Put the Power of Being AMD Aware in Your Own Hands

Age-Related Macular Degeneration (AMD) is the leading cause of blindness among older Americans, but new treatments have dramatically changed the course of this disease over the last 10 years, making AMD more manageable than ever before. During AMD Awareness Month in February, the American Academy of Ophthalmology is reminding people that even though currently there is no cure for age-related macular degeneration, there are a number of things you can do to slow its effects and prevent blindness, early detection being a critical first step. AMD is the leading cause of irreversible vision loss in people over 50 and is rapidly growing, worldwide.

What is AMD?
– AMD is a common eye condition and a leading cause of blindness in those 50 and older.  Aging can cause the macula to slowly degenerate and reduce central vision.
– AMD often advances so slowly that vision loss does not occur for many years and traces of the disease can go unnoticed.  In others, the disease may progress faster and lead to vision loss in one or both eyes.  Over time, objects in vision may not appear as bright as they once were and a blurred area in vision is common, further leading to blank spots in vision.
-AMD ultimately results in a loss of central vision that can interfere with simple everyday activities.

There is as of yet no outright cure for age-related macular degeneration, but some treatments may delay its progression or even improve vision. Treatments for macular degeneration depend on whether the disease is in its early-stage, dry form or in the more advanced, wet form that can lead to serious vision loss.

Dry Vs Wet AMD
Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula.  These new blood vessels tend to be very fragile and often leak blood and fluid. The blood and fluid raise the macula from its normal place at the back of the eye. Damage to the macula occurs rapidly. With wet AMD, loss of central vision can occur quickly. Wet AMD is considered to be advanced AMD and is more severe than the dry form.

Dry AMD occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. As dry AMD gets worse, you may see a blurred spot in the center of your vision. Over time, as less of the macula functions, central vision in the affected eye can be lost gradually.

The most common symptom of dry AMD is slightly blurred vision. You may have difficulty recognizing faces and may need more light for reading and other tasks. Dry AMD generally affects both eyes, but vision can be lost in one eye while the other eye seems unaffected.

One of the most common early signs of dry AMD is drusen. Drusen are yellow deposits under the retina. They often are found in people over age 60. Your eye care professional can detect drusen during a comprehensive eye exam.

How to Protect your Vision
While there is currently no cure for AMD, there are proactive steps that can be taken to help slow vision loss as well as certain risk factors to look out for.
1) Smoking.  Research shows that smoking doubles the risk of developing and the progression of AMD
2) Healthy Diet. Diets rich in antioxidants, zinc and healthy fats can contribute to health eyes.  Patients with AMD will benefit from diets high in omega-3 fatty acids.
3) Exercise.  Maintaining a healthy body weight and exercises will aid in healthy vision and may help slow progression of AMD.
4) Routine Eye exams.  Annual comprehensive eye exams are the best way to stay on top of your eye health and prevent vision loss. Everyone should have their eyes regularly examined by an eye care professional who uses optomap® technology. optomap is the only technology that can show up to 200⁰ of the retina which will facilitate early detection of eye health diseases, including AMD.

AMD Detection
AMD is usually detected during a comprehensive eye exam. During an eye exam, you may be asked to look at an Amsler grid. The pattern of the grid resembles a checkerboard. You will cover one eye and stare at a black dot in the center of the grid. While staring at the dot, you may notice that the straight lines in the pattern appear wavy. You may notice that some of the lines are missing. These may be signs of AMD.

If your eye care professional believes you need treatment for wet AMD, he or she may suggest a fluorescein angiogram. In this test, a special dye is injected, and pictures are taken as the dye passes through the blood vessels in your retina. The test allows your eye care professional to identify any leaking blood vessels and recommend treatment.

Clinical Summary Sheet – Peripheral changes found in 97% of Patients with AMD

Peripheral Retinal Changes Associated with Age-Related Macular Degeneration
The 12 year follow-up of a study known as the Reykjavik Eye Study evaluated subjects with optomap color and autofluorescence (af) imaging and found that 67% of subjects in the study had peripheral AMD-like changes.  Additionally, a subsequent study, knowns as the OPERA (Optos Peripheral RetinA) study found that peripheral retinal changes were more prevalent in eyes with AMD than in those without.  Drusen were evident in the majority of the eye with AMD in both the mid and far periphery.  These studies go to show that Age-related macular degeneration may be more than a “macular” condition but one that involves the entire retina.    Other research also shows that optomap UWF icg captured significant peripheral changes in 80% of AMD patients.  These studies all contribute to the benefits of ultra-widefield imaging in the diagnosis and management of AMD.  Future longitudinal studies of peripheral changes in AMD and their impact on visual function may also contribute to further understanding of the disease.  Click here for more information regarding these studies or visit our website to learn more about optomap and its assistance in managing eye disease.

optomap Image Reveals Life-Threatening Pathology During Routine Eye Exam

Jessica describes the events of that October 2017 day as somewhat serendipitous, even though what transpired illuminated a hidden threat to her life.  Jessica, an actress, had just started rehearsing for a play in Billings, Montana, when she decided that contacts, rather than glasses, would better suit her part.  “Really, I just thought it would be a good idea to be able to see while I was on stage,“ she laughs. “That’s all I needed was to get fitted for contacts. I didn’t feel that I needed, nor did I have time for, an eye exam.  Besides I absolutely despise being dilated.”  However, as fate would have it, she went that day to see Tom Felstet, OD, who feels strongly that a thorough view of the retina should be a part of every eye exam. Accordingly, Felstet had made it a priority to purchase an optomap ultra-widefield (UWF™) imaging device when he opened his new practice four years ago. He had the opportunity to utilize the technology during medical school and during his early years in practice. optomap is the only technology that captures over 80% of the retina in a single image, and it does so in a fraction of a second through an undilated pupil. When patients come to see Felstet he explains to them that it is important to have a comprehensive eye exam. He gives them the option to be dilated or, for a small fee, to have optomap screening without dilation.  “Like many practitioners, I have always told my patients that they need to have a dilated exam at least every other year.” he explains. However, he stresses that changed after his experience with Jessica.  “Now, it’s every year.  I give all my patients the choice of dilation or an optomap exam. Over the past few years utilizing optomap I have realized that I discover far more pathology, often far sooner, than I might without it. I have found changes and pathology, that I could have missed otherwise.”

Felstet recalls that when Jessica came to see him that day, she was clearly in a hurry and quite adamant that she simply needed a contacts prescription and did not want to be dilated.  “She was a healthy woman in her mid-50’s, with no remarkable family history and she did not report any symptoms. But fortunately for her she checked the box to get the optomap screening.”

When Dr. Felstet walked in to see Jessica he took one look at her image up on the screen and saw very clearly that there was a lesion in her right eye. “It was just far enough out that it would have been missed on an undilated slit lamp examination,” notes Felstet. When he showed it to Jessica he explained the area of concern and indicated that she should see an ophthalmologist.  “He was very discreet,” Jessica recounts. “I know he did not want to alarm me.  I could see quite clearly what he was talking about on the image, but even then, I was not really worried.”  Jessica recalls that even when she did see the ophthalmologist, and he diagnosed the pathology as a choroidal melanoma, she still had difficulty accepting the gravity of the situation.  “I mean, who had ever heard of a melanoma of the eye?  That wasn’t even something on my radar.  I had noticed some little flashes of light, but they were insignificant, and I just passed it off as reflections from some new glasses. Besides, in all other respects I was quite healthy.”

Jessica was then referred to an ocular oncologist in Denver and it was not until then that she grasped the significance of what was occurring.  “My tumor was 11 mm wide, so it was right on the cusp – just ½ mm from what would have resulted in an automatic enucleation. Jessica was treated immediately and successfully with radioactive plaque therapy, but during surgery the tumor was biopsied revealing that she was genetically at high risk for metastases, particularly to the liver. Ocular melanoma tends to be aggressive and metastasizes, or spreads to other organs in the body, in about half of all cases.

Felstet says that he still gets chills when he thinks of how close Jessica came to losing her eye and how disruptive this experience was for him as a practitioner.  He underscores that he has always been committed to providing comprehensive eye care, however he gives extra priority to communicating to his patients the critical importance of having a thorough examination of the retina every year.

“It is interesting to me how close that tumor was to her macula and yet she was not aware of any changes to her vision in that field, if she had not come in for her contacts when she did and if we had allowed her to refuse dilation, or an optomap, she would have likely lost her eye or could have lost her life.” He muses, “She returned to me recently and we took another optomap image, in looking at it I think that it is amazing that she is still here but that she also still has her central vision.  Looking at that image again, I told her that she is miracle.”

Felstet notes that he has detected numerous pathologies since Jessica’s visit, from subtle pigment changes that suggested dangerous lesions, to BRVO in young, outwardly healthy individuals.  “I am much more direct now about the importance of getting an optomap and about what I see on those images. I really would not want to practice without it because it would be hard to miss something as the pathology really stands out.  It gives me enormous peace of mind.”  Felstet is confident that optomap UWF will become the gold standard of care. “It helps me provide the best service to my patients.  I honestly think there is no reason to practice without it.”

Read Dr. Felset’s full testimonial here

Optos is committed to educating all on the importance of having regular eye exams.  Protect your eye health by making optomap part of your yearly comprehensive eye exam.  Visit our website for more sight-saving stories like Jessica’s and to find an optomap provider near you to schedule your eye exam today!

Glaucoma – the “Sneak Thief of Sight”

Currently, there are more than 3 million people in the United States and over 60 million worldwide living with glaucoma, otherwise known as “the sneak thief of sight”.  It is estimated that half of those with glaucoma, do not know they have it.  The disease presents no symptoms and is the leading cause of irreversible blindness, taking as much as 40% of sight without notice.  January has been deemed National Glaucoma Awareness Month and is an important time to spread the world about this sight-stealing disease.

What is Glaucoma?

Glaucoma is a group of eye diseases that gradually progress, stealing sight, without symptom. Glaucoma can affect people of all ages but is most prevalent in middle-aged adults and the elderly.  While there is no cure, surgery or medication can slow its affects and help to prevent further vision loss.  The word ‘glaucoma’ is actually an umbrella term for a group of eye diseases that damage the delicate fibers that run from your eye to your optic nerve, which is the nerve that carries information about the images your eye sees to your brain. This damage is often the result of high fluid pressure inside the eye.

What can you do?

It is important to know your risks, those at higher risk include people of African, Asian, and Hispanic descent. Other high-risk groups include: people over 60, family members of those already diagnosed, diabetics, and people who are severely nearsighted.  Annual comprehensive eye exams are important to detect, prevent and treat the effects of the disease.

optomap’s role in the management of glaucoma

Results from recently published clinical studies suggest that optomap ultra-widefield (UWF™) retinal imaging may play an essential role in glaucoma management.  optomap enables eyecare professionals to discover, diagnose, document and treat ocular pathology that may first present in the periphery.  optomap is a high resolution single capture image of 82% or 200 degrees of the retina.  Currently, the gold standard tool for glaucoma detection is a clinical examination with a dilated slit-lamp bio-microscopy carried out by a glaucoma specialist to assess the optic disc.  Recent studies suggest that UWF imaging may be suitable for diagnosing glaucoma in situations where slit-lamp bio-microscopy or digital color stereoscopy are not available.  Another study also confirms that optomap has almost perfect agreement with color digital stereoscopy when assessed
by a glaucoma specialist. Continued reading on these studies and additional findings here

stereo pair of optic nerve head images with can be viewed using a stereo viewer, when there is suspicion of glaucoma

optomap is continuing to become a key player in the role of eye care professionals.  optomap provides details needed for specialty exams, while simultaneously delivering an integrated view to the eye, as said by Dr. Savak Tymoorian, MD of Harvard Eye Associates. When Dr. Tymoorian first began using Optos technology, he employed it primary for patients presenting with flashers or floaters.  While reviewing the images, he was able to pick up on more peripheral issues and early indicators of pathology.  “The more I use the device, the more I appreciate this dynamic technology, I now image all my patients this way”, states Tymoorian.   As a glaucoma specialist, Dr Tymoorian finds that optomap helps reassure him that he is not missing peripheral issues that could be relevant to the disease.

Recognizing January as National Glaucoma Awareness Month, allows us to shed light on glaucoma and stress the importance of protecting your sight and preventing the onset of the disease.  The best way to protect your sight from glaucoma is to get a comprehensive eye examination. This way, if you have glaucoma, treatment can begin immediately.

optomap UWF imaging captures more than 80% of the retina in a single image, whereas traditional imaging methods can sometimes only reveal 10 – 15%.  optomap is a fast and easy addition to a standard comprehensive eye exam.  Don’t hesitate, and ask your eye care professional about optomap today.

Top Tips for Eye Safety this Holiday and Winter Season

Top Tips for Eye Safety this Holiday and Winter Season

With the holiday season upon us, it’s important to note the extra care we need to take to make sure the toys and gifts our children receive are safe and age-appropriate.  For this reason, Prevent Blindness America has declared December “Safe Toys and Gifts Awareness Month”.

In 2017, the U.S. Consumer Product Safety Commission reported an estimated 240,000 toy-related injuries treated in United States hospital emergency departments, with an estimated 80,100 of these injuries on children younger than five. 45% of the total injuries were to the head and face area. These statistics show that consumers should keep eye safety in mind when shopping for kids this holiday season. To help them do that, Prevent Blindness has complied some important tips for ensuring safety while shopping.

Look at every toy before you buy it. Is the toy durable? Can it stand the wear and tear of everyday use without breaking, cracking or coming apart? Does it shoot objects or have sharp edges? Toys that fail these tests should be reconsidered.

Before you purchase a toy:

  • Read all warnings and instructions on the box.
  • Ask yourself if the toy is right for your child’s ability and age.
  • Avoid purchasing toys with sharp or rigid points, spikes, rods, or dangerous edges.
  • Buy toys that will withstand impact and not break into dangerous shards.
  • Look for the letters “ASTM.” This designation means the product meets the national safety standards set by ASTM International.
  • Avoid toys that shoot or include parts that fly off.

 

Aside from the holidays, there are certain winter precautions to take involving eye protection and safety.  Protecting your eyes from the sun’s UV rays is just as important in January as it is in July. It is a common misconception that eye damage cannot occur during the winter months. Sun exposure can increase the development of cataracts, and cause growths on the eye regardless of the season.

The sun can have a vividly harsh reflection off the snow in the winter and it’s critical to take the necessary precautions in protecting yourself and your children.  Hats, sunscreen, goggles or other UV protective eyewear are all ways to protect your eyes from the glare of the sun, even in the winter. Studies have found that exposure to UV radiation can even be high on cloudy days with the northern hemisphere having its highest exposure at midday. Dr. Anne Sumers, a practicing ophthalmologist in Ridgewood, NJ and spokeswoman for the American Academy of Ophthalmologist states, “Sunlight reflected off the snow can actually sunburn the cornea in the winter.”

With the chill of winter just around the corner, here’s a few tips on what you can do to stay ahead of the weather and protect your eyes:

Wear sunglasses

Snowy and icy conditions double the sun’s effects as ultraviolet rays have access to your eyes from both above and as reflections off the snow. Wearing sunglasses can block 99% of UV light, therefore taking the pressure off your eyes. Many people aren’t aware that the sun’s harsh effects are not specific to sunny days.

Moisturize your eyes

If you already suffer from dry eye, its likely for you to have difficulty in keeping your eyes moist and comfortable – even in the winter. It’s important to try to use eye drops, sit farther away from heat sources, or use a humidifier to alleviate dryness in the environment for your eyes.

Use goggles during winter activities

Goggles help protect your eyes during activities where dirt, slush, snow and ice can get into your eyes while outdoors. Find goggles that either have enough room to wear UV protection sunglasses underneath them or a find a pair with UV protection already built into the goggles themselves.

If you experience discomfort with your vision when the temperatures cool off, be sure to ask your eyecare professional to include optomap in your comprehensive eye exam. optomap can help diagnose and treat early signs of eye ailments. To find a provider near you, visit www.optomap.com

http://www.visionmonday.com/latest-news/article/prevent-blindness-names-december-safe-toys-and-gifts-awareness-month/
https://www.aao.org/eye-health/news/buying-safe-toys
https://yoursightmatters.com/protect-your-e-in-the-winter/

New Study Confirms the Equivalence of optomap to ETDRS Gold Standard for Grading Diabetic Retinopathy

November is Diabetes Awareness Month.  In 2015, 30.3 million Americans, or 9.4% of the population, had diabetes and approximately 1.25 million American children and adults had type 1 diabetes. These numbers are on the rise and the disease manifests with deleterious and deadly impact throughout the body – including the eye. An understanding of the disease, early detection and treatment are more imperative than ever.

 

A recent study cooperatively funded by the National Eye Institute, the National Institute of Diabetes and Digestive and Kidney diseases and the US Department of Health and Human Services concluded  that optomap ultra-widefield (UWF™) retinal imaging is a useful diagnostic tool for detection and assessment of severity of diabetic retinopathy (DR). The study published recently in JAMA Ophthalmology demonstrates that optomap UWF imaging can be used reliably in place of Early Treatment Diabetic Retinopathy Study (ETDRS) 7-Field imaging in clinical use and future clinical trials.  The paper, which builds off recent single site studies that found moderate to perfect agreement between the modalities, supports these findings through data acquired over a two-year period from multiple sites.

The gold standard assessment of DR severity has been based on grading of lesions within the ETDRS 7 standard fields. These 7 fields are time consuming in their acquisition, require dilation and once compiled represent only 34% of the retinal surface.  Advances in retinal imaging technology now allow UWF imaging to capture 82% of the retina in a single image and in less than ½ second without the need for dilation. This collaborative study offers that given the technological advances now enabling UWF imaging, and the potential benefits of this approach, there may be substantial impetus for moving to UWF imaging if it is compatible in determining DR severity, and if pathology in the retinal periphery provides additional clinically useful information on prospective worsening of retinopathy.

In this current multi-site study, there were 737 gradable eyes on both ETDRS 7-field images and UWF images masked to contain the same 7 fields after adjudication; 59% had exact agreement, and 96% were within 1 step of agreement.  The conclusion of the study clearly supported moderate to perfect agreement between modalities within the limited masked scope of the current gold standard.  As seen was seen in previous studies, when the area outside of ETDRS was assessed predominantly peripheral DR lesions (PPL) were present in 41.0% of these eyes and suggested increased DR severity  by 2 or more steps in 11.0%.

Cursorily referenced in this preliminary paper was a consideration of efficiency between modalities.  This initial study release notes that the use of UWF imaging in clinical settings not only increases the frequency of DR identification nearly 2-fold but also reduces acquisition time by more than half, ungradable image rate by 71% and image evaluation by 28% compared with non-mydriatic fundus photography.

The study suggests the possibility of UWF imaging becoming a preferred method of assessment of DR severity, not only because of moderate to perfect agreement between modalities within the ETDRS scope, but also because of the information found in UWF outside the ETDRS mask. This raises the question regarding the potential for detecting DR change and severity earlier.  Data collected from a previous study, suggests that lesions observed outside of the area captured within ETDRS may identify a possible subset of patients with the disease that may be more aggressive.  These lesions were found to suggest a 4.7 times greater risk of worsening to treatable DR over a period of four years.  That study also concludes that the identification of a subset of patients at greatly increased risk of experiencing DR progression and onset of proliferative DR that cannot be assessed by ETDRS 7-field imaging, would have important implications for the evaluation and care of diabetic eye disease.

The significance of the additional peripheral information gleaned through UWF imaging in assessing the risk of future DR progression will develop with the data collected from this ongoing study.  The complete study and summary document, as well as our entire clinical library is available on our website. We encourage you to learn more about the clinical benefits of utilizing ultra-widefield optomap in your practice or clinic.

Sources:
Comparison of Early Treatment Diabetic Retinopathy Study Standard 7-Field Imaging with Ultra Widefield Imaging for Determining Severity of Diabetic Retinopathy. Journal of American Medicine, 2018
Peripheral Lesions Identified on Ultra Widefield Imaging Predict Increased Risk of Diabetic Retinopathy Progression Over Four Years. Ophthalmology 2015