Meet the Growing Challenge: Treating Macular Degeneration

Our aging population is providing more cases of macular degeneration. Serve this growing need by discussing UV protection and lifestyle changes, and by providing early detection and early treatment. Technology is advancing; educate yourself on improved detection and treatment options.

With the Baby Boomer generation (those between 1946-1964) aging into senior citizens, macular degeneration is increasingly being diagnosed.  Taking steps to prevent and treat macular degeneration is the right thing to do, but it also is a great practice builder as you are providing services vital to the health of your community.

Institute Screening for all Patients

Patients who have a family history of macular degeneration are the most susceptible to this disease, but with the occurrence of it so common today, you should screen all patients. Take a baseline digital retinal photo and then review the image with patients letting them know if and where you see potential for disease inside their eyes. Point out details such as their optic nerve, the blood vessels and macula. Create a policy to photograph the retina at each annual exam (similar to a dentist requiring an x-ray annually), and, more frequently if they have diabetic or hypertensive retinopathy, AMD or a retinal hole, tear or degeneration that should be monitored more frequently. That way, everyone is screened and that creates an ideal opportunity to discuss prevention of potentially blinding eye diseases, like AMD and glaucoma with annual eye examinations, good nutrition and protecting the retina from UV damage. You can charge for the photo taken and advise the patient there will be a charge. You can participate with Medicare and Horizon BCBS for medically based eyecare. The billing code is 92250 and the diagnosis would be 362.57 (drusen) or 362.51 (dry AMD).

You shoulde explain the effect that ultra violet radiation has on this part of the eye and why it is important for patients to protect their eyes from the sun with quality sunwear.

Educate Nutrition and Personal Habits

In addition to explaining the importance of sun protection, you can point out how smoking triples the risk of developing AMD.  Explain the importance diet plays in prevention. For instance, according to the Mayo Clinic, eating kale, spinach, broccoli, peas and other vegetables, which have high levels of antioxidants, including lutein and zeaxanthin, may also reduce the risk of macular degeneration.

Talk Supplements

In addition to protecting eyes through the use of quality sunwear, a better diet and avoiding smoking, you should recommend that all patients, and especially those who are 50 and over, or those with a family history of macular degeneration, take MacuHealth, a macular degeneration-focused nutraceutical. The script has a toll-free number patients can call; it is $75 for a 90-day supply. Macuhealth is only available through a Doctor of Optometry or Ophthalmology or by dialing the toll-free number on the Rx pad. It is NOT available in drugstores or on other web sites.

Educate that in an Era of Electronic Screens, All Are At Risk

More research needs to be conducted in this area, but evidence is beginning to emerge that the blue light emitted from electronic devices like laptops and mobile devices, along with the light emitted from compact fluorescent (CFL) lightbulbs, increases macular degeneration risk. This is one more reason to take precautions regardless of your age or family history. Explaining the possible role these modern forms of light play in increasing macular degeneration risk, you can also emphasize the importance of annual comprehensive examinations in protecting eye health.

Retinopathy Screenings Can Be Less Frequent

Screenings for retinopathy every 2 years instead of the recommended annual screening would be safe and could reduce screening costs by about 25% for people in the United Kingdom who have type 2 diabetes but who have not developed retinopathy, according to an article published in Diabetes Care.

Current guidelines by the United Kingdom’s National Institute for Health and Clinical Excellence (NICE) recommend either annual retinopathy screenings for people with diabetes or, if the patients have developed retinopathy beyond mild disease, screenings every 3 to 6 months.

The new model developed by the researchers, called retinopathy screening simulation (ReSS), builds on an established simulation model called patient-oriented simulation technique. ReSS allowed the authors to evaluate more individual patient states specifying how far the disease has progressed, from R0 (no retinopathy) to R1-R3 (background diabetic retinopathy), to proliferative diabetic retinopathy.

Switching to 2-year screening for this population subset could reduce screening costs from a projected 1.83 million pounds to 1.36 million, and screening appointments from 23,611 to 12,561, over the course of 15 years under the model.

Retinal Microchip Restores Vision in Retinitis Pigmentosa

A subretinal microchip implant has entered new clinical trials in the United Kingdom and Hong Kong, and early results are encouraging. The technology is important because until now, vision loss from retinitis pigmentosa, a genetic disorder that frequently leads to blindness, has been considered permanent. More than 200,000 people in the U.S and Europe suffer from the disease at this time.

Retinitis pigmentosa is a progressive genetic disorder that causes an imbalance of proteins to be produced by photoreceptor cells. This limits the retina’s ability to produce eyesight, and the cells die gradually, eventually leading to blindness. Antioxidants such as vitamin A palmitate may slow the disease, but they cannot restore lost vision.

Researchers believe that the microchip technology will work because inner retinal nerve cells continue to function even after vision has been lost. For this reason, 2 approaches have been explored to restore vision; (1) epiretinal implantation of electrode arrays which interfere with retinal ganglion cells forming the retinal output pathway, requiring external image and  processing because it bypasses retinal image analysis. The clinical trials in the United Kingdom and Hong Kong involve the (2) approach, the implantation of a 3x3mm, 1500-electrode microchip below the retina, in the macular region. This type of microchip senses the light of an image and translates it, point by point, into small currents proportional to the light. Each electrode contains a photodiode amplifier electrode set within a single pixel that stimulates nearby neurons, closely resembling normal visula signals.

The operation takes about 9 hours and requires maxillofacial surgeions; ear, nose, and throat surgeons; and ophthalmic surgeons.

Visual implant gives blind some vision

http://www.sciencedirect.com/science/article/pii/S0161642011008840