By Patrick Dundas
If you think cell phone, PDA and WiFi computer technology has changed your life for the better, imagine how it can change the lives of those with low vision. With innovative, new low-vision-friendly electronics, these patients can carry a digital magnifier, read Kindle books, magnify email text, watch TV and have hope restored for maintaining their independence and dignity.
There has never been a better time to add low vision evaluation and product sales to a practice. New products abound and with an exploding age-related macular degeneration (AMD) patient population, the need for service providers is growing. Over 20 million Americans have early or intermediate AMD and one in five will lose some vision, according to an article by A. Loewenstein in Retina 2007; Vol. 27. Add the updated National Eye Institute (NEI) and Prevent Blindness America’s Vision Problems in the U.S. report, and we see that cases of AMD indeed grew a stunning 25 percent between 2002 and 2008—the largest increase of all major eye diseases.
An American Academy of Ophthalmology (AAO) survey conducted in December 2009 identified the breakthrough in anti-vascular endothelial growth factor (anti-VEGF) injectable medicines for treatment of wet AMD as the single most significant advance in ophthalmology over the past decade. The escalating incidence of AMD combined with successful wet AMD treatments are driving low vision product innovation and the availability of breakthrough products. All this is opening the door for eyecare professionals to fill the needs of this patient base with positive outcomes and resulting incremental revenue.
The NEI’s landmark Age-Related Eye Disease Study (AREDS) completed in 2001 is the first to show a decreased risk of macular degeneration progression in the high-risk group when treated with a high-dose combination of vitamin C, vitamin E, beta-carotene and zinc ( www.nei.nih.gov/amd). This success has led to AREDS2, an NEI follow-up study with a modified formula designed to increase effectiveness.
The Nutrition Business Journal reports that following the publishing of AREDS, the U.S. vision supplement market exploded from $63 million in 2001 to $223 million in 2007. Not surprisingly, there are now a number of supplement products available with AREDS and AREDS2 formulations for ECP recommendation and/or dispensing to AMD and at-risk AMD patients.
DIAGNOSTIC INSTRUMENTS AND TESTING
Recommending supplements calls for identifying patients with significant risk factors. Leading the way are age, smoking, obesity, hypertension and perhaps most importantly, family history. Recent breakthroughs in genetic profiling have yielded a way to identify an individual patient’s risk of inheriting AMD. Macula Risk, a one-time “in-office” saliva swab from ArcticDx, can detect and analyze certain genetic markers known to be responsible for vision loss.
Low macular pigment optical density (MPOD) is another risk factor. Using a Heterochromatic Flicker Photometer from MacuScope or ZeaVision, MPOD can be measured and monitored in advance of any vision loss or signs of extracellular material buildup (drusen) in the retinal layers. Test results provide a guide to recommending dietary nutritional supplements and measuring their effectiveness.
Preferential Hyperacuity Perimetry
Early detection of wet AMD is even more critically important. Usher in Preferential Hyperacuity Perimetry (PHP). PHP is a specialized perimeter that detects and measures subtle misalignment of an object on the retina or elevation of retinal pigment epithelium. This highly sensitive instrument is able to objectively identify advancing AMD that has not yet changed visual acuity and detect the conversion to choroidal neovascularization or “wet” AMD. With the advent of effective treatments for wet AMD, doctors can catch and stop or slow the progression of the disease.
The Foresee PHP in-office device is made by Reichert Technologies, which acquired the product from Notal Vision in November, 2009. The instrument is easy for the staff and patient to use and represents a giant step in helping practitioners with early detection of abnormalities consistent with wet AMD.
Notal Vision retained the rights to a soon to be available home-based PHP where high-risk patients can test themselves daily and transmit the data over a phone line to Notal Vision. The test results are then available to the patient’s doctor through a secure online connection where they are able to monitor suspected wet AMD patients for early detection so critical to the decision to proceed with macular treatments.
Optical Coherence Tomography
Advances in laser scanning technology have brought us Optical Coherence Tomography (OCT) that provides high-resolution cross-sectional retinal images for diagnosing and monitoring a wide range of ocular disease states. In the AAO survey, OCT trailed only anti-VEGF treatments as the most significant advance in the last decade.
The newest, most dramatic improvement in OCT technology uses spectral-domain 3D imaging. With SD-OCT, a virtual HD image of the retina and its individual layers are viewed in three dimensions making it possible to see pathology in detail that might have been missed in a single OCT image. For AMD diagnosis and tracking, SD-OCT makes it possible to clearly see drusen detail buried in the retinal layers. There are several SD-OCT instruments on the market with similar core components. Differences exist in the peripheral features such as built-in fundus camera, angiographic system, retinal tracking and anterior segment modules.
LOW VISION AIDS
The explosion in imaging and optics technology for the consumer electronics and communications industries are being applied to low vision magnification and adaptive products with a resulting surge in popularity.
Portable Video Magnifiers
While conventional hand-held and stand magnifiers are often the most cost effective and practical for certain patients and certain tasks, new portable video magnifiers are rocketing ahead in sales to motivated and competent seniors. Rich with features like variable magnification, multiple contrast viewing modes and freeze frame capability, these devices have become a very popular choice. Seemingly overnight, whole families of hand-held and pocket video magnifiers have become available from the leading low vision device companies. Choices range from tilting 7" screen models to pocket magnifiers that are smaller and lighter than a cell phone like the 3"x 3 ½" Mini from Optelec and i-vu with a two-inch screen from Clarity. SenseView Duo from GW Micro has near magnification features with the added capability of a distance viewing camera that allows the user to shoot, pan and zoom saved images. The Ash Technologies Quicklook 2 from Eschenbach features a second side-mounted camera for writing, plus touch screen focusing and magnification control.
Desktop Video Magnifying Systems
Closed circuit television units of old have been replaced with newer technology desktop video camera systems. These systems are so versatile that patients can use them for reading, writing, real-time hobbies, self grooming and other daily tasks. Today’s desktops come equipped with ultra-thin pivoting telescoping HD flat screen monitors, auto-focus, crisp LCD image resolution, multiple viewing/contrast modes, adjustable magnification ranges from as low as 2X to more than 70X in a single device. For patients and tasks needing no magnification but improved contrast with multiple background viewing modes, Optelec has recently added 1X magnification to their ClearView+HD product. With SmartView from HumanWare, the user can capture/store up to 10 book page images, reformat the text and then zoom in for automatic or manual scrolling. For portability, Vision Technology has designed a 15-inch screen battery-operated unit that folds together like a laptop and opens up into a fully operational desktop video system for home, office or travel.
Several desktop models are computer compatible so that the user can split the screen to view magnified print materials alongside their own computer files. Bierley Associates make a full line of portable computer mouse-like cameras with multiple viewing modes for video output TVs or with USB computer connectivity. Images are magnified on screen as the mouse is moved across the page.
Lightweight foldable video cameras for use by on-the-go laptop computer users are now available from several manufacturers. Newest is the battery operated Transformer from Enhanced Vision. Weighing less than two pounds, it features USB connectivity with multiple viewing options. These products are equipped with an adjustable rotating camera for near, mid-range and distance viewing of classroom chalkboards or meeting room presentations. The user can snap a picture and store it for later viewing. They also feature split screen capability for magnifying external images alongside computer files. With the ABiSee portable text-to-speech systems, laptop computer users view and listen to printed material as the camera snaps and starts reading automatically with the turn of a page. Users can read along with the words magnified and highlighted as the text is read.
Part 2 of this article explores the use of low vision aids such as video eyewear, optical magnifiers, magnification software and low vision friendly keyboard as well as lighting and sun filters, and wireless GPS systems and readers.
Pat Dundas is a business development and marketing consultant specializing in ophthalmic markets. His company, Teamwork-Marketing, www.teamwork-marketing.com, serves clients in an advisory role, provides market research, prepares business plans and works on special projects. He can be reached at firstname.lastname@example.org or (909) 912-9020.