Blind World


Macular degeneration.
Macular degeneration impairs daily activities for many.





January 28, 2004.

By John J. Vander Meer,
The Enquirer.





They hang like dark clouds in the windows on the world for millions of Americans.


For area residents such as Arney Chapman, the loss of mobility has been one of the worst parts of having macular degeneration -- the leading cause of blindness for those age 55 and older in the United States.


"At first it was very traumatic," he said. "I don't think people realize how difficult it can be to not be able to get around."


Chapman has had macular degeneration for two years, a condition which has rendered him legally blind. Consequently, he's unable to read, write, drive a car or do many of the things most people with proper vision take for granted.


According to the American Macular Degeneration Foundation, more than 10 million Americans are affected by this condition -- more than cataracts and glaucoma combined.


The condition is caused by a deterioration of the central portion of the retina -- the inside back layer of the eye that records the images we see and sends them via the optic nerve from the eye to the brain -- the foundation's Web site said.


The retina's central portion, known as the macula, is responsible for focusing central vision in the eye, and it controls a person's ability to read, drive a car, recognize faces or colors and see objects in fine detail.


There are two types of the disease:


Dry type: Makes up 85 percent to 90 percent of the cases. Patients may have good central vision but substantial functional limitations, including fluctuating vision, difficulty reading because of their limited area of central vision, limited vision at night or under conditions of reduced illumination.


However, loss of vision still may occur. The deterioration of the retina is associated with the formation of small yellow deposits under the macula. This phenomena leads to a thinning and drying out of the macula, causing the macula to lose its function.


Wet type: Comprises 10 percent to 15 percent of the cases of the condition. Abnormal blood vessels grow under the retina and macula. These new blood vessels may then bleed and leak fluid, causing the macula to bulge or lift up, thus distorting or destroying central vision.


Under these circumstances, vision loss may be rapid and severe. The patient may see a dark spot in the center of their vision. Straight lines may look wavy because the macula is no longer smooth. Side or "peripheral" vision rarely is affected.


TREATMENTS


"It can be very debilitating," said Dr. P. Jeffrey Colquhoun, an ophthalmologist with the Southwest Michigan Eye Center in Battle Creek. "It's very distressing and requires a lot of emotional support."


But there is hope for those with either type of macular degeneration, Colquhoun said.


The best treatment for the wet form is a laser procedure called photo dynamic therapy, Colquhoun said, a combination of a diode laser and the intravenous dosage of a drug called Visudyne. The laser targets the leakage in the macular or the central retina, and the drug allows the laser dose to be much more gentle.


"It's a very specific treatment," he said. "(But) it's not an absolute cure. ... If they have a lot of damage most don't recover to 20/20 vision, but they preserve their baseline vision."


Colquhoun said the procedure is repeatable, and the average number of laser treatments is about three in the first year. A majority of patients get a repeat treatment within the first three months.


Treatment for the dry form of macular degeneration is even less invasive.


Colquhoun said according to a National Eye Institute study done in recent years, vitamins and anti-oxidants such as E, C, A and the mineral zinc can be used to prevent the dry form from progressing to the wet form.


"Early detection is critical," he said. "If a patient comes in early they have a pretty good shot at maintaining their existing vision."


LIVING WITH IT.


While macular degeneration can make life difficult for many people, some find ways to deal with the problems associated with the disease.


Emmett Township resident Mike Medich was in his 50s when he first noticed a deterioration in his vision. Then, about eight years ago, his physician diagnosed him as legally blind.


But compared to those with the wet type of macular degeneration, the 73-year-old counts himself lucky. He still drives during the day with the aid of telescopic lenses.


"I'm very thankful and I can get around. ... I'm fortunate that I can drive," he said.


Because of the restrictions on his license, Medich said he has to take a road test every year.


Both Medich and Chapman said without the assistance of the Michigan Commission for the Blind, adjusting to the new darkness in their lives would have been much more difficult.


Shigeru Toda, an independent living specialist with the Michigan Commission for the Blind, works for a program called the Independent Living Program for people who are 55 and older.


The purpose of the program is to go into people's homes and determine what services are available to maintain them living on their own.


"We provide what's necessary for that person to survive," he said.


Chapman said he saw Toda, who has been blind for years, as a model to emulate.


"If he can do that and be totally blind -- I shouldn't give up hope," Chapman said.


Toda said the program offers service to about 1,000 legally blind residents around the state, and more than 25 percent of the people helped by the program have macular degeneration.


In the Independent Living Program, Toda said he helps design a program for individuals that involves daily living exercises, such as dialing a telephone, writing checks, being able to handle money and tell time, taking care of medication and being able to prepare meals.


"I can relate to their problems," he said. "I see the processes, and I can relate to the emotional trial of the experience. "I don't hide things I just tell them what they need to know."



ON THE WEB:


American Macular Degeneration Foundation: www.macular.org.


WHAT CAN I DO TO REDUCE MY RISK OF DEVELOPING MACULAR DEGENERATION?


Eat large quantities of dark green leafy vegetables rich in carotenoids, the yellowish pigments that include precursors of Vitamin A. Spinach and collard greens are possibly the most beneficial vegetables in this respect.


Protect your eyes from potentially harmful ultraviolet light and blue light.


Antioxidant vitamin and zinc supplements may help.


Don't smoke.


Eat a low-fat diet. Avoid junk food.


Exercise regularly.


Source: American Macular Degeneration Foundation.


THE INDEPENDENT LIVING PROGRAM.


Before contacting the Michigan Commission for the Blind, talk to your eye doctor to make sure you are legally blind.


Only a physician can determine an individual is legally blind -- a prerequisite for receiving assistance. You also must be 55 years old or older.


Once the physician has given those assurances and it's clear the patient has the desire to live independently, a consultation can be set up.



John J. Vander Meer covers health issues. He can be reached at 966-0665 or johnvm@battlecr.gannett.com.



Copyright 2004 Battle Creek Enquirer. All rights reserved.




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