Macular Degeneration Low Vision Treatment

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Dr. Randolph Kinkade, a low vision optometrist with a Master of Public Health degree reports age-related macular degeneration (AMD) is the most common form of permanent vision loss in older adults.  Dr. Kinkade and the National Eye Institute, a division of the National Institutes of Health, know the prevalence of AMD will increase with our aging population. 

 



Dry AMD

Wet AMD




With the baby boomers moving into the macular degeneration age group it is estimated that there will be 3 million people with AMD by the year 2020 in the United States.



 

“Macular degeneration is a progressive condition that destroys the macula in back of the eye,” said Dr. Kinkade.  “It usually progress slowly in most individuals with minimal vision loss for years while in others it can appear to dramatically destroy eyesight overnight.” 

The vision loss can make it difficult to read, write or drive a car.  Daily activities (i.e., cooking, sewing, bill paying) and recreational activities (i.e., card playing, knitting, painting) become challenging for some and difficult or impossible for others.

From a Public Health stand point, macular degeneration is most likely caused by a complex set of aging, genetic and environmental factors,” said Dr. Kinkade.  Vitamin and antioxidant therapy appears to slow down the progress in some individuals.  Telescopic, high-power prismatic lenses and E-scoop lenses are usually beneficial.

AMD alters your central vision and leaves your side or peripheral vision unaltered.  So despite the vision loss, AMD does not cause complete blindness allowing individuals to walk and see where you are going. 

 

Simulated Central Scotoma

 

“The macula is part of the central retina in the back of the eye and is made up of millions of light-sensitive cells that give sharp, detailed central vision,” said Dr. Kinkade.  “The retina is responsible for converting light energy into electrical energy and sending the information via the optic nerve to the brain.  The eye can be considered to be an extension of the brain.”

When the macula is damaged fine detailed vision is lost and images in the brain are no longer clear.  Individuals can see, but the fine points in your vision are missing.

 

 

In the early stages of AMD vision becomes slightly unclear and reading can become challenging.  With moderate advancement, distortion and blank spots appear in your central vision and reading becomes significantly more difficult without the use of magnification.  Faces and television are no longer clear.  With the advanced stage of the disease individuals require low vision rehabilitation to resume many visually-guided daily activities. 

There is no cure for AMD, but its progression can be slow with vitamins and nutritional supplements.  Medical treatment is available to curb the progression in the “wet” form of AMD with eye injections.  There is no medical treatment for the “dry” form.

Dr. Kinkade describes the term “Low Vision” as the level of permanent vision loss that significantly impairs the ability of individuals to see when there is no treatment by medicine, surgery or regular eyeglasses.

Low Vision Rehabilitation offers good news to those with low vision caused by AMD.   With the use of proper magnification, enhanced illumination and high-contrast materials vision can be improved.

Dr. Randolph Kinkade Fitting Bioptic Telescopic Glasses

“If you remember that if the eye is part of the brain you can relearn to see,” said Dr. Kinkade.

Dr. Kinkade has been treating the low vision rehabilitation needs of patients with AMD for over 30 years.  He continues to study the causes and treatment of macular degeneration from a medical, rehabilitative and public health point of view.  

 

(800) 756-0677
www.LowVisionEyeglasses.com
DrKinkade@SeeandHearAmerica.com
Cheshire - Danbury - Farmington - Litchfield - Manchester - Norwalk - Waterford

 

Dr. Kinkade's Low Vision Patient Gallery 2012

(800) 756-0677

www.LowVisionEyeglasses.com

Cheshire - Danbury - Farmington - Litchfield - Manchester - Norwalk - Waterford





Electronic Magnification
Reverse Polarity
 

Binocular Reading Telescope
Increased Reading Distance






E-Scoop Prism
Driving Enhancement

 



Binocular Distance Telescope

Binocular Reading Telescope




 






Prescription Bioptic Glasses
for Albinism

 

 

 

Reading Telescope

Reading Telescope
for e-book

 

 

Bioptic Telescopic Eyeglasses

 

 

 

Dr. Kinkade with Macular
Degeneration Prismatic
Eyeglass Patient 
 

Reading Telescope for
Drawing Insulin and
Close Work

 

 

Electronic Magnifier for
Macular Degeneration

 

 

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DrKinkade@SeeandHearAmerica.com

Cheshire - Danbury - Farmington - Litchfield - Manchester - Norwalk - Waterford

 

 

www.VisionDynamics.com



 

Magnifier Guide For Macular Degeneration

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www.LowVisionEyeglasses.com
Cheshire - Danbury - Farmington - Litchfield - Manchester - Norwalk - Waterford



Dr. Randolph Kinkade
Magnification Treatment for Macular Degeneration

Why does magnification help reading with macular degeneration?

The macula is in the center of your retina in the back of the eye.  A healthy macula is needed for reading.   With advancing macular degeneration, you lose this sharp center vision that is necessary for reading and seeing details. 

Patients with macular degeneration describe their center vision as being “cloudy” or “greyed-out” or “distorted”.  They describe “letters are missing” or “letters come and go” as they read.  This loss in vision is a relative blind spot or central scotoma that usually cannot be restored.

 

Simulated Reading Scotoma

Magnification aids make what you are looking at bigger so it is it is easier to see.  The more you magnify, the smaller your blind spot becomes relative to the size of the magnified print you are looking at.  This makes reading better, not perfect, but better.   Magnification means more healthy macular cells are being stimulated.  Depending on the level of vision loss, magnification may not always make vision clearer. 

What is the power of my magnifier?

There is always confusion between magnification power (X power) and optical power (diopter power) of a magnifier.

What is a “X” power of a magnifier really mean?
Magnification power is the ratio between the image size you see through the magnifier compared to the true size of the object you are looking at.  If an object seen through magnifiers appears five times larger than its true size, the magnification power is 5 times or 5X.

Why do I see “diopter” power listed or printed on some magnifiers?

The term diopter refers to the optical power of the lens with regards to its ability to bend light and not directly to the magnification power.   The higher the dioptric power the more the lens bends light and the higher the potential magnification.  The higher the dioptric power the higher the magnification.

All “X” power is not the same, but all “diopter” power is the same.

Unfortunately manufactures use different formulas to calculate the power of their magnifiers so it can be challenging to tell whether one manufacture’s 6X magnifier is really stronger than another’s 5X magnifier.  With diopters you cannot go wrong.  A 24-diopter magnifier is stronger than a 16-diopter magnifier.

Some manufacturers divide the “diopter” power by four to get their “X” power.  Other manufacturers divide the “diopter” power by four and add one more “X” to their formula to get their “X” power.

Another challenge in comparing strengths is the manufacture may not disclose the diopter power to you and they often inflate the “X” power.

Why can I not find a really strong page magnifier to help me read?
Sorry, it is the laws of physics and optics that prevent you.  The stronger the lens (more diopters or magnification) the more curved the lens has to be.  It is the lens curvature that limits the physical size of the magnifier.  Flat page magnifiers cover a large area, but offer minimal magnification.  A chicken egg has a very steep curvature and is small in size.  An ostrich egg is relatively large because its shell is not as curved. 

 

Curvature adds power, but limits its diameter.

In the movies, Sherlock Holmes’ magnifiers were large, but also with minimal power.  Most large magnifiers are only 1-2.5X.  A medium size magnifier will be 3-4X.  Small magnifiers will be 5-7X The tiniest magnifiers, about the size of a quarter and with a very steep curve will be 10-12X.  






Dr. Randolph Kinkade 
large diameter, 4-diopter magnifier.

Some magnifiers come with an additional tiny strong button magnifier near the edge.  Noticed how powerful and curved that extra lens is. 

What is “focal length”?
Focal length is the distance behind the lens where print focuses the best.  The higher the “diopter power” or “X power” of the lens, the shorter the focal length of the lens. 

Why do I have to hold a stronger magnifier closer to the page?
Since a strong magnifier has a very short focal length it needs to be held close to the page.  A

2X magnifier needs to be held 5” from the page for best magnification.  A 5X magnifier needs be held 2” from the page and a 10X magnifier needs to be held 1” from the page.

Why should I hold a strong magnifier closer to my eye?

One of the challenges of using a strong magnifier is the small field of vision it provides (i.e., only a few letters at a time).  The closer you hold the magnifier to your eye the more letters you will see at a time before you have to move the magnifier.

How do I use a 10X (40-diopter) or 12X (48-diopter) magnifier?

This lens has a very small diameter and visual field.   You will want your best seeing eye almost against the lens to see as many letters as possible.  This lens has a very short focal length and should be held very close to the page. 

At this power, it works best to have a built in illumination source.   It is difficult to get an external reading lamp to brighten what you are reading due to the required short viewing distances.  Your head and magnifier get in the way of a reading lamp illuminating the page properly so it is best to use a magnifier with its own illumination source.



10X LED Illuminated
Eschenbach Stand Magnifier

(800) 756-0677
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DrKinkade@SeeandHearAmerica.com
Cheshire - Danbury - Farmington - Litchfield - Manchester - Norwalk - Waterford



 

 

Using Peripheral Vision with Macular Disease and Low Vision Rehabilitation

 

 







Patient with an Inferior Preferred Retinal Locus
 

Patients with macular disease and central field loss with apparently identical pathology can exhibit very different levels of visual impairments.  These patients often adopt an eccentric preferred retinal locus (PRL).  The term “preferred retinal locus” describes a retinal area that acts as a pseudofovea by providing better vision than the diseased fovea/macula. 

While a PRL appears to naturally develop in patients experiencing a central scotoma without formal training, the ability to use this non-foveal area varies widely.

Eccentric viewing (EV) describes fixation in which the eye moves off center as to place the image of an object outside the fovea.   There is a science and art to eccentric view training (EVT).  Preferred retinal locus and eccentric viewing are important components for successful low vision rehabilitation.

Scanning laser ophthalmoscope macular perimetry can be used to find the PRL relative to the fovea.  The Fletcher Central Field Test using a red laser pen appears to be an effective test when an SLO is not available.

During the course of the disease, the location of the patient’s PRL may change.  The PRL appears to be task specific and more than one PRL can be used by a patient.  Research continues to gather data on this topic.

Unanswered Questions:

1.      What factors determine the patient’s section of the PRL location?

2.      Why do some patients seem to develop a functional PRL and others do not?

3.      Can a PRL be taught?

4.      Does the PRL match the patient’s best acuity area?

5.      How does the placement of the PRL impact reading ability?

6.      Can an eccentric PRL favorable for effective reading be established through a trained retinal locus (TRL)?

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rkinkade@optonline.net
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Connecticut Eye Doctor Designs Glasses to Help Those with Vision Loss





Dr. Randolph Kinkade with Prototype
Low Vision Glasses

Dr. Randolph Kinkade is designing glasses to help patients in Connecticut with vision loss with macular degeneration regain some of their ability to read.  People with vision loss due to macular degeneration and other eye conditions require optimal lighting conditions and magnification. 

 

 

Dr. Randolph Kinkade, a Connecticut optometrist and founder of Low Vision Consulting, believes that each person with vision loss responds differently to light and magnification. 

 

“Continued advances in lighting and telescopic eye glasses show promise for treating vision impairments, said Dr. Kinkade. “Too much or too little light and magnification is a problem when it comes to reading.”

 

The type of lighting, its intensity, color and aim are often the difference between being able to read and not being able to read with telescopic glasses.  New adjustable LED lights maximize patient’s ability to read when combined with magnification.
 

 Dr. Kinkade's Prototype Glasses Video:

http://youtu.be/CuQIAV-obSI

 

“Studies have shown macular degeneration patients need 3-4 times the amount of light to read and to do other close tasks as a person with normal vision,” explains Dr. Kinkade.  “Special high-power glasses and telescopic glasses for reading require even more illumination.”


Dr. Randolph Kinkade with Low Vision
Lighting Enhancement Options

With their flexible arms the LED lights focus best at about 12 inches and are attached to reading telescopes called tele-microscopes.

“It is all about the physics, in particular electricity, radiation and optics, needed to create the proper reading environment”, said Dr. Kinkade.  “My job is to help people see well enough to read.  My patients know the frustrations of not being able to read.”

Dr. Kinkade has tried many types of illumination sources including incandescent, neodymium, halogen, and fluorescent.  For his glasses, LED’s remain the most effective option due to their adaptability. As he says, “There is always a better way.”

 

(800) 756-0766
www.LowVisionEyeglasses.com
DrKinkade@SeeandHearAmerica.com
Cheshire - Danbury - Farmington - Litchfield - Manchester - Norwalk - Waterford

 

 

 

 

 

New Telescope Treatment For Macular Degeneration

Dr. Randolph Kinkade, a Connecticut optometrist and founding member of the International Academy of Low Vision Specialists, reports the availability of new telescopic glasses for returning some useful vision for those with macular degeneration.  New advances and innovations provide magnification and renewed sight for people with this condition.

Television Interview with Dr. Kinkade

http://www.youtube.com/watch?v=8M5evKk0L9Y&feature=plcp
 

 

In macular degeneration, and other sight robbing conditions, there is vision loss in the middle of the retina, the point of maximum vision.  According to the National Eye Institute, macular degeneration affects between 30 and 35 percent of seniors in the USA. 

Macular degeneration occurs in both “wet” and “dry” forms and makes it difficult or even impossible to do the daily things most people take for granted. The symptoms include blurring of the central field of vision, as well as, distortion or loss of vision.

The macula is part of the central retina in the back of the eye and is made up of millions of light-sensitive cells that give sharp, detailed vision.  The retina is responsible for converting light energy into electrical energy and sending the information via the optic nerve to the brain. 

Dr. Kinkade describes telescopic glasses as miniaturized prescription-based binoculars that are designed in different strengths and positions according to the needs of the patient. Microscope spectacles are also available offering high-power magnification.






     

Dr. Randolph Kinkade and William Baiocchi
New Bioptic Telescopic Eyeglass Design


 

Magnification is needed to see things up close to participate in activities like reading and to see in the distance for watching television and driving.  Dr. Kinkade believes by combining several different lenses it offers the best chance for success.

Research and new treatments offer improved quality of life to those who with macular degeneration and other vision limiting conditions. There is hope for those who thought nothing more could be done.
 

 

 

  

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DrKinkade@SeeandHearAmerica.com

Cheshire - Danbury - Farmington - Litchfield - Manchester - Norwalk - Waterford

Connecticut Eye Doctor Uses E-Scoop Glasses: Offering New Treatment for Macular Degeneration

Dr. Randolph Kinkade
(800) 756-0677

www.LowVisionEyeglasses.com

Cheshire - Danbury - Farmington - Litchfield - Manchester - Norwalk - Waterford



E-Scoop

Dr. Randolph Kinkade with
Marianne Girard wearing E-Scoops

New E-Scoop glasses have been developed to help patients with macular degeneration.  Dr. Randolph Kinkade, a Connecticut optometrist and a founding member of the International Academy of Low Vision Specialists (IALVS), offers new hope and vision. 

Mrs. Marianne Girard, a 76-year-old who lives in Seymour, Connecticut, and suffers from macular degeneration, uses these new E-Scoop glasses to help her drive more confidently and watch television.  “I really need them for driving and they make all the difference for watching TV,” said Mrs. Girard.  “I even use them to play bocce!” 



E-Scoop Glasses

Macular Degeneration is the leading cause of legal blindness and reading impairment in the country.  These lenses can help vision by improving clarity for some people.  “These lenses cannot make vision perfect, but they do make things better,” said Dr. Kinkade.  “They also assist with night driving and glare reduction.”

Macular Degeneration is a progressive disease that leads to damage of cells in the retina in the back of the eye.  Specifically, it affects the central vision in the area called the macula. 

When the macula is damaged, vision is blurred or distorted. When this happens individuals have difficulty seeing well enough to do activities that require fine detail vision like reading, driving, recognizing faces and watching television.

Patient with E-Scoops

“It is all about the physics and particularly precision optics,” said Dr. Kinkade.  By combining six different optical properties into a two lens system, vision can often be enhanced. “We start with the patient’s prescription and then add prism to move the image to a healthy seeing part of the macula,” said Dr. Kinkade. 

 

People with macular degeneration lose some or all of their central straight-ahead vision over time, but their peripheral side vision is not affected. Often this means they see better looking slightly to the side, rather than looking straight ahead.  





Patient with E-Scoops

E-Scoop lenses provide some magnification by using a combination of special lens curvature and thickness.  The lenses also incorporate a custom yellow filter and anti-reflective coatings. Dr. Kinkade reports, “this is an example of two lenses definitely being better than one”.

E-Scoops were developed by Frans Oosterhof, a Dutch optometrist, who won the Herman Wijffels Award for optics in Holland.  Dr. Kinkade has met with Dr. Oosterhof and continues to meet semi-annually with other members of IALVS to study optics and research new ways to help patients with macular degeneration.  For more information on E-scoop lenses visit www.IALVS.org.

(800) 756-0677
www.LowVisionEyeglasses.com
DrKinkade@SeeandHearAmerica.com
Cheshire - Danbury - Farmington - Litchfield - Manchester - Norwalk - Waterford

 

 

 

Low Vision Magnifying Telescopes: Macular Degeneration and Other Vision Loss Conditions

 

 

http://www.LowVisionEyeglasses.com

 

                                    

Telescopic Eyeglasses can greatly improve quality of life, independence and a sense of well-being for adaptable patients with low vision.  Depending on the level of impairment and visual demand, telescopes offer excellent magnification.  They often provide the best option for enhancing available vision when traditional eyeglasses are no longer effective.

Patient expectations must be tempered and realistic goals need to be established.

Telescopes are afocal (parallel light rays entering and leaving the system) consisting of two lenses (objective and ocular) separated in distance by the sum of their focal lengths. 

The patient’s prescription can be incorporated into the carrier lens and/or the telescope.  The telescopes can be mounted in the center position (full diameter), in the superior position (bioptic), or in the inferior position (reading), depending on the visual task required.   

Collimation (optical alignment) and convergence for binocular systems are crucial for best rehabilitation outcomes.  Enhanced illumination is required for reading with tele-microscopes.

Keplerian telescopes have a plus power objective lens and a plus power ocular lens and require an erecting prism or mirror system for the otherwise inverted image.   

 


Keplerian Telescope Diagram

6X Keplerian Telescope
Designs for Vision

1.  Benefits
    A. widest field of view
    B. sharpest edge-to-edge image
    C. superior optical image 4X and stronger

2.  Challengers
    A.  complicated design due to erecting prism/mirrors
    B.  more expensive to fabricate
    C.  smaller exit pupil (more difficult to center and aim)                                   


 

 

Galilean telescopes have a plus power objective lens and a minus power ocular lens. They form an erect and upright image. Galilean telescopes have several functional advantages for low vision rehabilitation especially in lower powers. 

 



Dr. Randolph Kinkade's
Bioptic Rimless Prescription

Galilean Telescope Diagram

 

1.     Benefits

a.      Shorter in length (better cosmetics)

b.      Lighter (no erecting prisms/mirrors)

c.      Large exit pupil (helps with centering)

D.      2 and 3X magnification very functional

2.     Challenges

a.      Narrower field of view and less edge sharpness

b.      Not functional for high power magnification 




Diagnostic Galilean Telescopes



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