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Ophthalmologist shares insight on macular degeneration

by Cindy Abole
Public Relations
Imagine what it's like to clearly spot something as small as a button lying on the floor, but struggle to see the bright and toothy grin of a happy child. That’s what it's like for 95-year-old Charles R. Good and many others who live with macular degeneration. 

Dr. Lylas G. Mogk

Good’s story is a familiar one to many who live with the challenges of low vision. It was through this man’s struggle and positive example that inspired a daughter, Ophthalmologist Lylas G. Mogk, M.D., founding director of the Visual Rehabilitation Research Center of Henry Ford Health System in Detroit, Michigan, to organize basic information and resources about the disease that can be used as a reference for patients and families who must learn to cope.

Mogk and writer-daughter, Marja Mogk, co-authored her 1999 book, “Macular Degeneration: The Complete Guide to Saving and Maximizing Your Sight.” Mogk, who is a member of the American Academy of Ophthalmology’s Low Vision Rehabilitation Committee, was a recent guest speaker and visiting professor at Storm Eye Institute’s 25th anniversary celebration and open house on Sept. 28. 

“We chose to highlight the epidemic of vision loss in America from macular degeneration, ” said Ed Wilson, M.D, professor of ophthalmology and Storm Eye Institute director. “Dr. Mogk and I work on a committee striving to improve medicare coverage for multidisciplinary teams like the Feldberg Center for Vision Rehabilitation here at SEI.”

Within the United States, it's estimated that more than 15.5 million people suffer from Age-Related Macular Degeneration (ARMD). By this year’s end, another 200,000 Americans will be diagnosed with this sight-robbing condition making it the leading cause of adult vision loss in this country.

“It's amazing that people who show symptoms for macular degeneration within the past five years never realize how it fully affects their lives,” said Mogk, remarking how the disease affects about 18 percent of seniors age 65 to 75 and 30 percent for seniors older than age 75. 

The public's greatest challenge concerning ARMD is its proper diagnosis and treatment. Unlike other eye diseases like cataracts, which can be seen, or glaucoma, which can be measured, macular degeneration is difficult to detect and manage.

Mogk has advocated improvements in ARMD education for patients and their families, development of better products and tools, plus ongoing support of visual rehabilitation programs to help people through this manageable condition.

Previously, vision research in ARMD has been low-key, but has improved recently bringing more physicians, laboratories, pharmaceutical companies and organizations like the NIH’s National Eye Institute together to focus more attention on this major health issue. 

People with ARMD possess good peripheral vision but lose the ability to see clearly, viewing objects at the edges of their vision. For example, they find it difficult to read a street sign, but can see a leaf on the sidewalk out of the corners of their eyes. For ARMD sufferers, the combination of visual ability and visual loss can be extremely frustrating. Everyday activities like reading, driving and writing become too difficult to perform.

“What’s worst is how it affects vision, which has a global impact on everything a person does,” Mogk said. “Americans naturally fear the specter of blindness. It’s difficult to properly differentiate gradual vision loss compared to measuring hearing loss. The problems are not visible to anyone other than the patient.”

So far, the disease has been linked to family history, diet and nutrition and environmental exposures to light, air pollution and herbicides can affect the disease's progress. Even risk factors like smoking, environmental factors,  prolonged sun exposure provides further clues to scientists as they seek to understand the disease, according to Mogk. 

In a 1994 Harvard study that examined the connection between ARMD and diet with test patients, results indicated that people who ate more than five servings a day of dark, leafy green vegetables like kale, collards, mustards and turnips, had 42 percent less macular degeneration. Vegetables rich in lutein and zeaxanthin, two anti-oxidents have been proven to be good for the macula. Another part of the study explored the benefits of oils, specifically Omega 3 fatty acids, which are normally found in fish that are found to have helpful affects with the retina. 

“America has a good food supply,” Mogk said. “Unfortunately, it is the way we manufacture processed foods and preserve fruits and vegetables that allows some foods to lose vitamins and nutritional value throughout a period of time. We need to improve our variety and selection of specific foods to meet a healthy, natural low-balanced diet.” 

Mogk also reminds people that having ARMD does not mean that their lives are over. The marketplace is full of tools and techniques to help patients manage and perform everyday activities to support their lifestyle and independence. Her book cites simple ideas from improvements in lighting and contrast techniques that can help low-vision patients function. Even pouring coffee into a light-colored versus a dark-colored cup can make a big difference for an ARMD patient.

Today, ophthalmologists are teaming up with rehabilitation therapists, optometrists and other specialists to help ARMD patients cope by retraining their vision through line drawing exercises, eye-hand coordination training and Scotoma training, a technique that helps patients see by refocusing on a good visual spot. 

Mogk also recognized the importance of changing federal funding and legislation has changed to support visually impaired and low vision patients. The idea of visual rehabilitation grew from medical standards developed to treat veterans following World War II. But advanced techniques and surgeries have provided improvements for children with sight disabilities.

“What's needed is a shift to support improved medicare coverage for visual rehabilitation services including legislation that lets specialists utilize the best tools and techniques that specifically supports each patient,” Mogk said. “We need to impose a change in these standards to help benefit seniors diagnosed with macular degeneration and other eye diseases. If these services can be provided early in the disease process, they may not have to give up their dependence.”