UPDATE Macular Degeneration

FALL 2024

Seeing a Brighter Future:

Navigating Low Vision Together with Innovative Rehabilitation

Vanessa Carmody OTD, OTR/L,CAPS, Low Vision Works of Florida

Vision rehabilitation is a comprehensive field that provides a variety of services to help individuals with low vision maximize the use of their residual sight. This area of care greatly benefits from a multidisciplinary approach, which includes not just general medical care but also a range of allied health services, educational support, psychological counseling, and community specialized services. Tailored to meet the distinct needs of individuals experiencing visual impairments, this comprehensive approach can foster a robust support system that significantly enhances quality of life (American Academy of Ophthalmology, 2022). Recognizing the pivotal role of comprehensive eye care, the American Optometric Association (AOA) highlights their importance in connecting patients with essential rehabilitation services. The AOA advocates for early referral to vision rehabilitation specialists, aiming to optimize patient health and overall well-being (American Optometric Association, n.d.). An effective implementation of the vision rehabilitation model results in improved function, increased safety, and enhanced emotional well-being (Murphy, 2023).

The “Low Vision Rehabilitation Delivery Model” graphic from the Prevent Blindness website represents the continuum of care for low vision rehabilitation. The diagram shows four key services joined in a circular model by arrows, emphasizing the paths to follow for optimal rehabilitation. Each step is designed to build upon the previous, ensuring that a patient’s needs are met comprehensively through a combination of specialized assessments and referrals to appropriate rehabilitation professionals. At the top of this graphic, the parallel service professions in vision rehabilitation are showcased. This team consists of occupational therapists, who provide medical rehabilitation care, and non-medical community rehabilitation professionals, including certified vision rehabilitation therapists, certified low vision therapists, and certified orientation and mobility specialists. The background of the graphic is labeled “Patient Education” and underscores its significance in driving the entire model (Living Well with Low Vision, 2024).

Vision rehabilitation services extend beyond mere sight improvement; they play a crucial role in boosting overall life satisfaction. Occupational therapists (OTs) are indispensable medical professionals who are instrumental in assisting individuals, especially seniors, with low vision to overcome the obstacles associated with their condition. Their services, recognized as crucial medical interventions, encompass a comprehensive approach addressing a myriad of physical, cognitive, and psychosocial factors that influence the rehabilitation process for vision impairments. Occupational therapy services are eligible for coverage under insurance plans (Centers for Medicare & Medicaid Services, 2022). Alongside community and parallel low vision service providers, OTs assist individuals in maintaining, improving, or regaining the ability to engage in meaningful daily activities, contributing to health, wellness, and overall quality of life. This holistic approach transcends physical limitations, addressing the emotional and social repercussions of low vision, thus markedly improving patients’ quality of life and independence. Current practice guidelines for older adults with low vision stress the routine inclusion of low vision rehabilitation to address impairments in daily living activities and instrumental activities of daily living. These guidelines underscore the efficacy of multicomponent interventions in enhancing performance in daily tasks, leisure, and social participation, thereby affirming the critical contribution of OT in the realm of low vision rehabilitation (Kaldenberg & Smallfield, 2020).

OT, specifically, can bolster engagement in leisure and social activities through strategies like problem-solving, combined service delivery, skills training, and skilled home modifications. Programs like the Seniors’ Eye Rehabilitation (SEER), which dispatched specialized low vision occupational therapists to patients’ homes, showed impressive outcomes in enhancing well-being and reducing activity limitations (Tan et al., 2023). The effectiveness of programs like SEER is largely due to a patient-centered approach, where interventions are customized to tackle the unique challenges of each participant, ensuring that the interventions are both relevant and impactful (Tan et al., 2023; Berger et al., 2013). Moreover, the development and execution of OT low vision rehabilitation programs, as evidenced in the research reviewed in Boey & Warren’s 2019 study of a program in Singapore, confirm the viability and success of such initiatives in meeting the needs of visually impaired adults. These programs aim to enhance daily activity performance and life quality, showcasing the potential of OT in low vision care across diverse cultural contexts (Boey & Warren, 2019).

Addressing the psychosocial well-being of older adults with low vision and mental health issues is paramount. Studies indicate that effective coping mechanisms can profoundly affect the quality of life for individuals with low vision or blindness, highlighting the importance of psychological support in vision rehabilitation. OTs, federally recognized as qualified mental health providers, are adept at collaborating with other healthcare professionals to devise and implement effective treatment plans in this domain (Liu & Chang, 2019). Evidence supports the essential role of OT in addressing both the functional and psychological aspects of vision loss (Barber et al., 2021).

OTs uniquely empower clients to maximize their residual vision with functional restorative exercises and meaningful environmental practices, leveraging vision retraining principles to enhance visual functional acuity and reading precision, offering new hope beyond the limitations of low vision (Low Vision Works, 2021). OT low vision specialists can be certified driving specialists as well and offer certified driving rehabilitation services to those with low vision (Association for Driver Rehabilitation Specialists, n.d.). Making environmental adjustments or specific task modifications (including training in the use of technology and contemporary assistive devices where appropriate) are other ways OT collaboratively aids people with low vision in safely maintaining their independence. Simple modifications, such as improving lighting or utilizing contrasting colors, can significantly simplify daily tasks (Rai, Rohatgi, & Dhaliwal, 2019).

OT also plays a crucial role in addressing the social isolation often associated with low vision (Berger et al., 2013). Through personalized interventions, often provided in the home and community environment, OTs enable individuals to reconnect with their communities and rediscover joy in activities they might have considered out of reach. The core of OT lies in its personalized approach—by focusing on each person’s unique needs and goals, therapists ensure that every strategy and intervention is as effective as possible, exemplifying the hallmark of OT in low vision rehabilitation.

In the field of helping people with low vision, there is a wide variety of assistance available. Making these services work effectively involves customizing them for each person’s specific needs, focusing on enhancing safety, independence, and quality of life in daily activities. OTs play a pivotal role in this process, acting as facilitators who guide individuals to appropriate community resources and specialized assistance, thereby expanding the support network for those with low vision. OTs demonstrate an unwavering commitment to making tangible improvements in individuals’ lives by facilitating engagement in meaningful activities, underscoring their essential role on the comprehensive vision care team. Together, all those involved in the recommended low vision rehabilitation care model, are illuminating a path toward a brighter, more accessible future for individuals navigating the challenges of low vision. For further details regarding occupational therapy, vision rehabilitation, and the concepts discussed within this article, please consult the reference list provided.

References

American Academy of Ophthalmology. (2022). Vision Rehabilitation Preferred Practice Pattern®. [PDF document]. Retrieved from https://www.aao.org/education/preferred-practice-pattern/vision-rehabilitation-ppp-2022

American Optometric Association. (n.d.). Vision Rehabilitation. Retrieved from https://www.aoa.org/practice/specialties/vision-rehabilitation?sso=y

Association for Driver Rehabilitation Specialists. (n.d.). Who provides driver rehabilitation services. Retrieved from https://www.aded.net/page/230

Barber, C., Gould, C., Guillermo, G., Dupree, J., McLeer, M., Benevides, T., & Rosche, M. (2021). Interventions in the Scope of Occupational Therapy to Improve Psychosocial Well-Being in Older Adults with Low Vision and Mental Health Concerns: A Systematic Review. Occupational Therapy in Health Care, 35, 397 – 423. https://doi.org/10.1080/07380577.2021.1946733.

Berger, S., McAteer, J., Schreier, K., & Kaldenberg, J. (2013). Occupational therapy interventions to improve leisure and social participation for older adults with low vision: A systematic review. American Journal of Occupational Therapy, 67, 303–311. http://dx.doi.org/10.5014/ajot.2013.005447

Boey, D., & Warren, M. (2019). Implementing an Occupational Therapy Low Vision Rehabilitation Program in Singapore. Journal of Visual Impairment & Blindness, 113, 419 – 432. https://doi.org/10.1177/0145482X19877265.

Centers for Medicare & Medicaid Services. (2022). Home Health Occupational Therapy (LCD No. 34560) [Webpage]. Retrieved from https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=34560

Kaldenberg, J., & Smallfield, S. (2020). Occupational Therapy Practice Guidelines for Older Adults with Low Vision. The American journal of occupational therapy: official publication of the American Occupational Therapy Association, 74 2, 7402397010p1-7402397010p23. https://doi.org/10.7139/2017.978-1-56900-456-2.

Liu, C., & Chang, M. (2019). Interventions Within the Scope of Occupational Therapy Practice to Improve Performance of Daily Activities for Older Adults with Low Vision: A Systematic Review. The American journal of occupational therapy: official publication of the American Occupational Therapy Association, 74 1, 7401185010p1-7401185010p18. https://doi.org/10.5014/ajot.2020.038372.

Living Well with Low Vision. (2024). The Low Vision Rehabilitation Delivery Model. Prevent Blindness. Retrieved from https://lowvision.preventblindness.org/the-low-vision-rehabilitation-delivery-model/

Low Vision Works. (2021). The LVW difference. Retrieved from http://lowvisionworks.com/rehabilitation-program/the-lvw-difference/

Murphy, L. (2023, June 22). How to connect older adults to life-changing vision rehabilitation services. Vision Serve Alliance. Retrieved April 10, 2024, from https://www.ncoa.org/article/how-to-connect-older-adults-to-life-changing-vision-rehabilitation-services

Rai P, Rohatgi J, Dhaliwal U. Coping strategy in persons with low vision or blindness – an exploratory study. Indian J Ophthalmic. 2019 May;67(5):669-676. Doi: 10.4103/ijo.IJO_1655_18. Erratum in: Indian J Ophthalmic. 2022 Feb;70(2):712. PMID: 31007237; PMCID: PMC6498927.

Tan, Y., Tan, A. C. S., Hui, J. H. S., Tang, L. L., & Chen, L. W. (2023). Low vision home therapy service by occupational therapists: The effectiveness of the Seniors’ Eye Rehabilitation programmed—a pilot study. British Journal of Occupational Therapy, 86(5), 359–366. https://doi.org/10.1177/03080226231153340

Medical Director’s Corner:

If you have been watching television lately, you may have noticed a growing focus on age-related macular degeneration (AMD). There are at least four companies currently investing in direct-to-consumer campaigns to raise awareness about AMD. This increased spending on advertising and research reflects the rising awareness and commitment to addressing this condition.

This year, the Macular Degeneration Association (MDA) will continue to invest in research, building on the significant advancements already underway and the promising developments on the horizon. As a result, being an AMD patient today holds more promise than ever before.

MDA also allocates resources to education. This year, we will host over a dozen in-person conferences and a similar number of virtual webinars. While the in-person conferences primarily focus on AMD, they also cover related topics such as diabetic retinopathy and dry eyes.

If you can attend one of our upcoming conferences, I strongly encourage you to do so. If not, there will be additional opportunities next year.

Our virtual webinars provide a convenient way to learn about a variety of topics from the comfort of your own home.

Please utilize our website to take advantage of all we have to offer. And when a friend or family member have questions about AMD, please guide them to MacularHope.org. You can be their hero!

Jeffry D. Gerson, O.D., F.A.A.O.

Medical Director

Macular Degeneration Association

Diabetes Linked to Other Eye Diseases

By: A. Paul Chous, MA, OD, FAAO

Diabetes is linked to a number of eye diseases, including dry eye (ocular surface disease), cataract (clouding of the eye’s internal lens), eye muscle paralysis (cranial nerve palsy), glaucoma (optic nerve damage usually, but not always caused by high internal eye pressure), optic nerve stroke (anterior ischemic optic neuropathy) and diabetic retinopathy (DR – damage to the eye’s light-sensitive internal lining, the retina, which can result in severe vision loss if not detected and treated in a timely fashion).

DR affects about 10 million Americans and, like age-related macular degeneration (AMD), often causes few or no symptoms in its early stages. Some studies have linked DR to increased AMD risk and vice versa, though the link is not strong. Both eye conditions, however, have been linked to eating a lot of unrefined carbohydrates, so it is wise to limit consumption of sugar-laden foods (soda, snacks, starchy vegetables like rice/corn/potatoes, even salad dressings). I tell patients to limit intake of refined carbohydrates to no more than 30 grams per day and focus on eating non-starchy vegetables, lean protein like cold-water, fatty fish and healthy fats like avocado and tree nuts (walnuts, almonds, hazelnuts linked to lower risk of eye disease, heart disease, diabetes, and dementia).

The best ways to avoid vision loss from diabetes include not getting diabetes (dietary advice above plus regular exercise -walking 30 minutes daily – and not smoking). Regular visits to your eye doctor to detect problems early is also of great importance. These exact same strategies also lower the risk of getting AMD and losing vision.

This article is the property of the Macular Degeneration Association & Dr. Chous. You must ask for permission to use it.

Geographic Atrophy – Yesterday, Today And Tomorrow

Leo Semes, OD, FAAO for the Macular Degeneration Association

The enigma of geographic atrophy (GA) is slowly crystallizing. In the decades before the 2020’s, it was thought that nothing could be done once the condition was diagnosed, short of visual aids for specific tasks. In fact, one of my most memorable patients attended for examination in his late 50s complaining that he was unable to follow his golf ball on his tee shot. Over about thirty years of visits, his condition took a course of relentless progression ultimately limiting his daily activities. He resorted to books on tape and requiring his wife to be his major source of transportation. Supplementation using the AREDS formulation was offered and implemented but showed no benefit.

That was the unfortunate past. Recent research has led to the introduction of two FDA-approved medications to limit the progression of GA. Each of these is administered by injection into the eyeball. The choice of optimal candidacy for the treatment is now directed by sophisticated clinical imaging using optical coherence tomography (OCT), a study that may have been ordered by your eyecare provider. The medications approved by the FDA are Syfovre® and Izervay®. Currently, there are commercials on television that you may have seen. Practical recommendations for patients diagnosed with GA include smoking cessation, enhancing physical activity and maximizing dietary potential (following a Mediterranean diet and avoiding foods from drive-thru, those advertised on TV or offered via vending machines).

Looking over the horizon, clinical trials are currently being conducted with brimonidine, which may be recognized by those being treated for glaucoma. Elamipretide, already approved in the EU, is being studied for its application to GA. Photobiomodulation, red-light therapy, which has been invoked for skin and joint disorders has shown promise among a cohort of patients with early and intermediate GA. Finally, it has been reported that metformin use, among patients with diabetes, is associated with a lower prevalence of GA. The news regarding GA is, “Stay tuned, promising things are happening.”

MATTERS OF VISION! 2024 In-Person Program Series

Learn about the latest developments, treatments & research for macular degeneration, diabetic eye disease and low vision.

September 14th— Detroit, MI — Doubletree Detroit Dearborn — 5801 Southfield Expressway Detroit, MI 48228 — Dr. Brown

September 21st— Hauppauge, NY — Hyatt Regency Long Island — 1717 Motor Pkwy, Hauppauge, NY 11788 — Dr. Weber

October 5^th — Clearwater, FL — Ruth Eckerd Hall — 1111 McMullen Booth Rd, Clearwater, FL — Dr. Deupree

October 19^th — Doubletree @ Bell Tower Shops Fort Myers, FL — 13051 Bell Tower Dr., Fort Myers, FL 33907 — Dr. Semes

Please visit MacularHope.org/programs/for additional in-person & virtual programs.

Registration required for all programs. (Conference dates and locations subject to change.)

To register for in-person programs please call (855)962-2852.

Please visit our website to register for virtual programs.

We look forward to welcoming you.

THE GOOD NEWS ABOUT AMD IN 2024

Pamela A. Lowe, OD, FAAO, Dipl. ABO

Age-related macular degeneration (AMD) has traditionally been a disease synonymous with debilitating central vision loss that too often led to the need for specialty low vision care. Past studies have reported that 78% of patients first diagnosed with this disease present for treatment with irreversible vision loss including 37% who are legally blind in at least one eye.1 2 As with many chronic diseases, AMD severity is measured on a spectrum, and the sooner doctors, patients and caregivers are aware of its presence, the sooner everyone can work together to protect against it.

A study in 2019 estimated a staggering 18+ million Americans, aged 40 years and over, are living with early-stage AMD, and nearly 1.5 million have late-stage (advanced) AMD.3 As with any sight-threatening condition, the goal is to identify who is at risk and how to mitigate disease progression. Timely, consistent eye care is every adult’s first line of defense in identifying risk factors and instituting treatment plans that are critical in delaying the onset and slowing potential progression. With age being the biggest risk factor for this condition along with family history (genetics) and ethnicity (Caucasian) being the non-modifiable risk factors4, adults should have yearly comprehensive eye examinations to enable their eye care team the opportunity to fully educate them on the modifiable risks of macular degeneration which include:

Smoking
High Cholesterol
Cardiovascular Disease
Diabetes
Obesity
Chronic sunlight (UV) exposure

It is essential the primary eye care physician, not only educate but prescribe the appropriate lifestyle modifications and UV protecting eyewear to help patients reduce the risk of converting to and/or progression of early disease. Since smoking is the greatest of modifiable risk factors (2.5-4.8 times higher risk)5, it is imperative that patients are given and seek out resources to help with smoking cessation. Keeping fit with moderate, consistent exercise (which includes 150 minutes of cardiovascular exercise per week) along with adopting a healthy diet rich in phytonutrients and antioxidants is not only heart healthy, but it also supports macular health. The Ocular Wellness & Nutrition Society and the American Nutrition Association recommend a Mediterranean Diet rich in plant-based foods focusing on a rainbow spectrum of colors, fiber rich whole grains, healthy fats such as extra virgin olive oil, and a variety of spices and fresh or dried herbs along with nuts and seeds. Healthy animal protein sources such as fish and seafood along with poultry and eggs while limiting red and processed meats and avoiding all sodas, high fructose corn syrup, commercial fruit juice and ultra processed foods is also advantageous6 7.

Past studies like the AREDS (Age-Related Eye Disease Study) and AREDS 2, found that nutritional supplements were beneficial for slowing AMD progression in patients with intermediate stage to advanced stage. It was commonplace for many doctors to wait until patients were in the intermediate stage of AMD before prescribing supplements. Fortunately, many studies since, have now shown that supplementing those at risk in early-stage AMD is also beneficial in slowing progression. Carotenoids are pigments found in nature that protect. The two carotenoids in our food supply that find their way to protect the macula are lutein and zeaxanthin. Lutein and zeaxanthin are found in foods like egg yolk, fish, corn, spinach, broccoli and carrots; supplementing these carotenoids has been shown to not only improve macular function8 in the normal, healthy macula, but also helps protect the macula from the damaging effects of blue and ultra-violet light9. It’s important to ask your primary care eye provider if you are a candidate for carotenoid nutraceuticals and get a recommendation for the best formula to align with your clinical needs.

To aid in more timely and accurate diagnoses of AMD, many clinicians have utilized technology that goes beyond assessing the physical macular structure. The traditional stages of macular degeneration are all based on structure changes in the macula with either cholesterol deposits (drusen) or pigment disruptions. Here are the classifications along with symptoms:

Early AMD—vision is still good yet night vision problems may be reported, medium size drusen are present (>63microns and <125 microns), no pigmentary abnormalities.
Intermediate AMD—blur or spot in the center of vision with night vision difficulties and decreased contrast sensitivity. Some pigmentary abnormalities may be present and at least one druse >125 microns is present.
Advanced AMD—vision loss is noticeable due to geographic atrophy (GA) or choroidal neovascularization (CNV) or wet AMD.

Macular function can now be measured at a higher level with dark adaptation testing. The photoreceptors responsible for night vision (known as rods) are the first to lose function when the retina starts becoming sick from the earliest of AMD changes. Dark adaptation testing measures how quickly the eye adapts to going from normal daylight to dark illumination, which studies have shown can detect AMD up to three years earlier than traditional structure examination and/or imaging.10 Delayed dark adaptation time is the earliest biomarker for identifying AMD and has added a fourth, new AMD classification to precede the original three.

Subclinical AMD—vision is still intact, there is no presence of drusen or pigmentary changes, noting delayed dark adaptation time of greater than 6.5 minutes.

So, the very good news about macular degeneration is with today’s advancements in early detection, patients need not feel powerless when it comes to managing this condition. Early diagnosis leads to early intervention which slows disease progression thus improving visual outcomes. With the ever-increasing numbers of patients currently diagnosed with early AMD, and technology available to identify and treat those with subclinical AMD well before visible structure changes and the loss of central vision, eye care professionals and patients can take charge of this condition for a brighter future.

References

1 Olsen TW, Feng X, Kasper TJ, Rath PP, Steuer ER. Fluorescein angiographic lesion type frequency in neovascular age-related macular degeneration. Ophthalmology. 2004;111(2):250-255. doi:10.1016/j.ophtha.2003.05.030.

2 Cervantes-Castañeda RA, Banin E, Hemo I, Shpigel M, Averbukh E, Chowers I. Lack of benefit of early awareness to age-related macular degeneration. Eye. 2007;22(6):777-781. doi:10.1038/sj.eye.6702691

3 Rein DB, Wittenborn JS, Burke-Conte Z, et al. Prevalence of Age-Related Macular Degeneration in the US in 2019. JAMA Ophthalmol. 2022;140(12):1202–1208. doi:10.1001/jamaophthalmol.2022.4401

4 Age-Related Macular Degeneration (AMD) Data and Statistics. National Eye Institute. https://www.nei.nih.gov/learn-about-eye-health/resources-for-health-educators/eye-health-data-and-statistics/age-related-macular-degeneration-amd-data-and-statistics. Accessed 19 November 2020

5 Chakravarthy U, Augood C, Bentham G, et al. Cigarette smoking and age-related macular degeneration in the EUREYE Study. Ophthalmology. 2007;114(6):1157-1163.

6 OcularNutritionSociety.org

7 theANA.org

8 Herman JP, Goudey SJK, Davis RL. Case report of dietary supplements improving macular pigment and visual function. Adv Ophthalmol Vis Syst. 2017;6(1):24-35. DOI: 10.15406/aovs.2017.06.00166

9 Kumar P, Banik SP, Ohia SE, Moriyama H, Chakraborty S, Wang CK, Song YS, Goel A, Bagchi M, Bagchi D. Current Insights on the Photoprotective Mechanism of the Macular Carotenoids, Lutein and Zeaxanthin: Safety, Efficacy and Bio-Delivery. J Am Nutr Assoc. 2024 Aug;43(6):505-518. doi: 10.1080/27697061.2024.2319090. Epub 2024 Feb 23. PMID: 38393321.

10 Owsley, Cynthia, Gerald McGwin, Mark E. Clark, Gregory R. Jackson, Michael A. Callahan, Lanning B. Kline, C. Douglas Witherspoon, and Christine A. Curcio. “Delayed Rod-Mediated Dark Adaptation Is a Functional Biomarker for Incident Early Age-Related Macular Degeneration.” Ophthalmology, October 30, 2015. doi:10.1016/j.ophtha.2015.09.041.

PRESERVE & PROTECT YOUR VISION DONATE TODAY

Without ongoing contributions from generous donors like you, the Macular Degeneration Association would be

unable to fund Research and Education for the millions of people living with macular degeneration.

HOW TO GIVE

Phone, Mail or Online

Phone: Please call (941)893-4387 today to speak to one of our Donor Services Representatives.

Mail: Send your check or money order today payable to:

MACULAR DEGENERATION ASSOCIATION

5969 Cattleridge Boulevard, Suite 100 | Sarasota, FL 34232

Online: Please visit www.macularhope.org today and click on the Donation tab.

Stocks, Securities, Mutual Funds and IRAs

Please give serious consideration to the donation of stock and mutual fund shares as this offers numerous opportunities

to make a most gracious gift and receive tax advantages.

Wills, Bequests and Planned Gifts

Please give serious consideration to the designation of MDA in your Will, Charitable Trusts, Life Insurance, Appreciated

Securities and Real Estate as this offers preplanned giving opportunities that will serve the macular community for

years to come. Please call Lynne Henry (941)893-4389 at the Macular Degeneration Association, today, for personal

assistance in initiating this effort.

The following language has been reviewed and is deemed a legally acceptable form for including such a bequest in a will:

“I give and bequeath to the Macular Degeneration Association, 5969 Cattleridge Blvd. Suite # 100 Sarasota, FL 34232

for discretionary use in carrying out its aims and purposes, (the sum of $_____) or ( a sum equal to _______% of

the value of my gross estate at the time of my death under this will or any codicil hereto).”

The Macular Degeneration Association Federal ID number is 27-3025707

MEMORIAL AND HONOR GIVING

Honor a family member, friend or special event by donating to MDA. Pay tribute to someone you love whose life

has been impacted by macular degeneration. In lieu of flowers, please consider designating Macular Degeneration

Association as your charity of choice.

WORKPLACE GIVING

Launch a Giving Campaign

Please consider leading a team at work by encouraging your colleagues and staff to join together to help those

living with macular degeneration. Launch a workplace giving campaign today.

Ask about Matching Gifts

Many gracious employers double or even triple charitable donations made by individual employees. Some companies

will match gifts made by retirees and or their spouses. Contact your employer for matching gift eligibility

as this allows you to maximize your personal donation.

Thank you!