Ophthalmological Macular and Glaucoma

The Dual Diagnosis That Can Box a Patient in 

Dear 
The most perplexing patient that presents in a low vision clinic, is the patient that has both macular degeneration and glaucoma.  Not only is central acuity diminished, but peripheral sight is compromised.  As a low vision specialist, we usually turn heavily to magnification, but that can often cause problems with this dual diagnosis.

During the evaluation I always ensure that the patient is not prescribed over-magnification which would land the image onto cells that are no longer viable due to the ravishing effects of glaucoma which means the image won’t be visible to the patient.  With macular degeneration, spreading light over as much area of the field is key, which would indicate the need for high powered telescopes; however, it decreases the visual field. As a result, telescopic lenses may actually degrade the vision for these patients.  With high powered telescopes they sometimes feel visually claustrophobic.  

To not address this aspect, leaves the patient desiring more function.  So, I provide low powered telescopes which maintains a balance between central and peripheral vision.  This approach results in increased function which means a happy patient. This is a nuance that many Low Vision practitioners don’t fully understand.  Matching central enhancement with peripheral awareness requires a very delicate balance.

There is a unique, rarely prescribed lens that may also be implemented for these patients. In fact, I am the only prescriber in Michigan that utilizes this approach.  Escoop, is a complex lens that magnifies by five percent.  In my practice, my staff has dubbed it the “miracle lens.”  I have taken patients down three lines on “the chart,” even after I stalled out with the patient at two lines down with ten times the magnification.  It is a reminder that the optimum contrast sensitivity may occur at a much lower power than you would have initially considered.

Whether your low vision patient is strongly requesting help with their vision, or the patient is suffering quietly with the restrictions caused by the loss of vision – please consider referring the patient to my office, it could make all the difference.  Low vision patients can often require a lot of support, rest assured I can counsel your patients on their best options to improve their quality of life.

Cordially,
John P. Jacobi, OD, FCOVD, FIALVS