New Research: Automobile Side Windows Do not Offer Sufficient Protection from UV Light, Increase the Risk of Cataracts and Other Eye DiseasesPosted on 5/23/2016 at 8:29 PM
by Maureen Duffy
United States government regulations require automobile windshields to be made with laminated glass to lessen potential injury when shattered. The combination of laminated glass and extra-thick glass in front windshields provides protection against ultraviolet-A radiation.
However, new research from California indicates that automobile side windows do not provide the same level of protection against ultraviolet-A radiation compared to the front-facing windshield, which may increase the risk of cataracts and skin cancer for frequent drivers. In addition, there is increasing evidence that related "blue light" is harmful to the eye and can amplify damage to retinal cells, in eye diseases such as macular degeneration.
From JAMA Ophthalmology
This new automobile and ultraviolet light research, entitled Assessment of Levels of Ultraviolet A Light Protection in Automobile Windshields and Side Windows, has been published "online first" in the May 12, 2016 edition of JAMA Ophthalmology (formerly Archives of Ophthalmology). JAMA Ophthalmology is an international peer-reviewed journal published monthly by the American Medical Association. The study author is Brian S. Boxer Wachler, MD, from the Boxer Wachler Vision Institute, Los Angeles, California.
About the Research
It is a long-known fact that prolonged exposure to ultraviolet A (UV-A) rays can raise the risk for skin cancer and cataracts. For the first time, a research team has indicated that side windows of the car don't offer enough protection from harmful sun rays.
A recent JAMA Ophthalmology study assessed the protection provided by front windshields and side windows of automobiles from ultraviolet A (UV-A) rays. The study found that protection was consistently high in the front windshields while it was lower and highly variable in side windows. Scientists say that the study findings may to some extent explain the reported increased rates of cataract in left eyes and left-sided facial skin cancer.
For the study, the outside ambient UV-A radiation along with UV-A radiation behind the front windshield and behind the driver's side window was measured in 29 automobiles from 15 manufacturers. The years of the automobiles ranged from 1990 to 2014, with an average of 2010. [The study] found that the average percentage of front-windshield UV-A blockage was 96%, higher than the average 71% of side-window blockage. A high level of side-window UV-A blockage (more than 90%) was found in four of 29 automobiles (14%).
"Automakers may wish to consider increasing the degree of UV-A protection in the side windows of automobiles. This could contribute to a higher prevalence of left eye cataracts and skin cancer on the left side of people's faces. Based on the new data, automakers may wish to consider increasing the degree of UV-A protection in the side windows of automobiles," says [study author] Dr. Brian Wachler.
Visible Light and Light Rays
When discussing sunlight and its damaging effects, an important factor to consider is the measurement of visible light and light rays, beginning with the definition of a nanometer:
- A nanometer (nm) is the measurement of a wavelength of light.
- One nanometer = 1/1,000,000,000 of a meter, or one-billionth of a meter. It's very small!
- A wavelength is the distance between two successive wave "crests" (ups) or "troughs" (downs):
Visible light rays range from 400 nm (shorter, higher-energy blue wavelengths, bottom) to 700 nm (longer, lower-energy red wavelengths, top).
Ultraviolet Light and Blue Light
The human visual system is not uniformly sensitive to all light rays, however. The visible light spectrum occupies just one portion of the electromagnetic spectrum:
- Below blue-violet (400 nm and below), is ultraviolet (UV) light.
- Above red (700 nm and above), is infrared (IR) light.
- Neither UV nor IR light is visible to the human eye.
Ultraviolet (UV) light has several components:
- Ultraviolet A, or UVA (320 nm to 400 nm): UVA rays age us and penetrate the skin more deeply than do UVB rays. It is now believed that UVA rays contribute to, and may even initiate the development of, skin cancers. They are also able to penetrate glass, unlike UVB rays.
- Ultraviolet B, or UVB (290 nm to 320 nm): UVB rays burn us and play a key role in the development of skin cancer and photoaging [i.e., skin wrinkling and sun damage].
- Ultraviolet C, or UVC (100 nm to 290 nm): UVC rays are filtered by the atmosphere before they reach us.
Blue light rays (400 nm to 470 nm) are adjacent to the invisible band of UV light rays:
- There is increasing evidence that blue light is harmful to the eye and can amplify damage to retinal cells.
- A 2014 study from the National Eye Institute (a) confirmed that sunlight can increase the risk of cataracts and (b) established a link between ultraviolet (UV) rays and oxidative stress, the harmful chemical reactions that occur when cells consume oxygen and other fuels to produce energy.
- UV and blue light are still present even when it is cloudy or overcast.
Absorptive Sunglasses, UV Light, and Blue Light
Absorptive sunglasses help filter out bothersome glare and harmful light rays. Most sunglasses now block out ultraviolet light. However, to block out "blue" light, which causes concern for macular degeneration and other eye conditions, sunglasses need to have some amount of yellow in them.
The colors of sunglasses that contain some yellow and block out blue light are: amber, orange, amber/orange combination, plum, and yellow. Grey and green-grey colored sunglasses do not block out any blue light. Grey and green-grey sunglasses also do not provide contrast as well as do amber, orange, plum, and yellow.
in amber fit over
Some advantages of absorptive sunglasses are:
- They can reduce glare, enhance or clarify vision in the sunlight, ease eye fatigue, and protect the eyes from injuries.
- They block out harmful light rays. Most block out ultraviolet (UV) light, while amber, orange, plum, and yellow-colored sunglasses also block out blue light.
- Amber, orange, plum, and yellow-colored sunglasses also help enhance or increase contrast.
- Yellow-colored sunglasses are helpful for use indoors (reading, writing, doing handicrafts, using a computer) to reduce glare and enhance contrast.
- They are generally inexpensive and easy to obtain.
- They can be fitted over regular glasses, and they are available in clip-on or insert styles.
- Please note: Clip-ons and inserts are usually not as effective as fit-over or wrap-around styles, since they do not block light from the top and sides.
- It is recommended that you try on a range of colors and styles during the low vision examination to determine which color or colors work best for you.
You can learn more about absorptive sunglasses at Helpful Non-Optical Devices for Low Vision and Helpful Products and Technology for Living with Vision Loss.
More about the Study from JAMA Ophthalmology
Edited and excerpted from the study abstract:
Importance: Ultraviolet A (UV-A) light is associated with the risks of cataract and skin cancer.
Objective: To assess the level of UV-A light protection in the front windshields and side windows of automobiles.
Design: In this cross-sectional study [i.e., at one specific point in time], 29 automobiles from 15 automobile manufacturers were analyzed. The outside ambient UV-A radiation, along with UV-A radiation behind the front windshield and behind the driver's side window of all automobiles, was measured. The years of the automobiles ranged from 1990 to 2014, with an average year of 2010. The automobile dealerships were located in Los Angeles, California.
Main Outcomes and Measures: Amount of UV-A blockage from windshields and side windows. The average percentage of front-windshield UV-A blockage was 96% and was higher than the average percentage of side-window blockage, which was 71%. The difference between these average percentages is 25%. A high level of side-window UV-A blockage (more than 90%) was found in 4 of 29 automobiles (13.8%).
Conclusions and Relevance: The level of front-windshield UV-A protection was consistently high among automobiles. The level of side-window UV-A protection was lower and highly variable. These results may in part explain the reported increased rates of cataract in left eyes and left-sided facial skin cancer. Automakers may wish to consider increasing the degree of UV-A protection in the side windows of automobiles.
What You Can Do to Protect Yourself
- Always wear sunglasses outside, and make sure they offer protection from UVA, UVB, and blue light.
- Wear fit-over or wrap-around sunglass styles, since they block harmful light from the top and sides.
- Be aware that UV and blue light are still present even when it is cloudy or overcast.
- Wear a minimum of SPF 15 sunscreen outdoors and when driving.
- Investigate UV-blocking window tints or tinted window film for your automobile. Before you invest in this option, however, it is important to determine if these tints are legal in your specific area.
The American Foundation for the Blind (AFB) 21st Century Agenda on Aging and Vision Loss Is Moving Forward!Posted on 5/17/2016 at 3:43 PM
by Priscilla Rogers
The 21st Century Agenda on Aging and Vision Loss: Some Background
AFB began a "national conversation" on aging and vision loss over a year ago in anticipation of the 2015 White House Conference on Aging. As noted in our post on the outcome of the conference, AFB and other stakeholders have been extremely concerned that aging and vision loss issues have not been addressed in any significant way on a national level: "Older persons with vision problems should not be sidelined or forgotten because of their inability to engage – due to transportation issues, lack of technology access, and/or lack of vision rehabilitation services."
Now that our national conversation has officially launched, you can
- Read about AFB's national teleconference
- Let us know how you will take part by completing our online participant form
- Learn why the Agenda is so important
AFB Initiates the 21st Century Agenda on Aging and Vision Loss
On May 5, 2016, AFB hosted a teleconference call to initiate the 21st Century Agenda on Aging and Vision Loss. During the call we discussed designing our Agenda around three major goals and two multidisciplinary themes that built on our national conversation:
- Building support for increased funding of services
- Ensuring availability and quality of professional services
- Collaborating and coordinating across delivery systems to maximize resources for tackling critical needs (e.g., transportation, employment)
- Multidisciplinary themes: research needs and raising public awareness.
Participation in the Call
Over 100 people participated in the call and raised many topics that are critical to older persons with vision loss: housing, fitness, transportation, employment, service delivery programs and personnel, and funding for low vision and independent living. Although wide-ranging, all of these topics share one overarching issue: the critical importance of "being at the table" to ensure that the needs of people with vision loss are represented and voiced.
The Next Step: We Need Your Response to Our Participant Form
To take the 21st Century Agenda to the next level, we are asking individuals and organizations to respond to a participant form about their interest in participating in one of the goals or becoming involved in some additional ways in the Agenda.
Please complete the online participant form as soon as possible. We will leave the online form open until the end of May 2016.
We hope that individuals and organizations will volunteer to take on the role of "championing" or co-championing a goal to move the Agenda forward. We are also seeking partners with whom to collaborate. We will be establishing a planning committee that will meet monthly to keep the momentum going. We will also host topical meetings about critical issues and best practices and will meet as a group at AFB's next Leadership Conference in March 2017.
Do You Have Questions or Concerns?
E-mail any of your questions, concerns, or requests for more information to email@example.com. We hope you will join us in helping build a future and "blaze a trail" that will hold hope and promise for older persons experiencing vision loss.
More about the Agenda and Background
In 2015, AFB conducted a "national conversation" with individuals with vision loss and service providers through forums and a national survey. AFB then wrote a letter to President Obama, articulating the major issues related to aging and vision loss.
In that letter, AFB and the 80+ agencies that signed on to the letter emphasized the need for a systemic approach to ensure that older Americans who are blind or visually impaired are able to (a) receive the training in independent living they need to carry out everyday tasks, (b) obtain critical technologies to enhance their health, independence and safety, and (c) access appropriate support services, such as transportation.
Major Concerns Voiced in the "National Conversation"
- Medicare and Medicaid, the primary health programs serving older Americans, do not cover technology and specialized services (e.g. low vision devices, rehabilitation therapy, etc.) for older Americans who are blind or visually impaired. (Note: Be sure to read about the efforts to pass the Medicare Demonstration of Coverage for Low Vision Devices Act of 2015.)
- A common refrain in feedback gathered by AFB, related to the 2015 White House Conference on Aging, is reflected in the following quotation: "Aids for vision, such as glasses, magnifiers, and talking devices, should be covered. This could mean the difference between a person being independent and having to hire someone, or ask a family member, to provide these services."
- Service delivery systems addressing the needs of older Americans are fragmented and poorly coordinated.
- Funding for specialized services for older adults with vision loss is insufficient. Important services do not reach many of those who have the greatest need for assistance – including those in rural areas, those who are isolated from social and family networks, and those who have additional disabilities and medical conditions (especially deafness/hearing loss, memory loss, and diabetes).
- AFB heard from seniors and service providers that "There seems to be a lack of adequate vision rehabilitation professionals and funding to serve seniors with low vision/vision loss. Priority is often placed on 'working age adults' in terms of funding. This becomes a quality of life issue, as well as safety issue, when seniors are struggling with vision loss without the benefits of vision rehab training and services."
- The number of qualified professionals providing supports for adults with vision loss is vastly inadequate to meet the service delivery needs of the growing population of older Americans with vision loss.
- Older Americans with vision loss can continue to live independent and fulfilling lives if given access to appropriate home and community-based supports for carrying out everyday tasks. Seniors should have access to qualified, trusted assistance for reviewing printed materials and managing finances in a way that respects their independence and privacy.
- Additionally, all Americans – particularly seniors – benefit from affordable reliable public transportation access, not only for medical appointments and grocery shopping, but also for social activities, visiting family, and pursuing their retirement goals and aspirations.
- AFB routinely heard from people with vision loss that "Public transportation is critical for all persons with vision loss to maintain their independence. Unfortunately however, public transportation is often limited or not available at all. This results in older individuals who are blind or experiencing vision loss being dependent on friends and relatives for transportation, or being housebound."
Learn More about the Agenda, History, Facts, and Findings
by Priscilla Rogers
by Mary E. Worstell, MPH
Editor's note: Guest blogger Mary E. Worstell, MPH, is Senior Advisor, Office on Women's Health, United States Department of Health and Human Services. Ms. Worstell recently spoke on a panel at the American Foundation for the Blind (AFB) Leadership Conference and at a recent teleconference on the 21st Century Agenda on Vision Loss and Aging. She spoke to the health and disability disparities represented by seniors with vision loss and the need for collaborative efforts to improve services for older persons with vision loss. She encouraged our community to "be proactive and at the table to ensure that concerns related to living with aging and vision loss stay at the forefront."
One Size Does Not Fit All
When considering the challenges of the aging population, the solutions are not one-size-fits-all. There are distinct experiences for aging men compared with women, as well as individual differences. My 93-year-old mother is legally blind from macular degeneration and almost deaf, but is otherwise in fine fettle. Her needs are as unique as she is.
Treatment Not a Panacea
Most individuals with low vision are familiar with "the shots" needed to treat macular degeneration. My mother has had them all. Because of this, the specialists now tell us that her condition shouldn't get any worse, but won't get any better.
Continuing to Be Able to Read is Important
My mother, an avid reader, misses reading above all; she tears up when she talks about her special books. I am especially grateful for the Library of Congress program That All May Read, which continues to feed her hunger for history, ballet and Broadway. While her low vision has greatly diminished her daily quality of life over time, this program illuminates her life today with new insights on history, philosophy, and the lives of women of every decade.
Statistics Related to Women and Low Vision
I guess my mother's low vision is due to bad luck, and to a certain extent, bad genes. Her mother had this condition as well. I've learned, however, that it may also be due to her sex. Low vision – due to any cause - affects more women than men after age 60, and especially white, non-Hispanic women. According to the 2012 Vision Problems in the U.S. report of the Prevent Blindness America, roughly 6,000 more women than men aged 60-64, and 40,000 more women than men aged 75-79 have macular degeneration. After age 89, it is more than double the number of women to men with vision loss.
Racial and Ethnic Statistics Related to Low Vision
Racial and ethnic diversities among aging Baby Boomers also contribute to a growing subpopulation of low vision older adults. The Vision Problems in the U.S. report shows that non-Hispanic whites have more low vision conditions – by a large margin – than any other race. Hispanics, which are the fastest growing minority group among adults 65+, have the second largest population with low vision conditions, followed by Blacks.
As a public health professional for over 40 years, I understand the implications of these statistics on the health and well-being of older men and women, on the impact of health disparities due to low income, a rural environment, or lack of access to information a person can understand.
Office on Women's Health
The Office on Women's Health (OWH) at the U.S. Department for Health and Human Services in Washington, DC is focused on reducing the disproportionate burden of diseases in girls and women throughout their lives. Through policy, programs, and education, the OWH addresses health risks for women and girls. Because low vision impacts tens of millions of adults and disproportionately affects older women, we need to raise awareness and find support for individuals. Here are two examples:
- Low vision diminishes a woman's ability to manage her own – or her family's – health records and finances, thereby increasing her risk of mis-information and fraud. And all adults need to be aware of low vision needs as they plan their retirement. Did you know Medicare does not cover routine eye care visits or eyeglasses? The costs can be high and most people don't think about this when they retire.
- Low vision can greatly affect a woman's ability to care for her partner and family, putting herself as well as her family member at risk. Doctors need to support her to manage this.
Dual Sensory Impairment Leads to More Issues
As a daughter and caregiver, my mother's hearing deficit has more day-to-day impact on our relationship and stress levels. When you add deafness to the low vision, my mother's world has contracted significantly, with the deafness the most defining element of her increasing lack of socialization. There is a paucity of resources (and research) for people like my mom with dual disabilities. She had an uncle who was deaf and blind, too. What is being done to help my brother, sister, and their children in the future? We can't change the genes, but can we change our future?
Understanding Low Vision Care and Low Vision Devices: Part 2 in a Series on Low Vision and Low Vision Services by Bryan Gerritsen, CLVTPosted on 5/11/2016 at 9:39 AM
by Maureen Duffy
Guest blogger Bryan Gerritsen is a certified low vision therapist (CLVT) and owner of Low Vision Rehabilitation Services, providing low vision services throughout Utah. He is also the author of An Overview of Low Vision Devices, What are Low Vision Optical Devices?, Helpful Non-Optical Devices for Low Vision, Electronic Magnifiers and Magnifying Systems, and the Video Series: Better Lighting for Better Sight on the VisionAware website.
In this week's concluding Part 2, Bryan explains what you can expect from your low vision examination and the low vision devices that have been prescribed for you. As Bryan says, "Like success following a hip replacement, or in learning to play the piano, it takes practice, it takes persistence, and it takes patience. It takes hard work. But there is help. There is hope."
Regular Eyeglasses and Vision Correction
When you were age 20 or 40 or 60, what did you do if your vision changed? You went and got new glasses, which probably solved most of your vision problems: seeing things more clearly that were far away, at an intermediate (arm's length) distance, and up close. In this case, your new glasses worked well because they corrected vision problems related to the front parts of your eye, including the cornea, iris, and lens, and/or the front-to-back length of your eyeball.
But when you are older, and if you have macular degeneration, diabetic retinopathy, or any other eye disease, your vision problems are most likely caused by changes related to the back parts of your eye, including the retina and optic nerve. In this case, changing your glasses by ½ or ¾ of a diopter (which is how we measure the strength, or power, of glasses and lenses, and is typical of an average change in a new prescription), probably won't make much of a difference in how you see. What you do need now is a much stronger eyeglass correction – along with improved illumination and enhanced contrast.
But most importantly, what you also need is training—perhaps to view things slightly off to one side, rather than straight ahead, due to the presence of distortion, blurriness, or a blind or blank "spot" (scotoma) near the center of your vision.
An Initial Low Vision Training Session: the Basics
Near the beginning of a visit with a patient and their family, I often tell them that they were probably expecting to get a magnifier or new glasses to help them. I explain that we will get to that, but tell them that there are things that are perhaps even more important than a magnifier or devices – or at least as important.
Finding the Blurry "Spot" and Learning to See around It
What a person with macular
degeneration may see
If the person has distortion, blurriness, or a central scotoma (spot), I explain that the first order of business is to help locate where the scotoma is most problematic and, conversely, where they can see best. (In the field of low vision, we call it the preferred retinal locus or PRL). I then provide training for the first 25-30 minutes to help the person learn to look around that blurriness or spot, even though many people don't even realize they have a spot.
I explain to the person and their family that no matter how good a magnifier, strong reading glasses, or an electronic video magnifier might be, that spot will always be in the way if they look straight ahead.
I show the spouse or children "simulator goggles" to illustrate how the spot may appear to the person. I tell them about a patient who said that if they don't want to see people's faces in church, they just look straight ahead. Good low vision care includes training—to help a person use their remaining vision to the utmost. It may include training to help them look slightly off to one side, around their blurriness or that spot.
Low Vision Training is More than Just a Magnifier
About 26 years ago, I interviewed to be the low vision specialist at a center for the blind. They asked me what I would change about their services if I was hired. I stated that I would change their name, which at the time was "Low Vision Lens Service."
They asked me why I would change the name. I said it implied that they were just giving out lenses, such as magnifiers.
They asked me, "What is wrong with that?" I said this implies that all they are doing is handing out magnifiers to their patients.
They asked me, "What is wrong with giving a magnifier to a patient?" I responded, "Low vision is much more than a magnifier."
They asked me, "What is low vision, then?"
"Low vision is more than a magnifier," I answered. "It includes training, such as 'eccentric viewing' training to learn to see around a person's blurriness or scotoma/spot. It includes helping the person to improve their illumination. It includes helping the person to enhance contrast. It includes helping the person to reduce glare, along with many other services."
Incredibly, they still hired me, and we changed their name to "Low Vision Services."
Good Low Vision Services Include Training
Good low vision care should provide training, and not just with magnifiers and other types of low vision devices. Good low vision care will tutor persons with low vision and their families about the need for improved illumination and options for various lighting choices. It assists persons to learn ways to enhance contrast in every room and part of their home, school, or workplace. It teaches ways to reduce glare, as well as to improve organization and reduce clutter.
Good Low Vision Services Encourage Early and Prompt Referrals
Good low vision rehabilitation services help people to get help early in the process of their vision loss. It encourages doctors, staff, and others in the community to refer patients early. Doctors often ask, "At what point should I refer my patients to you?" I'm sure they are looking for a specific visual acuity that the person should be at before they refer them, such as 20/100, 20/200, or even 20/400.
The answer has nothing to do with visual acuity. People should be referred to low vision services when they have trouble doing everyday tasks, such reading, preparing meals, seeing faces, or driving. And the person themselves, their spouse, or their children should also seek help early on, whenever they feel they are having difficulty with these tasks.
Explaining Low Vision Devices
To help better understand low vision devices, I like to compare them to the tools used to build a house. A hammer helps with some tasks, a screwdriver with other tasks, and a wrench, plane, or a saw help with still others. As helpful as a hammer is, it won't help you build the whole house. And a single pair of glasses probably won't help you do everything any more. You need different tools for different tasks.
Similarly, low vision devices are used for different tasks, and do different things:
- A strong illuminated magnifier, digital magnifier, or reading glasses can help with reading, but do not help for seeing television or faces.
- Telescopic glasses or monoculars are very helpful for seeing television, faces, or scenery, but are not very beneficial for reading or close tasks.
- A clip-on loupe, prism half-eye glasses, or other devices may help for seeing the computer screen, sheet music, or hand work, but may not work for other tasks.
Therefore, most persons with low vision may have 4-5 devices (tools) to do different tasks:
- a strong magnifier or device for reading at home, and a portable device for reading at a restaurant, store, or church
- telescopic glasses to see the television, and perhaps a telescopic monocular to read signs, menu boards, and the aisle numbers in a grocery store
- a device for seeing the computer screen or sheet music better
- sunglasses to help reduce glare, and perhaps even two pairs: amber/orange for bright sunny days, and yellow for cloudy days, early mornings, or indoors.
It's not that a low vision clinic is trying to sell you many different devices; instead, it's because different devices do different things at different distances, and are used for different tasks.
Just Changing Your Prescription Glasses Is not the Answer
Many persons with a vision loss expect that changing their prescription glasses, like they have done all their lives, will solve all their problems. In the past, when a person's vision changed, they just got new glasses to see more clearly. And that is what they expect to happen now. However, with a serious vision loss, just making their prescription glasses a little stronger by ½ or ¾ of a diopter will probably not solve the problem any longer.
The person with a vision loss may need +8 diopters, +12 diopters, +20 diopters, or even +40 diopters. And just as important, they probably need improved illumination. One pair of glasses or one tool may not solve all of their problems or help with all tasks, just like a hammer won't help build the whole house. Different tasks require different tools.
No Tool is a Miracle Tool
Finally, no tool is truly a miracle tool. No magnifier, no strong reading glasses, telescopic devices, or even electronic or digital device will make things perfect. It will require a willingness to do things in a new way, the patience to try and persist, and the will to work to make it happen. It takes desire, it takes the support and help of those around you, and it takes going back to the low vision rehabilitation service for further training and for revision of the devices you are using, if your vision changes or your needs change.
Low vision care is not a "one and done" visit. I was strongly influenced by Dr. Randall Jose, who brought his optometry residents to the center in Atlanta, Georgia, where I worked in my first job. His belief for good low vision care was that it should be a three-visit minimum. I also believe this helps to ensure good training and proper follow-up.
Persistence Is Key!
I love to use the following quote from Ralph Waldo Emerson: "That which we persist in doing becomes easier to do, not that the nature of the thing has changed but that our power to do has increased." I wrote a song to that verse and added these words at the ending: "Persist, keep trying."
For More Information
You can ask your own eye care specialist for more information about low vision services and low vision practitioners, or use the AFB Directory of Services to locate service providers in your area.
by Maureen Duffy
New results from the Los Angeles Latino Eye Study indicate that early – as opposed to later and more severe – vision changes resulting from macular degeneration (AMD) are associated with a lower self-reported vision-specific health-related quality of life.
According to study co-author Dr. Rohit Varma, "The study results are a wake-up call for both ophthalmologists and those in the Latino community to avoid a quality of life decline due to ocular conditions, especially in earlier stages of eye diseases such as AMD. More importantly, the lower level of health care access and utilization among this group is likely to impact follow-up care of these patients and may also make them more susceptible to diminished quality of life."
From JAMA Ophthalmology
The research, entitled Age-Related Macular Degeneration and Quality of Life in Latinos: The Los Angeles Latino Eye Study, has been published "online first" in the April 28, 2016 edition 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 Farzana Choudhury, MBBS, MS, PhD; Rohit Varma, MD, MPH; Ronald Klein, MD, MPH; W. James Gauderman, PhD; Stanley P. Azen, PhD; and Roberta McKean-Cowdin, PhD, all part of the Los Angeles Latino Eye Study Group, who represent the following institutions: the University of Southern California, Los Angeles and the University of Wisconsin School of Medicine and Public Health, Madison.
The Los Angeles Latino Eye Study
The Los Angeles Latino Eye Study (LALES) is a major research project in Los Angeles County, California, designed to gain a greater understanding of the prevalence and incidence of eye disease among Latinos. Because so little is known about the visual health needs of this segment of the population, the data collected from this study will be instrumental in determining the prevalence of cataracts, glaucoma, age-related macular degeneration, and diabetic retinopathy among Latinos in this community. The study will also determine the proportion of blindness and visual impairment that is caused by these diseases, and will explore the association of various risk factors, such as smoking or sun exposure with ocular disease.
The LALES is supported by the National Eye Institute and the National Center of Minority Health and Health Disparities, which are two components of the National Institutes of Health. You can read more about the range of research studies that have been produced by the Los Angeles Latino Eye Study at the LALES home page.
About the Research
Researchers have published results of the largest population-based study of adult Latinos and age-related macular degeneration (AMD) in the National Eye Institute-funded Los Angeles Latino Eye Study (LALES), the first to analyze the risk and prevalence of early and late stage AMD and its impact on quality of life for older Latinos.
The LALES study, conducted among 4,876 Latinos in Los Angeles with a mean age of 54.8 years old, indicates that Latinos diagnosed with bilateral [i.e., both eyes] AMD with large drusen (explained below) and depigmentation as well as a more severe AMD had a substantially lower health-related quality of life as compared to those with AMD lesions in only one eye. In addition, the findings point to a more significant health-related quality of life decline beginning in early rather than later stages of the disease.
For instance … 91.6 percent of early AMD participants reported vision-related social function impact and 74.4 percent had near vision problems as compared to 67.7 percent and 46.9 percent respectively of late AMD participants who reported the same. The researchers also found that while participants may not have a measurable decrease in their visual acuity, their reported reduced visual function may possibly be the result of reduced contrast sensitivity associated with early-stage AMD.
"The study results are a wake-up call for both ophthalmologists and those in the Latino community to avoid a quality of life decline due to ocular conditions, especially in earlier stages of eye diseases such as AMD," said [study co-author] Rohit Varma, MD, MPH. "What was significant but not intuitively obvious was that Latinos diagnosed with AMD in both eyes or more severe AMD had a markedly diminished vision-specific quality of life requiring us to shift our clinical focus from treating advanced stages of AMD to finding earlier stage interventions and treatment options."
"Previous studies on Latinos have found this population to have a different pattern of AMD prevalence, incidence, progression and risk factors," said Dr. Varma. "More importantly, the lower level of health care access and utilization among this group is likely to impact follow-up care of these patients and may make them more susceptible to diminished quality of life."
"The LALES findings unexpectedly demonstrate that even the earliest stages of AMD may impair eyesight enough to interfere with daily activities. People with early AMD affecting both eyes appear to be especially vulnerable to declines in their vision-related quality of life, and might benefit from any early referral to a low vision specialist," said Maryann Redford, MPH, program director at the National Eye Institute.
About Age-Related Macular Degeneration
Age-related macular degeneration (AMD) is a gradual, progressive, painless deterioration of the macula, the small sensitive area in the center of the retina that provides clear central vision. Damage to the macula impairs the central (or "detail") vision that helps with essential everyday activities, such as reading, preparing meals, watching television, playing card and board games, and sewing.
AMD is the leading cause of vision loss for people aged 60 and older in the United States. According to the American Academy of Ophthalmology, 10-15 million individuals have AMD and about 10% of people who are affected have the "wet" type of AMD.
Wet (Neovascular) Macular Degeneration
In wet, or exudative, macular degeneration (AMD), the choroid (a part of the eye containing blood vessels that nourish the retina) begins to sprout abnormal new blood vessels that develop into a cluster under the macula, called choroidal neovascularization (neo = new; vascular = blood vessels).
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.
Dry Macular Degeneration
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. "Atrophy" refers to the degeneration of cells in a portion of the body; in this case, the cell degeneration occurs in the retina.
In dry age-related macular degeneration, small white or yellowish deposits, called drusen, form on the retina, in the macula, 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 vision loss.
Risk Factors for Macular Degeneration
The primary risk factors for AMD include the following:
- Smoking: Current smokers have a 2-3 times higher risk for developing AMD than do people who never smoked. It's best to avoid second-hand smoke as well.
- Sunlight: Ultraviolet (UV) light is not visible to the human eye, but can damage the lens and retina. Blue light waves that make the sky, or any object, appear blue, are visible to the human eye and can also damage the lens and retina. Avoid UV light and blue/violet light as much as possible by wearing sunglasses with an amber, brown, or orange tint that blocks both blue and UV light.
- Uncontrolled hypertension: The National Eye Institute (NEI) reports that persons with hypertension were 1.5 times more likely to develop wet macular degeneration than persons without hypertension. It's important to keep your blood pressure controlled within normal limits.
- A diet high in packaged, processed food and low in fresh vegetables: NEI suggests that eating antioxidant-rich foods, such as fresh fruits and dark green leafy vegetables (kale, collard greens, and spinach) may delay the onset or reduce the severity of AMD. Eating at least one serving of fatty fish (salmon, tuna, or trout) per week may also delay the onset or reduce the severity of AMD.
- Race: According to NEI, Whites/Caucasians are more likely to have AMD than people of African descent.
- Family history: NEI reports that individuals with a parent or sibling with AMD have a 3-4 times higher risk of developing AMD.
You can read more about the full range of AMD risk factors at Risk Factors for Age-Related Macular Degeneration on the VisionAware website.
More about the Study from JAMA Ophthalmology
Edited and excerpted from the study abstract:
Importance: This study found evidence of a threshold effect [i.e., reaching a level or point at which something starts to change] in which the presence of bilateral [i.e., occurring in both eyes] drusen (explained above) and depigmentation of retinal pigment epithelium was associated with substantially low health-related quality of life in adult Latinos from the United States.
[Editor's note: Retinal pigment epithelium (RPE) cells are the deepest cells of the retina. The RPE helps to maintain the health of the retinal photoreceptor cells, called rods and cones. These photoreceptor cells are triggered by light to set off a series of electrical and chemical reactions that helps brain to interpret what the eye sees. Degeneration of the RPE cells also leads to the death of the rods and cones and, ultimately, to loss of vision.]
Objective: To assess the association of general and vision-specific health-related quality of life with age-related macular degeneration (AMD), overall and by bilaterality [i.e., occurring in both eyes] and severity, in adult Latinos.
Design, Setting, and Participants: The study included 4,876 participants from the general urban community in six US Census tracts in La Puente, California. The data for these analyses were collected as part of a population-based study of ocular diseases in adult Latinos in the Los Angeles Latino Eye Study from February 1, 2000 through May 31, 2003. The analysis was performed from November 2010 to February 2011. Additional analyses were performed in June 2014.
Results: Of the 4,876 participants included in the analysis, 4,402 (90.3%) had no AMD, and 474 (9.7%) had any AMD, with 453 having early (9.3%) and 21 (0.4%) having late stages of the disease. The mean age was 54.8 years. Of the 4,876 participants, 2,001 (41.0%) were male and 2,875 (59.0%) were female. In this [research group] of Latinos, participants with AMD had lower vision-specific health-related quality of life scores.
General health-related quality of life was assessed by the Medical Outcomes Study 12-Item Short-Form Health Survey and self-reported vision-related health-related quality of life by the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25).
Conclusions and Relevance: In this study of adult Latinos, early AMD lesions are associated with lower self-reported vision-specific health-related quality of life, but not general health-related quality of life. Severity and bilaterality of AMD are associated with measurably lower health-related quality of life, with the largest difference in scores occurring for individuals with both eyes affected.
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