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Macular degeneration: the last great frontier?
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All things considered, this decade’s technological advances in eye care have been nothing short of amazing. The ‘90s brought us clear corneal incision, foldable IOL, no-stitch 10-minute cataract surgery. It’s when laser in situ keratomileusis emerged as a viable means by which to eradicate many refractive errors in a matter of seconds. Further more, during the ‘90s we witnessed ofttimes cumbersome glaucoma therapies give way to four-times-daily dosing regimens. Finally, this decade has produced contact lenses with the convenience of daily disposability or extended wear.
By all estimates, the eye care industry has met – and exceeded — patient needs in just about every conceivable way. In fact, like many other service-oriented sectors, we’ve provided our patients with quick, easy, convenient and quality eye care. Well, perhaps, not all of our patients.
Technology cannot answer everything
Yes, there is undoubtedly a group of patients who feel they’ve not benefited from the technology “boom” of the ‘90s. A group whose numbers are swelling, who are becoming increasingly vocal and are growing a little weary of being told “nothing can be done.” Of course, I speak of our patients with macular degeneration. For many of these individuals, this has not been a particularly productive decade.
It’s not that we haven’t made strides in dealing with macular degeneration. Actually, we have a much better understanding of macular degeneration — epidemiology, pathophysiology, early diagnosis and intervention, and prevention – than 10 years ago. Perhaps, it’s just that we haven’t been very effective in communicating these advances to our patients. And this is precisely why macular degeneration is often perceived as a disease that is neither preventable nor treatable.
Finding a better approach
As we enter the new millennium (you knew it would show up somewhere!), it may be time to rethink macular degeneration. Time to be a bit more proactive in patient education, more sensitive in monitoring and measuring and more considerate of emerging treatment protocols. This shouldn’t require a paradigm shift in macular degeneration management, but rather a more focused effort. For instance, every patient encounter should involve a brief discussion of recent developments in treatment and prevention. Certainly, this is a perfect venue for discussing dietary and supplementation issues relevant to macular degeneration patients as well as at-risk family members.
From an examination perspective, we might monitor visual function (and disease progression) by techniques other than standard Snellen visual acuity. Indeed, for many macular degeneration patients Snellen visual acuity is not particularly revealing and is often quite demoralizing.
Finally, with many emerging photocoagulation and surgical techniques, and a variety of optical/nonoptical aids, it’s imperative we stay abreast of all treatment options. While it’s unrealistic to personally provide every treatment strategy, it’s our duty to be patient advocates. In this respect, a more aggressive approach to macular degeneration management may simply entail a low vision or vitreo-retinal referral.
Indeed, macular degeneration may be one of eye care’s last great frontiers. And while a “miracle cure” may be some time away, each year brings advances. Advances we must always share with those affected by macular degeneration.