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"You & Your Eye Exam: What to Know, What to Ask"

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Featuring

Emily Chew, MD

Emily Y. Chew, MD

Retina Specialist

The telephone discussion features Emily Y. Chew, MD, who is a retina specialist and is the deputy director of the Division of Epidemiology and Clinical Applications, and the deputy clinical director at the National Eye Institute (NEI), National Institutes of Health (NIH). Dr. Chew has extensive experience in age-related eye diseases, and designing and implementing clinical trials, including the Age-Related Eye Disease Study 2 (AREDS2).

  • BrightFocus Foundation
    “You & Your Eye Exam: What to Know, What to Ask”
    Transcript of Teleconference with Emily Y. Chew, M.D. 
    May 27, 2015
    1:00 – 2:00 p.m. EDT

    Please note: BrightFocus Chats may be edited for clarity and brevity.

    GUY EAKIN: Hello, everyone, and welcome to our monthly BrightFocus Chat, presented by the BrightFocus Foundation (BFF). My name is Guy Eakin; I’m the Vice President of Scientific Affairs at BrightFocus. Today we are delighted to talk with Dr. Emily Chew. She is at our National Eye Institute (NEI), which is an arm of our federal government, where she is the deputy director of the Division of Epidemiology and Clinical Applications, and also the director of the Medical Fellowship Program. In this capacity, Dr. Chew has extensive experience in designing and implementing clinical trials at the NIH Clinical Center, and in particular, she is the study chair for the Age-Related Eye Disease Study or AREDS. This is a topic we talk about frequently on our BrightFocus Chats, and as many of you know, the AREDS vitamins are very often prescribed for dry AMD. Dr. Chew and her group have been leaders in gathering the data that leads to the confidence to say that these vitamins work. Dr. Chew, we’re grateful to have you join this call today and we’d like to give you a chance to tell us if we missed anything in the introductions. Did we get it?

    EMILY CHEW: Thank you very much for having you me. You got it right on. Thank you so much. It’s a pleasure to be here. 

    GUY EAKIN: Well, thank you for joining us. I do want to mention that if you have a question that you’d like to ask Dr. Chew at any time during today’s call, please press *3 to submit your question to an operator, and if for some reason you are disconnected from the call, the number to call back in is 877-229-8493. You will then be asked to punch in the ID code 112435. So, that ID code is 112435 and the number is 877-229-8493. And really quickly before we get started, we’d like to take a minute to poll the listeners today on a couple questions that will help us do these chats and plan other resources for the future. And the question I’d like to ask right now is very simple: Have you ever had a dilated eye exam? If you’re answer is “yes,” press 1; if the answer is “no,” press 2; and press 3 if you’re unsure what a dilated eye exam is. So that’s 1 if the answer is “yes,” 2 if the answer is “no,” or 3 if you’re just not sure what a dilated eye exam is. While that is getting started, I’d like to say, Dr. Chew, we just discussed–you have extensive experience with age-related macular degeneration, which is frequently referred to as AMD, but I’d like to take a moment say it’s Healthy Vision Month this month and both the National Eye Institute and BrightFocus are reminding the public to get eye exams to detect disease like macular degeneration. So, can you briefly tell us what a comprehensive eye exam is and what one should expect when you’re visiting with the eye doctor?

    EMILY CHEW: Sure. A comprehensive eye exam usually includes what we call dilation. It includes having a visual acuity test to see how well you can see–you know that 20/20 line and that great big “E” you’re looking at. The physician puts drops in the eyes to dilate the color part of your eye, the iris becomes very large–and for many of us, you can’t read after that–but that allows us to look inside the eye for many other diseases. We can look at cataracts a little bit better. We can look for signs of macular degeneration or AMD, and if you have diabetes, that’s a good way to look for any diabetic eye disease. Of course, if you have a family history of glaucoma, that’s another way to check to see if you have glaucoma. It’s a very important part of it–to actually have that dilation and to be seen and we encourage you to have that done because it helps to protect your vision and take good care of your eyes.

    GUY EAKIN: So knowing that, it does beg the question what kind of eye care professionals typically perform the eye exam, and does it differ–for instance, the typical eye exam you might get when you go in to be measured for reading glasses or something of that nature?

    EMILY CHEW: There are really two types of eye care providers. The first are the ophthalmologists who are the ones with the medical degree. They have to go to medical school first and then learn about eye care after that. They’re more tuned to more of the systemic or other medical problems such as high pressure, diabetes. You should really consider taking the care from someone with a medical degree. Of course, there’s the optometrist who also have a degree and doctors of optometry, and they can take care of the eyes as well. What they do is very similar; however, they’re limited in what they can treat. So if you do need treatment, have diseases that need treatment, the optimal choice for you is the medical doctors, the ophthalmologists. So those are the two main categories we’re talking about. 

    GUY EAKIN: What’s the typical frequency that people in the general population would be encouraged to have those eye exams, especially the comprehensive eye exams?

    EMILY CHEW: Quite often, your own eye care professional can tell you that specifically for your own case, but if you’re over 65 you definitely should have one at least once, and then depending on what you have, it could be yearly, could be every 2 or 3 years. If you have a family history of glaucoma and have a great propensity for other eye diseases, you might want to go sooner. Anyone over the age of 40 should have at least a check, especially if you have family history. People with diabetes should have a yearly exam at least, if not more often, depending on what your eye care professional tells you. Of course, everyone should have one dilated eye exam. One of the main causes of vision impairment in our American population is uncorrected vision problems. The need for glasses–for example, nearsightedness, farsightedness, what we call astigmatism and presbyopia, and you get a little older and your arms aren’t long enough–you just need to have that checked. It’s really important to have your eyes examined for all those reasons.

    GUY EAKIN: So, we’re generally talking about an eye exam every year or 2 for most people, and typically an optometrist or an ophthalmologist is conducting those examinations. Of course, most of the people on the call our day are specifically interested in age-related macular degeneration, or AMD. What type of questions should someone who knows they have AMD be asking in that comprehensive eye exam? One question I would have would be, do those eye exams continue in parallel with the treatment you’re receiving for AMD, or will they be worked in by your ophthalmologist?

    EMILY CHEW: Well, the ophthalmologist would obviously be interested that you have macular degeneration for follow-up, and it also means that, other than regular follow-ups, they may encourage you to monitor your eyes at home. One of the monitoring techniques is looking at a grid, which is like a graph paper, and you’re looking for any signs of blurriness or distortion, where the lines become very crooked. So, that’s one way of monitoring it. And if you have macular degeneration, you should ask whether you should be on vitamins or any certain treatment, and only those people who actually have certain macular degeneration should be taking these vitamins, and you alluded to them earlier. The AREDS supplement–the Age-Related Eye Disease Supplement–which contains vitamins and minerals that have been proven to be helpful, particularly in patients that the early signs of macular degeneration. So those are important things. That, and monitoring your own vision. That’s very important. 

    GUY EAKIN: So, for people with the dry form of macular degeneration, we’ve touched on the AREDS vitamins, and there’s a lot of language out there on the shelves around the AREDS vitamins. You have the AREDS trial, the original one, and then you have the more recent AREDS2 trials. Can you help people sort through this language, what they should be looking for, and what the reasons are for the different names for the different types of vitamins?

    EMILY CHEW: Sure. This is an area of constant confusion for our core patients. Certainly because we have so many brands out there. As you mentioned, Guy, the latest one we did is AREDS2, in which we looked at vitamin C, vitamin B, carotene, and zinc. We found that beta carotene was a bit of a problem, especially for people who were former smokers–and obviously if you’re a smoker you should not be taking that supplement because it increases the risk of lung cancer, so I think that’s one thing we have to remember. What we did in the second one was to look at a different type of what we call the carotenoids-–which we get from eating leafy vegetables–is called lutein and zeaxanthin, and that’s an important ingredient that we added on the AREDS2. We actually recommend the AREDS2 because it eliminates the issue about lung cancer and also we believe it has a slightly increased beneficial factor the AREDS1 supplement, so we feel if you’re going to go out look for it, look for the AREDS2 mark, and that’s very important. 

    GUY EAKIN: Its summer. A lot of people have their gardens out. Are there any particularly good foods for healthy eyes? You mentioned green, leafy vegetables. Are they going to help, or are we going to need to make sure that you’re supplementing with the vitamins?

    EMILY CHEW: Well, supplementing with the vitamins is vital, you have to continue with that. Nothing else can give you that much–in terms of the ingredients, all of the vitamins. You cannot possibly eat that much. Having said that, it’s also important to have a healthy diet. We’ve found that people with a healthier diet have less risk of macular degeneration, and that includes green, leafy vegetables several times a week. Spinach, collard greens, and kale are the top three that had the highest level of lutein and zeaxanthin, and then although we did not prove that omega-3 fish oil was important in the AREDS2 study, still eating fish twice a week is very important for you. A diet with fish and green leafy vegetables and a lot of vegetables is probably good for you, because the Cancer Institute and Heart, Lung, and Blood Institute tell us that for heart disease and cancer, overall, for your well-being, those are important parts of your diet, and especially so for macular degeneration.

    GUY EAKIN: Certainly the BrightFocus Foundation is–as well as being interested in vision disorders–is also interested in Alzheimer’s disease, and that generally the same types of brain-healthy foods that are recommended tend to be eye-healthy as well. So, one of the questions that we haven’t mentioned this summer–there’s a number of sunglasses that are out there that are offered for people with low vision or with impaired vision of any sort. Is there any guidance you can give people with macular degeneration about choosing summer protection for their eyes?

    EMILY CHEW: Well it’s become common for patients with AMD to have glare, and it’s very comforting to have some form of protection that wraps right away, you know, to block 90-100 percent UVA/UVB rays. That would be very important. Although I say it’s important, it’s more for comfort. We can’t prove that these rays are damaging to the eyes in the macula, but we do know that they affect the cataracts, so all in all, it is important for you to protect your eyes by wearing these sunglasses to block out these dangerous sunrays.

    GUY EAKIN: Are these typically…would these be prescription glasses, or would they be glasses one could buy over-the-counter at the pharmacy?

    EMILY CHEW: You can buy it at the pharmacy. You can definitely buy them at the pharmacy. 

    GUY EAKIN: So one of the reasons we talked about the comprehensive eye exam is it’s one of the best ways to achieve an early warning for macular degeneration. There’s many services out there that are using things like genetic testing to identify people who may be at risk for macular degeneration. What can you tell us about these services in general? When we get either commercial or clinical data about genetics, how do we as patients interpret that data? 

    EMILY CHEW: That’s a very good question, Guy. Genetic testing is very important for us in the research world, because we can better understand why one might have macular degeneration and how it might work, but how it predicts future disease is still very difficult to use. That information, you can take it to your ophthalmologist. They may just scratch their head and say, “Well your risk is such-and-such. I don’t really know what that means. It could be a certain percentage, etc.” So the one thing we do know is, when we look inside the eye, we find changes that are very predictive of macular degeneration. When you look at those changes in the eye and you add the genetics to it, it does not add too much more. So, in other words, genetic testing does not increase our knowledge. The most important thing, we still feel, is–if you have a family history of AMD–is to be vigilant and have a dilated eye exam for your eye doctor to look in to see if you have some of early signs of macular degeneration. That’s much more predictive. There’s now a trend suggesting for people to get genetic testing prior to having any vitamin supplements like the AREDS supplement. There’s even been fears of having harmful side effects, but we have not proven that. It’s very important to know that the AREDS supplement is not harmful with regards to genetic testing, you should take that when your physician tells you to do that. The genetic testing does not increase our knowledge or predict what will happen in the future. That’s still something we’d love to be able to work on, and perhaps get better treatment based on genetics. We’re just not there yet. We hope one day to be there, but that’s a fertile area for research that we’re working very hard on. 

    GUY EAKIN: It’s certainly a question we get a lot of information coming into our organization about, and we have a lot of questions coming from the public about that topic. So, perhaps, we can talk about things somebody can do at home if genetic testing is perhaps still a little way out in terms of the scientific literature. Where are we in monitoring the progression of the disease and understanding how fast it’s moving and the speed of which it’s moving is changing over time? What do you ask patients to use to monitor the disease at home and are there any aids for that?

    EMILY CHEW: That’s a very good question about inviting yourself to do what you need to do. Patients will ask the physician, you know, “How fast will I progress? What can I do to stop this?” We can’t predict, but what we do know is that if we can pick up changes early and you’ve got good vision, the treatment is much better. So there are services that provide home monitoring that actually links onto a telemonitoring or telemedicine system that someone is watching those changes, and letting you know that there are changes and that has been very useful in our hands. We’ve done a study in which we show patients given this monitor, they were able to pick up the disease of the wet-form macular degeneration earlier and with better vision, and that really gives you a better chance of preserving what you have and that’s very important. So, that’s for people picking up early changes for the wet-form of macular degeneration. For those of you who already have macular degeneration in one eye and have been treated, another way to look at that is with that graph paper I discussed, the grid, and then just perhaps monitoring, covering one eye and then covering the other to see if there are any differences over time. That will bring you in earlier to see the doctor. There’s even an app on your iPhone that can be used to test visual acuity that’s also monitored remotely, as well. That’s being investigated to really pick up any changes, especially if you had treatment in macular degeneration. So, there are various ways of doing that that you can look at. The other thing you can do for yourself as I already mentioned, is to keep a healthy diet and to live healthy. You know, exercise, keep your cholesterol low, and reduce your blood pressure, all those things that are very important. We know that people who have increased body mass index or are a little bit more overweight may have a higher risk, so keep good healthy habits is very important for your eyes as well your heart and your brain.

    GUY EAKIN: Thank you, and as a reminder to everyone, you can briefly leave the call and ask a question by asking *3 to submit the question to an operator, and if for some reason you are disconnected from the call, the number to call back in is 877-229-8493. You will then be asked to punch in the ID code 112435. I should say if you’re frantically trying to write down things that Dr. Chew is saying, don’t worry about that. We will be posting a transcript of this conversation and all our BrightFocus Chats on the BrightFocus website. If you give us about a week, we’ll get that up and if you don’t tend to use our website, then you’re more than welcome–we encourage you to call in at 1-800-437-2423. That number, again, is 1-800-437-2423, and we can send you a copy of that transcript along with some of the other information we have, such as other chat transcripts. We have literature about questions to ask your eye doctors, as well as some of the literature about the at-home monitoring device that Dr. Chew just mentioned. So we do have questions that are coming in, and right before we get to those questions, we’d like to do the next poll that we have, so if you’d be willing to bear with us one moment. The question is, quite simply, how frequently do you have your eyes checked? So, if you’ve had an eye exam every 1-2 years or more frequently, please press 1. Press 2 if you are having eye exams every 3 years or more and press 3 if you’ve never had an eye exam and perhaps you’re on the phone for another person. So again, that’s every 1-2 years, press 1; press 2 if your eye exam has been 3 years; and 3 if you’ve never had an eye exam. So, let’s turn to the questions and, of course, we’ll address as many of the questions as we can in the course of the conversation. If there are some questions that aren’t covered during this particular chat, then we’ll try to get them covered in a future chat or work them into the conversation in another way.

    So, one of our first questions is from Rebecca from Alabama who has a question about the progression of AMD while on the vitamins supplements. So, we know that AREDS delay progression and, in her case, she is also on a zinc-free vitamin that was recommended by her doctor, but in general, how do we measure whether AMD progression is slowed, and what should the average person’s expectation be for their vision while on these vitamins?

    EMILY CHEW: Well this AREDS supplement is an interesting set of vitamins, because it does not really improve your vision. It will slow down the progression, which is typical for you to measure. You’d have to go into the eye doctor to see where things are. You won’t be symptomatic, you won’t in fact improve. What it does do is reduce the risk of developing the more severe end of disease–in other words, it will prevent you from going into the more vision impaired type, so that part is good. It doesn’t really change you from going from one step to the other, so clearly this is something your doctor has to work with you on, but it is an important vitamin because of the fact that we can reduce the risk of approximately 300,000 people if you take it for 5 years, so it’s really an important aspect. I think you have to have trust in your doctor as to how it will be going and not look for actual improvement in vision, but to know that this is going to prevent you from getting worse.

    GUY EAKIN: Thank you. So, Mr. Catina from Pennsylvania is asking, he has dry macular degeneration in one eye and wet in the other eye, and he’s asking generally about the chances of the dry eye turning into the wet form of the disease. He follows the question with how does he go about preventing it from turning into wet and, of course, we’ve talked about the vitamins, but what are the chances of an eye that is dry turning into the wet form of the disease in any given time frame?

    EMILY CHEW: Mr. Catina, we don’t know for sure for you personally, but in a big group of people, we can tell, like for 5,000 patients we follow, about 30% in 5 years may develop the wet form as well from the dry. So at 30%, you may be lucky and be the 70% and not develop it at all. What you can do is to monitor your eye with the home monitoring type or with the grid and look for changes; early changes will get you in to the doctor and they can treat you much earlier. The wet form is quite treatable and people can improve their vision and 90 percent maintain what they have, so that’s the good part of that aspect of the disease.

    GUY EAKIN: Thank you so much. Michael from New York is seeing some flashes of light in front of him that dissipate within 20 seconds and describes them as looking like the Milky Way. Is that something that is common to macular degeneration, or is that potentially something that might be another condition with his eyesight?

    EMILY CHEW: Well Michael, I think you should have your eye doctor look at your eye and have it dilated to look for vitreous separation. That’s a jelly part of your eye that separates from the retina, which is quite common, and it causes what we call floaters. The vitreous separation is a normal part of growing up, actually, so it may not be dangerous, but the only dangerous part is that it can cause retinal detachment, so if you have those flashes of light that are sudden and you have lots of floaters, you should see an eye care provider as soon as possible to see that you don’t have retinal detachment. That’s not part of the macular degeneration.

    GUY EAKIN: Hope that helps. Thank you. We have two questions that are quite the same–so, Joanne from Wisconsin and Mr. Burton from California both are asking about lutein and zeaxanthin as a supplement possibly in addition to the AREDS2 formulation. So, taken outside of AREDS2–which, of course, already has both these vitamins in it–taken outside of AREDS2, is there any benefit or any general medical knowledge about benefits that might be had by taking additional lutein and zeaxanthin? 

    EMILY CHEW: When we say lutein and zeaxanthin, we felt that this is a good dose and maybe as much as you need, because when we did differently we found this elevated your blood levels to a certain degree and this was sufficient to really make a difference. Adding more may not necessarily improve your chance of suppressing the disease, so we went with this particular dose based on the experts in this field who felt this was sufficient. You’re also eating some, so really, you don’t need any more than this than we have in the AREDS2 supplement. We don’t know what the effects are for having more, because you could suppress the absorption of other types of vitamins, because vitamins are taken into the blood by certain transport system and when that gets overloaded because you have so much more of one than the other, then you might actually cause a suppression of some others. So, we think that it is probably sufficient, and adding more may not be that helpful at this point

    GUY EAKIN: Okay, so we have a caller, Ann from Pennsylvania, and she’s asking about what changes in the Amsler grid mean. So, she says when she looks at her Amsler grid, things appear pretty normal, but when she looks out at her neighbor’s window, the grids on that window seem to look very wavy, and she specifically asking if this could be an indication that she is going into a wet form, a more advanced form, of macular degeneration, but maybe what does it mean when that Amsler grid changes? What is going on behind the scenes in the eye, and what should the person do with that information?

    EMILY CHEW: Ann, it is quite common that Amsler grid changes might already be there because you have certain changes to macular degeneration. It’s the change from what you have today that might be more important. For example, other diseases can cause some changes like that, so what it means is that the retina, the back of the eye, has some abnormal changes, but it might not be macular degeneration. So, when you have changes and you’ve seen your doctor and they say you’re fine, that’s your normal state. Then you look the next several months and weeks and see if you see any change on top of that. So, I wouldn’t be too alarmed, and if you have changes you’d like to be seen about, you should see your doctor and be reassured that you’re actually in good shape, but once you have established what we would call your “normal state,” you want to look beyond that. What the Amsler grid reflects are changes in the part of the eye that is important for seeing and when it’s not absolutely flat, it bulges out and causes things to look angulating or distorted, or it might bow. Those are good signs of early changes in macular degeneration, and that’s what makes it such an important monitoring device for you to look at it and monitor your own vision.

    GUY EAKIN: Okay, thank you so much. So, Dorothy from Maryland is asking about diseases that might come along with macular degeneration, and so she’s asking if we’ve found any connections between moderate Alzheimer’s disease and dry macular degeneration–but broader, if not Alzheimer’s disease – and maybe there is a connection, but are there other diseases that travel in packs with macular degeneration or other ocular disorders?

    EMILY CHEW: Dorothy, that’s a very good question. We don’t know whether Alzheimer’s is related to macular degeneration. We don’t have data on that. We don’t think so. We’re looking now at patients with Alzheimer’s to see if they have any early changes of AMD. Our friends in England have suggested that there’s some early changes–like way, way out in the retinal in the far peripheral area of the eye that doesn’t really contribute to your vision. There may be some early changes, but that’s yet to be really established. You know, macular degeneration occurs–the biggest risk factor is age, and as you age, you get cataracts, so that’s a part of, sometimes, a package. They’re probably not related, and in particular, people are concerned about cataracts surgery, whether that instigates macular degeneration. We don’t think that happens either, so these are independent things that occur because as we age, these different aspects of the eye age as well, so we don’t see any other associations that we know of.

    GUY EAKIN: So, we have a number of questions that ask about what the first indications of macular degeneration are, and they come in a lot of forms. People have asked about high levels of drusen. They’ve asked about difficulty adjusting between light and dark locations. There’s been questions about waviness in lines. What are the signs of macular degeneration that would spur you to suggest that someone go and have their eyes evaluated by an eye care professional?

    EMILY CHEW: For most cases, macular degeneration has no symptoms, in early cases. You may not even notice you have it. Those yellow spots called drusen, which one of your astute listeners is talking about, are yellow spots in the back of the eye. There is a hallmark for macular degeneration. You have go in to  your doctor and they see drusen, they’ll declare you have macular degeneration. So, in terms of the symptoms, people who have difficulty adjusting from a very bright light to a dark room can have early macular degeneration. Those are kind of the rare signs that we sometimes may see in patients who, otherwise have good vision, but may have problems adapting to the dark, so that’s a good reason to go in and see the eye doctor. The waviness really means that it could be having some changes in the part that really gives you good vision, and that could be related to macular degeneration, but it could be other conditions, so when you have those symptoms, definitely go in and see your eye doctor. If you have a family history, you should go in and have a dilated eye exam to make sure you don’t have those drusen, and if you do have drusen then you should take the precaution of taking the vitamins and monitoring your eyes carefully.

    GUY EAKIN: Well, the family history question begs the next question, which is, what is the importance and how does one address a family history of macular degeneration with people who do not have macular degeneration? So, if I have macular degeneration and I have children or siblings, what are the data points, what are the talking points that I might put into a request to my family members to ask that they go and have their eyes checked?

    EMILY CHEW: Yes, that’s a very good question. You know, macular degeneration is a genetic disease. We know that because it runs in families, but it’s not one of these clear cut, “If I have it, my son and daughter will have it,” because other factors, such as environmental factors, are important. If you’re a smoker, you have a greater chance for macular degeneration so all those things come into play. But if there’s a family member who does have macular degeneration, you should go in and be seen by an eye doctor or eye care professional who dilates your eyes and looks for those drusen to get you into early vitamin prevention and also monitoring your vision. So a family history is not 100%, it doesn’t mean you’re doomed. If your mother and father have it, it doesn’t mean you’re going to have it too, and that’s why it’s important to get in and be seen because it doesn’t quite work that way, so an eye exam is crucial for this.

    GUY EAKIN: Thank you. So, Leonard from New Jersey is calling in, saying that he’s been on injections for quite some time of two VEGF inhibitors and has had some problems, and is wondering if there’s anything going on in the world of research that might lead to a retinal transplants or a macular transplant. These things are a bit in the future, but what’s your opinion? What’s the state of the art on retinal transplants or some of these alternative technologies?

    EMILY CHEW: Oh, that’s a very exciting field right now. A lot of things are happening. It’s experimental, of course, there’s nothing proven. There’s ways of looking at stem cells. They’re growing cells from the skin and then making different parts of the retina. It’s unbelievable what researchers are doing. There are number of studies that are ongoing, looking at injecting cells that might be useful or transplanting cells that are grown from your own skin to replace some of the things that are happening, but all that is still very experimental. It will not be ready, at least not in the near future, but it’s very exciting because there are methods of using stem cells that might be able to help us with the very severe cases of macular degeneration. And there’s also gene therapy that’s happening, so there are a number of things happening in the investigation field, and we hope that we’ll have some good results in the next–over the next decade we should see some interesting things come out of that

    GUY EAKIN: And certainly anybody that’s interested in clinical trials, there is a resource for finding clinical trials that is a webpage. It is clinicaltrials.gov, and some of these future technologies are currently in trials and we encourage anybody that has an interest in clinical trials to find out more information either through clinicaltrials.gov or you can call in: 1-800-437-2423 and one of our staff here at BrightFocus will be happy to tell you a little bit about what’s on clinicaltrials.gov in your area. So, there’s a question from Mary from Illinois whose retinal specialist–she had had a conversation about devices for at-home monitoring, and the retinal specialist had not recommended it. These are FDA approved now, so what are the downsides to those devices, or what would you suggest to Mary in terms of continuing the conversation with that doctor?

    EMILY CHEW: The devices for home monitoring also depend on the vision. If the vision is not moderately good, it will not be very useful. The downside, of course, is that some of them do cost money. It is not paid for yet by Medicare or any of the insurance companies, so that is a bit of a downside because that is extra costs that one would incur. But on the other hand I think there are other things one can do. Simply if you’re going to monitor yourself–and many people read so can you read newsprint? Can you cover one eye and then the other to see if there’s any difference? It’s that monitoring one eye, just using one eye at a time, because when we use two eyes and something goes wrong with the one eye, you actually don’t pick it up quite as well. So if you’re vigilantly covering one eye and then the other and going that regularly, you can pick up differences that may not be as good as the home monitoring that uses techniques that are slightly different and are much more sensitive. They can pick up earlier changes from that perspective, but sometimes some people cannot use the monitoring device for various reasons, so it’s not for everyone. That’s for sure. 

    GUY EAKIN: Thank you for clearing that up. We probably have time for one more question. Judy from California is wondering about proper lighting for someone with macular degeneration. We mentioned glare earlier on in the context of sunglasses, but what do you advise people who are looking for lighting that will make the most of their vision?

    EMILY CHEW: Judy, lighting is everything for macular degeneration. People complain at the fact that they can’t read unless they have very bright light. Some of those gooseneck lamps that go over your shoulder and shine directly on the material that you’re looking at is probably the most helpful. The other issue with that is, if you’re computer savvy, you want to look at good contrast and big letters, and sometimes reading with things like Kindles, you want to have a dark background with white lettering. Maximizing that contrast is important, and maximizing the light as much as you can tolerate without getting glare is also important. Those will help you to really function well even with macular degeneration that decreases your vision. 

    GUY EAKIN: Well, to Judy and everyone else, we want to thank you so much for participating in the conversation today, and especially to Dr. Chew. We certainly want to thank you for taking the time to speak with us, and we want to remind everyone that within about a week, we will be posting a recording of this call, as well as a transcript of the call on our website. You can also listen to and download past chats through iTunes or SoundCloud, or you can call that 1-800-437-2423 number. There, you can order a large print transcript of the call. So our next chat will be, of course, next month and the topic that we’ll be considering is, “What You Need to Know about Wet Macular Degeneration”, so looking at wet macular degeneration specifically. We encourage you to register and submit questions in advance, and we’ll certainly be sending anyone who registered today, we’ll be sending you a reminder email. So, in fact, you can register for the June chat right now and request free materials from BrightFocus for yourself or your loved ones. I mentioned earlier our “Top 5 Questions to Ask Your Eye Doctor” and some of the other publications that we offer. To do so, you can call BrightFocus at 1-800-437-2423 or by visiting our website at BrightFocus.org. And of course, if you want to stay on the line after the call, you can leave a message after this call concludes.

    Again, thank you to everyone for joining us today and to you, Dr. Chew, for providing your expertise. If you’d like to leave a comment after the call, just stay on the line. Thanks from all of us at BrightFocus and have a great day!

    • BrightFocus Foundation, 1-800-437-2423, or visit us at brightfocus.org
    • National Eye Institute at www.nei.nih.gov
    • Clinical trials information at www.clinicaltrials.gov
    • AREDS information at www.nei.nih/amd/summary
    • ARED2 information at www.nei.nih/AREDS2/MediaQandA
    • The Eye Exam for Macular Degeneration (Article)
    • Home monitoring
      • Amsler grid
      • Telemonitoring and telemedicine systems
      • Self-tests such as trying to read by covering one eye, then the other
    • Healthy diet
      • Leafy greens, such as spinach, kale, and collard greens
      • Eat fish twice a week

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