RETINA SPECIALIST AND OPTOMETRIST CO-MANAGEMENT OF AMD PATIENTS

Eye care professionals can partner for optimal patient care.

By Jeffry Gerson, OD;

Rishi P. Singh, MD

Although age-related macular degeneration (AMD) is a leading cause of vision loss for Americans 50 and older,1 many people do not currently have the condition on their radar. When facing a diagnosis, patients often feel unsettled as a result of an overall lack of awareness of the condition. Those who are familiar with AMD typically associate it with intravitreal eye injections, usually because someone they know has an advanced stage of the disease, which leads patients to feel even more intimidated. The most effective AMD treatment typically requires a multidisciplinary care team, which can be comprised of optometrists and retina specialists. Having a strong, collaborative relationship with all members of the team is critical not only to ease some of the understandable apprehension that patients experience after an AMD diagnosis, but also to help ensure effective treatment over the patient’s lifetime. This article will present a few ways optometrists and retina specialists can work side by side to best manage and support patients with AMD. IDENTIFYING AND CONFIRMING THE

DIAGNOSIS Age-related macular degeneration is most often detected first by optometrists because they are typically responsible for administering annual dilated eye exams. As a result, they tend to be the first to inform patients of the diagnosis as well as to explain what the diagnosis means — how it can impact their sight, and their life, now and in the future. Following the diagnosis, some optometrists might choose to refer patients to a retina specialist immediately. Others may wait until they see worsening progression. Given that each diagnosis and situation is unique, the appropriate time to refer an AMD patient to a retina specialist varies, but sometimes optometrists refer patients too late because they are concerned about overburdening them. To ensure appropriate referrals, the optometrist should lean on AAO guidelines and communicate with the retina specialist directly to discuss at what point they would prefer or expect to see patients. Typically, there is an urgency to refer patients with suspected exudative (wet) macular degeneration, but in those with intermediate AMD or geographic atrophy, routine referral within a few weeks may be a reasonable approach.

Optometrists and retina specialists can also discuss the possibility of masquerading syndromes or other conditions that may cause retinal problems that can look like AMD, potential options for therapy depending on diagnosis and stage, or other clinical issues as they arise. Doing so collaboratively allows them to holistically determine the appropriate next step in the patient’s treatment plan. After the diagnosis has been confirmed, retina specialists tend to lead the AMD patient’s treatment and management plan, while keeping the optometrist informed as to the patient’s progress, as appropriate. Optometrists can — and should — continue to help these patients even when undergoing treatment by providing them the best refraction, offering low-vision aids, and further educating on warning symptoms and signs to watch for.

SUCCESSFULLY CO-MANAGING THE CONDITION

When it comes to successfully co-managing AMD, communication across the care team and with the patient should be a top priority. Following an AMD diagnosis, optometrists should encourage patients to ask their retina specialists specific questions (once they have examined the patient and confirmed the diagnosis) and voice any concerns. Retina specialists should be prepared to answer patient inquiries and requests with the appropriate information and resources on hand. Retina specialists should also ask optometrists for the results of the patient’s vision, eye pressure, and imaging tests along with any comorbidities prior to the appointment with the patient. Patient education should start as soon as the diagnosis is confirmed. While an optometrist will likely be the one to begin the conversation with the patient, retina specialists should continue to educate and empower patients during each appointment. This will help to mitigate the anxiety that often lingers after a diagnosis and ensure they are taking the right actions to manage their condition. Both eye care professionals should reiterate why the referral was necessary (i.e., “As a specialist, I’m able to do even further testing than what your optometrist has available”) and the reasoning for the timing of the referral. The message consistency goes a long way in sustaining patient confidence and comfort.

A FOCUS ON SLOWING THE PROGRESSION

While there is no known way to reverse AMD, there are ways patients can help slow its progression. Both optometrists and retina specialists play a large role in communicating these steps to their patients. The National Eye Institute (NEI) AREDS2 10-year follow-on study results were recently published and they demonstrate continued efficacy in reducing the risk of moderate to advanced AMD progression with a specific eye vitamin formulation: vitamin C (500 mg), zinc (80 mg), copper (2 mg), vitamin E (180 mg), lutein (10 mg), and zeaxanthin (2 mg).2 Taking these supplements may help reduce the risk of progression from intermediate to advanced AMD by about 25%, yet 64% of patients with moderate to advanced AMD are not currently taking an AREDS2 formula eye vitamin.3,4 We have seen misconceptions in the industry that any multivitamin can have this impact, but this isn’t supported by science or rigorous clinical trials. Many AMD patients are not having proactive conversations with their optometrists or retina specialists about the benefits of the AREDS2 formulation — and getting education on the two decades of data that backs up that recommendation. In reality, many people are unaware that eye vitamin formulas even exist and the tangible impact they have been proven to have. One of the most essential recommendations retina specialists should provide to their patients with moderate to advanced AMD is a twice-daily AREDS2 formula eye vitamin. The AREDS2 eye vitamin formulation recommendation that has been studied and proven by the NEI to work simply cannot be obtained from diet alone. This specific eye vitamin formula should be taken in addition to any other multivitamins or supplements a patient is currently taking. Although patients with mild AMD were not a part of the AREDS and AREDS2 clinical studies, many professionals recommend an eye vitamin formula that includes lutein, zeaxanthin, and other antioxidants for eye health. ENCOURAGING HEALTHY LIFESTYLE CHANGES Given that AMD is a condition patients will have for life, both eye care professionals can encourage ongoing healthy lifestyle changes to patients at every appointment to help reduce their risk of AMD progression. Optometrists and retina specialists should be aligned in terms of what they are sharing with patients during follow-up visits so there is message consistency. It is important to reiterate the steps patients can take every day to help reduce their risk of progression, such as taking an AREDS2 formula eye vitamin and adopting

a healthy lifestyle.

Two European studies found participants with AMD who closely followed a Mediterranean diet rich in fruits, vegetables, fish, whole grains, legumes, and olive oil were 41% less likely to develop advanced AMD compared to those who did not.5 Daily exercise can also help reduce the risk of progression. If your patient is not currently active, you can recommend that they ease into aerobic activity with things like swimming, cycling, brisk walking, or even yard work. Lastly, it is extremely important that a patient’s care team is clear about the benefits of smoking cessation. A smoker likely already knows the associated risks of tobacco use, but it is important for optometrists and retina specialists to reiterate the benefits that quitting has on eye health. People who smoke have up to 4 times the risk of developing AMD compared with people who do not.4 Take the time to have a thoughtful discussion with patients about these specific lifestyle changes they can make to help slow AMD progression and make sure these conversations are consistently happening throughout their care. In addition to these lifestyle recommendations, providing patients with the tools they need to track AMD progression on their own also gives them the opportunity to take an active role at home by taking charge of

monitoring their eye health. Take-home materials like an Amsler grid should be provided to patients after a diagnosis as part of their initial visit. We recommend writing this down so patients can refer back to their takehome materials that explain key AMD terminology and outline the suggested lifestyle changes and supplements they can take to help protect their vision. Many patients will continue to see their optometrist and retina specialist, as both perform different functions and routine follow-ups with both are important to properly track progression. Followup appointments allow the care team to reiterate the healthy lifestyle recommendations and the benefits of taking an AREDS2 formula eye vitamin. Even with routine follow-ups scheduled, any reported changes in vision between appointments warrants a visit to either eye care professional in case there is a new occurrence of wet AMD. Retina specialists can also inform patients of online resources like the Macular Degeneration Association website (MacularHope.org ), or groups like sightmatters.com that offer AMD patients a sense of community that they can lean on for support and to learn about the journeys of other patients.

CONCLUSION

Many optometrists see their patients for years and have built long-term, trusting relationships and it’s important that retina specialists continue that supportive momentum. While an AMD diagnosis can lead to uncertainty among patients, an open, collaborative partnership between optometrists and retina specialists can alleviate some of the fear patients have about AMD and help patients feel more confident about their AMD journey. RP Jeffry Gerson, OD, is a fellow of the Academy of Optometry and the Optometric Retina Society, and a member of the American Optometric Association and the Kansas Optometric Association. Rishi P. Singh, MD, is a staff physician at the Cleveland Clinic in Florida and president of Cleveland Clinic Martin hospitals. The authors report no relevant disclosures. Reach Dr. Singh at drrishisingh@gmail.com. Editor’s note: Hear discussion of this article on the Retina Podcast at www.retinapodcast.com .

REFERENCES

1. Centers For Disease Control and Prevention. Learn about agerelated

macular degeneration. Accessed September 27, 2022.

https://www.cdc.gov/visionhealth/resources/features/maculardegeneration.

html#:~:text=AMD%20is%20a%20major%20

cause,vision%20needed%20to%20see%20clearly

2. Chew EY, Clemons TE, Agrón E, et al. Long-term outcomes

of adding lutein/zeaxanthin and ω-3 fatty acids to the areds

supplements on age-related macular degeneration progression:

AREDS2 Report 28. JAMA Ophthalmol. 2022;140(7):692-698.

doi:10.1001/jamaophthalmol.2022.1640

3. AMD, age-related macular degeneration; AREDS, Age-related

Eye Disease Study. Data on File at Bausch + Lomb.

4. Age-Related Eye Disease Study Research Group. A randomized,

placebo-controlled, clinical trial of high-dose supplementation

with vitamins C and E, beta carotene, and zinc for age-related

macular degeneration and vision loss: AREDS report no.

8 [published correction appears in Arch Ophthalmol. 2008

Sep;126(9):1251]. Arch Ophthalmol. 2001;119(10):1417-1436.

doi:10.1001/archopht.119.10.1417

5. Merle BMJ, Colijn JM, Cougnard-Grégoire A, et al. Mediterranean

diet and incidence of advanced age-related macular degeneration:

The EYE-RISK consortium. Ophthalmology. 2019;126(3):381-390.

doi:10.1016/j.ophtha.2018.08.006

Retinal Physician, Volume: 19, Issue: November/December 2022,

page(s): 28-30

Permission granted by Jeffry Gerson, OD, FAAO to use this article.

Chairman’s Column | Winter Edition 2023

 

Dear Friends,

As 2023 begins I sit and reflect on the past year. Research has come so far in such a short time. There have been advances made and failures acknowledged. The future looks bright with new technology and new treatments coming in 2023. In the New Year we maintain our vision to support research to find a cure. Our organization is not content to rest on its laurels but persists forward to build its programs, innovate and lead. We will continue to generate new programs in response to emerging needs of the senior population, adults and young adults diagnosed with devastating eye diseases that can lead to Blindness. In 2022 we completed 14 robust educational programs throughout the United States reaching over 1,300 people and 6 virtual meetings reaching 650 people.

Our educational programs are designed to give the participants a better understanding of their eye disease. At these programs current information involving research, treatments, new medications, risk factors and genetic predisposition is provided. All program information is offered by a specialist in their field with access to the doctor. The participants leave the program with necessary tools to make informed decisions about their treatment options thus providing a better quality of life and visual outcomes. Thank you for your continued support of the Macular Degeneration Association.

Sincerely,

Lawrence S. Hoffheimer,

Chairman Macular Degeneration Association

ENSURE YOUR MEDICATION SAFETY WITH FREE TALKING PRESCRIPTION LABELS

As we battle Macular Degeneration, it may become more difficult to read the small print on

prescription bottles. Ensuring medication safety is vital to avoiding illness and hospitalization.

Help is available in the form of ScripTalk Talking Prescription Labels. These are available for free at hundreds of participating pharmacies in Florida and will help you access all the prescription label information out loud. Simply let your pharmacist know you would like these labels or call En-Vision America directly to request them and we’ll get you set up with a pharmacy. The pharmacist will place a small electronic tag on your prescription bottle and you can use a free ScripTalk Station Reader or the ScripTalk Mobile App to hear all the label information out loud, including doctor name, medication name, dosage, instructions, warnings and more. Florida participating pharmacies include Florida Health Care Pharmacy, Publix, Walmart, Sam’s Club, Winn-Dixie and many independent pharmacies. CVS Retail offers SpokenRx, which is similar. Mail orders that offer ScripTalk include Humana (CenterWell), CVS Caremark, Kaiser Permante, Accredo, Aetna, Express Scripts, OptumRx and more. To find a participating pharmacy near you, visit www.envisionamerica.com and scroll to the bottom of the page where you’ll see a link for “Find a Participating ScriptAbility Pharmacy.” Simply enter your ZIP code or allow the app to access your location and it will bring up participating pharmacies near you. You can also call 1-800-890- 1180 and we’ll answer any questions you may have and get you set up with a participating pharmacy.

The Macular Degeneration Association would like to announce the following doctors to our Medical Board and Blue Ocean West Clinical Research.

Christine Kay, MD – Dr. Kay has a special interest in inherited retinal disease and is actively involved as an investigator in multiple clinical trials at VRA involving Stargardt disease, Achromatopsia and Usher syndrome. She was previously an Assistant Professor at the University of Florida, and is currently Affiliate faculty at the University of South Florida. Dr. Kay was recently inducted into Retina Society in 2017 and received an honor award from American Society of Retina Specialists in 2012. She practices at the Vitreo Retinal Associates with locations in Gainesville, Lake City & Ocala, Florida.

Marc H Levy, MD – Neuro-Ophthalmology and Orbital Surgery Specialist. Board-Certified Ophthalmologist. Fellowship Trained in Neuro-Ophthalmology. Fellowship Trained in Orbital Surgery Dr. Levy has been with Sarasota Retina since 1986 and is married with 4 children and 4 grandchildren. Dr. Levy was an undergraduate at Tulane University (Chemistry) and received his B.S. Degree (with Honors) in 1978 from the University of Miami. From there he went on to receive his M.D. Degree from the University of Miami School of Medicine in 1981. Dr. Levy did his Internship in Internal Medicine (1981-1982) and Residency in Ophthalmology (1982-1985) at the Alton Ochsner Medical Foundation Hospital in New Orleans, Louisiana. During his residency in 1984, he was invited to spend a resident fellowship at the Bascom Palmer Eye Institute in Miami, Florida and study under J. Lawton Smith, M.D. a prominent Neuro-Ophthalmologist. He performed the first Implantable Miniature Telescope (IMT) in the state of Florida in 2002 as part of the multicenter FDA National Trial and was the lead eye surgeon in Florida. Dr. Levy is affiliated with Sarasota Memorial Hospital, Sarasota Physicians Surgical Center and the University of South Florida where he holds the rank of Associate Professor of Ophthalmology. Dr. Levy also acts as a team physician ophthalmologist for the Tampa Bay Rays, donating his time since 2013. Currently doing clinical trials with Samsara Vision on the new Implantable Miniature Telescope

Dana Deupree, MD – Dana M. Deupree, M.D., F.A.C.S. is a boardcertified  ophthalmologist, retina specialist, managing diseases of the vitreous and retina and serving the Tampa Bay, Florida area. As a retina specialist, Dr. Deupree focuses on medical and surgical management of macular disorders, diabetic retinopathy, complex retinal detachments and trauma. In 2003, after 12 years as vitreo-retina specialist and surgeon at St. Luke’s Cataract & Laser Institute in Tarpon Springs, Florida, Dr. Deupree opened his solo practice in Palm Harbor, Florida. In November of 2010, Dr. Deupree built and opened a state-ofthe-art retina clinic and surgery center in Clearwater where The Macula Center is now located. The Macula Center is devoted exclusively to treatment of the vitreous, retina and macula. Dr. Deupree is a Fellow of the American Academy ofOphthalmology and the American College of Surgeons. He also formerly served as clinical assistant professor at the University of South Florida, Tampa. He received his medical degree from the American University of the Caribbean in 1983. He was a Harvard Research Fellow on a National Eye Institute grant in Boston with a focus on diabetic eye disease. His internship and residency were completed at St. Francis Medical Center in Pittsburgh, PA. He received his subspecialty training in retina after completing a two-year fellowship at Tulane University, New Orleans, Louisiana. After fellowship training he entered practice at St. Luke’s. Current research interests have included Rheopheresis treatment for macular degeneration being the principal investigator in a phase three FDA clinical trial.

Blue Ocean West Clinical Research (BOCRW):

Seeking dramatic improvements in ophthalmic care Blue Ocean Clinical Research West is composed of a seasoned research staff at the renowned Florida retina practice, The Macula Center. Specializing in retina research, BOCRW will continue to expand into all fields of ophthalmology and other pertinent

medical fields. Doctors Deupree, Macoul and Lin are currently accepting new patients who they are screening for possible research trial candidates. To schedule an appointment to be evaluated for

studies inclusion, call The Macula Center today at (727) 789-8770.

Woman’s Vision and High Blood Pressure

By: Dr. Pamela Weber, MD

Blood pressure is an extremely important factor to consider when monitoring your health. Not only does it pose a risk to organs like the heart and liver, but it can also affect your eyes. Many individuals are at increased risk for high blood pressure. Lifestyle choices can put individuals at high risk. For example, a sedentary lifestyle, a poor diet, excessive stress, moderate to high alcohol intake, and lack of exercise put individuals at higher risk for high blood pressure. In addition, having a family history of high blood pressure or diabetes can also put an individual at increased risk. One of the less talked about risks for high blood pressure is gender. High blood pressure is a major threat to anyone’s health, but women are at increased risk. Blood pressure elevation begins earlier in life for women and increases at a quicker rate as women age. Also, research has shown that standard noninvasive blood pressure diagnostics may not be as accurate for women as men. Blood pressure readings are modified for certain variables like arm circumference, but are not modified for sex. Obviously the male and female bodies differ in many ways, therefore if there are less accurate blood pressure readings for women, there is an increased risk for undetected elevated blood pressure. Beyond diagnostic methods possibly putting women at increased risk, women’s risk of high blood pressure increases after menopause. The female body undergoes various changes during menopause

including changes in body weight and hormone levels. These changes can increase the risk of high blood pressure. Also, there is a specific form of high blood pressure that can occur during

pregnancy called preeclampsia. Symptoms of high blood pressure are hard to recognize because the symptoms are extremely generic. High blood pressure symptoms are headaches, fatigue, shortness of breath, and chest discomfort. Some women show no detectable symptoms at all. The effects of high blood pressure on eyesight can be detrimental. High blood pressure can damage the blood vessels in your eye. If the blood vessels in the back of your eye are damaged, you can develop hypertensive retinopathy, which can cause eye swelling, impaired vision, and headaches. In addition, high blood pressure can also cause fluid to build up under the retina, which can cause scarring and distorted vision. Also, High blood pressure can restrict blood flow and damage the optic nerve, which can cause bleeding, vision impairment or even vision loss. To protect yourself from the consequences of high blood pressure, ensure that you constantly check your blood pressure. The earlier that elevated blood pressure is detected, the better. If high blood pressure is detected early, it is more manageable, and damage can be prevented with treatment. Normal blood pressure is lower than 120/ 80 mmHg. Elevated blood pressure is between 120- 129/ <80mmHHg. Hypertension, stage 1 is between 130-139/ 80 -< 90 mmHg. Lastly, Hypertension, stage 2 is 140/ 90 mmHg or higher. High blood pressure is preventable and manageable. Beyond frequently checking your blood pressure, you should maintain a healthy body weight, eat a well-balanced diet, limit processed foods, limit your salt intake, exercise, make healthy lifestyle choices and see your doctor regularly. Lastly, don’t forget about your eyes. High blood pressure can astronomically impact your eye health. If you are experiencing elevated blood pressure or are managing high blood pressure. When you are diagnosed with high blood pressure or diabetes, see us at Island Retina regularly to monitor your sight. For more detailed information about how Island Retina can help you see a brighter future, call us at one of our 2 convenient locations: Commack, NY 631-486-6672 or Shirley,

NY 631-924-4300. You can also reach us by email through

our website’s secure contact page.

Permission to use this article given by Pamela Weber, MD

We are pleased to announce the retina and optometric practices awarded the distinction of AMD Centers of Excellence!

Allisonville Eye Care (Fishers, IN)

Brown Retina Institute (San Antonio, TX)

Carolina Eye Associates, P.A. (North & South Carolina)

Chous Eyecare Associates (University Park, WA)

Central Optometry (London, Ontario)

Dr. Dorothy L. Hitchmoth, PLLC (New London, NH)

Eye Associates of Boca Raton, P.A. (Boca Raton, FL)

Eye Care Plus, LLP (Amarillo, TX)

Eyes on Sheppard (North York, Ontario)

Grin Eye Care (Leawood, KS)

In Focus Eyecare (Sarnia, Ontario)

Integrative Vision (Shrewsbury, NJ)

Island Retina (Shirley, NY)

Joseph R. Podhorzer, MD, PLLC (Brooklyn, NY)

Laguna Eyes Optometry (Laguna Beach, CA)

Lipski Eye Center, PC (Lewisburg, PA)

Low Vision Doctors of Ohio (Columbus, OH)

Low Vision Optometry of Southern California (Mission

Viejo, CA)

Low Vision Specialists of Maryland & Virginia

(Timonium, MD)

Marshall EyeCare Physicians, PC (Holmdel, NJ)

Memorial Vision, PA (Houston, TX)

Mississippi Retina Associates (Jackson, MS)

MyEyeDr (Acworth, GA)

Ophthalmic Physicians Inc. (Mentor, OH)

Ophthalmology Associates PSC (Louisville, KY)

Optimal Vision Care (Medford, OR)

Orange County Retina (Santa Ana, CA)

Pacific Eye Surgery Center (Honolulu, HI)

Palmetto Retina Center, LLC (West Columbia, SC)

Paul Vision Institute (Wilmington, NC)

Philadelphia Retina Associates (Plymouth Meeting, PA)

Premier Vision Group (Bowling Green, OH)

Professional Eye Care Center (Niles, IL)

Rancho Mirage Eye Care + Optometry (Rancho

Mirage, CA)

Retina Associates of Orange County (Laguna Hills, CA)

Retina Associates of Western NY, P.C. (Rochester, NY)

Retina Consultants of Southern Colorado, P.C. (Colorado

Springs, CO)

Retinal Consultants of Texas (San Antonio, TX &

Houston, TX)

Rouse Family Eye Care (Sunrise, FL)

Sarasota Retina Institute (Sarasota, FL)

Sight Improvement Center, Inc. (New York, NY)

Southern Montana Optometric Center (Laurel, MT)

The Macula Center (Clearwater, FL)

The Retina Center of St. Louis (St. Louis, MO)

The VitreoRetinal Eye Center (Biloxi, MS)

Toronto Integrated Eye Care (Etobicoke, Ontario)

Upper Richmond Optometry (Arva, ON)

Vision Center of Lake Norman (Mooresville, NC)

Vitreo Retinal Associates (Gainesville, FL)

 

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!