I contend that optometrists should have the same passion for diagnosing and managing age-related macular degeneration as the other conditions they oversee because patients who have the central-vision stealing condition also depend on them for guidance.
Consider the 61-year-old Caucasian patient who presents with 20/20 vision, reduced contrast sensitivity, a blonde fundus, flat macula with the absence of drusen and subtle, non-specific macular pigment changes in one eye and a family history of AMD.
This patient, as is the case with our glaucoma and dry eye disease patients, as examples, is looking to optometry for answers and guidance; we have both the knowledge and skill set to provide it in the following ways:
EARLY, ACCURATE AND THOROUGH DIAGNOSIS
The NIH reports that in 2010 over 2 million Americans suffered from AMD, and that this number is anticipated to almost double by 2030 — 10 years from now — with a projected 5.6 million by 2050. What does this data tell us? The answer is that diagnosis, in every sense of the word, is the place to start. Additionally, by diagnosing AMD early, we can determine early interventions.
Several diagnostic technologies can aid us here. In “Add Contrast Sensitivity Testing for AMD” (p.18), Mark W. Roark, O.D., F.A.A.O., discusses the tools that aid in this assessment and provides an “AMD Diagnostic Toolkit,” comprised of additional valuable diagnostic tests to aid the practitioner.
A PREVENTIVE MEASURES DISCUSSION
Because optometrists are the primary eye care providers, we are often the first to be in the position of diagnosing AMD. When we identify the condition early, we have the opportunity to inform the patient of their potential future vision disruption without specific modifications. This leads into a discussion on what modifications can be made, such as smoking cessation. The therapeutics article by Aaron McNulty, O.D., F.A.A.O., “Prescribing Supplements for AMD,” (p.22) delves into this further.
Dr. McNulty discusses the importance of the optometrist scrutinizing the available research and patient candidacy related to supplementation before deciding on prescribing a scientifically sound option, based on the needs of each patient.
EDUCATION ON DISEASE PROGRESSION
Although our tendency may be to educate the patient on what we see today, and what we plan to do as a result of today’s findings, we can also help these patients by preparing them for what to expect, should their condition convert to the wet form. Examples include: What will happen if the condition progresses? Is there a chance of permanent vision loss? Is there a treatment available if it gets worse, and what can I expect should you have to refer me to a retinal specialist? The latter is the topic of Rob Pate O.D.’s practice management article, “AMD: Prepare Patients for the Referral” (p.28). Incidentally, this article also includes a discussion on identifying low vision specialists and what goes into making the patient referral.
As we dive into these three areas in the following pages, let’s work to define our role as the AMD patient’s best advocate. After all, they are counting on us. OM