about low vision solutions earlier?

I recently had a patient who had his visual impairment from childhood. He went to many doctors and was told that nothing could be done for him. He tried to go to school, and ended up having difficulty coping. He passed elementary but during high school, he was not able to cope and was asked to enroll in the school for the blind. After graduating, he was able to find work in a place who accepts visually impaired people.

When he came to me, he was able to read with just plain LED hand and stand magnifiers, but when he tried out the videomagnifier, he claimed, “why was I not told earlier that there are solutions like these? I could have done better in School, I could have gone to college!!!

If your relatives are visually impaired and were told that nothing can be done for them, don’t forget to ask your doctor about low vision and vision rehabilitation. Indeed there is hope for the visually challenged individuals.