Category: Treatments

Who Needs Eye Vitamins | AREDS and AREDS2

Post author By Randall Wong, M.D.
Post date September 6, 2019
2 Comments on Who Needs Eye Vitamins | AREDS and AREDS2

There is only one eye vitamin proven to be effective for any eye disease. The AREDS 2 formulation for macular degeneration is the only vitamin proven to reduce the chance of severe vision loss in select patients with macular degeneration.

AREDS

The initial study, funded by the National Eye Institute, was the “Age Related Eye Disease Study” (AREDS) and was to determine the effects of antioxidants and other minerals (principally zinc) on the development and progression of macular degeneration and cataracts.

The initial NIH study found the following:

Antioxidants and zinc had no effect on the development or progression of cataracts.
Antioxidants and zinc reduced the chance of vision loss in a select group of patients with macular degeneration.
Beta-carotene (an antioxidant) increased the chance of lung cancer in smokers.

AREDS 2

A second study, Age Related Eye Disease Study 2, also conducted by the National Eye Institute (NEI), was designed to determine:

if beta-carotene could be replaced with the antioxidants lutein (anti-oxidant) and zeaxanthin (carotenoid)
if the addition of omega-3 fatty acids affected the development and progression of macular degeneration
the value of zinc in the development and progression of macular degeneration.

AREDS 2 Conclusions

Essentially, the AREDS 2 study confirmed the positive conclusions of the first study, and that:

Omega-3 fatty acids had no effect on the development or progression of macular degeneration.
Removal of beta-carotene did not negatively affect the progression of macular degeneration.
Lutein and zeaxanthin may serve as an adequate substitute for beta-carotene and did not show evidence of promoting lung cancer in smokers.

Do You Need Any Vitamins?

It should be stressed that most patients do NOT need to be taking vitamins.

Only patients who have been diagnosed with macular degeneration AND who also have select risk factors should be advised to take the AREDS 2 formulation. Specifically, if your doctor determines that you have intermediate or advanced risk factors based upon a dilated eye examination, then you may consider taking the AREDS 2 formulation for macular degeneration.

Risk factors determining the severity of the disease include

What Can You Expect?

The AREDS 2 are NOT going to improve your vision. The AREDS 2 will decrease the chance of severe vision loss by about 25% given the fact the you have higher than normal risk factors for the progression of the disease.

Tags AREDS, Macular Degeneration

“Other” Eye Conditions Treatments

“Alexa, Read This” | Personal Voice Assistants Aid Low Vision Patients

Post author By Randall Wong, M.D.
Post date June 22, 2017
No Comments on “Alexa, Read This” | Personal Voice Assistants Aid Low Vision Patients

This article has been contributed by Paul Burden. Paul’s mother suffers from wet macular degeneration. Paul founded Our Voice after he discovered the advantages of personal voice assistants and how they can help blind or low vision patients such as his mom. I am impressed with the variety of information and tasks a personal voice assistant, such as Amazon’s Echo, can perform. Enjoy. – Randy.

Personal Voice Assistants have fundamentally changed the way we use technology. A voice assistant can be especially beneficial for the blind and low vision community. It’s difficult to use and keep up with ever changing technology.

Voice Instead of Keyboard

With a voice assistant, there’s no more complicated software to learn and update; no keyboard, users simply speak. Using voice only, users can:

have their music played
get the latest headlines and weather
listen to their favorite radio stations and podcasts
have books read to them
do their shopping
manage their calendars
contact family and friends in case of an emergency
query the Internet for information
make and receive phone calls
and much more

Meet Amazon’s “Alexa”

There are several voice assistants on the market, but the Amazon Echo family of products is far and away the most widely used voice assistant with more than 70% market share.

The Echo’s voice is named Alexa.

Once the Echo is connected to your Wi-Fi, you have immediate access to a wide variety of information. For example,

Just say, “Alexa, what are today’s headlines?” Headlines are immediately read to you.

“Alexa, what’s the weather look like for tomorrow?” You’ll get tomorrow’s forecast, or the 10 day forecast if you like.

In addition to all the information immediately available, there are lots of Apps available as well. What you think of as an App on your smartphone or computer, is called a “skill” on the Echo. They’re the same thing. A large number of skills are particularly useful for blind and low vision users. A few examples:

My Buddy Skill

“My Buddy” allows the user to call, text or email any number of designated “buddies” or family members.

If you find yourself in distress and need help, say: “Alexa, my buddy.” Alexa will ask: “Who do you want me to contact?” You reply, “My family.”

Your family can include as many members as you’d like. Do you have 20 members of your family you’d like contacted? All at once? No problem. The call/email/text goes out to all 20 simultaneously.

Shopping by Voice

You can shop from the comfort of your home, using your voice only. Amazon has nearly 500 million products in stock!

Down to your last roll of paper towels? Say, “Alexa, order paper towels.” Alexa will offer a few options, asking for your permission to place the order.

When you hear what you like and confirm, your order is placed. Your order will arrive in a day or two, frequently your order is delivered on the same day.

Would you like to know when your order will be delivered? Just say, “Alexa, where’s my stuff?”. Alexa responds with the day and approximate time your order will be delivered.

“Alexa – Read This!”

Alexa will read books on your Kindle. The books are read to the listener in Alexa’s own computer generated voice.

Amazon owns another electronic book service called Audible. Audible works very well with the Echo family of products. The listener can bookmark particular chapters, fast forward/rewind, pause, adjust volume and summon a different book.

Audible books are read by professional voices. While most Echo skills are free, Audible is not. Audible requires a monthly subscription of $14.99, allowing 2 books a month. More books can be added.

What’s the Next Step?

While the Echo is very easy to use, it can be difficult to set up and configure. That’s where Our Voice comes in, we’re Amazon Echo experts. Our Voice is a company dedicated to making voice assistants available to everyone. Our Voice installs and configures the Echo for the specific needs of the customer. We then train the customer to use device so they get the most out of their voice assistant experience. To learn more about Our Voice, visit www.ourvoice.net or call toll free: 844-voice 13 – 844-864-2313.

Paul Burden is the Founder of Our Voice; a company dedicated to bringing voice technology to the blind and low vision community. Prior to Our Voice, Burden held executive positions at Microsoft, Cyveillance and XAPPmedia. You may contact Paul at www.ourvoice.net.

Tags Alexa, Echo Dot, Voice Assistant

Floaters Treatments

What is the Vitreous?

Vitrectomy is performed by retina specialists to repair various retinal diseases. Randall Wong, M.D.

As a retina specialist, my specialty niche is disease pertaining to the retina and vitreous. The retina is the light sensitive tissue which lines the inside of the eye.

The vitreous is the gel like substance which fills most of the eye in the posterior chamber (that portion of the eye behind the iris and lens).

What Does the Vitreous Do?

The vitreous is critical to embryonic development, that is, it’s part of the development of the eye.

The vitreous should be optically clear. You should not be able to see your own vitreous although your eye doctor should be able to see all of your vitreous!

Once we are born, there is no practical function of the vitreous. Because it is 2-3 times thicker than water, it potentially could “plug” cuts or holes into the eye…kind of like putting a finger in a dike.

Vitreous Causes Retinal Detachments

Many of the diseases I treat as a retina specialist stem from the vitreous. If it weren’t for the vitreous, there would not be a retinal surgical sub-specialty – there wouldn’t be any diseases upon which to operate!

The vitreous causes;

Retinal Tears – the vitreous is adherent to the retina. Forces tugging on the retina can cause a retinal tear. This may happen during a PVD (posterior vitreous detachment) or trauma.
Retinal Detachments – There are two basic types of retinal detachments. The vitreous is implicated in both.

Rhegmatogenous retinal detachment – these are the most common types of retinal detachments emanating from a retinal tear. Fluid migrates through the tear and underneath the retina…causing a retinal detachment.

Certain diseases, such as advance diabetic retinopathy can lead to a “traction” retinal detachment. These detachments occur when sheets of protein/scar tissue grow on the surface of the retina and start to detach the retina by “pulling” or causing traction.

These sheets of protein develop in between the vitreous and retina.

Epiretinal membranes are microscopic types of traction retinal detachments as are macular holes.

Diabetic macular edema improves if a PVD develops or a vitrectomy is performed.

Floaters are a common annoyance and for some impair the vision by causing spots in the vision, glare or blurriness.

What Does this Mean?

This is a vestigial tissue, the vitreous is important in our development. Once born, we don’t really need the vitreous.

A vitrectomy, the core operation performed by a retinal specialist, removes the vitreous and is performed a part of the procedure to fix a variety of the problems noted above.

The vitreous does not need to be replaced – we simply don’t need it. During the operation, artificial saline is pumped into the eye. After the vitrectomy, the artificial saline is replaced by our own.

Tags Vitreous

Treatments

Jetrea (Ocriplasmin) for VMA (vitreomacular adhesion)

Post author By Randall Wong, M.D.
Post date July 5, 2013
2 Comments on Jetrea (Ocriplasmin) for VMA (vitreomacular adhesion)

Randall Wong, M.D., Retinal Specialist, Fairfax, Virginia, Jetrea for Injectino for the treatment of VMA Jetrea, aka ocriplasmin, manufactured by Thrombogenics is FDA approved to enzymatically induce, or create, a posterior vitreous detachment. By creating a PVD, several retinal diseases might be treated without conventional eye surgery such as vitrectomy.

I recently started using Jetrea for treatment of vitreomacular adhesion, coined VMA. This is also known as vitreomacular traction (VMT). It is not dissimilar to an epiretinal membrane where the surface of the retina is affected by the overlying vitreous.

Signs and Symptoms of VMA

Most patients with VMA have mild vision loss, say 20/40 to 20/80, and may or may not have symptoms of metamorphopsia. Metamorphopsia is the fancy term for distortion.

The OCT demonstrates typical findings; minimal vitreoretinal adherence but only on the fovea. Unlike epiretinal membranes, the affected area appears solely at the foveal center.

Patients with VMA have subtle changes on examination. There is no obvious ERM, no cystic macular edema, but there may be subtle elevation of the macula and/or blunting of the foveal reflex (it’s not as shiny looking).

Preparation of Patients

My usual routine is to discuss the options for treating VMA; observation (do nothing), vitrectomy or Jetrea. For those who choose Jetrea (ocriplasmin), I’ll give the appropriate informed consent (chance blindness from endophthalmitis or retinal detachment) and prescribe topical antibiotics for use 4 days prior to the scheduled day of the intravitreal injection.

This is the same regimen I prescribe for all patients receiving intravitreal injections. In theory, pre-treating with antibiotics may further reduce the chance of infection.

Injecting Jetrea (Ocriplasmin)

On the day of injection, patients are dilated and then “marinate” for about 20-30 with a cotton applicator soaked in lidocaine solution. The applicators are usually changed every 10 minutes. Most patients require only a 20 minute “numbing period.”

The vial of Jetrea is kept frozen up until the injection is delivered. Thrombogenics recommends thawing the solution just prior to anticipated injection. The small amount of diluent thaws rapidly, rolling the vial between your hands can hasten the process.

The injection kit has all the needles and syringes needed for injection. Add 0.2 ml of 0.9% NaCl to the thawed Jetrea (Ocriplasmin) and swirl.

Withdraw most of the solution into a syringe, shake out bubbles and expel all but 0.1 ml of the diluted solutions of Jetrea.

0.1 ml of Jetrea is injected per treatment.

Reclining for 30 Minutes

Immediately after injection, I’ll often recline the patient for 30 minutes. In theory, this may allow the injected solution to accumulate faster on the macula. Given the relatively short half-life of the enzyme, this may make sense.

While this is a relatively new treatment, treatment patterns are certainly going to vary, but the head reclining makes practical sense to me.

What Does this Mean?

Jetrea (Ocrisplasmin) represents a novel non-surgical approach to treat VMA/VMT, macular holes and certain epiretinal membranes. Jetrea works by enzymatically cleaving the adherent vitreous from the retina. By simply causing a PVD, vitreomacular traction may often be cured…without an operation.

This has implications for the treatment of other conditions such as certain macular holes and epiretinal membranes, classically treated with surgery.

Randy

Randall V. Wong, M.D.
Retina Specialist
Fairfax, Virginia
www.RetinaEyeDoctor.comwww.TotalRetina.com

Tags Jetrea, ocriplasmin, Thrombogenics, VMA