Low Vision Advocacy for AMD

In the October 2017 article “Flex Your Core Muscles,” Paul Karpecki, OD, describes a patient with a condition and symptoms that had been managed medically without improvement. He states the most important step in solving this person’s issues was “remembering the core strengths that set optometrists apart from other professions; in this case, looking for and measuring subtle eye misalignments,” which changed the patient’s life. He concludes, “never lose sight of the core strengths we have in this profession—that’s what truly differentiates us.”

Yet, in a supplement in the same issue (“Practical Guidelines for the Treatment of AMD”), seven highly respected optometrists have done exactly what Dr. Karpecki warns against. It ignores why people visit optometrists: they want to see. 

One line stands out: “Currently, there is no cure for AMD.” Medically that may be true, but not visually, and optometry is the vision care profession. So it confounds me why the most important practical recommendation—referral to a low vision optometrist—is not mentioned. 

The recommendations that are included are correct:

• Prescribe smoking cessation.
• Prescribe nutritional supplementation.
• Discuss lifestyle modifications such as diet and exercise.
• Manage systemic disease.
• Prescribe blue light protection.
• Prescribe UVA and UVB sunglasses protection for outdoors.

But not one of these will improve the vision, function or independence of the person seeking help for their vision loss. Not one of these recommendations will alleviate the anxiety and possible depression that frequently accompanies the AMD diagnosis.¹ None can, as Dr. Karpecki states, “change the patient’s life.”

The introduction states the sponsor assembled a clinical advisory board to develop practical guidelines that can be implemented in a medically oriented practice. While this makes sense to optometrists, I question whether people who visit optometrists know the difference between an optometrist and a medically oriented optometrist, given that optometry has no “specialties.”     

We must, as a profession, start speaking about low vision to all AMD patients. The only way for that to happen is for our leaders to speak it in the journals, supplemental publications and CE courses. 

People visit us because they want to see better. Let’s remember our core strengths, regardless of how we orient our optometric practices.

Richard J. Shuldiner, OD, Low Vision Diplomate,  American Academy of Optometry; President, International Academy of Low Vision Specialists; Clinical Director, Low Vision Optometry of Southern California

1. Cimarolli VR, Casten RJ, Rovner BW, et al.  Anxiety and depression in patients with advanced macular degeneration: current perspectives. Clin Ophthalmol. 2016;10:55-63.

Editor’s note: There’s no doubt that patients with visual disabilities can be helped through low vision interventions. However, the goal of the AMD piece in question was to describe how an optometrist can influence the disease course itself. Managing the visual consequences, while certainly important, fell outside the scope of that particular project, just as an article on treating glaucoma might be limited to medical options and exclude surgical methods (or vice-versa). Other articles Review publishes are narrowly focused on low vision specifically and, by design, don’t devote space to diagnostic or medical issues. 

We at Review strive to cover all important topics in the profession in due course, while limiting the scope of any given article to a specific segment of the chosen topic for brevity and simplicity of message.

Dr. Shuldiner is to be commended for raising awareness of low vision services and the ways an optometrist can use these interventions on their patient’s behalf.

Praise for Planner

Just wanted to express my gratitude for your 2018 Conference Planner in the December issue. I’m involved in planning for various groups, and it’s important to know the dates and focus of events in the field. No one person can keep up with it all, so your supplement is really handy, not just for doctors but exhibitors, too. People can pick and choose meetings that interest them educationally, strategically and even socially.

During my long career, I’ve watched many of these meetings grow into real powerhouses. They advance our profession as a whole and each of us as individuals. What a wonderful way for us to help each other to learn and improve.

Frank D. Fontana, OD, St. Louis, Mo.

Editor’s note: Dr. Fontana entered practice in 1950 and was instrumental in founding the Heart of America conference in 1962.