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New Year’s Resolution for Assistive Technology

A man holding a business diagram, featuring different types of technology.

If like many individuals experiencing vision loss, you are finding it difficult to read the text on the computer screen, tablet, or smartphone, you may be completely unaware of what options are available on your existing devices to make them easier to see, or in some cases, read the screen to you. Chances are, if you have a recent loss of vision, you may have no idea that features or technology exists called Assistive Technology (AT) that makes it easier for users with vision loss to access their devices. With the other New Year’s resolutions you may have thought to commit to this year, why not make a resolution to learn what AT is available to make your tech gadgets more usable?

Recently, a client was referred for vision rehabilitation services that included, among other things, difficulty reading her computer screen. When I called to make an appointment for our first meeting, I asked about her computer use. She reported she was using a Mac desktop and often had to use her handheld magnifier to see sections on the screen. When asked if she used a screen magnifier, she reported she’d tried a plastic device that went in front of the screen but found that it didn’t really help.

When asked if she’d ever adjusted the System Preferences on the Mac to turn on the Zoom screen magnifier, built into the Mac, there was a long pause in the conversation. "I didn’t know there was anything like that on the computer," she replied. I knew at that point it was going to be a successful first meeting and that she most likely already had what she needed to see her computer screen more effectively built into the operating system of her computer. It was a very successful first meeting because, at the end of our lesson, she had Zoom turned on the computer, magnifying the screen two to three times, making the text much easier to read. She also learned the few keyboard commands needed to increase and decrease the magnification. Because the computer screen was placed next to a window, there was also a demonstration of how much clearer the screen was when the glare was reduced by drawing the blinds when using the computer.

This recent training is by no means unusual, in fact it is very typical—clients with recent vision loss have been using computer technology visually with generally good sight for many years, as have most of their acquaintances, so there has never been any training or resources provided for using the computer with reduced vision or none at all. This is often not addressed in the doctor’s office, and many individuals with a recent loss of vision are left to uncover these resources on their own.

If you’re reading this, you’ve already started looking, so congratulations! Your next resource can be the VisionAware Service Directory. This is a national list of services by state and category of service. For a comprehensive list of services, select "All" from the drop-down menu or "Computer/Assistive Technology Training" for a more targeted search on technology training. This directory will point you to state and local agencies with vision rehabilitation therapists, assistive technology specialists, orientation and mobility specialists, and low vision therapists, all of whom will either have some training in assistive technology or can point you in the right direction.

Additionally, the federal Assistive Technology (AT) Act provides financial assistance to states to help support programing to provide AT training, device demonstrations and loaners, and funding for consumers who will benefit from AT. Look up your state in the ATAP Directory of AT Act Programs for additional resources that are not limited to blindness and low vision tech.

An older man and woman at a desk in business attire working on a computer together

If you too have a Mac and didn’t realize you had a built-in screen magnifier, try pressing, Command + Option + 8 to turn Zoom off and on, and once on, Command + Option + Plus to increase the magnification and Command + Option + Minus to reduce the magnification. Users will find more options in the Apple Menu under System Preferences, Universal Access. For more accessibility shortcuts, check out Mac Accessibility Shortcuts on Apple’s Support website. For other types of computers and assistive technology, check out Low-Cost Computing on VisionAware.

A vision loss may change the way you use a computer to some degree, and the first step is figuring out what you need. It’s a new year, and there are more assistive technology features than ever before. Make a commitment to yourself to find out more about them!

Technology Resources for Individuals with Vision Loss

Lesson on Restoring Your Technology Skills

Helpful Products and Technology for Living with Vision Loss

Using a Computer

Overview of Low Vision Devices

Technology Resources for People with Vision Loss

Using a Computer with a Visual Impairment: A Beginner's Guide to Computer Accessibility


Topics:
Assistive Technology
Low Vision
Online Tools
Planning for the Future
Reading
Technology

A Vision Specialist Reassures Clients About Charles Bonnet Syndrome

Engraving of Charles Bonnet in profile. File source: Wikimedia Commons. This image is in the public domain because its copyright has expired

Portrait of Charles Bonnet

As an itinerant vision rehabilitation teacher, I travel the highways of Central Indiana making home visits to people learning to adapt to vision loss. Each initial appointment begins on the front porch of a stranger’s home. When the door opens, I follow my new client inside to sit at their kitchen table. As I unpack the tools of my trade—tactile labels, magnifiers, talking watches—my clients confidently answer my routine questions about their eye condition, their ability to read print, or sensitivity to glare. There is an understandably more varied reaction, however, when I ask if they are having hallucinations of plants, animals, or people; "Did you know," I ask, "that it’s common for people who are losing sight to think they see things that aren’t there? It’s called Charles Bonnet Syndrome."

Sometimes I see a wave of relief pass over the client’s face. One elderly lady who had macular degeneration leaned forward to tell me that my car appeared to be covered in beautiful flowering vines when I pulled in the driveway. Another client living with glaucoma turned to his wife and said, "See, honey! Just because I see parrots in the houseplants doesn’t mean I’m crazy!"

Introducing Charles Bonnet

Curiosity piqued, they want to know about this Mr. Charles Bonnet and the tricks he plays on the eyes. And so I explain.

The syndrome was named for a French naturalist and philosopher who lived in the 18th century and first recognized the phenomenon. Charles Bonnet was aware that his grandfather was having hallucinations of handkerchiefs floating in the air and saw horse-drawn carriages and buildings appear out of nowhere. Noting that his grandfather was quite mentally sharp, Charles Bonnet attributed these hallucinations to his grandfather’s failing eyesight. Neurologists have since proved him right.

Your Eyes Are Just Dreaming

We think of blindness or a visual impairment as something that happens to our eyes, but the visual system is very much rooted in our brains. In Charles Bonnet Syndrome, the brain is no longer getting visual input or cannot make sense of the images impaired eyes are transmitting. Seeking stimulation, the brain rummages through its storage bins of past visual memories and simply invents something to look at. Or, as I explain to my clients, "You may be wide awake, but your eyes are dreaming."

Because these hallucinations are triggered by the part of the brain that is associated exclusively with vision, there is nothing to hear, touch, or taste. In a wonderful Ted Talk, the late neurologist and acclaimed author Oliver Sacks explains the difference between the noiseless hallucinations of Charles Bonnet Syndrome and hallucinations brought on by mental illness. The latter, explains Dr. Sacks, assaults all the senses and triggers a strong emotional response that compels the observer to engage verbally or physically with the hallucination. In contrast, the visual images of Charles Bonnet Syndrome don’t demand one’s attention and, in fact, seem to ignore the viewer. If a psychotic episode is more like being dropped into a virtual reality game, then Charles Bonnet is akin to passively watching a silent movie on an old film reel.

Charles Bonnet syndrome hallucination of a blue moose

Hallucination of a blue moose

Entertaining Hallucinations or Boring Visual Memories?

Many hallucinations have a surreal quality—elephants in the tomato plants or a large firetruck parked on the back patio—but a good percentage are so mundane that they might go unnoticed. Walking through a department store one day, Wendy admired the colorful array of purses on display until her friend pointed out they were in the lingerie section. Wendy tells me that many of her Charles Bonnet moments feature unremarkable, everyday objects such as a box of cookies on the counter, a grandfather clock in a hotel lobby, a flag in a parking lot. The tip-off, she notes, is that the hallucinations have a sharpness and detail that in reality, she is no longer able to see.

The vast majority of my clients see very pleasant images. They look forward to chatting with me about the river that came down the hallway of their assisted living facility or the colorful checkered patterns and interlocking circles that dance on their kitchen walls. One woman was comforted by the image of a little girl with a headful of colorful barrettes sitting on the end of her bed. "I thought she was an angel," She confided, a bit disappointed.

Nina, a lawyer and mother of five, is quite delighted by the fact she has Charles Bonnet Syndrome. Nina’s first experience occurred when she was putting up holiday decorations and alerted her family to the playful bears shimmying up the Christmas tree. After some quick research on the Internet, the family agreed Nina had a case of Charles Bonnet Syndrome. These days Nina looks forward to her Charles Bonnet moments. In fact, she confesses to occasionally slipping away to a dark room where she squints until her inner eye conjures up some images. She says, "I’m bored. Bring me something good, Charles Bonnet!"

Shake Off Unpleasant Hallucinations

Not all visual hallucinations are pleasant. One client was cheered by the image of her sister as a young girl wearing her favorite blue dress but was less thrilled to see spiders on her bedroom quilt. Some disturbing images feature common themes such as deformed faces. One gentleman told me that he couldn’t see his television well, but it always seemed that the newscasters had very distinctive, over-sized teeth that glinted. In Oliver Sacks’ Ted Talk, he explains that certain visual cells are associated with specific images. It seems that the visual cells that correspond to teeth and eyes, as well as those that are associated with cartoon characters and geometric patterns, are most frequently triggered in Charles Bonnet Syndrome.

It’s easy to be rattled if one suspects that the vision loss is accompanied by an undiagnosed mental illness. And of course, it’s no surprise that my elderly clients, fearing dementia, keep secrets from their adult children. But the vast majority of people can live at peace with Charles Bonnet Syndrome once they understand the cause.

The good news about unwelcome hallucinations is that they usually can be disrupted by flicking on lights, blinking, or turning one’s head away. So far, there is no medication for the condition although doctors who misdiagnose the syndrome may mistakenly prescribe anti-psychotic medicine. The website of the Royal National Institute of the Blind (RNIB) explains why anti-psychotics are not advised and offers solid advice for dealing with distressing Charles Bonnet experiences. One word of caution: Sometimes consultation with a neurologist or other specialist is necessary to rule out any serious disorders that may mimic Charles Bonnet syndrome [such as migraine, epilepsy, brain tumors, dementia, Parkinson's disease, or mental illness}.

Getting the Word Out About Charles Bonnet

Neurologists estimate that 10 percent of people with vision loss will experience Charles Bonnet Syndrome but only one percent of them will admit to it. I enlist the support of my clients to take Charles Bonnet Syndrome out of the shadows and into the limelight. Some return to their ophthalmologists and encourage them to distribute information about the syndrome to new patients. I like to picture my clients holding court at parties in their Senior residences and at family gatherings as they freely share lighthearted anecdotes about their Charles Bonnet moments. As the word gets out, more people will be fully prepared when they encounter a visual hallucination for the first time. Instead of recoiling in fear, they will simply nod and smile knowingly at the apparition, "Hello there. I’ve been expecting you Charles Bonnet."

Learn More About Charles Bonnet Syndrome

Charles Bonnet Syndrome?

Our Readers Want to Know: Why Am I Having Visual Hallucinations Along with My Vision Loss?

Visual Hallucinations Are My Constant Companions by VisionAware Peer Advisor Sheila Rousey

New Research from Canada: Approximately One in Five Persons with Vision Loss Experience Visual Hallucinations

Charles Bonnet Syndrome: My Personal and Professional Journey

How Alzheimer's Affects Vision and Perception


Topics:
Health
Low Vision

Four Misconceptions to Learning and Reading Braille

January Is Braille Awareness Month

engraved image of Louis Braille and his birthplace

January is braille awareness month, in honor of Louis Braille, the inventor of the raised dot system of reading and writing. He was born January 4, 1809. If you were born without sight or limited vision, there is a very good chance you learned braille at an early age, and that is how you learned to read and write your way through school. For many of us who are able to read print or could access it at one point in our lives, braille is like another "language." In fact, we may even consider it a language that individuals who are blind or visually impaired use to communicate with one another. These are misconceptions about braille that I think sometimes get in the way of learning or using braille for individuals who acquire a vision loss later in life.

The Creation of Braille

Louis Braille developed a system of raised dots that simply provided a symbol that could be felt for each character of the alphabet and punctuation symbols. At the time Louis Braille invented his system, students who were blind like him often used raised print letters. They also used embossed letters on paper to learn the alphabet and read the few books that existed in embossed print. Raised dots on paper were easier to create, both for reading and writing notes, and later for embossing books. In fact, long before braille was widely adopted, the students at the Royal Institute for Blind Youth in Paris, where Louis Braille went to school, quickly adopted his system of writing to pass notes among themselves that no one else could read!

Louis Braille’s idea for using raised dots was inspired by Charles Barbier’s more elaborate system of "Night Writing." Barbier developed this system for French soldiers so that they would have the ability to pass written communication back and forth at night, without needing to use a light. Ironically, braille was originally inspired by raised dot writing developed for fully sighted soldiers needing to read in the dark!

Braille Is Not Another Language

While there are certain rules in braille one would not find in print and contractions that do not exist in print, it is nonetheless just an alternative set of tactile symbols for the language of the user—whether that is English, French, Spanish, or virtually any other language. Therefore, braille is not another language but more a communication or literacy tool used to access information for those with vision loss.

Braille Not Just for Literary Pursuits

Another misconception seems to be that braille is primarily used for literary pursuits, like reading journals, books, and school textbooks. One of the handiest ways to use braille is for creating quick labels for clothing, appliances, food, spices, cleaning chemicals, CDs, and so much more. The level of expertise for reading these tactile labels does not have to be high. A very slow braille reader could quickly tell the difference between a gallon jug of bleach and a jug of glass cleaner with a few letters transcribed to braille on an adhesive plastic label or a note card tied to the neck of the bottle.

Braille Is Still Relevant with Advancements in Technology

A man in an office uses a braille note taker

With the proliferation of screen readers, converting the text on a screen into speech on computers, tablets, and smartphones, we’ve heard again and again that the need or relevancy of braille is much less than it was before these electronic devices. Ironically, these devices have embraced braille in the last few years to make braille even more available! I shared about this braille technology in a previous post on VisionAware. Many off-the-shelf devices including Windows 10, Mac and iOS devices, Android tablets and phones, the latest Kindle Fire tablets, and many more support a variety of braille displays. By connecting a braille display, users are able to read email, web pages, and books in braille using a portable braille display that can easily be put in a pocket or backpack! In fact, as we celebrate the 208th anniversary of Louis Braille’s birthday and his invention that transformed reading for individuals with a vision impairment, we are awaiting the distribution of the Orbit Reader 20 from the American Printing House for the Blind (APH) among other organizations. This distribution will reduce the cost for an electronic braille reader to below $500!

Lack of Interest in Braille When Vision Loss Is Later in Life

Photo of older people in a class

Lastly, it’s been my experience, with the occasional exception, most individuals with an acquired vision loss who did not grow up using braille express little interest in learning even the alphabet. Learning the alphabet would be enough to do some simple labeling around the house, workshop, or office. I wonder to what degree braille, like the long white cane, may simply be stereotypical symbols of vision loss that some are just not ready to embrace regardless of their value? If that describes you, the beginning of a new year is always a great time to stretch and make a commitment to try something new!

I have shared four misconceptions about learning and reading braille, but I am sure there are more. So, let’s get the conversation going as we honor Louis Braille this month. What misconceptions have you heard about braille? Have you learned braille? Why or why not? Is braille an important part of your life? Share your thoughts and comments in the section below.

Braille Resources

For readers interested in learning more about braille, a great place to start is through a correspondence course taken via postal mail with the Hadley Institute for the Blind and Visually Impaired. The courses are at no cost, and there are several on braille. For more information, visit www.hadley.edu or call 800-323-4238. Readers may also find a local service provider by consulting the Directory of Services on VisionAware. Many state agencies providing vision rehabilitation services will have professionals who can teach braille.

Learn More About Braille

All About Braille

Braille Technology: What's New and Emerging?

Reading, Writing, and Vision Loss

Check out Steve's blog post, "31 Days of Braille"


Topics:
Low Vision
Planning for the Future
Reading

New Research: The Importance of Supporting the Well-Being of Adults with Sensory Loss and Their Spouses in Rehabilitation

Disability and Rehabilitation journal cover

Many websites, including VisionAware, emphasize the importance of emotional support and coping strategies when dealing with adult-onset vision loss and combined vision and hearing loss.

Some of these strategies include joining peer support groups; reading books about blindness and vision loss; reading personal stories of people who have adjusted to vision loss; and encouraging family and friends to participate in the adjustment process.

A number of research studies also emphasize the importance of emotional support: The American Academy of Ophthalmology stresses that eye doctors must learn to pay closer attention to depression in their patients with vision loss and a recent study from the United Kingdom revealed that 89% of patients who showed anxiety and 91% who showed depression were not receiving appropriate emotional and psychological treatment.

Now, new research from Denmark and Canada has added to this growing body of knowledge by emphasizing the role of the spouse, partner, or significant other in the adjustment process to sensory loss, which includes vision loss, hearing loss, and combined vision and hearing loss.

According to the authors, "the results highlight the need to support the well-being of adults with sensory loss and their spouses in rehabilitation, and the importance of both intrapersonal coping (our own internal thoughts and feelings) and interpersonal coping (relationships and actions that take place between two or more people) in the adjustment process."

From the Journal Disability and Rehabilitation

This new research, titled Intra- and interpersonal effects of coping on the psychological well-being of adults with sensory loss and their spouses, has been published online in the November 30, 2017 edition of Disability and Rehabilitation, an international journal that "seeks to encourage a better understanding of all aspects of disability and to promote rehabilitation science, practice and policy aspects of the rehabilitation process.

The authors are Christine M. Lehane, Jesper Dammeyer and Walter Wittich, from the Department of Psychology, University of Copenhagen, Denmark, and the School of Optometry, University of Montreal, Canada.

Related Research by the Authors

This new research builds on previous work from the research team, including Couples' Experience of Sensory Loss: A Research and Rehabilitation Imperative, which revealed the following:

Acquired sensory loss of one family member can have a significant impact on the well-being of the entire family, especially the spouse. In the context of acquired sensory loss, the presence of a spouse or partner is an important support structure. When asked which areas individuals are most interested in receiving help with, one of the primary responses is managing relationships.

Considering that sensory loss has the potential to disrupt a couple's communication and social life, it is reasonable to suggest that sensory loss is a shared experience. …For the purpose of research and rehabilitation, the individual with impairment, as well as the spouse, need to be considered in combination.

More About the New Disability and Rehabilitation Coping Research

Edited and excerpted from the study Abstract and Implications for Rehabilitation:

  • The aim of the current study was to examine the associations between coping and psychological well-being among adults with sensory loss and their spouses. A total of 183 adults with sensory loss and 133 spouses participated in an online survey and were followed up six months later.
  • 27.9% reported having a hearing loss, 32.2% reported vision loss, and 39.9% reported some degree of both hearing and vision loss (dual-sensory loss).
  • Results showed that a significant portion of adults with sensory loss (32.4%) and spouses (23.8%) had poor well-being, and this remained stable over the six-month period.
  • The results highlight the need to support the well-being of adults with sensory loss and their spouses in rehabilitation, and the importance of both intra- and interpersonal coping in the adjustment process.
  • Rehabilitation specialists and social workers working with adults with sensory loss should, where possible, incorporate family members into support plans.
  • Rehabilitation specialists and social workers working in sensory rehabilitation should be mindful of how the coping styles of one partner can impact the well-being of their significant other.
  • Online and print information for spouses on how to cope with a partner's sensory loss should be available and accessible for couples attending sensory rehabilitation clinics.

Important Study Highlights from the Research Project

Edited and excerpted from the full study:

  • [F]ew studies have examined how adults with sensory loss and their spouses cope or the impact of each partner's coping styles on one another's psychological well-being over time.
  • [W]hile current guidelines for the rehabilitation of adults with sensory loss typically acknowledge the benefit of integrating spouses into clients' rehabilitation goal planning, they do not consider how the personal coping abilities of each partner may directly affect rehabilitation outcomes (e.g., well-being). This view can be problematic as it tends to ignore the dynamic, interactional nature of couples' sensory loss experience.
  • Unlike many other physical disabilities, hearing and/or vision loss primarily impact communication and mobility that can reduce social participation and increase isolation and loneliness over time.
  • In fact, studies have shown that the medical severity of one's hearing and/or vision loss tends not to be directly associated with psychological outcomes; instead, self-reported degree of loss and an individual's perception of its impact on factors such as communication ability or perceived social support have been found to be linked to psychological well-being.
  • However, while coping styles may influence an individual's decision to educate themselves on available rehabilitation options, coping strategies have not been found to be associated with actual entry into rehabilitation.
  • Interpersonal coping … involves the understanding that couples' lives are interdependent and that one partner's way of coping with the sensory loss is also likely to influence the well-being of their spouse.
  • Adults with sensory loss whose spouse reported higher levels of support seeking at [the beginning of the study] were more likely to report positive well-being at [the six-month follow-up]. Given that the aim of sensory rehabilitation programs is to enhance quality of life, this finding highlights the importance of including spouses in the support process.
  • In fact, because spouse support-seeking was also positively associated with the psychological well-being of spouses at time one, fully incorporating spouses into the rehabilitation process may not only enhance the well-being of adults with sensory loss but also that of their spouse. Maintaining spouses' well-being should also be a priority for sensory loss rehabilitation, given that spouses are often referred to as an individual's primary and most valuable resource.
  • First, given the ... consistency of couples' risk for poor well-being in the present study, rehabilitative or therapeutic interventions are needed. Ideally, such interventions should include spouses and recognize the potential intrapersonal and interpersonal effects of each partner's coping on well-being.
  • Finally, considering the beneficial effects of spouse support-seeking, it may also be worthwhile for sensory rehabilitation centers to form counselor-moderated peer support groups (in-person or online).
  • Although further study is needed, the results of the current study suggest that couples living with sensory loss are in need of support and that coping styles and relational behaviors may be useful to target in psychosocial interventions. Future research is needed to understand, in more depth, the exact mechanisms through which each partner's coping styles affect one another's well-being over time.

More Information About Combined Vision and Hearing Loss


Topics:
Aging
Caregiving
Low Vision
Support Groups

Is It Possible to Prevent the Inflammation that Triggers Dry Macular Degeneration? New Research Says Maybe

a retinal photograph of dry AMD

A retina with dry AMD

One of the most significant challenges facing eye and vision researchers is developing an effective treatment for dry age-related macular degeneration (AMD). Although there are now a number of well-regarded FDA-approved drug treatments for wet AMD, the key to effective dry AMD treatment remains elusive, although several potential treatments have emerged in recent years.

Current treatments for dry AMD include a number of non-drug-related measures, including (a) nutritional supplements recommended by the Age-Related Eye Disease Study 2 (AREDS2), and (b) controlling a range of lifestyle factors, including diet, weight, blood pressure, smoking, and blue and ultraviolet light exposure.

Most recently, researchers from the United States and Japan have discovered a "critical trigger"—an enzyme called cGAS, explained below—which starts the inflammation that damages cells and leads to dry AMD and geographic atrophy. Their hope is that this finding will halt inflammation early on in the course of the disease and prevent the progression to vision loss.

Please note that this research is in its very earliest stages and has been conducted thus far only with laboratory mice and human tissue samples. The researchers expect that the development of a drug to stop the cGAS enzyme will take several years. The drug would then have to go through extensive testing to determine its safety and effectiveness. Nevertheless, this research shows promise for developing treatments to prevent inflammation and its progression to dry AMD.

About Enzymes and Dry Age-Related Macular Degeneration (AMD)

This new AMD research has been published in the November 29, 2017 edition of Nature Medicine. Nature Publishing Group (NPG) is a publisher of scientific and medical information in print and online. NPG publishes a range of journals across the life, physical, chemical, and applied sciences and clinical medicine. Topics include current affairs, science funding, scientific ethics, and research breakthroughs.

The authors and researchers represent the following institutions from the United States and Japan: Icahn School of Medicine at Mount Sinai, NY; Texas A&M University; University of California Los Angeles; University of California Irvine; University of Kentucky, Lexington; University of Massachusetts Medical School; University of Virginia School of Medicine; Doheny Eye Institute, Los Angeles; Nagoya University Graduate School of Medicine; Kobe University Graduate School of Medicine; Wakayama Medical University; and University of Tsukuba, Japan.

Some Terminology Related to the Research

Geographic atrophy (GA) is the most severe and advanced form of dry AMD. GA involves patches of cells in the retina that have degenerated or died off:

  • Atrophy: Degeneration of the deepest cells of the retina, called the retinal pigment epithelium (RPE).
  • Geographic: The shape of the atrophied portion of the retina, which resembles the irregular outline of a land mass (geography).
  • The RPE helps to maintain the health of the retinal photoreceptor cells, called rods and cones. These cells are triggered by light to set off a series of electrical and chemical reactions that helps the brain to interpret what the eye sees.
  • The degeneration of the RPE cells also leads to the death of the rods and cones.
  • At present, there is no medical or surgical treatment for geographic atrophy.

Other helpful terms include:

  • Enzyme: A protein that stimulates chemical reactions within the body.
  • DNA: The hereditary material in humans and almost all other organisms. It contains the genetic code that determines all characteristics of a living organism.
  • cGAS: An enzyme that is a component of the immune system. It stimulates the body's immune response to infections by detecting the presence of foreign DNA and triggering inflammation in response to it.

About 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 – the small sensitive area in the center of the retina that provides clear central vision – causing it to deteriorate or degenerate over time.

Photograph of a retina with drusen

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.

More About the Research

Edited and excerpted from UVA Discovers Trigger for Macular Degeneration That Robs Millions of Vision, via University of Virginia (UVA) Today:

[R]esearchers at the University of Virginia School of Medicine have discovered a critical trigger for the damaging inflammation that ultimately robs millions of their sight. The finding may allow doctors to halt the inflammation early on, potentially saving patients from blindness.

"Almost 200 million people in the world have macular degeneration. If macular degeneration were a country, it would be the eighth-most-populated nation in the world. That's how large a problem this is," [they] said. "For the first time, we know in macular degeneration what is one of the very first events that triggers the system to get alarmed and start … hyperventilating. This overdrive of inflammation is what ultimately damages cells, and so, potentially, we have a way of interfering very early in the process."

[The researchers] determined that the culprit is an enzyme called cGAS. The enzyme plays an important role in the body's immune response to infections by detecting foreign DNA. But the molecule's newly identified role in the "dry" form of age-related macular degeneration – which involves no leakage of blood or [fluid] in the eye, and accounts for 85 to 90 percent of all macular degeneration cases – comes as wholly unexpected.

"It's really surprising that in macular degeneration, which, as far as we know, has nothing to do with viruses or bacteria, that cGAS is activated, and that this alarm system is turned on. This is what leads to the killing of the cells in the retina, and, ultimately, vision loss."

The researchers noted that … the enzyme may also play important roles in conditions such as diabetes, lupus and obesity, and researchers already are working to create drugs that could inhibit its function.

"Because the target we're talking about is an enzyme, we could develop [drugs] that could block it," [they] said. "There are many drugs already on the market that target specific enzymes, such as the statins [which are used to lower cholesterol levels.]"

The researchers also hope to develop a way to detect the levels of the enzyme in patients' eyes. That would let them determine when best to administer a treatment that blocks cGAS.

"If they have high levels of this enzyme in their eye, they might be a wonderful candidate for this sort of treatment. This is really precision medicine at the single-molecule level."

VisionAware will continue to report the results of this macular degeneration research as they become available.

Additional Information


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In the News
Low Vision
Macular Degeneration
Medical Updates

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