Q: My 73-year-old father just had an occipital lobe stroke and lost three-quarters of his vision in each eye. While this has resulted in memory loss and affected his stability, the loss of vision is the worst part. He also has glaucoma but the pressure is good right now. I wondered if he could benefit from a low vision specialist.

A: A low vision evaluation as well as other vision rehabilitation services might be very helpful for your father and help family members better understand his vision loss.

Your father's loss of visual field in each eye due to the occipital lobe stroke can cause mobility problems, specifically falling over unseen objects. In addition, glaucoma can also have an effect on the remaining visual field.

An evaluation by a low vision specialist can help determine the remaining usable portion of the visual field in each eye. Inferior field loss (the lower portion of the visual field), for example, can potentially lead to a fall if objects near the floor aren't seen. His visual field loss might also make it difficult for him to sign a check or find a line of print in the newspaper. A low vision specialist will be able to determine whether a simple check writing guide, a line guide, or specialized low vision devices, as well as lighting may improve your father's visual function. Other vision rehabilitation therapists also may help him learn safe techniques for travel and managing everyday personal and home tasks. To find a low vision specialist in your area, go to Help Near You.

There are, however, serious mitigating circumstances, including the memory loss, which must be taken into account for the well being of your father. It would be advisable to consult other specialists in geriatric medicine as well, to see whether your father would be better off in an assistive living environment.

Q: I am a software professional who works on a PC for more than 12 hours a day. Lately, I have been experiencing eye irritation. My doctor gave me artificial tears (eye drops). He said that my tear content had decreased. Are there any good habits to follow to keep this condition from worsening? Any nutritional implications?

A: From Dr. Bruce Rosenthal, Chief of Low Vision Programs at Lighthouse International:

Eyestrain is a very common complaint of computer users, regardless of their age. In fact, complaints of eye fatigue have escalated in the past few years with the increase in, as well as the prolonged use of, computers at work and home. Artificial tears, the answer for the complaints of the majority of computer users, may be especially beneficial for individuals with "dry" eyes.

Eye fatigue may set in after you have been focusing on the computer screen for long periods of time. Glasses that have been prescribed for reading will not work for the computer unless you sit at a distance of 13-16" from the computer. This distance, of course, is not very comfortable for most people. Measure the distance from your eyes to the computer screen; it will likely be 18-24". You may therefore benefit from a special pair of dedicated "computer" glasses. Computer glasses are set for this "intermediate" distance from the eye and will significantly reduce eyestrain, especially if you are staring at the computer screen for extremely long periods of time.

Other sources of eye fatigue to consider: Glare. Make sure that the computer is away from glare sources, including lights or external sources (outside light) that may reflect off the computer screen. Low-resolution monitors are another source of eye fatigue. The newer flat panel LCD and LED screens have been found to be better than the old CRT monitors, when used for long periods of time. You can also eliminate glare with special polarizing filters that fit over the computer screen. Taking breaks away from the computer will lessen fatigue as well.

As for nutrition, unhealthy dietary behaviors, as well as an increase in obesity, has been found in young people, especially boys, who are involved in sedentary activities such as using the computer for long periods of time. Exercise, as well as a healthy diet, is therefore strongly advised in addition to the other recommendations above.

It is also advised that every computer user, regardless of age, have a comprehensive eye examination from an optometrist or ophthalmologist to determine whether prescriptive lenses would be beneficial in reducing eyestrain. It is also advised that you discuss with your eye doctor the current approach to managing dry eye.

Q: Are there any new techniques for assisting patients with hemianopia or loss of peripheral vision other than scanning?

A: I assume that by "scanning" you mean turning the head or eyes laterally to pick up clues from the missing left side of the visual field. There are several variations of prisms that can enhance your field of vision.

There are 3 approaches:

  1. The standard practice is to introduce a base left full prism of about 12 diopters facing base left for both eyes which shifts the visual field to the right. This means that a portion of the missing left field is brought into the right field area.
  2. A variation of this is a prism that occupies only the left half of the eyeglass which allows a person to look into that prism and experience a shift of invisible left field into the visible field.
  3. The third method is an invention by Dr. Eli Peli, a research optometrist in Boston. The innovation is also a prism but set in a different way. Two small rectangular prisms are set on a lens in a frame above and below the horizontal axis. The person shifts his or her gaze up or down into these small prisms and experiences the missing field that "jumps" into the prism. These are difficult to get used to, but Dr. Peli claims in his research paper that over 40% of patients persist using them.

Q: Is it at all possible to transplant the retina from one person's eye to another? Is this surgery being done in Cuba or anywhere else in the world? How long before technologies such as the bionic eye will be available to the general public?

A: Eleanor Faye, MD, Medical Director of Lighthouse International

Let's take this one question at a time:

In regards to your first question, is it possible to transplant the retina from one person's eye to another, the answer is no. The retina is part of a delicate neurologically based structure that is connected to the brain through a complex network of specialized cells. If a portion of retina is cut off or removed, it dies instantly. It is tissue that is paper thin and has a double blood supply, both from underneath the retina and on the surface. As far as I know this surgery is not being done anywhere. If it were, it would have been a major news story as it would be a "miracle".

As for your "bionic eye" question, that's tougher to answer as many different people use the term to mean different things. Technically, a bionic eye would mean an artificial eye. There are experiments going on with computer chips that are implanted under the retina in the back of the eye that can respond to light and gross objects, but that is as close to an artificial eye as it's come. This has been done in Sweden and they report some success in giving totally blind people form perception and enabling them to at least distinguish light from dark. These implants require that an electrode or wire be implanted in the visual cortex at the back of the brain. The problem so far, has been getting detailed vision with these chips. The retina itself is so refined that it has millions of cells to do the job of detailed seeing, but a chip can't duplicate this yet.

Q:What support is available for a parent of with a child with congenital cataract? This single parent is living in Spokane, Washington and is in need of support on all levels.

A: From Kim Rossi, Online Content Manager for Lighthouse International and Editor of At-A-Glance

This is, far and away, the most frequently asked question we receive in the At-A-Glance inbox. While geographic locations and reasons for asking vary, it all comes down to one thing: you all just want to know where you can get help.

For those of you who are not in the New York City or Hudson Valley areas, the Lighthouse can still provide you with assistance in locating resources in your area.
Help Near You is an online resource that allows you to search for services by geographic location, area of specialty, or services provided. With listings both nationally and internationally, Help Near You is a great online resource to find services in your area.

Additionally, the Lighthouse International Information & Resource Service, helps people nationwide identify and connect to services of interest, including: vision rehabilitation, low vision care, career and employment training, counseling, support groups, leisure activities and more. Callers may also request free literature about low vision, the major causes of vision loss and the specialized care of rehabilitation professionals. The Information & Resource Service can be reached by emailing info@lighthouse.org or calling 1-800-829-0500, Monday - Friday, 9 a.m. - 5 p.m. EST.

Q: What daily lutein dosage does the most recent research recommend?

A: From Eleanor Faye, MD, Medical Director of Lighthouse International and pioneer in low vision care:

Research with the Macuscope (which measures the amount of lutein in the macula) shows that the macula can absorb no more than 20mgm of lutein. Most vitamins on the market have only 2-6 mgm. Many health food stores carry the 20 mgm, but foods that contain lutein are important too--colorful vegetables have lutein in their fiber---anything yellow, or red. There are no side effects to increasing your lutein intake unless you are allergic to Marigolds or carrots. Lutein goes directly to the macula nowhere else.

Read more about nutrition and eye health.

Q. I have recently begun having problems reading small type in newspapers, financial publications, etc. What font is best for this sort of printed material?

A. From Dr. Bruce Rosenthal, Chief of Low Vision Programs, Lighthouse International

Small print gets more difficult to read as you get older because of the development of a condition known as presbyopia. The lens of the eye becomes less flexible (this is known as accommodation), as we all age, making reading more difficult. It is very important therefore that you get a complete eye examination by an ophthalmologist or optometrist for the appropriate distance, intermediate, or near glasses and to screen for any eye diseases. Intermediate vision is especially important in the modern world with the necessity of being plugged in to the world through the computer

With regards to users of Blackberries or other PDA devices, I suggest using a 16 point sans serif font. I also recommend sans serif font (e.g. Verdana) for the computer as well with an increase in the font size as well as bold facing letters.

In summary, the message is that routine eye care, especially if one has a family history of eye problems warrants an eye examination to screen out for eye disease as well as to determine the appropriate (refractive correction) eyeglasses.

Q: My mom had age-related macular degeneration. Is this inherited? Should my family be tested?

A: From Dr. Eleanor E. Faye, M.D., FACS, Lighthouse International:

As the most common cause of vision loss among people over the age of 60, macular degeneration impacts millions of older adults every year. You may be three times as likely to develop the condition if you have a close relative who has the disease. However, the disease does not necessarily progress in the same way in all family members.

Early detection of macular degeneration gives you the best options for successful treatment and stabilization of the condition in the future. You should have regular eye exams with an ophthalmologist or optometrist for early detection of the disease.

It is important that your mother, who has already been diagnosed with macular degeneration, continue regular eye exams to monitor her condition, and to check for other conditions such as glaucoma and cataracts. If you experience any sudden vision changes, contact your doctor immediately.

Q: My girlfriend recently suffered blunt eye trauma caused by a champagne cork. She was about one meter away from the bottle. After consulting with a general practitioner, she was told that her cornea was scratched and given eye drops for any infection. However, she still complains of seeing small objects, which were termed floaters. How long can we expect these floaters to remain? Is there anything we can do in the meantime?

A. From Dr. Bruce Rosenthal, Chief of Low Vision Programs, Lighthouse International: Blunt trauma from a cork under pressure can cause damage to the front as well as the back of the eye. It is advisable that your girlfriend be evaluated by an ophthalmologist specializing in the retina. It is possible that the vitreous floaters are an indication of a more serious underlying condition such as a retinal tear or retinal detachment. Be on the safe side and take her for an evaluation to give everyone peace of mind.

Q: I am a 53-year-old male who needs glasses for reading. But a few hours after reading or doing close up work wearing my glasses, I get very painful headaches. Do you know what could be causing this? My reading glasses are 1.5 magnification.

A: From Dr. Bruce Rosenthal, OD, FAAO, Chief of the Low Vision Clinical Practice at Lighthouse International: It is not clear whether your +1.50 prescription is an over-the-counter (OTC) prescription or that you received a full evaluation as well as a prescription from an optometrist or ophthalmologist. There are many problems associated with OTC prescriptions. They do not correct for unequal prescriptions (unequal refractive error), astigmatism or properly position the pupils of each eye in the lenses. They do not often correct for lens aberrations as well. I would consult with an eye doctor to make sure that you have the appropriate reading, distance, as well as intermediate correction for the computer.

Q: I’ve noticed lately that my eyes are more sensitive to the sun. I’ve been working indoors a lot but have recently retired. How can I protect my eyes now that I’m more out and about, particularly this summer?

A: From Dr. Bruce Rosenthal, OD, FAAO, Chief of the Low Vision Clinical Practice at Lighthouse International:

Exposure to UV radiation can harm your eyes and affect your vision.

If you are exposed, unprotected, to excessive amounts of UV radiation over a short period of time, you are likely to experience an effect called photokeratitis.

Like a "sunburn of the eye," it may be painful, and you may have symptoms including red eyes, a foreign body sensation or gritty feeling in your eyes. Fortunately, this is usually temporary and rarely causes permanent damage to eyes.

However, exposure to small amounts of UV radiation over a period of many years may increase your chance of developing a cataract and may cause damage to the retina, the nerve-rich lining of your eye that is used for seeing. The damage to the retina is usually not reversible.

There are three types of UV radiation. One type, called UV-C, is absorbed by the ozone layer and does not present any threat. That's not true of the other two types: UV-A and UV-B. Scientific evidence is continuing to show that exposure to both UV-A and UV-B can have adverse long- and short-term effects on your eyes and vision.

The effects of UV radiation are cumulative. This means the longer your eyes are exposed to UV radiation, the greater the risk of developing such conditions as cataracts or macular degeneration in later life.

To provide protection for your eyes, your sunglasses should:

  • Block out 99 to 100 percent of both UV-A and UV-B radiation.
  • Screen out 75 to 90 percent of visible light.
  • Be perfectly matched in color and free of distortion and imperfection.
  • Have lenses that are gray for proper color recognition.

Q: My mother was just diagnosed with AMD. Her sight has really started to deteriorate recently, and while she’s now on medication to help manage it, should I be worried that she might accidentally injure herself? Or that she’ll become socially isolated?

A: From Dr. Bruce Rosenthal, OD, FAAO, Chief of the Low Vision Clinical Practice at Lighthouse International: One of the things we are constantly aware of at the Lighthouse, and what all vision rehabilitation specialists should be concerned about in general, is an individual’s ability to get around independently. Such as traveling on his or her own, reading street signs, identifying street lights, stairs, or curbs Depth perception loss, especially when one eye has profoundly reduced vision will often result in falls which may have devastating consequences. But with the right training, those who are losing partial or all of their vision, people who want to remain active can do so easily and safely.

Older adults want to stay active in the community as well continue with their hobbies and interests. Seeing the television, books, newspapers and perhaps going to the theatre, or using the computer is especially essential in keeping these individuals connected. Your mother’s low vision doctor (optometrist or ophthalmologist) should prescribe distance, intermediate (computer), or reading glasses as well as special lenses for activities, such as bridge. But, of course, this is different for every individual and communicating with your service provider is of the utmost importance.

Q: A friend of mine recently lost most of his vision due to what he called an "eye stroke". I've never heard that term before, what does it mean?

A: From Dr. Eleanor E. Faye, M.D., FACS, Lighthouse International:

The term "eye stroke" is misleading. The word "stroke" in diagnosing such an eye condition is not scientific and has other connotations related to brain activity that are scary to a lay person. Some ophthalmologists use the term as a simple (and I think misleading) diagnosis for an occlusion of a major eye vessel. The occluding blood clot or spasm of a vessel in the eye cuts off the blood supply and causes the retinal area fed by that vessel to die off, which leads to loss of vision in that part of the retina.

Most eye vessel occlusions are secondary to hypertension or some blood dysfunction. That means the person needs to see a medical doctor, have his or her blood pressure checked and have some blood studies done to rule out a blood clotting disorder or some other blood problem such as leukemia.

The occlusion is usually permanent but rarely results in total blindness. It is usually unilateral as well and has no other systemic effects (unlike a stroke in the brain).

Q: What would cause a woman in her early forties to have sudden retinal detachment?

A: From Dr. Eleanor E. Faye, M.D., FACS, Lighthouse International:

First of all, that is a question that would require an entire textbook to answer. There are many reasons this could happen, and many are tied to much larger health concerns. Things that would need to be taken into account include the woman's family history, if she is near-sighted, has suffered trauma (even in childhood), if she has diabetes, or even some other type of systemic illness.

But the bottom line is that it is unusual someone in her 40s to suffer a detachment. It means there is an abnormal attachment of the vitreous humor (the clear gel-like that fills the space between the retina and the eyeball) to the retina that may be hereditary, or due to trauma, prematurity or some vascular systemic disease.

Without any further details, it's hard to judge the real reason. But she should speak with her eye doctor about what the origin might be.

Q: My mom had age-related macular degeneration. Is this inherited? Should my family be tested?

A: From Dr. Eleanor E. Faye, M.D., FACS, Lighthouse International:

As the most common cause of vision loss among people over the age of 60, macular degeneration impacts millions of older adults every year. You may be three times as likely to develop the condition if you have a close relative who has the disease. However, the disease does not necessarily progress in the same way in all family members.

Early detection of macular degeneration gives you the best options for successful treatment and stabilization of the condition in the future. You should have regular eye exams with an ophthalmologist or optometrist for early detection of the disease.

It is important that your mother, who has already been diagnosed with macular degeneration, continue regular eye exams to monitor her condition, and to check for other conditions such as glaucoma and cataracts. If you experience any sudden vision changes, contact your doctor immediately.

 

 

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