by Maureen Duffy
Editor's note: One of the many benefits associated with an online information center and website, such as VisionAware, is the ability to track readers' search terms [i.e., information readers are seeking as they search the Internet]. Since the earliest days of VisionAware.org, the following questions about eye doctors and eye care consistently rank within the top ten searches:
- What are the different kinds of eye doctors?
- What is the difference between an ophthalmologist and an optometrist?
Ophthalmology and Ophthalmologists
What is ophthalmology?
Ophthalmology is a branch of medicine that specializes in the anatomy, function, and diseases of the eye.
What is an ophthalmologist?
An ophthalmologist is a medical or osteopathic physician who specializes in the medical and surgical care of the eyes and the prevention of eye disease.
- An ophthalmologist diagnoses and treats refractive, medical, and surgical problems related to eye diseases and disorders.
- Ophthalmologists are licensed by state regulatory boards to practice medicine and surgery, as well as deliver routine eye care.
- An ophthalmologist will have the initials "M.D." (Doctor of Medicine) or "D.O." (Doctor of Osteopathy) after his or her name.
What does an ophthalmologist do?
- Ophthalmologists are trained to provide the full spectrum of eye care, from prescribing glasses and contact lenses to complex and delicate eye surgery.
- Ophthalmologists treat eye diseases, prescribe medications, and perform all types of surgery to improve, or prevent the worsening of, eye and vision-related conditions.
How is an ophthalmologist educated and trained?
- In addition to four years of medical school and one year of internship, all ophthalmologists spend a minimum of three years of residency (hospital-based training) in ophthalmology.
- During residency, ophthalmologists receive specialized training in all aspects of eye care, including prevention, diagnosis, and medical and surgical treatment of eye conditions and diseases.
- Often, an ophthalmologist spends an additional one to two years training in a subspecialty, or a specific area of eye care, such as glaucoma or pediatric ophthalmology.
- All ophthalmologists are required to fulfill continuing education requirements to stay current regarding the latest standards of care.
More Information about Ophthalmology
- For more information, you can visit the American Academy of Ophthalmology website.
- The EyeSmart® public awareness campaign, sponsored by the American Academy of Ophthalmology, helps Americans to take charge of their eye health; know their risk factors for eye diseases; and understand how ophthalmologists can help prevent, diagnose, and treat eye conditions.
Optometry and Optometrists
What is optometry?
Optometry is a vision care specialty that is concerned with the health of the eyes, the visual system, and related structures.
What is an optometrist?
An optometrist is a health care professional who specializes in function and disorders of the eye, detection of eye disease, and some types of eye disease management.
- An optometrist conducts eye examinations, prescribes corrective contact lenses and glasses, and diagnoses and treats eye diseases and disorders.
- Optometrists are licensed by state regulatory boards that determine their scope of practice, which may vary from state to state.
- An optometrist will have the initials "O.D." (Doctor of Optometry) after his or her name.
What does an optometrist do?
- Optometrists are trained to examine the eyes for visual defects, diagnose problems or impairments, prescribe corrective lenses, and provide certain types of treatment.
- Many (but not all) U.S. states have passed legislation that allows optometrists to perform certain surgical procedures, such as laser treatment; administer injections, such as local anesthesia or treatment for macular degeneration; and prescribe additional diagnostic, therapeutic, and oral medications. Visit the American Optometric Association website to determine if your state permits optometrists to perform these additional procedures.
How is an optometrist educated and trained?
- Prior to admittance into optometry school, optometrists typically complete four years of undergraduate study, culminating in a bachelor's degree.
- Optometrists then complete a four-year postgraduate program in optometry school to earn the Doctor of Optometry degree.
- Some optometrists go on to complete one- to two-year residencies with training in a specific sub-specialty area, such as pediatric or geriatric eye care, specialty contact lens, ocular disease, or neuro-optometry.
- All optometrists are required to fulfill continuing education requirements to stay current regarding the latest standards of care.
More Information about Optometry
- For more information, you can visit the American Optometric Association and American Academy of Optometry websites.
Low Vision Specialist
- Many optometrists and some ophthalmologists have additional credentials or specialization in low vision testing, diagnosis, and treatment, and are trained to conduct low vision eye examinations and prescribe special low vision optical devices.
- If you're experiencing significant vision loss, a low vision specialist can determine whether special optical and non-optical devices, improved lighting, or other types of specialized services and equipment can help make the best use of your remaining vision.
- You can find a listing of low vision specialists in the "Low Vision Services" category in the VisionAware Directory of Services.
In addition to the low vision providers in the Directory listings, you can find additional providers through the following directories:
- The American Academy of Ophthalmology directory. Use the subspecialty category "Low Vision Rehab."
- The American Optometric Association database. Use the "Advanced Search" and look for members of the Vision Rehabilitation Section.
Locate an Eye Care Professional in Your Area
by Maureen Duffy
As the holiday season approaches, creative drinks and cocktails are in demand! We especially like this non-alcoholic, easy-to-assemble drink – along with adaptations for our favorite blind and visually impaired "mixologists."
Apple Cider Milkshake
From MaryBeth at Dunkin Cooking the Semi-Homemade Way (used with permission), who says this about the Apple Cider Milkshake: "I highly recommend giving this a try. It's a great-tasting shake and an excellent way to enjoy the taste of apples."
- 6 scoops vanilla ice cream
- 1¼ cups apple juice
- ½ tablespoon ground cinnamon
Place all ingredients into a blender.
Blend on high speed for approximately one minute.
Serve in a glass of your choice.
Yield: Two goblets/glasses
Here are some practical, easy-to-implement adaptations for mixologists who are blind, visually impaired, or have low vision (and all other mixologists, too).
Measuring Your Drink Ingredients
Use a long-handled measuring spoon placed over a larger flat-bottomed measuring cup. If the spoon overflows, the excess liquid will spill into the cup and can be returned to the bottle or container with a funnel.
Use a white measuring spoon for darker liquids and place it over a dark measuring cup for better contrast:
Use a dark measuring spoon for white liquids and place it over a white measuring cup for better contrast:
You can also place your jigger or shot glass inside a larger flat-bottomed measuring cup:
And place your measuring cup inside a larger contrasting bowl:
Pouring Tips and Tricks
Electronic liquid level indicators will beep, buzz, vibrate, or play music to indicate when the rising liquid is close to the top rim of the glass.
When you pour, use an electronic liquid level indicator on the rim of your glass to help prevent overflow:
You can even use an electronic liquid level indicator with your champagne glass!
If You Have Diabetes
Although this recipe isn't for you if you have diabetes, you can find a wealth of information to help with meal planning, diabetes-appropriate recipes, and portion control at Resources and Support for Adults with Diabetes and Diabetic Retinopathy and How Can I Manage My Diabetes? on the VisionAware website.
For additional information about pouring, eating, and kitchen techniques, you can explore Hints for Easier Eating and Pouring, the Locating Technique, and Safe Cooking Techniques for Cooks Who Are Blind or Have Low Vision.
Enjoy your holiday, everyone!
by Maureen Duffy
The results of the HOme Monitoring of the Eye study, a subset of the Age-Related Eye Disease Study 2 (AREDS2), were presented last week at the Annual Meeting of the American Academy of Ophthalmology (AAO) in New Orleans, Louisiana, November 16-19, 2013.
The study revealed that participants at high risk for developing wet (or neovascular) age-related macular degeneration (AMD) who used the ForeseeHome AMD Monitoring Program and device (pictured at left) had significantly better preservation of visual acuity when their AMD progressed from dry to wet than the control group of participants who were using standard care methods alone to self-monitor the progression of their AMD.
About the ForeseeHome AMD Monitoring Program
The ForeseeHome AMD Monitoring Program was developed by Notal Vision, Ltd. The company was founded in 2000 and is based in Tel Aviv, Israel, with additional offices in Israel and the United States.
The ForeseeHome AMD Monitoring Program is a prescription-based, comprehensive telemonitoring and data management system that (a) extends the management of AMD to patients' homes between office visits, (b) provides access to both patients and physicians to monitor AMD progression, and (c) alerts physicians to immediate, significant visual field changes in their patients, so that timely follow-up and treatment can be initiated.
To monitor AMD progression, the patient checks his or her vision once a day at home, via a non-invasive three-to-four minute test for each at-risk eye, using the ForeseeHome AMD Monitor. The test results are sent immediately via phone line or modem to the Notal Vision Data Monitoring Center (DMC), which provides live, ongoing monitoring.
The DMC then posts the patient's daily test data on a secure web site where his or her physician can review it at any time. In the case of a statistically significant change in visual acuity test scores, both the patient and doctor are notified immediately to schedule an appointment.
You can view the operation of the ForeseeHome AMD Monitor at YouTube.
Dry and Wet Age-Related Macular Disease
There are two types of AMD: dry (atrophic) and wet (neovascular or exudative). Most AMD starts as the dry type and in 10-20% of individuals, it progresses to the wet type. Age-related macular degeneration is always bilateral (i.e., occurs in both eyes), but does not necessarily progress at the same pace in both eyes. It is possible to experience the wet type in one eye and the dry type in the other.
The dry (also called atrophic) type of AMD affects approximately 80-90% of individuals with AMD. Its cause is unknown, it tends to progress more slowly than the wet type, and there is not – as of yet – an approved treatment or cure; however, there are clinical trials underway.
In dry macular degeneration, small white or yellowish deposits, called drusen, form on the retina, in the macula – the small sensitive area in the center of the retina that provides clear central vision – causing it to deteriorate or degenerate over time.
A retina with drusen
Drusen are the hallmark of dry AMD. These small yellow deposits beneath the retina are a buildup of waste materials, composed of cholesterol, protein, and fats. Typically, when drusen first form, they do not cause vision loss. However, they are a risk factor for progressing to further vision loss from wet AMD.
In wet macular degeneration, the choroid (a part of the eye containing blood vessels that nourish the retina) begins to sprout abnormal blood vessels that develop into a cluster under the macula (called choroidal neovascularization).
The macula is the part of the retina that provides the clearest central vision. Because these new blood vessels are abnormal, they tend to break, bleed, and leak fluid under the macula, causing it to lift up and pull away from its base. This damages the fragile photoreceptor cells, which sense and receive light, resulting in a rapid and severe loss of central vision.
The Study and Results
The The HOME Study: HOme Vision Monitoring in AREDS2 for Progression to Neovascular AMD using the ForeseeHome Device was a collaborative effort led by the National Eye Institute (NEI) to evaluate the performance of the home monitoring device plus standard care compared to standard care monitoring alone for the detection of AMD progression to the neovascular phase.
Here is further background on the study/clinical trial from NEI:
In the wet form of age-related macular degeneration (AMD), new blood vessels grow and cause fluid leaks into the retina, which leads to loss of vision. Some studies suggest that if the development of new blood vessels (choroidal neovascularization, or CNV) is detected early, treatment could be started sooner, which may help prevent visual loss.
One possible method of early detection is the ForeseeHome device, which is part of a program designed to allow individuals to monitor their eyes for vision changes at home. Researchers are interested in comparing eye disease progression in people using the ForeseeHome device with those not using the device.
The results of the HOME study show that 94% of participants with high risk for developing [wet AMD] maintained 20/40 vision or better at the time they were diagnosed while using ForeseeHome … compared to 62% in the standard care alone group.
Also, in contrast to current home monitoring strategies, those with intermediate AMD (bilateral large drusen) or advanced AMD in one eye are likely to benefit from home monitoring with the ForeseeHome device to detect the development of [wet AMD] at an earlier stage with better preservation of their visual acuity.
For more information about the ForeseeHome AMD Monitoring Program, you can visit the ForeseeHome website. VisionAware will continue to provide updates of this macular degeneration research as they become available.
by Maureen Duffy
Guest blogger Jeremiah Taylor (pictured at left with his wife Jo-Ann) is the founder and CEO of ProActive Sales, Inc., a full-service sales management company. In 1999, Jeremiah became suddenly and totally blind as a result of complications during routine back surgery. You can read more about Jeremiah's (and Jo-Ann's) long, steady, and inspirational journey – from sudden blindness through rehabilitation to full employment – at the VisionAware website.
In addition to his talents as a dynamic sales professional and motivational speaker, Jeremiah is a serious movie buff. "Going to the movies," he says, "is not just the movie! It's a night out with friends and family, hanging out together, enjoying conversations in the car or on the train as you travel to the theater. Movie night is pure Americana! Just because I can't experience the entire event visually doesn't mean I can't be a part of it!"
Descriptive Audio and the Sony Entertainment Access System
Recently, Jeremiah and Jo-Ann had the opportunity to "test drive" the newly-released Sony Entertainment Access System, which provides descriptive video service (or descriptive audio narration) for blind and visually impaired film-goers, as well as closed-captioning and volume control for deaf and hearing impaired audiences.
Descriptive video service (DVS) provides audio narration of key visual elements inserted into natural pauses in the film dialogue. Key visual elements are those cinematic features that viewers with vision loss would ordinarily miss and include actions, costumes, gestures, facial expressions, scene changes, and onscreen text.
The Sony Entertainment Access System (explained and demonstrated in this YouTube video) is available at approximately 6,000 Regal Cinemas since late summer. The service can be accessed on any film for which captions and descriptive text have been included with the digital print. You can check online at the Regal Cinema website for the availability of the system in your local area.
For deaf patrons, the system includes lightweight glasses that project holographic subtitles on the lens, keeping the captions within the wearer's direct line of sight. The system also provides volume control for patrons with hearing impairments. For patrons who are blind or have low vision, the system includes headphones that provide descriptive audio narration.
The Sony Entertainment Access System
Jeremiah, Sony, and "Gravity"
Here is Jeremiah's first-person experience using the Sony system at a showing of Gravity, starring George Clooney and Sandra Bullock as a veteran astronaut and a medical engineer who become stranded in deep space during a routine spacewalk:
We went to see Gravity last night. It was my suggestion, since the theater had DVS and I thought my wife and friends would love the 3-D aspect of the film. It also got great reviews. The first shock was the price: We paid $13.50 per ticket for the 3-D version of the film and that was with a senior discount!
When you request the device, the box office has you fill out a form with your personal information. This took some time and a long line was forming. The box office had several DVS devices right at the window, so I knew immediately there would be some confusion. I knew the theater wasn't expecting a rush of blind people coming to see Gravity. (The device is used for deaf and hard of hearing patrons as well as for vision impaired people.)
I was right, as all the devices were "set" for hearing impairment. Luckily, I had called in advance and spoken with a manager and she brought down the device "set" for audio narration.
Now here's the best part of the story. I seemed to enjoy the movie better than my wife or my friends, since there were many silent scenes of the astronauts working with their equipment. Because I had the narration, I knew what they were doing, but my wife was getting confused. So I was leaning towards her and telling her what was going on. Usually she would be telling me!
My guess is that if you are an action or special-effects person you will love the movie; plus, it did have a good story line and a spiritual side. The DVS worked fine and they did a great job of describing the action. The evening was a total success. Go see it! (PS: with those prices – no popcorn!)
- AMC Theaters provide Descriptive Video and Assisted Listening Devices in select theaters
- Regal outfits almost 6,000 theaters with Sony closed-captioning glasses at Engadget.com
- Enjoying Theater, Film, and Television When You Are Blind or Have Low Vision at VisionAware.org
- Video Description Explained at American Foundation for the Blind
by Maureen Duffy
A team of British researchers has determined that there is no positive association between age-related macular degeneration (AMD) Alzheimer's disease (AD) or dementia. The study findings do indicate, however, that people in England with dementia may be less likely to receive treatment for AMD.
The research, entitled Associations between Age-Related Macular Degeneration, Alzheimer Disease, and Dementia: Record Linkage Study of Hospital Admissions, was published in the November 14, 2013 issue of JAMA Ophthalmology (formerly Archives of Ophthalmology). JAMA Ophthalmology is an international peer-reviewed journal published monthly by the American Medical Association.
The authors are Tiarnan D. L. Keenan; Raph Goldacre; and Michael J. Goldacre, who represent the following institutions: the Centre for Hearing and Vision Research, University of Manchester; and the Department of Public Health, University of Oxford.
About the Research
From Age-Related Macular Degeneration, Alzheimer's, Dementia Not Linked in Older People in SeniorJournal.com:
Alzheimer's disease (AD), dementia and … age-related macular degeneration (AMD) are all strongly associated with advancing age. A very large study of patients in England has determined, however, that there is no association between having AMD and then developing dementia or AD.
Several previous studies have reported an association between AMD and cognitive impairment, based on mental state examination or word fluency scores.
AMD and AD are diseases that share environmental risk factors, including cigarette smoking, high blood pressure, and high cholesterol and other features such as the depositing of plaques in the brain. But the genetic risk factors for AMD and AD seem to be different, according to the report published by JAMA Ophthalmology, a JAMA Network publication.
A group of 65,894 patients with AMD was constructed from data in the English National Health Service. A dementia group (168,092 patients) and a reference group (more than 7.7 million people) were assembled in similar ways. Researchers measured the risk of AD or dementia following AMD and the risk of AMD following AD or dementia.
The study indicates that risk of AD or dementia after AMD was not elevated. However, the study findings indicate that patients in England with dementia may be less likely to receive treatment for AMD and several factors may contribute to this, including that patients with dementia may be less likely to get their eyes examined.
More about the study from JAMA Ophthalmology
From the article abstract:
Importance: The potential association between age-related macular degeneration (AMD) and Alzheimer disease (AD) is uncertain and has implications for understanding disease pathogenesis [i.e., development], referral, and treatments.
Objectives: To determine whether individuals admitted to the hospital with AMD were significantly more or less likely to develop AD or dementia in the following years, as well as to assess whether people with AD or dementia were significantly more or less likely to be admitted to the hospital for AMD treatment in the years following diagnosis of dementia.
Design, Setting, and Participants: An AMD cohort of 65?894 people was constructed from English National Health Service, linked hospital episode statistics from January 1, 1999, through February 28, 2011, by identifying computerized record abstracts for all people with an admission or day case care for AMD. A dementia cohort (168, 092 people) and a reference cohort (>7.7 million people) were constructed in similar ways.
Results: The risk of AD or dementia following AMD was not elevated. The rate ratio was 0.86 for AD and 0.91 for dementia. The likelihood of being admitted for AMD following AD or dementia was very low: the rate ratio was 0.04 for people with AD and 0.07 for those with dementia.
Conclusions and Relevance: These neurodegenerative conditions may share environmental risk factors and histopathologic features [i.e., microscopic examination of tissue in order to study disease]. However, considering AD and other dementia after AMD, their coexistence at the individual level is no different from that expected by chance. Our data also suggest that patients in England with dementia may be substantially less likely to receive AMD treatment. Further research is required to determine whether people with dementia receive appropriate investigation and treatment for AMD, as well as identify and address potential barriers.
VisionAware will continue to provide updates on macular degeneration and dementia research as they become available.
More on the blog: Cataracts and Alzheimer's Disease: Are They Related?