EP #21: Navigating Macular Degeneration: Understanding the Transition from Dry to Wet and Embracing Hope

Ever wondered what the journey from dry to wet macular degeneration looks like, or why it doesn't lead to complete blindness? Tune in as Dr. Laura Falco and Jeremy Wolf, joined by the insightful Dr. Nguyen, unravel the complexities of this eye condition, offering clarity on its progression and the hope that remains for those diagnosed. Our discussion promises to reveal the subtle yet significant differences between dry and wet forms, and why understanding these can be a game-changer for patients and their families.

This episode is a beacon of light for anyone navigating the murky waters of macular degeneration. We confront the common myths and fears surrounding legal blindness and illustrate how peripheral vision remains a saving grace, ensuring that life's visual story continues beyond a central vision loss. Through our conversation, we not only provide education but also illuminate the supportive resources available, like the benefits at the Lighthouse for the Visually Impaired of Broward County. Let's embark on this enlightening journey together, discovering not just treatments, but a community of support and reassurance.

For more information visit: JazzyEyes.com

or contact: (954) 473-0100

Transcript

Speaker 1: 0:02

Welcome to the Jazzy Eyes podcast. Taking care of your vision with expert precision. Here's your host, dr Laura Falco.

Jeremy: 0:14

Hello, hello everyone, Welcome back to the Jazzy Eyes podcast. Co-host Jeremy Wolfe here with your host, Dr Falco. Dr Falco, fancy meeting you here again. We were just talking about macular degeneration. I learned a lot of interesting stuff going on. I know you talked about what it is, how it comes about. I know now you wanted to talk a little bit about the treatment, the various treatment forms for macular degeneration, the dry variety. I know we're going to get into the dry variety, yeah.

Dr. Falco: 0:49

Dr Nguyen is going to cover the wet macular degeneration At some point. Anyone who has dry has a risk of converting to wet. Some people will convert in one eye, some people will convert in both and some people will never convert. So she'll go through that.

Jeremy: 1:06

Oh, I think, before you go into treatment for this type of ailment, maybe you could I don't know if you did this in the previous segment could you maybe distinguish between the dry and the wet version for listeners, just so?

Dr. Falco: 1:19

they understand what the differences are. I'll talk about this in more detail. But blood, the presence of blood in the back of the eye, makes macular degeneration wet wet basically. So yes, we have blood supply, but there's an abnormal blood supply, and when you have that come into the back of the eye with the drusen, then it has now converted from dry no abnormal blood to wet. So the presence of bleeding in the back of the eye is what makes it wet.

Jeremy: 1:50

In the macula and the phobia.

Dr. Falco: 1:53

That whole? Yeah, it has a parallel. Did I get the terms right?

Jeremy: 1:55

Am I just my memory right?

Dr. Falco: 1:56

now? Yes, look at us.

Jeremy: 1:59

I'm learning. I'm learning, yes, yes, all right. So treatment options what can somebody do? They have macular degeneration. They've been diagnosed. What are some of the treatment options to do with it?

Dr. Falco: 2:08

Right, or you have a family member or a parent and they're struggling with it and a lot of times the retinal specialists can diagnose but they don't treat the dry so much because there's really not a lot of special the retinal specialists can do for for dry I. I do want to clarify that people think they're going to go quote-unquote blind from macular degeneration. Now, legal blindness Means that with glasses you can't get a patient to see better than 2200 or it can be a very, very restricted field of view. You can have a patient who is 2020, who has a five degree Peripheral visual field and they are considered legally blind from field versus acuity macular degeneration. Even if it's Terrible, you will never go completely blind, because I think people get very scared when they hear this term and you're gonna go blind Like you close your eyes, you see black and that's it. That's never what macular degeneration is going to result in. You might have somebody with the best glasses you can get them. The best they can see at distance is 2400, that big E that qualifies them as quote-unquote legally blind, but they can see somebody coming in the periphery. When they wake up, they know if it's sunny or if it's dark. You know like it's a very big distinction.

Dr. Falco: 3:31

We have a complete loss of vision versus having visual impairment centrally from macular degeneration. So, like we said earlier, it has a predilection for the macular area. It's not going to destroy the peripheral retina. The rest of your retina, I mean, you can have another disease. That's a whole different situation. But if you only end up with macular degeneration, it degenerates exactly that part, the macula. The peripheral retina stays intact, which is a big deal when you're talking about Complete blindness and someone who's, you know, losing all vision and can't see if it's light or dark outside. So so it's not complete blindness but it's quote-unquote legal blindness.

Dr. Falco: 4:16

If you can't with glasses get this patient better than 2200 and I mentioned that because one of the treatments or I should like therapies or hope for these patients they then qualify for benefits at the lighthouse for the visually impaired of Broward County. For me we, as Dave County, the lighthouse international is is in New York City. I spent months there when I was an intern. But there are tricks and tips and Ways to teach someone how to navigate the world who is visually impaired. It doesn't mean you have to stop so once you hit that legal blindness. One of the things I recommend to my patients is to pay a visit to the lighthouse. You now qualify for benefits when you have that diagnosis of legal blindness and there's so many different things they have there that can teach you how to Continue to do some activities of daily living that maybe you thought you had to depend on other people for. That will give you a little bit of sense of your life back and then and I can do this Going off of that, I do a special Refraction exam for patients who have been diagnosed.

Dr. Falco: 5:30

It's a low vision refraction. It's different, and I'll put them behind the big foropter. That's useless to them. We have to make much bigger jumps to see if I can get them to see as best I can at distance. Oftentimes distance is harder for me to correct.

Dr. Falco: 5:46

But if somebody has a large monitor, if somebody wants to write their checks, if somebody wants to be able to read their bills and they don't have to wait for their daughter to come over two weeks later to write a bill for the utility, something like that, we can work on high-powered Magnification glasses that can really help somebody. Especially with this technology we have, you can make your font size gigantic on your phone or gigantic on your iPad. You can now actually Say make uber eats, have an Uber pick you up, you know, put an order in so it can actually help you function in life where you thought I will never be able to read my bills again, you can. It's. It's more time consuming. I block a bigger space out for patients, but it's important to know that that's out there so I can do that for patients that that need that kind of refraction.

Dr. Falco: 6:42

I was talking about doing a special eye exam where I can try to get a patient, using Magnification, to take a little bit of their life back and see up close. It's a different type of exam. It's a different kind of. It's a lot of working with a patient and really kind of honing in on prioritizing their visual needs and trying to get a Paraglass as a hand magnifier, stand magnifier something that will help them with their activities of daily living so they can feel more Independent and less relying on others. So that's a really, really important part of what I do At Jazzy eyes. That is a specialty. It's a low vision specialty. There's there's a vitamins that people recommend For people who have already started to develop macular degeneration. If you go down the aisles, you'll see all these eye health vitamins. Vitamins are always a little bit controversial For as far as macular degeneration goes. They're really not recommended For patients who have no signs of macular degeneration because there is absolutely no proof that they're going to prevent it from happening.

Jeremy: 7:49

So that was going to be a question I had, so there's really no right.

Dr. Falco: 7:52

So there's really nothing for that.

Jeremy: 7:54

No, yes, yes just get eye exams regularly and make sure you're correct.

Dr. Falco: 7:58

Yeah, take care of yourself one of the reasons why, as we mature, we need to have annual eye exams, as we want. If you start developing the presence of drusen, then there is some data to show that some people will have a. It'll be less severe. It won't reverse but perhaps slow down the progression of macular degeneration. And there's a vitamin over the counter, like you know there's, there's a few. Basically, you're looking for vitamins that say AREDS2, formula A-R-E-D-S2, which is a study that showed that there was a the presence of Lutein. Ziaxanthine are important for retinal health.

Jeremy: 8:45

Now there you go with those fancy words again I know, I know.

Dr. Falco: 8:48

Now, the other thing I could tell you that's easier is if you don't like to take vitamins green leafy vegetables kale has a ton of it. If you like cruciferous vegetables like broccoli, you're going to get a ton of it. So there are ways to get Ziaxanthine and Lutein in your diet Essentially, anything that is good for your body diet-wise, like fried food, bad saturated fat, bad green leafies, plant-based, everything like that. And there's a Mediterranean, you know, like the omegas, that's great. So your walnuts, your salmon, it's basically what's good for your body is good for your eyes.

Dr. Falco: 9:24

And then the last thing I want to touch on is that there are some devices. One is a simple looks like graph paper, we call it an Amzler grid, and when somebody has the presence of Druzen, this graph paper, this grid, can have distortions and missing parts on it, and this is important to establish a baseline. What is your normal right? And then, every a couple of days, a week, is the goal for a patient to look at this grid. If one day they look at the grid and there's a whole different part of distortion that there wasn't there last week, or a new part of the grid is missing, we need to come in and see the doctor and see what's changed in the back. There's a new technology that has come out that is electronic. That I'm having some success because sometimes insurance pays I can't even get into insurance with you. That's a whole. You can solve that problem. You can solve something.

Jeremy: 10:20

Topic for another day.

Dr. Falco: 10:22

Yeah, that's a. This is the Nobel Prize, but it's a technology where you look into a device and after 14 times of you doing the test which is about a two-minute test and it asks you questions to see if you can find a dot that's not in line with the rest of these dots, it creates a baseline for you and then after that, you do that device and it can detect before the grid, actually showing that they can detect change before I can clinically see a change in drusen, specifically if we're maybe converting from dry to wet, because then there are treatments and Dr Nguyen is going to talk about that that are important to start immediately. You don't wait on those. So I think it's important for people to know.

Dr. Falco: 11:08

Number one if you just have dry, there are things that can be done to help you navigate the world and, more importantly, if you have dry, you have to really stay on it, because nobody has a crystal ball to tell you if you will or will not convert to wet. So the only way is you know you're doing your grids, you're doing everything at home and then you also coming in for your eye exam. So these are important things because, as I've said before, about everything we talk about here. Early detection is key in better outcome visually, so it's important to get your eyes checked.

Jeremy: 11:43

Last question for you before we close up here. I'm assuming, as you didn't mention it, there's no surgical options for this when somebody has too much drusen and they're kind of later stages. There's no way, there's no technology.

Dr. Falco: 11:54

Not for the dry. Yeah, not for the dry. There are options for the wet and it involves going to a retinal specialist, but not the dry. We're not there and, to be honest, I don't know. I don't know if they're going to come up with something that identifies it and genetically treats it before, so you don't develop that, that problem. It's interesting. You know, there's a lot of things. I don't know if our friend Elon is going to come out with a microchip.

Jeremy: 12:24

Well, it's coming. You know it's coming no 100%, 100%.

Dr. Falco: 12:28

It's already out but it's not get. It's like taking patients who are totally blind to see shadows. It's not. It's not what people want it to be, but not for nothing. I mean these VR headsets, also with magnification. It's interesting, I feel like. I feel like we're on the precipice of, maybe, in the next 20 years, a lot of things coming, coming out, but right now, no All right, fair enough, we'll.

Jeremy: 12:53

We'll keep our hopes high for the future. Yes, all right. Well, dr Falco, always a pleasure, always incredibly informative, lots of good, good bits of knowledge picked up there. So thanks everybody for joining us and we will catch everyone next time. Have a great day and take care.

Dr. Falco: 13:09

Take care.

Speaker 1: 13:14

Thank you for listening to the Jazzy Eyes podcast. For more information, visit jazzyeyescom or contact 954-473-0100.