Focus On Low Vision
Ask the Doctor
By Barbara Anan Kogan, OD

For this month's column, we invited a panel of low vision specialists from around the country to answer a number of questions recently posed to us about the category.

Participants are: Roy Cole, OD, Jewish Guild for the Blind, New York; Wayne Hoeft, OD, Burbank Family Optometry, Burbank, Calif.; Randy Jose, OD, FAAO, University of Houston, Houston; Tom Porter, OD, Department of Ophthalmology, St. Louis University, St. Louis, Mo.; and Bruce Rosenthal, OD, Lighthouse International, New York.

Here's what they have to say about several hot topics.

UV EXPOSURE

Q What is the correlation between UV exposure and cataracts and macular degeneration?

A "Due to the high incidence of UV exposure with cataracts and macular degeneration, I recommend more protection the older patients become, including broad caps and sunglasses. I also warn my 30- and 40-year-old patients about this correlation and the importance of protecting themselves before they develop cataracts or acquire macular degeneration," reports Hoeft.

Rosenthal adds that he brings up the UV, cataract, and macular degeneration correlation "all the time. I cite the 1988 study in which fisherman not using UV protection experienced three times the amount of cataracts as people who did use UV protection on the water."

He recommends UV protectors, clip-ons, and 100 percent UV protection to all of his visually impaired patients. And for pre-surgical cataract patients, Rosenthal advises the use of a UV-absorbing intraocular (IOL) implant.

	PHOTO COURTESY OF VISION ADVANTAGE

TAKING SUPPLEMENTS

Q Is there any clinical data to support the benefits from lutein and antioxidants to prevent macular degeneration?

A "I take the research findings and recommend patients take a reasonable lutein dosage in the hope of stabilizing macular degeneration versus preventing its onset," reports Rosenthal,

How much is enough? "While there is a lot more information available now, and research is pointing in the benefit and protection direction, the amount is an individual thing," says Cole.

Porter, however, says that he is skeptical about the benefits of lutein and antioxidants, noting that he hasn't seen any "real clinical findings. Research is more anecdotal than proving that these supplements are helpful."

BETTER OUTCOMES?

Q With more and more technologies for low vision, what do you see on the horizon that will provide better outcomes?

A "Better definition and measurement of outcomes is necessary, especially since most of today's studies are test-based," says Cole. "While low vision patients want to read better, see better than 20/40, and read faster, they are really more like rehabilitation patients."

He adds that low vision specialists ask patients to "compensate and routinely do things differently, but we also need to be aware there are emotional and psychological aspects that can affect outcomes."

Talking about the latest technologies, Porter points out, "There is an incredible change in technology, which now includes diffractive optics." As for electronic aids, he says they are becoming "more user-friendly, smaller, better, easier to adapt to--and less expensive."

CHANGING ROLE?

Q A lot of money is being spent on new modalities for the treatment of macular degeneration. Will traditional low vision rehabilitation begin to take a backseat to this new wave of treatments?

A "Low vision practitioners are glad to see the development of new options," explains Jose. "And from a
humanitarian point of view, we all wish there would be lots of cures. But at this time, there is nothing that will deliver the restoration of a high quality of vision. And even when there is, it will still be a long time before all patients have access to them."

And what then? "There is a lot more to low vision than macular degeneration," says Jose, "so there will always be a need for low vision services. There are always going to be other ocular pathologies that will need our care."

Does that mean the need for low vision services won't decrease? "If you accept the fact that only 25 percent of low vision patients have ever received any kind of care," responds Jose, "and if you then add to that an aging population, the answer is yes, we'll be seeing even greater numbers of Americans enter the low vision population. Any way you look at it, we still have a great number of people to serve."

DEVICE EXPENDITURES

Q How much does the average low vision patient spend on devices?

A Porter's estimate is between $300 and $600 per patient. The problem, adds Rosenthal, is that "because there is no reimbursement nationally, and we do not have good statistics from the insurance companies, it is difficult to track down the bottom line." He estimates, however, that the expenditure per patient is between $250 and $500--adding that this is approximately the same as they would spend for designer eyewear.

Cole points to consumer resistance as what sometimes limits spending. "A lot of people do not feel they should have to pay for low vision devices," he explains, "especially when their resources are limited." Part of the problem, he adds, is that low vision devices are not a planned expense by the consumer, which is why some "patients will not spend $50 for a magnifier, but will find $2,000 for a cruise."

Hoeft says there are really several different levels of spending. "There are those who get help from the state; the middle income patients who spend between $300 and $400; and the rich who spend upwards of $5,000 for a CCTV and other low vision devices."

Looking ahead, Hoeft concludes: "The government should help all low vision patients, especially the retiree who would benefit the most from being able to get the necessary low vision devices."