Optometrists Ignore AMD Checkup

Age-related macular degeneration (AMD) is on track to increase from approximately 11 million Americans currently afflicted to about 22 million by 2050. It is a disease that creates deep vision challenges which eventually causes blindness for so many people and still, there is no cure. Most optometrists (eye doctors who have received their degree as a Doctor of Optometry, OD), will search for telltale signs of AMD, if at all, and then stop there. In addition, upon finding a positive diagnosis, some ODs will tell you there is no cure and that there is nothing that can be done. 

Don’t let your optometrist ignore a full AMD checkup. These are professionals often inundated with a waiting room full of patients leaving little room for excessive testing. Yet, this can cause an AMD diagnosis to go undetected or untreated leaving adverse life changing vision results which may have been mitigated otherwise. 

Criteria Demographic

Talking to your eye doctor about monitoring a vision transition is essential. This is particularly important if you fit the criteria demographic. According to the Mayo Clinic, this is a list of those that may be at risk for macular degeneration. 

• Age – This disease is most common in people over 60.
• Family history and genetics – This disease has a hereditary component. Researchers have identified several genes that are related to developing the condition.
• Race – Macular degeneration is more common in caucasians.
• Smoking – Smoking cigarettes or being regularly exposed to smoke significantly increases your risk of macular degeneration.
• Obesity – Research indicates that being obese may increase your chance that early or intermediate macular degeneration will progress to the more severe form of the disease.
• Cardiovascular disease – If you have had diseases that affected your heart and blood vessels, you may be at higher risk of macular degeneration.

If you can check off one or more of these risk factors for AMD then you may want to question your optometrist more closely. Being a patient often puts one in a submissive position trusting everything a medical practitioner proposes. Yet, having the courage to ask questions or even demand testing could be a sight-saving practice. This is even more essential if you not only fall into the criteria demographic but are experiencing one to more symptoms.

Be Aware of Symptoms

These macular degeneration symptoms, also posted by the Mayo Clinic, are a good checklist to stay on top of your vision and be able to articulate such challenges to your optometrist. 

• Visual distortions, such as straight lines seeming bent
• Reduced central vision in one or both eyes
• The need for brighter light when reading or doing close-up work
• Increased difficulty adapting to low light levels, such as when entering a dimly lit restaurant
• Increased blurriness of printed words
• Decreased intensity or brightness of colors
• Difficulty recognizing faces
• A well-defined blurry spot or blind spot in your field of vision

Know What to Ask For

If your criteria and/or symptoms match any of these, it may be best to inquire with your optometrist. Some presentations of these symptoms could indicate as being a marker for specific testing your optometrist might not take into consideration.

Optometry Times (OT) cites some tests you can ask for.

Dark Adaptation Test – If a patient with a family history of macular degeneration has signs of drusen (waste material which contributes to AMD) or RPE (retinal pigmented epithelium) remodeling, a dark adaptation test is recommended. It measures the number of minutes it takes for the eye to adapt from bright light to darkness. This is known as the rod intercept (RI) time. An RI of less than 6.5 minutes indicates impaired function with 90% sensitivity and specificity. 

Review of Optometry reported, 

“Dark adaptation testing may allow clinicians to detect subclinical AMD at least three years earlier than it is clinically evident, according to investigators.”

Genetic Test – Steven Ferrucci, OD and FAAO (Fellow of the American Academy of Optometry) comments to OT,  “In patients who already show signs of AMD, I strongly consider performing a genetic test to determine each patient’s individual risk of progression to advanced disease and subsequent vision loss.”

ForeseeHome – The Amsler grid has been the gold standard in detecting vision compromise associated with macular degeneration. However, new technology is now available to catch a possible transition from dry to wet macular degeneration through home monitoring. OT reported, “Results from the AREDS-2 HOME study showed that 50% more patients using ForeseeHome maintained visual acuity greater than 20/40 when compared with patients who used the Amsler grid alone.”

Question Your OD

In addition to knowing what tests to ask for, questioning your OD is essential. Just because a practitioner is educated and wearing a white lab coat doesn’t mean you can’t ask questions. It is well known that lifestyle changes can help mitigate any disease but maybe your OD can offer more specific advice. Doing an internet search yourself could lead you down a rabbit hole of misinformation so getting info on the following, directly from your OD, may be more concrete. 

Ask your eye doctor about:

• Diet – What are the best foods to help strengthen my eyes?
• Exercise – Are there any specific eye exercises to prevent AMD?
• Supplements – What are the best vitamins and minerals supplements for vision health?
• Sunglasses – What type of blue-blocking sunglasses should I wear, if at all?
• Recreational habits – How much tobacco, alcohol, or recreational drug use, such as marijuana, is too much for the eyes?

Changing the dynamics of the OD-patient relationship is by letting the OD know you are not going to take macular degeneration lying down. It is important to advocate for yourself by nudging your OD to look for every anomaly possible, recommend any test available, and hammer lifestyle changes into your head all to keep you seeing as clear as possible, for as long as possible. 

Sources:

https://www.optometrytimes.com/view/ods-are-ignoring-macular-degeneration

https://www.mayoclinic.org/diseases-conditions/dry-macular-degeneration/symptoms-causes/syc-20350375

https://www.reviewofoptometry.com/article/how-early-diagnosis-can-improve-amd-outcomes