Transcript: Aging and Low Vision

HadleyAging and Low VisionPresented by Bryan GerritsenDate May 19th, 2009

Good afternoon everyone today’s presentation is Aging and Low vision and will be presented by Mr. Bryan Gerritsen who is a certified low vision therapist. Welcome Mr. Gerritsen and I will turn over the microphone over to him.

Mr. Gerritsen: Thank you and welcome to everyone. I am a big fan of Hadley. They’re one of the premier researchers in the country as a vision resource. And I am so honored to be able to be affiliated with them this day and presenting on Aging and Low Vision. I hope this is beneficial for each of you and for those who may access this in an archived manner later.

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If you have low vision or have a family member or friend who does, please you know you are not alone. Perhaps one of the places to start on this is the prevalence demographics of low vision. If you were in high school and thought of people you knew who were blind, you may only know one person in the entire school or perhaps no one. And yet as we get older it’s not uncommon to have an aunt, a neighbor, a sister or someone very close to you with low vision. By the time people are 85 years old which is the largest growing segment of our population 85 and up. Probably one and four persons have some type of vision loss. They cannot be corrected with surgery or glasses. And low vision may be considered the third leading disability behind only arthritis and heart disease. So low vision is very common and of the various causes of “low vision”. Macular degeneration is far away the leading cause in the western hemisphere. Perhaps 20 years ago people didn’t talk about or 25 years ago … talk about macular degeneration and may not have even been in many of the major text. But now it’s on the lips of everyone. And all doctors are aware of it. It’s in literature right and left in every type of the journal. And most people have heard of macular degeneration. Today we’ll talk a little bit about that and will talk about other

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causes of the vision loss including diabetic retinopathy, glaucoma, stroke and some other things. I will not talk a lot about aging per say. And in a way wish this was titled low vision helps and resources because that’s I really want to focus in on is the helps that are available and the resources. And the fact that there is hope for people with low vision even though you may feel alone because your friends or family members may not understand you or realize the degree of your loss, or the type of your loss there is hope and you are not alone.

I first want to start a little discussion about macular degeneration. One of the doctors I work with, I’m in 13 different eye doctors practices throughout the State of Utah loves to talk about the etiology of words. And he points out that the word macula actually means spot. Imacula means spotless. So if someone has an imacula house it is spotless. And the macula is a spot or point on your retina, the back of your eyes where you actually see best it has the highest concentration of cone cells and receptors that allow you to read and see clearly to focus on detailed objects. But in another sense, the word macula refers to a spot of deterioration.

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Sometimes we call it scotoma. Wherein there has been a degeneration going from distortion or blurriness to perhaps even a noticeable white or grey or even black spot. I would bet most of people in the early stage of macular degeneration would say “I don’t think I have a spot. I don’t think I really have scotoma or a spot”. And in reality the doctor has a hard time seeing the spot. You cannot see that with an ophthalmoscope in a regular exam. You needed more sophisticated device called the scanning laser ophthalmoscope or Hyperacuity Perimetry. But nonetheless, most people do have some type of atrophic degeneration. They have distortion, blurriness and eventually some type of little spot in most cases. But because the peripheral vision it’s still pretty good. And we use our peripheral vision for travelling. Macular degeneration is kind of a hidden disability and therefore, a lot of people are misunderstood. A person with macular degeneration and some other forms of that like Starguard’s disease and Histoplasmosis and other things could walk into a grocery store and weave between the shopping carts never bump into any body or anything and look like they have absolutely no vision problem, but then pick up a canned food and say “What is this?”. Similarly they can go into a restaurant, go

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down the stairs and weave between the tables, find their chair, sit down and pick up a menu and say “Would you read this to me?” Their disability is hidden and misunderstood. With macular degeneration and many eye diseases there’s of course, diminished visual acuity or black clarity but there’s that spot or scotoma that we’ve talked about. And sometimes it’s multiple spots, multiple scotomas. It probably isn’t perfectly round. It may be more of an egg shape. It may be very irregular, maybe 2 or three of them. And it may even have a ring. Some doctors say as many as one out of the 7 patients with macular degeneration have a doughnut shaped scotoma or spot it’s more like a ring. And you’re probably used to looking through the middle part where can see clearly in that remaining ring and as we try to magnify things it’s very frustrating because if you magnify something you see less of the word or less of the line.

In addition to acuity and the spot or scotoma a person with macular degeneration generally also has reduced contrast and things are like a fog. I have several slides that I show when I do presentations of people with a very good visual

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acuity comparatively speaking for instance 20 over 40 or 20 over 50 and yet very diminished contrasts. And seeing faces or seeing a street scene, driving and recognizing text is very difficult with that diminished contrast. I did a 2 year study with a doctor in Utah about contrast sensitivity function with people and its impact on reading and the choice of magnifiers depending on their contrast score. And contrast is not always predictable by a person’s age and it may not be predictable on several other factors. But it usually predictable by their visual acuities. So someone with visual acuity… say 20 over 400 is more likely to have lower contrast than...say somebody with visual acuity 20 over 40. But contrast is huge in understanding how difficult it is for someone to see.

I work with one doctor who is in a habit of asking me “Bryan, do we know Mrs. Jones’s vision is?” And I am always tempted to say to him “No, Doctor, we don’t because although I’ve checked her visual acuity I haven’t checked her contrast score yet and I don’t know how much illumination she needs and I don’t know the shape or sizes of her scotoma at present. So no, I really don’t know what her vision

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is.” But I don’t want to say that. So I just say “Yes, her visual acuity is 20 over 60 in the best eye and 20 over 300 than the worse eye”. But to myself I always know that’s only very small part of the picture how well this patient sees.

A fourth aspect of someone’s vision is the need for illumination. Very often the type of cells that have been damage called cone cells and cone cells primarily do two things. They process colors and they receive light. And so a person with macular degeneration has more difficulty seeing reds. They have difficulty choosing between their pants that are navy blue, black and grey. They can’t tell the difference. More important the problem with color is the problem with lighting. They may walk in the room and think to themselves “Why is it so dark in here” and family saids “Well it’s not that dark”. But it is for them it is as though the lights are turned down and the drapes are pulled and they need more light. And one doctor put it this way. The solution, very often for a person with macular degeneration even their vision is 20 over 40 is illumination, illumination, illumination.

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And fifth, the person with macular degeneration or other eye diseases often have a problem with increased glare. So even though they need more light for reading or threading a needle or for tying flies or during repairs or turning keys or plugging something in they need to watch the glare and the reflectance of a shinny television tube or a window or other things, sitting next to some body that’s bald - just kidding; and seeing things that are on a bright sunny day or by a window or something.

Now I briefly want to mention 3 other eye diseases: diabetic retinopathy, glaucoma, and stroke. And parenthetically I want to add the Hadley school has 3 excellent courses on eye diseases. And I encourage you to consider taking those if you are not already done so. Dawn will clarify this later but as I understand persons who are blind and visual impaired themselves can take these courses at no charge and professional can take it at a reasonable charge. To learn more about the 3 topics they cover, one is macular degeneration, second: diabetic retinopathy and third: glaucoma. There are checks at the end of the course to see if you were able to learn the target objectives.

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Diabetic retinopathy may sneak up on you because there may not be real evident signs of it in the early stages. But it involves vessel growth that may not be there, the vessels are so tiny they can’t hold the blood supply and there may be leakage into the vitreous and onto the …putting the pressure on the macular doing real damage. There are many types of treatments for diabetic retinopathy and a person with a history of diabetes in their family should be checked at least annually to see if they’re at risk of developing diabetes themselves and diabetic retinopathy. Glaucoma is also considered a sneak thief of sight because the signs may not be evident until way too much damage has been done. Some people are tempted to say that it’s like tunnel vision or seeing through a paper towel tube. That’s not really accurate. It’s more correct perhaps to refer to as cone vision and so you’re closer to an object you see less than if it’s further away as that cone fans out. So for instance a person drops a pair of keys or coin or something near their feet they’re less likely to see it than if it was three feet away. Similarly, if they’re seeing their computer screen they do better by sitting back a foot or two a couple of feet than if their nose is right up next to the screen because they have a smaller field of view close up. When

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they’re vacuuming they similarly have more trouble right by their feet than stretching the vacuum further away.

Glaucoma should be cared for and it’s 7 times more prevalent with African Americans it’s also more prevalent in other populations like Hispanics. It’s often a secondary cause of vision loss from diabetic retinopathy and some other things and some medications.

A sister to glaucoma in its type of vision loss is retinitis pigmentosa. However, retinitis pigmentosa also has night vision loss and a person needs more light to do well with retinitis pigmentosa. A patient with retinitis pigmentosa may also have other conditions like hearing loss often called ascher syndrome or other things like Laurence-Moon-Biedl Syndrome or Bardet-Biedl Syndrome.

Finally, I just want to mention stroke because unfortunately far too many people as we age have stroke. Stroke is not limited to people in their 80’s or 90’s. I see patients all the time in their 20’s and 30’s, who’ve had a

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stroke or a tumor or cancer. But a stroke is usually evidenced in a couple of ways. One is with a loss of half of your vision either on the left half called the left Homonymous Hemianopsia. Hemia means half like hemisphere or right Homonymous Hemianopsia or right half. And so if a person is missing half of their vision, it’s hard to see the end of the line. If they’re missing the left half it’s hard to come back to the beginning of the line. It’s also difficult to travel because they may be missing the left side. So driving is very difficult if not strongly discouraged or prevented by many state laws. And just travelling down the street maybe bumping into a branch or a cupboard that’s left opened by someone in the kitchen. But reading is certainly challenge with right or left half loss with hemianopsia. Another evidence of stroke is the something called ischemic which means of the blood…where a person has a loss here loss there and so they may see individual letters but putting words together is difficult with that ischemic condition and the loss throughout the retina.

Now one of things that generally attends vision losses the emotional challenges including possibly depression. One of my colleagues, Dr. Lilas Moke in

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Detroit at Henry Ford Center did a study and said that perhaps 60% of people with macular degeneration and vision loss may experience some level of depression. Jokingly I told Dr. Moke that study is perhaps skewed because most people in Detroit are depressed because of the Detroit Lions and the Tigers and the Detroit Pistons. She hit me and then said that’s not fair. Depression is real thing and the need for somebody who understands and have a listening ear is very important. And this concept of the family not really understanding is a real thing because they see them do fairly well and the person with macular degeneration will pick up that fleck of paper on the floor. And yet they say how come you don’t say Hi any more. Well, the person with macular degeneration, remember, sees well with the peripheral vision so they’ll see a sign as you’re driving down the street, may not read it because to read it we have to look at it straight ahead and use our central vision our macula. But they see the sign as they’re passing by or they’ll see the fleck of paper then they go to face the paper and pick it up but it’s gone because that spot or scotoma is having to fade out.

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By the way, I put some simulator that figures on here one right under the resources if of Christine and another one is of Grant. Those are 2 phases and then there’s a picture of a wall with early macular degeneration and you see the distortion. So it may not really appear as a spot or scotoma but it suggests waving us distortion and then in a later stage of macular degeneration the actual black or white spot. There’s a website called MDsupport dot org that has a link at the top says departments and if you scroll down to the departments it will say Through Our Eyes and you click on that Through Our Eyes and it has stimulations of macular degeneration and all different types of macular degeneration, all different stages of houses and of text. And thanks to Dr. Moke, my friend of Detroit, she loaned me this slide at the bottom said patient reading with dense ring scotoma. Now that person really has a vision loss of only 20 over 40. Believe it or not this slide of the patient whose visual acuity is 20 over 40 and yet if you have some vision and you can scroll down and see that picture, you’ll see that great difficulty that person would have because that dense scotoma kindda of a white spot is phasing out most of the text except for the little ring in the middle or that doughnut hole. And the

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patient is tempted to try to read out of that center part of that ring rather than creating a new spot to read called the preferred retinal locus or PRL which is away from that ring or spot. As so one of the things that good low vision clinic will do is teach a person to look around that spot whatever kind of spot it is, whatever shape it is or where ever it’s that, or how many they are. And develop a new point of focus or a new preferred retinal locus, PRL. So that one of things that a good low vision clinic should do very first. I know that before I ever show people low vision devices I worked with a person on helping to determine where their scotomas are or spots and where they should probably look in order to see better to see around those spots or scotomas. And I’ll spend 20 minutes doing that before we ever talk about magnifiers. And then I’ll give them some homework to work on for the next couple of weeks with their dinner plate, in viewing check book, in viewing hand work or doing their nails and reading. That’s a very important part of seeing better.

One of the next how to find a good low vision clinic. And my first suggestion is that you ask your eye doctor. You ask your eye doctor because they

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probably have been asked before and have done a little research and know a good clinic verses a not so good low vision clinic. It might be an ophthalmologist practice. It might be an optometrist practice. It might be a mixed practice of ophthalmologist and optometrist. It might be a blind center. It might be a private university that has a low vision clinic that’s affiliated with it. There are all different models and types of low vision clinics. If your doctor is not helpful in finding a good low vision clinic, ask another person who has low vision themselves, for instance, someone with macular degeneration or diabetic retinopathy or glaucoma. Maybe they have heard of a good low vision clinic or been to one themselves. They can refer you to the most helpful place to get services. Third, you could look in the Yellow Pages. Sometimes, they have listings in the last two or three years of low vision rehabilitation services or low vision clinics. And fourth, I would suggest some websites and particularly the second one I listed as a resource which is visionaware dot org. They have a wonderful section on finding low vision services and they have a state by state where the service is in each state… visionaware dot org. Another one which is not listed on my resource list is called eschenbach dot com. That’s a vendor of

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low vision devices and you spell that eschenbach dot com and they do not list on their website the actual locations in each state but instead they ask you to contact them and then one of their representatives will suggest a doctor or agency in your state or local area where you can get services. Perhaps one of the reasons why they have the most complete list is because they track who are buying low vision devices. So they have an up-to-date list of providers. A third option would be called MDsupport which is the fourth one listed there. And they have a link that says finding help but it’s not totally complete and it’s not totally. One example, if you click for ophthalmologist who applied to do low vision clinic but never really have done low vision services and they may not list all the doctors who are currently doing low vision. The fourth one is the American Foundation for the Blinds website AFB dot org. But they only list state agencies. They do not list private sources such as universities and doctors doing low vision care only state agencies.

The next question is how do I find support groups and counseling if I really would like some help in getting to a support group. Some of the same

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sources would apply there too ask your doctor, ask another person with low vision, check out some of those wonderful websites, like visionaware, like MDsupport and AFB.

Let me give you one example of the MDsupport, even though I was not real crazy about their listing for low vision clinics I’m very excited about their helps for to other things and that is support groups and sources of transportation for people who cannot drive. You can click on their link for support groups and they will list support groups in every city in a state that has support groups. And they also have online support groups and call in support groups. The next question is… should I get low vision devices from a catalogue or a store or online. Or should I stay to a low vision clinic? And I strongly encourage you to not get low vision devices from a catalogue and I don’t want to name specific catalogues because I don’t want to get into trouble but please avoid buying a strong magnifier from a catalogue or from a store or online because you don’t know if it’s going to be the correct strength, and even it’s going to be a correct lighting.

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When you go get glasses like regular glasses, it makes a difference of a quarter of one diopter or a half a diopter and people will complain and say these glasses aren’t just right. And maybe they’re off a quarter of a diopter or half a diopter. Will something that small a difference makes a difference? Imagine what ten diopters or 20 diopters makes and when you buy online or through a catalogue you have no idea if what you’re buying is the correct strength. We measure lenses down to a tenth diopter and when we prescribe devices in clinics we make sure that is the correct diopteric strength and we show patients several magnifiers that are within a very small fraction of that diopter strength to do the task that they want to do. But just as importantly we get the type of light that they need. And we’ve done a study that helps identify whether a person will probably do better with an incandescent light, with an LED light, or with a bright halogen light or the new ones that even brighter than halogen called crytostar depending on what their score is on the contrast sensitivity function chart. And so one of the things I do is test their contrast sensitivity and then I’m better able to recommend what type of light will work best with their magnifier or pair of glasses.

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Time is moving on but I want to mention several low vision devices. And for reading, I would say most people who are 80 and up do best with illuminated stand magnifiers or something with good illumination as their primary reading device. The reason I say a stand magnifier or one that stands in front of the page so you don’t have to hold it. Is it’s less tiring. A handheld magnifier is marvelous for brief reading like reading the thermostat, or the microwave, or a dial, a price in the store, a menu in a restaurant. But for longer reading like reading your mail or a newspaper, or magazine or scriptures or something you probably would prefer the one that you don’t have to hold. So illuminated stand magnifier is a favorite of many people with macular degeneration, diabetic retinopathy and glaucoma. Handheld magnifiers with a light are wonderful for brief spot reading like I mentioned… a price, a label, a menu, a dial.

Glasses are good for reading and they leave you hand free but you have to hold things very close. And I found that people who have a poor contrast score or who are older often don’t do as well with glasses for reading because it requires that you

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hold things very, very close and what happens to the light as you hold things close. You’re blocking out the light. So a lot of people will prefer to use reading glasses for writing a check or doing hand work like sewing and use an illuminated magnifier for reading. If people have trouble with illuminated stand magnifiers or handheld magnifiers and they just really struggle, I often suggest an electronic device like a close circuit TV system, a CCTV. And it’s not just patients who are 20 over 400 or 20 or 600. It may be somebody who is 20 over 80 or even better. It’s people who struggle because of a ring scotoma or because of a poor contrast and they need more light and better contrast. So sometimes on electronic low vision device like a close circuit TV system can be very helpful.

For distance vision aids, there are telescopic monoculars. Mono means one eye. For reading signs like the bathroom scale, the aisle number the grocery store, the menu board at Wendy’s or Burger King, the departing flights in the airport and that kind of thing or binoculars mounted in a frame or telescopic spectacles for watching TV, or a ball game or a movie or their grandkids performances or something like that. You can of course use

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binoculars that are not mounted in a frame but then your arms get very tired and it’s discouraging after 5 or 10 minutes. So mounted in a frame is much easier. And they’re usually very reasonably priced 79 to 100 dollars or so at most places. For 2.8x or 2.1x telescopic glasses that give you a fairly wide of view to see the TV screen.

There are all kinds of helps for sewing including table and floor lamps where the lens attached where your hands are free. Big Eye makes a wonderful one without a distracting fluorescent lamp or rim around the outside. And there are many other companies that do so. There are loops that clip onto your glasses that leave you hands free. The word loop is a French word that means magnifier. In Europe any magnifier is a loop like a stand loop or hand loop. In US, when we talk about a loop we think of something that clips on and when we’re using it we bring it down in front of your glasses and when you are not using it you flip it up out of your way. It boosts power of your existing glasses and so you can use that for seeing the computer screen or sheet music or sewing or other things.

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Telescopic glasses for near are also available for those tasks of the seeing computer screen or sheet music. Normally telescopic glasses are thought of for seeing things far away like TV and scenery, movies, the symphonies and rodeos but telescopic glasses for near are great for seeing the computer screen and sheet music.

Now what types of electronic devices are available? I briefly mentioned close circuit TV systems and one are desktop units where it’s on a table or a desk and the old fashion ones had a regular TV monitor what we called a cathode ray tube or CRT. And they were a little bulky but they are very bright and wonderful contrast and they still are probably better contrast and better brightness than a new LCD screen. The newer units have the LCD screens. And they take up less space. They’re sleek and they are stylish. And they are improving each year but they smear a little bit as you move the tray underneath the camera. And they are not quite as bright as the old fashion CRT or cathode ray tube regular TVs. They have ones that can work with your computer. They have ones in the last 3 or 4 years that have a camera on the bottom and a monitor on top and range from 2.5

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inches to about 7 inches. So they’re small enough to fit in your pocket, your purse or a book bag and take with you to the store, the restaurant, church or down the hall to read the thermostat or something. And the underside has the camera pick up the image. The top has the and most of them now have a freeze button so that you can freeze the image and then lock in and read what’s on the screen. One example would be to look up a phone number, hit the freeze button and then walk over and dial the telephone. Another illustration would be to hold it the unit up on a shelf above your head where you can’t reach your regular magnifier read magnifier and take a picture so as it were of the price, bring it down and then read it.

A new unit that’s out in the last 2 weeks called the far view. Is takes literary 100 pictures and then you can manipulate the size, the contrast and store these hundred images and call them back at any time. There’s many different brands of those digital pocket magnifiers. The range from 2.5 inches to 7 inches. The most popular size begins approximately 4 inches and the desktop units and you can search online for close circuit TV systems and see the various companies that do.

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In the remaining 5 minutes I want to talk about eccentric fixation, driving and minimizing your further vision loss. Eccentric sensation training like I said it’s the first thing I do at a low vision clinic and perhaps one of the most important and I’ve saved it here to near the end because I just really want to emphasize the importance of learning to use your vision. A colleague of mine, Gill Watson wrote a book called Learn to Use Your Vision for Reading. And you abbreviate it LUV. And my model over the years has been treating patients with love LUV. I think it’s so important to teach a person to look around that deterioration they have near the center of their vision with macular degeneration and diabetes and to learn to locate a new preferred retina locus or off to the side. The MDsupport dot org website actually has a self taught course in how to do that yourself and I’m not recommending that by any means because I think a person should go to a low vision clinic and work with a low vision specialist to do that eccentric fixation training. There are many different approaches that occupational therapists and certified low vision therapists take. But nonetheless let me just say that that may be the most important thing you can do to help yourself to

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see better. And if you merely got a magnifier and you haven’t got proper training with eccentric fixation, I think you’re not getting all the help you can and that you need to really look at getting the eccentric fixation training and if your professional providing that training. Similarly, the rule of illumination is so important. Illumination, illumination, illumination. And I don’t mean getting on a ladder and change the light up in your ceiling. For one thing it may not be rated for a higher bulb and secondly, it doesn’t make that much difference clear up in the ceiling where it really makes a difference is on the desk with the little goose neck lamp that may cost 10 dollars at Home Depot, or Staples or Office Max and putting that goose neck lamp where you are eating dinner or writing your checks or threading a needle or working. Good lighting is so important. Carry a flash light when you’re turning the key or plugging something in. Use those little press on lamps. They used to be incandescent and they are only 2 dollars but they burned out so easily. I recommend the LED press on lamps. They are only about a dollar 50 more, 3.50 or 4 dollars at most hardware stores or something like Lowes or Home Depot. You can buy a multi LED one about 10 dollars and use them in a closet to help you pick your clothes. Use them in a

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cupboard to see your dishes. Log on to the website AFB dot org and go to their senior site and see their making adaptations in each room. They’ll have suggestions for making adaptations in your kitchen, in your bedroom, in your bathroom and all over. So, use some of the suggestions of that wonderful website AFB dot org senior site.

Finally, enhance the contrast that same website I’ve just mentioned has suggestions for enhancing the contrast and there are many seminars on enhancing contrast. Many things online I suggest little things like a different color light switch plate rather than having a regular white on white or if you have wood paneling of brown on brown where everything matches. Use one that contrasts. Put your butter on a navy blue plate rather than on a regular light plate. Use toothpaste with a different color or a stripe to it. Hang up some towels that are contrasting behind your head when you are doing makeup or your hair so that you can see your face more easily when you’re doing makeup or your hair. Use color glasses rather than clear glasses when you are pouring liquids in your kitchen. In a clear glass on that white counter with a white black splash just disappears, where’s if you have a

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brightly color glass and the butter on a contrasting butter plate, it shows up so much better. Colored soap in the soap dish. Finally, minimizing further vision loss and the risk of future macular degeneration. Let me mention 4 things in closing.

One, never, never, never smoke. Smoking doubles or perhaps triples the rate of macular degeneration. If a family member might get macular degeneration let’s say age 84 or age 86, their sibling who smokes may get it at age 54 or 66 and it often bites much harder. Just don’t smoke and if you do, stop.

Second, the rule of nutrition. Nutrition is huge. Some doctors say eat vegetables, fruits. Fruits and vegetables the color of the traffic light, dark green, yellow and red. Dr. Moke has a section in her book on nutrition and she says the darker green the better. For instance, kale is ten times better that spinach. What is kale? Well that’s the awful thing they put on cheese plates. Throw away the cheese and eat the kale. Well, maybe you don’t want to do that but you know yellow things like mangos, corn,

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squash, red things like watermelon, red grapes, grape juice, tomatoes. Fish, once a week. There’s one study a year ago that said fish once a week may reduce macular degeneration by 40 percent. Isn’t that astounding? Fish once a week in the early stages may reduce macular degeneration by 40 percent. So omega 3 oils may be very helpful and nutritional supplements may be a benefit.

Third is something we may not be sure but it’s certainly a strong possibility and that is blue light. Blue light is the short wave lengths of the light of spectrum that is adjacent to ultra violet. We talk a lot about ultra violet and that may be linked to cataracts. Ten percent of all cataracts may be linked to ultra violet. But we don’t talk a lot about blue light and blue light is present both in the natural sunlight and also in some of these new daylight lamps or full spectrum blubs. And one person said why bring that into our house and sit next to it all day. One of things we can do to reduce blue light is wear sunglasses that block out blue light. And those colors that do the best at blocking out the blue light are amber, which is brown or blue blockers, orange and both amber and orange block

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out 100 percent of blue light. My favorite is a combination amber and orange, amber orange is made by Noir or No ir. Some people pronounce it and the number is 533. Yellow and dark plum, not like plum but dark plum, those four colors will block out quote blue light. We’re not positive blue light is linked but there’s a very very strong possibility that it is. Gray and green gray sunglasses don’t block out any blue light.

And the fourth thing we want to minimize is high blood pressure. Take a look at the resources. Look at those sometime. Have fun just going through the National Eye Institute health resources on information of various eye conditions. Look at all the resources from Visionware. Look at the senior site and how to adapt your home on AFB website. All the wonderful things at MDsupport. There’re certainly many many more websites than those four. That’s a good place to start. It’s been delightful to be with you and now we can take some questions.Michelle: Hi my name is Michelle I’m a social worker in Denver with senior citizens. And thank you for your presentation I have been fascinated by this subject since I started working with seniors

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a few years ago. And especially this year I’m seeing a very common thread in all the social workers service coordinators who work with seniors at these housing complexes that so many problems are related I think started by low vision and the lack of identification and the lack of resources to identify them and help. I was just wondering if you could comment for a minute on what you’ve seen with seniors and vision loss and the quality of life in all aspects from nutrition to just activities that you’ve seen; and you have any good resources relating to not just the like things with low vision aids but. Especially, resources I guess that we who serve them can get to these people.Gerritsen: I think there’s been a proliferation of resources and information over the last 10 or 20 years. Ten years ago in New York I spoke at the International Low Vision conference. And I spoke right after a person presented from India and they said their goal was to have one low vision clinic for very 10 million people. And I mentioned that in low vision text like a classic landmark here in the United Sates written by my mentor and friend, Dr. Randy Joes who’s famous optometrist and low vision hardly even mentioned macular degeneration, the leading cause of eye diseases. In

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his book 25 years ago, published in 1983 and yet now you can open almost any optometry ophthalmology journal and there’s articles on treatments for wet macular degeneration. All aspects the efficacy of low vision rehabilitation so there’s lot more resources and there’s a lot more websites and help. I haven’t talked about aging here are the impact of other disabilities like heart disease, or stroke, hearing, slowing down and the stamina problems, being on oxygen, Parkinson’s, shakiness, and all other things. That’s one reason why I mentioned, for instance, stand magnifiers where they rest in front of the page where you don’t have to hold them. But be assured that there is hope. There are a lot more things available now than there ever were before. It’s marvelous to have Hadley sponsor this and to have so many seminars available on things and to find help. There’s a wonderful course on John Hopkin’s website www dot lowvisionproject dot org. And you can take classes there. And Donna I don’t mean to mention some other organizations besides Hadley but there’s so many resources available now. And people with low vision are doing great things. If there’s one thing I wish I could go back and do is write a book about all the people I’ve worked with in their 90s who are still working. Can people still

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be productive even? I’ve had a lady who still does the books at the airport, or people who are still doing work at the police station filing reports or people working for the forest service and on and on who are ranchers. People can be productive even with a serious vision loss. And it can benefit from low vision devices.

Michelle: Thank you, yes, I’m trying to get that message across to a lot of my colleagues that they can live very productive lives. Another question is that we have a big move in our subsidized housing for seniors. I mean hundred of people to go green which is great. But a big problem is that everybody’s going to the energy saver light bulbs and the constant complaints is I can’t see, I can’t see…. Do you have any suggestions in regards to this topic. I do a lot of advocating for clients to the housing people to change back. Any comments you can make in regards to energy saving light bulbs and seeing and is there a way to compromise on that?

Gerritsen: Yes, this is a good lead into two questions that Nancy Bill also asked about daylight lamps and LED lights. I did a presentation last

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February a year ago this month in Dallas on lighting for the visual impaired and that’s believed archived as well they’re doing 2 videos on their website. Just one question about Nancy, what about LED lights on magnifiers they are considered blue light. Actually, they’re not blue light is like all light is measured that what we call nanometers. And the wave lengths that we’re concerned about 400 to 500 nanometers and LED lights do not fall in that and so LED lights are not something we’re concerned about. What we really concerned about is light in that range and I used to suggest hot lamps. In fact, I did an article for the American Foundation for the Blind about 6 years ago and I rated hot lamps is one of the suggested lamps for people with low vision. The president of macular degeneration support contacted me and pointed out the research about blue light the impossible link to macula degeneration and asked me if I would retract my endorsement of hot lamps and other lights like that. And I did. And I no longer carry hot lamps and similar daylight lamps in my low vision clinics. And I tell people although we’re not sure that blue light is for sure linked to macular degeneration. There’s enough of possibility of that why take the risk and so I tell people any lamps rated above 5000 Kelvin and that’s the

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measurement of the color of the light. Probably avoid and you can check that on the package of a light lamp. And if you are not sure you can call the company and ask what the kelvin rating so anything 5000 and above. As far as energy saving I’ve been all for incandescent blubs but compacted fluorescents are great. They save energy. Next question…

Let me note a comment that Norma Sisen (?) said about her Lucentis shots other shots may be Advantis or the old Macugen. That brings up an interesting point in the past we could never say that any treatments for macular degeneration would actually improve your vision. We’re trying to prevent future damage but in the last year with the Advantis and Lucentis shots we can actually say that in some cases there’s a possibility that your vision may improve a line or two, possibly even two and the scotoma may shrink a touch. And we didn’t do that and that’s having a practical impact on referrals to low vision clinics. Doctors are waiting to refer the patients hoping that these injections may help and the patients hoping that they may help too. So they say I want to wait to go to a low vision clinic because I’m going to see if

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this Advantis or Lucentis injections are going to help me. And as a result one thing we’re seeing is that less people are being referred to low vision clinics. When they are referred their vision is often worse. For instance, the average acuity used to be about 20 over 80 and now we’re seeing the average acuity is about 20 over 150 partly because their visions have waited an extra year or two to come to a low vision clinic. And for many of them their vision did not increase or improve with the injections.

Narrator: That brings today’s seminar Aging and Low Vision by Mr. Bryan Gerritsen to a conclusion. We want to thank Mr. Gerritsen and our participants today for their interest in aging and low vision services and providing more information to the public. We invite you to again log in to the archive recording of Aging and Low Vision on our website which will be available within about one week for further information. Again thank you to Bryan Gerritsen for his comments today and his interest in providing more information about aging and low vision services. Thank you.

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