What should you do if you are diagnosed with Macular Degeneration?

Many people are diagnosed with this disorder every day. With a little research, people can learn that this disorder is one of the leading causes of legal blindness! So what do you do if you find that you have this eye condition? Fortunately, although there is no cure for macular degeneration, much can be done to manage the problem. Below are the logical steps to maintain the best visual function in spite of this diagnosis.

Step One: Develop a relationship with a Retina specialist. The macula is a specialized component of the retina.  Retina specialists are ophthalmologists that have completed a fellowship in the medical and surgical management of retina problems. These doctors follow the latest research and concepts in managing macular problems. New drugs are available to treat the “wet” or active form of the disease. Several research studies are underway to look at ways to prevent or retard the progression of the “dry” form of macular degeneration.

Step Two: Low Vision Refractive Evaluation. Low Vision refractions are provided by Low Vision specialists. Low Vision specialists are optometrists that have completed specialized training beyond optometry school. Most have completed a residency, fellowship or have attended special training programs. Low Vision refractions are different than the traditional refraction or auto refraction that are provided by a general optometrist or ophthalmologist.  The low vision refraction is often done at a closer distance than the standard eye examination and often done with loose lenses in a trial frame or with the assistance of prisms. Sometimes filters or telescopic lenses are employed. These special refractions are often overlooked in patients with macular degeneration but are actually critical to optimal function. The difficult aspect is obtaining the best focus to the part of the retinal with the best function. Glare and other problems that affect image quality can be managed with filters that are often prescribed as tints or coatings to be added to the final eyeglasses.

Step Three: Magnification. When the best corrected vision is below the level for reading or the performance of other detailed tasks, magnification is then added to the optical system. The most common way to add magnification is to increase the power of the bifocal or reading glasses. Although this shortens the focal distance, often very good results can be obtained when just a small increase is added to the reading power and this is combined with the optimal refractive result. When this is not practical for the required task, a series of handle held magnifiers, stand magnifiers, telescopic lenses or electrical magnifiers can be employed.

Step Four: Rehabilitation. When the best corrected vision drops below a certain level, patients with macular problems cannot easily position their eyes to use the part of the retina that is not damaged. When attempting to use their eyes for any detailed task such as reading or television, they execute the normal eye movements, which are designed for central fixation. When doing this, the object of regard drops completely into the “blind spot” and literally disappears. This only adds to the frustration of the patient and often leads to the common complaint that their vision is worsening each day and that they are “heading for total blindness”. These patients can be taught how to avoid the “blind spot” and use their peripheral vision for reading and discerning details though a course of rehabilitation. The process includes the shrinking of the “blind spot” with optical lenses that allow for a very close working distance. The patient then executes a series of simple and repetitive reading tasks that re-pattern the coordination between the eye and the brain. The System slowly decreases the difficulty of the reading task until the patient in able to read normal text. Once this is achieved, the patient then learns to use this pattern of eye movements to watch TV, cook, eat, and perform the other skills of daily living. Depending on the final level of function, various magnification options are then re-introduced to meet the needs for specific vision tasks.

Step Five: Long-term follow up. Long-term follow-up for patients with this disease are best coordinated with both the retina specialist and the Low Vision Specialist. Both the disease and the patient’s visual needs will change over time and when these doctors work together, the patient has the best opportunity for life long visual function.