focus on low vision

Addressing Patients with Macular Degeneration

AMD Alliance International

Macular degeneration, one of the leading causes of low vision and blindness in people over age 50, is often linked to depression and a decrease in overall quality of life. In addition, sometimes patients may not know the correct questions to ask to alleviate or manage their concerns.

Therefore, it is critically important to carefully address concerns and be aware of all relevant issues during chair time with a patient.

To help, following is a list of suggestions to make this time with your patient the most useful and beneficial for everyone.

ASSESS AND INFORM

1 If you are diagnosing patients with low vision and suspect macular degeneration, explain the difference between "wet" and "dry" and tell them which type you believe they have. Write this information down for them to take away in a readable format: That is, in large print or with a large black felt pen.

2 Inform patients that although at present there are no medical or surgical treatments for dry AMD, if they stay on top of their disease—including regular eye exams, taking the AREDS formula (see sidebar), and making healthy lifestyle choices—they can usually avoid serious vision loss.

Please do not say, "Nothing can be done." If they have long-standing dry AMD, don't assume help was given at the time of diagnosis. Offer a fresh perspective about what support and information they need.

TREATMENT AND PREVENTION

3 If the patient has wet AMD, explain about current options and make sure they understand the type of treatment they will be receiving.

4 Tell patients about how the AREDS formula can help those who are at high risk for developing advanced AMD. Let patients know the commercial names of the supplements and that they can purchase them from most pharmacies.

5 Warn patients to stop smoking and advise them to eat a balanced diet with plenty of leafy green vegetables and fruits.

STAYING VIGILANT

6 Tell patients that between 10 and 20 percent of patients who have dry AMD develop the wet form—and how to spot the signs (e.g., an Amsler grid). Provide an emergency contact number and emphasize the urgency of reporting sudden changes.

7 Tell patients that in a small number of cases, people with vision loss suffer from hallucinations (Charles Bonnet Syndrome). Explain to them that they are not going "mad," but that they should talk to their doctor and local low vision organization about the syndrome. Also emphasize the importance of securing personal and medical support.

REFERRALS AND SUPPORT

8 Advise patients about non-medical supportive measures, particularly low vision assessments, optical aids, counseling, emotional support, and lifestyle changes. Refer them to a low vision clinic [Ed. note: or specialist]. This is critical. It provides patients with the immediate hope and help they need.

9 Refer patients to others who can help, such as local organizations for the visually impaired, support groups, etc. Visit the website amdalliance.org for a list of its member organizations that can help.

This can be an overwhelming time for patients. Give patients a moment to think about everything that you have said, as well as time to ask further questions. Leave patients with the thought that there is hope and help for their conditions.

And remember: YOU make the difference between a patient leaving with concern and confusion or with answers and hope. EB