Question / Answer Forum
Please use the form below to post your questions to Dr. Lynne Noon.
Your questions will generally be answered within 24 to 48 hours after your post has been submitted.
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Please use the form below to post your questions to Dr. Lynne Noon.
Your questions will generally be answered within 24 to 48 hours after your post has been submitted.
Hi Dr. Noon,
I also suffer from retinitis pigmentosa. Actually doctors were calling it as Stargardt’s or macular degeneration when i was diagnosed at the age of 14. I am not sure whether they are all the same or not but this ls the name i heard from the last doctor.
Now I am 24 and my sight is 1/10. Do you have any treatment or any tools to increase quality of my vision? I live in Turkey and I am ready to go anywhere in the world.
Thank you.
Kind regards.
Dear Emrahg,
The retina is a thin layer of nerve cells that lines the inside of the eye. It is comparable to the film in a camera. The retina contains two types of photoreceptor cells called rods and cones that respond to light and help send images of what the eye is looking at to the brain. While both Stargardt’s disease and Retinitis Pigmentosa affect the retina, they are different diseases. A brief summary of the characteristics of both diseases follows below.
First, I suggest that you make sure you have the correct diagnosis so that you may understand your prognosis and learn how to manage both your eye disease and your vision loss. You should also find a clinic that specializes in both blind and low vision rehabilitation so that you will find the correct tools that will allow you to perform your daily activities and remain independent.
Unfortunately, I do not know the services that are available in Turkey. You may wish to start with BlindCorps.org an organization that addresses the rehabilitation needs of blind and visually impaired people around the world, including Turkey. They may be able to help you or direct you to the appropriate services. Of course, if you choose to come to the United States, there are several excellent clinics.
If you wish to visit clinics in the United States, you can communicate with me directly through this web site or at info@LowVision.com. I will be happy to recommend several clinics in the United States.
Good Luck,
Lynne Noon, OD
Stargardt’s disease is the most common form of inherited juvenile macular degeneration. It causes a progressive loss of central vision by progressive degeneration of the central cone photoreceptors. By middle age most patients have visual acuities of 20/200 – 20/400. Stargardt’s disease is usually inherited as an autosomal recessive disorder but a small percentage have a dominant mode of inheritance. As with retinitis pigmentosa, both eyes are affected, but night blindness and peripheral vision loss do not occur in Stargardt’s disease.
Retinitis pigmentosa (RP) refers to a group of hereditary diseases characterized by the progressive death of the photoreceptor cells leading to visual field loss (peripheral vision), night blindness and an abnormal electroretinogram. There are many forms of retinitis pigmentosa including Usher syndrome, Leber’s congenital amaurosis, rod-cone dystrophy, cone-rod dystrophy and Laurence-Moon-Bardet-Biedl syndrome. Retinitis Pigmentosa is usually inherited with the autosomal recessive forms being the most common (70%). The autosomal dominant form is the second most common (18%). The X-linked form is least common (12%). Typically those with the dominant inheritance have a milder form and latter onset of symptoms and the X-linked form have a more severe type and earlier symptoms.
Although there is considerable variance in the presentation, in most forms of RP, the rods are affected first. Because rods are concentrated in the outer portions of the retina and are triggered by dim light, their degeneration affects peripheral and night vision. Therefore, night blindness in one of the earliest symptoms of retinitis pigmentosa. This visual field loss usually begins in the mid-periphery and extends inward and outward.
In early stages of the disease visual acuity may remain a normal 20/20. When the more centrally located cones, responsible for color and sharp central vision, become involved, the loss is in color perception and central vision. Most people with RP are legally blind by age 40, with a central visual field of less than 20 degrees in diameter. Other common symptoms of RP include cataracts in about 50% of cases and the development of cystoid macular edema.
Dear scarlos,
You may want to see a doctor who specializes in low vision rehabilitation to help you with your glasses and other low vision solutions. My practice, ViewFinder Low Vision Resource Center has offices in both Mesa and Sun City Arizona. We also serve several satellite clinics in other locations. Our toll-free number is 866.924.8755. We will be happy to work with you or recommend other doctors and services in the Arizona.
Lynne Noon
My 19 year old son has ocular albinism. He wants to purchase a monocular for distance. He tried one on loan from a vision rehab clinic and was very pleased but we do not have the tech specs. We purchased a walters scope extra short focus 8×20 and the hole is way too small and he can’t see anything from it. We obviously bought the wrong item. What do the numbers mean and how do we purchase the correct item. Thanks in advance.
My 19 year old son has ocular albinism. He wants to purchase a hand-held monocular to see distances. He tried one and was very pleased but we do not have the tech specs on it. We purchased a Walters scope extra short focus 8×20 7.2 degrees. The hole though is way too small. What do the numbers mean and what do you need to know in order to order the correct item. Thanks in advance.
Hi Dr. Noon,
I am a fourth year optometry student, and I was wondering if you had a suggestion for a good low vision textbook.
Thank you for your time!
Hi Dr. Noon
I suffer from retinitis pigmentosa from birth, I am trying to find a good doctor that knows about my problem, or that can at least help me get a good pair of glasses that helps my problem, I wanted to know if you can help me, or recomend me another doctor, I live in arizona Thank you
Dear scarlos,
You may want to see a doctor who specializes in low vision rehabilitation to help you with your glasses and other low vision solutions that may help you. My practice, ViewFinder Low Vision Resource Center has offices in both Mesa and Sun City Arizona. We also serve several satellite clinics in other locations. Our toll-free number is 866.924.8755. We will be happy to work with you or recommend other doctors in the state.
Lynne Noon
Dear scarlos,
You may want to see a doctor who specializes in low vision rehabilitation to help you with your glasses and other low vision solutions. My practice, ViewFinder Low Vision Resource Center has offices in both Mesa and Sun City Arizona. We also serve several satellite clinics in other locations. Our toll-free number is 866.924.8755. We will be happy to work with you or recommend other doctors and services in Arizona.
Lynne Noon
Hi Dr. Noon
I suffer from retinitis pigmentosa and I want to find a doctor that could help me with my problem, I wanted to know if I should go visit you, or can you recomend me a doctor who can help me or give me at least a good pair of glasses. I live in Arizona thank you
I am looking for an eye doctor who has the Macuscope in the San Diego area. If you have any doctors you can refer me to, I would appreciate it.
Suzanne Thorley
Dear Ms. Thorley,
I do not know who has a Macuscope in San Diego. However, the manufacturer,Marco Ophthalmics should know the names of the doctors that they have sold this instrument to in your area. I have placed their phone number below and I am sure they will be happy to help.
Marco Ophthalmic, Inc.
11825 Central Parkway
Jacksonville, FL. 32224
Fax: 904-642-9338
Tel: 1-800-874-5274
Good luck,
Lynne Noon
Also, be aware that the VA is starting up new low vision programs all over the country. For job openings in your area look on the website: usajobs.gov and type in “blind services”
My daughter has ocular Albanism resulting in low vision. She recently moved to Tennessee and needs to see an Ophthalmologist that has knowledge in her condition. In the past, we have only found a few in Calif. Usually through the University system.
Dear Mrs. Rasmusson,
I do not know of an ophthalmologist in Tennessee that specializes in Albinism. However, I am surprised that you had trouble finding a doctor knowledgeable about this condition as albinism is not that uncommon, especially in a low vision clinic.
Because albinism is a stable condition that will not change over the course of your daughter’s lifetime, it does not require medical or surgical intervention. Her most pressing need is special glasses, tints and other low vision products that will help her see well enough to perform her daily tasks, go to school, maintain a job and perhaps drive if she lives in a state that allows bioptic driving.
I suggest you call the states optometric association or ophthalmology association to find a doctor who specializes in low vision rehabilitation. The doctor will perform an ocular health assessment and prescribe the low vision products that she needs. You may also want to call the Southern College of Optometry in Memphis, Tennessee as they have a low vision clinic and would be very familiar with albinism. I have placed some information below that may help in your search.
Lynne Noon, OD
SOUTHERN COLLEGE
OF OPTOMETRY
1245 Madison Avenue
Memphis, Tennessee 38104
http://www.sco.edu/
Tennessee Optometric Association
2727 Bransford Ave.
Nashville, TN 37204
TOA office: 1.800.451.2438
TOA office: 1.615.269.9092
Tennessee Academy of Ophthalmology
President: John C Hoskins MD
Executive Director: Sue Carson-Chasteen
E-mail: suechasteen@comcast.net
Web site: www.tneyemds.org
Hi,
My father, aged 84, lives in Escondido and has dry macular degeneration in both eyes and wet in one. He is being treated with avastin shots at the Shiley Center- second set of 3 monthly shots. He tells me he sees better if he holds his eyeglasses 3-4 inches in front of his head. Do you have any recommendation for an OD to refract him on the basis of duplicating this effect or anything else to help him see better.
Thank you.
Dear Mr. Noon,
Your father sees better by pulling his glasses down on his nose because this gives him more magnification. He definitely needs to be evaluated for a pair of reading glasses in a stronger power. He should be seeing a low vision specialist in conjunction to his retinal specialist.
To find a doctor who specializes in low vision rehabilitation please go to the American Optometric association (aoa.org) internet address to find eye doctors who specialize in low vision. Go to the doctor locator section and look under low vision and your zip code or call 866-999-9188 to have a representative locate one for you.
Take care,
Lynne Noon, OD
Do you sell some type of eye glasses that will help my mother that has MD wet?? we live in Oregon
Maurice
Mr. Joseph,
I am a certified low vision therapist (CLVT)with the VA in Portland. In addition to the Pacific University Program, you may also contact the Oregon Commission for the Blind (503) 378-3600 or toll free (888) 731-3221; the Casey Eye Institute (503)494-3098; Devers Memorial Eye Clinic (503) 413-7022 or Vision Northwest (503) 684-8389. The VA also offers low vision evaluations and services to qualified veterans. This includes low vision evaluations with an optometrist specially trained in low vision as well as myself. Additional training is also available at the Vancouver site. I may be contacted at (360)759-1634. As Dr. Noon had stated, it is important for your mom to have a comprehensive low vision evaluation to see if her vision can be corrected with glasses, or if low vision devices (i.e. magnifiers,CCTV’s, etc.)would be used in place of or in addition to corrective lenses.
Dear Mr. Joseph,
We have many products, including glasses to help people with wet AMD. If the vision loss is severe, you should consider purchasing a video magnifier such as the Optelec Clearview+.
I suggest an appointment with a doctor who specializes in Low Vision Rehabilitation to have the appropriate low vision aid or glasses prescribed for you. Please call Pacific College of Optometry (Phone: 503-352-2202, address: 2043 College Way,Forest Grove, OR 97116). Make an appointment to see a doctor at the low vision clinic or ask for the name of a doctor closer to you.
Good Luck,
Lynne Noon, OD
I am a 64 yr old woman with low vision from macular degeneration (legally blind in one eye with the other worsening all the time). I see my ophthalmologist again next month. What should I be asking him about as far vision aids. I have not been able to read anything without a magnifying glass for years. I have trouble with the computer as well and read things on here with magnifying glass as well. I know there are things out there to help - I have a relative who has a machine that looks like a computer but isn’t - he puts what he wants to read in a spot and it shows up on a screen. I understand these cost a lot of money which I can’t afford - I have been on SS disability since 1996-7. My husband is also on Social Security. Do you know of any income guidelines for me to be eligible to get help with vision aids? I don’t know where to start but I know other people who got help.
Thank you,
Donna Yoder
Dear Mrs. Yoder,
In addition to seeing your ophthalmologist, you should also see a low vision specialist. Ask your current ophthalmologist for a referral to a low vision specialist in your area. The low vision specialist will recommend the necessary low vision aids and products that will allow you to read and perform your daily activities. He or she will also recommend available services in your state that will help you remain independent. He or she will also know of funding sources for your low vision products.
Your cousin has an electronic video magnifier which can magnify print up to 65X. It can also enhance contrast and eliminate glare. While some models may cost $2000.00 or more, there are other products that provide the same type of magnification and cost only a few hundred dollars. Please see the line of Bierley products on ShopLowVision.com for low cost solutions (item #’s 5063 and 5064).
Unfortunately, there is limited funding for low vision products and funding varies by state. Vocational rehabilitation services in each state will provide low vision products, even costly products such as the video magnifier, for people who wish to continue or gain employment. Unfortunately, if you are retired, there is limited funding. Call the Commission for the Blind or Department of Economic Security Independent living program in your state to see if they have funding or if they have
used video magnifiers that they can donate.
Please look at the resource list on our LowVision.com website for services in your area. If you cannot find what you need or if your ophthalmologist is not aware of a low vision doctor in your area, please contact me again. Also, please call our toll-free number 800.826.4200 and ask for our free Daily Living Solutions catalog. This will give you valuable information.
Good luck,
Lynne Noon
Lynne,
Is there such thing as a low vision toothbrush?
Brian,
I am presuming that you want a tooth brush with dark bristles so that you can see the toothpaste when it is placed on the toothbrush. It is possible to find toothbrushes with dark or black bristles. Currently we do not carry such a toothbrush in our assortment.
However, it is easier to find a tooth brush with white bristles and use dark toothpaste such as Colgate gel that comes in dark green or dark blue. The goal is to increase the contrast between the toothbrush bristles and the toothpaste. It is easier to see dark on light rather than dark on dark or light on light.
Another alternative is for the visually impaired person to have his or her own bottle of toothpaste and just squeeze the toothpaste directly on to the tongue. No more missed toothbrush. Make sure you get a toothbrush that is in a color that is easy to see in the medicine cabinet or bathroom vanity. A white toothbrush and a white vanity does not provide enough contrast and will be difficult to find.
The tooth paste can also be squeezed onto the index finger and then scooped up with the toothbrush.
I hope this helps, please email me directly if you need further help.
Lynne Noon, OD
Hi Dr. Noon,
I’m afraid of vision loss getting worse. Is it true that prismatic lenses can strengthen the eyes? I have a friend that said she wore them as a young woman and to this day (in her 60’s) she isn’t wearing any glasses.
I had made an appointment for lasik surgery consultation and learned that I had retinal holes in both eyes and a large nevis in my left eye. Also that my cornea was too thin for the lasik but yet was a candidate for different more invasive/abrasive surgery however I am now too scared after learning all this unexpected info. I had only seen optomotrists and only went to see a REAL eye doctor since I wanted to get rid of glasses. Thank GOODNESS I went. Well, the retinal holes were lasered, and now have to see a retinal specialist every 6 months as well as the awesome Eye doctor who discovered these problems, yearly.
My eyes are progressively becoming more nearsighted and now I’m losing the near vision at the age of 45. Is there something I can do to help slow down vision loss such as prismatic lenses or exercises, etc? How big of a risk do I have of the nevis to become cancerous, getting a detached retina (losing central vision), and what can I do to protect myself, if anything?
Also, since I couldn’t get lasik surgery, I got new contacts (to wear occasionally) and then burned my eyes with contact solution (Clear Care) and have since had dry eyes wake me up in the middle of the night. Is that permanent damage or should they recover completely?
Dear Leigh,
Unfortunately prism glasses, eye exercises and Lasik will not repair the retinal holes or slow down the progression of Myopia or nearsightedness. As well as having routine retinal evaluations you will need to have routine
refractions to correct the power in your eyeglasses or contact lenses. Ask your retinal specialist for a referral to an eye doctor who specializes in low vision rehabilitation.
Loss of focusing at near (presbyopia) is a normal occurrence for all 45 year olds and is unrelated to your other ocular problems. As we age, the lens in
our eyes becomes less flexible making focusing at near difficult. Surgery will not correct this problem. Most people with presbyopia need reading glasses or bifocals. Your low vision specialist will recommend the
appropriate glasses for reading.
A retinal or choroidal nevus is a flat, benign pigmented area in the eye. They are similar to freckles and do not change with time. However, as with freckles, all nevi should be monitored for change to rule out a possible
melanoma. Your eye doctor will take a photo our use ultrasound to document the size and shape of the nevi. During your routine examinations, your eye doctor will monitor any changes.
Lynne Noon, OD
Hi ~
My 39 year old brother has Stargardt’s Disease. How close is a possible treatment or cure for this ? I know gene therapy is in the works but it realistic to think this could help him in a year or 10 years ? Any info. you can send me (good news !) would be so appreciated so that I can pass it on to him.
Thanks so much, Dawn
Dear Dawn,
Research has produced promising results with stem cell research and has been successful in using stem cells to make the retinal photoreceptor cells which are necessary for vision. They are now moving to place this type of therapy into clinical treatment with human studies. There are two goals. One is to halt disease progression in retinas with early disease. The second goal is to restore retinal cells in people who have already lost a significant amount of vision.
While the future holds tremendous hope and promise for people with degenerative retinal disease, a time frame for a cure can not be established at this point.
Lynne Noon, OD
Dear Siur or Madam:
My wife Jackie has had exotropia her whole life. Years ago she had surgery to cut and weaken the lateral rectus muscle in each eye, and that helped, but not completely. After that she had eyeglasses made with prisms in the lenses, to help keep her eyes both focussed straight ahead. She wore these for many years with great success, and she was able to see “3D” for the first time in her life. Her reading, which had been a chore, was now pleasurable.
A few years ago an optician decided that Jackie no longer needed prisms, so he had her glasses made without them. For a while there did not seem to be a problem - probably because her eyes had been “trained” by the prisms to stop their outward wandering. But as time passed, her reading gradually became less comfortable, and finally this year she asked for new lenses with prisms. She got them last week and she is disappointed. She hoped to have her reading comfort restored, but if anything the new lenses are worse than the ones without prisms.
Jackie wonders whether the prisms were done incorrectly. She cannot recall whether her previous prismatic lenses were thicker on the outer or inner edges. Her new ones are thicker on the lateral or outer parts of the lenses, and she thinks that maybe this is the reverse of what she needs. If not that, maybe the prisms should be stronger.
I called the optometrist and asked about this. I was told, “The lab certainly did it correctly.” That answer was not very satisfying, so I said, “Should the lenses be thicker on the outside edges or the inside edges?” and I was told, “I do not know, but the laboratory knows, and I am sure they did it right.”
I want Jackie to have the right prismatic lenses, and since the optometrist’s office does not seem to know exactly what they are doing, I found you on the Web and I hope you can provide an answer.
Thank you for your kind assistance.
Dr. Wiedemann,
It is difficult to answer this question without examining your wife. Rather than talk to the staff at the optometrists office, your wife needs to make another appointment with the doctor to discuss her needs and the problems that she is having with the new glasses. If she does not get satisfaction, she may want to get a copy of her old records that contained the original prescription with the prism and take them to a doctor who specializes in binocularity. If you live in the United States call your states optometric or ophthalmology association to find a doctor who specializes in binocular vision or go to the American Optometric Association link: http://www.aaopt.org/section/bv/diplomates/index.asp for a list of specialists in the United States.
Best Wishes,
Lynne Noon, OD
I have a question for Dr. Noon.
I was diagnosed with some type of a “cone-rod dystropy” 2 years ago at age 35. (I also have severe nearsightedness since age 9 with astigmatism.) This is a devastating dx, but even more so when you are a working mother of 3 very young children. I have educated myself as much as I can, but what is even harder, is trying to find out how to live the rest of my life. This is the first website I have seen with so much information. I have bulls-eye maculopathy with total blindness in this area. It can be very difficult to read at times and depending how fatigued I am, sometimes the words will “disappear” from the page for a few seconds. I have night blindness and difficulty adjusting to the slightess changes in light. I have alot of flashes when I am on the computer for very long and I have migraines on a frequent basis. My question is this: am I able to get disabilty or is this something I will just have to continue to work with? It is very stressful to deal with all of this daily. I recently mentioned my visual problems at work, and after being with a company over 2 and 1/2 years of excellent work history, I have now been written up 3 times in 2 weeks. I feel very afraid that I will not have a job soon. But I also do not feel that I can easily move into another position due to my visual difficulties. I am a nurse and my job requires that I am able to see accurately. How do someone cope with this loss at work? Now, not only do I worry about working with the loss, I worry about not having income. This is as much frightening as the vision loss itself.
Dear Jennifer,
I am sorry to hear about your diagnosis. It can be frightening when you do not know the services and options that are available. It is unfortunate that your current eye doctor cannot offer you more guidance.
In order to collect Social Security Disability, you must meet the criteria for Legal Blindness. The new rules state that a person must have a best corrected visual acuity of worse than 20/100 in the best eye or a visual field of less than 20 degrees to qualify for disability benefits. Keep in mind, a diagnosis of Legal Blindness does not mean that you have no usable vision; it is only a legal definition to qualify people for this benefit. Many “Legally Blind” people are able to work and some even drive. Your eye doctor can tell you if you meet this criteria. If you meet this criteria, you can apply for disability benefits. You may also choose to continue working while using the correct low vision glasses and products.
If you are not considered Legally Blind by the above definition, it does not mean that you do not have a visual impairment. Most people with low vision still have useful vision and should seek out the care of an eye doctor who specializes in low vision rehabilitation. A low vision examination differs from a basic ocular health assessment or eye glass examination in that it focuses on how the patient functions visually in day-to-day life. The goal of the low vision examination is to help the patient remain independent so that they will be able to perform their desired daily living tasks and hobbies. Eye doctors who specialize in low vision rehabilitation help their patients enhance their remaining vision by prescribing special low vision eyeglasses and microscopic and telescopic low vision aids. They will also recommend electronic magnification products, other optical and non-optical low vision products, training in the use of these products and referral to appropriate low vision services. Studies show that people are more successful and more likely to remain independent when they start using low vision products early in the course of their vision loss. Even if the closest doctor is not near by, it will be worth the trip. I frequently had people who came to my office from different states and hours away. To ensure the success of the patient, all optical low vision products should be prescribed by an eye doctor. To find a doctor who specializes in low vision rehabilitation:
1. You can find a low vision rehabilitation specialist at the American Academy of Optometry website: http://www.aaopt.org/section/lv/diplomates/index.asp or by phone at (301) 984-1441). The American Academy of Optometry lists eye doctors who have received advanced education and certification in this specialty.
2. Most optometry and ophthalmology schools have excellent low vision rehabilitation clinics. To see a list of optometry schools in the United States go to the following link: http://healthguideusa.org/optometry/optometry_schools.htm.
3. Call your states optometric or ophthalmology association for an eye doctor in your area who specializes in low vision rehabilitation.
Most states have Vocational Rehabilitation programs set up through the Department of Economic Security or your state’s Commission for the blind. These programs may pay for your low vision products if you wish to continue working. You do not have to be legally blind to qualify for services. You will also learn about other services that are available to you.
Good luck in your search to find the needed help and resources. In the meantime, don’t be afraid to use your eyes for reading, using the computer, watching TV, and other routine activities. Normal use of your eyes will not cause further damage to your vision.
To learn more about resources and low vision rehabilitation, use our LowVision.com website (www.LowVision.com) and download our latest Low Vision Solutions catalog at Download a PDF of the Daily Living Products 2008 catalog (10MB). You may also order a free copy of this catalog by calling toll-free 866.999.9188. Vision rehabilitation products can be found at: www.ShopLowVision.com .
Hello Dr. Noon,
When billing Medicare or any other private insurance, is it best to bill for the low vision exam as code 99204 or 99205, or as a low vision examination code 92499? And for follow up visits for 30 minutes for example, which code is best for that visit?
Thank you for all your help.
Michael Bourgoin, O.D.
Dr. Bourgoin,
Nice to hear from you. Since different insurance carriers have different policies there is no answer to fit all situations. Please give me a call when you get a chance so that we can discuss billing. You have my phone number, I look forward to talking to you.
My wife and I are considering a move to Lake County, Florida. I am seeking guidance as to whether I could obtain a drivers’ license in Florida.
This
license would be used for short distance, personal/essential driving over familiar routes.
Current age is 56. General health is good. My vision is stable. I currently hold an unrestricted Michigan drivers’ license (18 years with no tickets, 1 accident). My vision is 20/40 -2 in the left eye. I have no vision in my right eye (since birth). I assume that my visual field is in excess of 130 degrees as that is the minimum requirement in Michigan.
Can you give me assistance in determining how Florida DMV will handle an applicant with slightly under 20/40 vision. Names, phone numbers, addresses would be appreciated. I have called numerous DMV and doctor’s offices but have been given no more information than is generally available on the internet.
Thanks in advance for your assistance.
From the information that I have, Florida requires a minimum visual acuity of 20/40 with both eyes combined and a minimum visual field of 130 degrees.
Your only problem is the 20/40- in your only eye. If you fail at the motor vehicle office, you can go to a doctor and have a doctor fill out your vision form. You can also bypass the motor vehicle dept and go to an eye doctor’s office and have the doctor take your acuity and submit the information to the motor vehicle department. Quite often, doctors have better eye charts than the motor vehicle department and the patient is able to read more easily.
If you have measured 20/40- on an eye doctor’s chart, you may want to go to an eye doctor that specializes in low vision rehabilitation as they use higher contrast charts which give the best acuity. When the time comes, we can help you find a doctor in your area.
I hope this helps,
Lynne Noon
Dr Noon,
Thanks for your prompt response to my inquiry placed through your web site today regarding restricted vision driving in Florida. Since you are a doctor, I thought I’d share a bit more of my history on the subject. I’m hoping this might further enable you to direct me to an individual or group who might facilitate some sort of discussion with the Florida DMV people toward obtaining at least restricted driving privileges should we decide to move to Florida.
In a nutshell, I was born with bilateral cataracts in 1951. I underwent multiple surgeries using that vintage technology to remove the cataract from my right eye. Complications developed including glaucoma that necessitated removal of my right eye at age 13. You may be interested to note that between the ages of 14 – 35, I did use telescopes mounted individually at the top (for distance) and bottom (for reading) of plain carrier lenses and frames. In about 1982, I did take drivers’ training while using a single telescope but voluntarily backed off because both the instructor and I concluded that while I could be trained to pass the road test, I would probably not be a safe driver. I continued functioning relatively well (B.A, M.A, house, wife, kids, etc.) until age 35 when the cataract in my left eye started growing. At age 37 the left cataract was removed, bringing my vision from 20/400 to almost 20/40 virtually overnight. In order to minimize risk, my eye surgeon recommended not using a lens implant. Since then I have relied on a traditional cataract lens for correction. Much trial and error in my doctor’s office indicates that the current 20/40- is probably as good as it’s going to get unless some sort of telescope could be integrated. Is that an option?
In 1988, I was granted an unrestricted Michigan drivers’ license based on the 20/40- acuity and an otherwise normal (single eye) field of vision. My driving has been done predominantly over well rehearsed routes such as to and from work, shopping, medical appointments, etc. As you suggested, the state required vision exams have been performed by my Ophthalmologist in her office. Recently, I have begun using a dashboard mounted GPS receiver with text to speech capability to help me “read” street names and house numbers, the only visual aspect of driving that restricts my mobility. Is the use of GPS with text to speech something that may be of benefit to your patients?
With the above in mind, do you have any further recommendations as to eyewear, mobility counselors or DMV people that might assist me in staying on the road were we to move to Florida? All I’m looking for is limited mobility over well rehearsed routes in a relatively uncongested area (Lake County). As I read the FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES REPORT OF EYE EXAM (http://www.hsmv.state.fl.us/hsmvdocs/vision.pdf ), I do see the State asking for the doctor’s professional judgment as to whether a license should be issued and under what restrictions, if any. What does your experience in this area indicate? What would be your recommendations?
Thanks you in advance for your kind attention to this matter.
I am a young OD who is trying to build a low vision/neuro rehabilitation practice in Nashville, TN. I would like to know if it is possible to be listed as a low vision resource on your site? I’d also like any advice on how I can market to myself to other professional as well as the public. Thanks!
Dear Dr.
Thank you for asking to be listed as a resource on our website. Please send me information regarding your practice and I will have it placed on our website. Please call me so that we can discuss some marketing ideas for your practice. My number is 800.826.4200X176. I look forward to working with you.
Lynne Noon
Dr. Noone,
Could you please clarify how peripheral field testing, such as the perimetry bowl or tangent screen, may guide treatment strategies? I understand that these tests give precise data concerning field loss versus a simple confrontation test. However, when instructing patients for systematic scanning, it’s not feasible to instruct them to move their eyes 20 degrees temporally, etc.
Thanks,
Rhonda
Bowl perimeters can test both the central and the peripheral visual field. The Tangent Screen will test only the central 30 degrees when placed at 1 meter. For the most part, visual fields are used to detect or follow pathology. However, in low vision rehabilitation, they are used to direct treatment strategies. A visual field loss only becomes a problem when the field loss is bilateral and the image falls in an area of visual field loss. There are three types of visual field loss:
1. Hemianopic or sector defects are generally acquired after head trauma or stroke. The goal of rehabilitation is to place information present in the non-seeing visual field into the seeing portion of the visual field. This is accomplished by several methods. Prism placed in or on lenses acts to move images into the seeing field increasing patient awareness. Training involves teaching the patient to develop both head and eye scanning techniques to improve awareness of the surroundings. All three techniques should help with orientation to surroundings and mobility.
2. Over all field constriction is usually caused by retinal diseases such as retinitis pigmentosa, advanced glaucoma or optic nerve disease. It is difficult to treat and clients generally need referral to a mobility specialist. Generally, overall field loss develops slowly and most patients develop compensatory head and eye scanning techniques. Rehabilitation treatments include training in effective head and eye scanning. Prism can also be place in glasses to increase awareness of the missing visual field. To further increase the visual field, reverse telescopes or minus lenses can be use for temporary viewing of surroundings. While a telescope or minus lens can increase the size of the visual field, they also decrease visual acuity and are only used for spotting.
3. Central field loss is most often due to macular degeneration. Central field testing may locate the position of scotoma relative to the fovea. Training involves increasing the patient’s awareness of the scotoma and having them develop appropriate eccentric viewing techniques.
Please contact me directly so that we can discuss your needs. I can be reached at 800.826.4200 X 176.
Dr. Noon, I have been seeing Low Vision Patients here at Kasier for a long time, but have not really had the opportunity to prescribe many bioptic telescopes. I am in need of some help/guidance in prescribing bioptic telescopes to two of my patients.
One is 52 yr. old patient with Stargardts disease. He has best corrected vision of 20/150 in each eye(using eccentric fixation)I do not have a telescopic fitting set her yet, however last time he was here I had him look through a specwell 6 X 16 monocular, and he was able to get down to 20/20 in his right eye, and about 20/40 in the left eye. In looking through the Designs for Vision Catalog, I guess it would be between a 4X and the 3X Wide Angle. I am not sure if magnification is going to be more important, or if field of view will be more important. What do you recommend?
The other patient is an 18 yr. old patient with a congenital rod-cone dystrophy with a high hyperopic astigmatic correction. Best vision of 20/150 in one eye, and 20/200 in the other eye. He is wanting to drive now. I have not done any telescopic work with him. What do you recommend?
Hi Dr. Noon,
I am an optometrist employed by an ophthalmologist who is starting a low vision department from the ground up. We currently do not have any low vision equipment and currently have a tight budget. There is such an incredible amount of information out there on low vision that it is difficult for me to assess what are the particular devices that are “must haves”. If you have any suggestions on what a low vision department should have to start with, I would so appreciate any information that you can share.
Also do you know what medicare covers for low vision? The practice is in the state of New Mexico.
Thank you so much for your time. This website is just fantastic!
Thanks again,
Adrienne
Dear Adrienne,
I have had a full-time low vision rehabilitation practice in Arizona for 15 years. Now with LowVision.com, I am offering free practice consultation to doctors who want to start a low vision practice. Call me at 800.826.4200 X 176 so that we can discuss your needs. I look forward to working with you.
Dr. Noon:
As a low vision optometrist, could you give me your opinion as to how an occupational therapist trained in LV rehab should approach an optometrist or ophthalmologist when marketing services? Since you are an optometrist who values the contributions OTs can make in the LV community, your perspective would be most helpful.
I’ve been an OT for 13 years and am also currently a student in the graduate certificate program for low vision rehab at the University of Alabama at Birmingham.
Thanks very much.
Paul Scaglione
Dear Paul,
I am thrilled to see so many OT’s interested in the field of low vision rehabilitation. I have seveal ideas for your marketing, but feel it would be more benefical to discuss over the telephone. Please call me at 800.826.4200 X176. I look forward to talking to you.
Lynne Noon
Hello Dr. Noon
I am seeking some advice as to which magnifying product would be best for viewing a screen on a palm pilot or cell phone. The person who would benefit from this has mentioned problems with these tasks, as she has some degree of visual impairment.
Thanks in advance for your help!
Rhonda
Dear Rhonda,
Many devices will magnify a Palm or cell phone. Hand magnifiers, strong reading glasses or portable video magnifiers (such as the Compact+ by Optelec) are all good choices. However, just like prescription eye glasses, all of these magnification products are available in many strengths. The exact power that a person needs depends on their eyesight or visual acuity. If you simply pick a drugstore magnifier, it may not be strong enough for the task.
To ensure sucess when using magnifcation products, a magnifier or reading glass should be prescribed by an eye dotor a professional who specializes in low vision rehabilitation. See our resources list to find low vision resources in your area.
Hello please help I need a directory of doctors who will perform laser eye corrective eye vision surgery, lasik or other on a patien who has had optic neuritis in her left eye in 1999. I live new york can anyone help me. I know the surgery is being performed I just don’t know who is doing it. Thanks
Dear Npemb,
Unfortunately Lasik or similar surgeries to correct a refractive error will not help optic neuritis. These surgeries correct an eye that is not in focus so that the person no longer needs to wear eyeglasses.
Optic neuritis damages the optic nerve leading to poor vision; this is not correctable by eyeglasses or surgery. Talk to your ophthalmologist regarding other forms of treatment.
My husband suffered trauma to his eye last September when it was hit with a piece of wood in the lower outside quadrant. The tear damaged extended to the edge of the iris, but the wood hit with a great deal of force. He immediately had surgery at our local eye center to repair the tears. He had little vision in the eye. His retina detached in late October and the surgeon put in a scleral buckle. A large cataract has developed. His eye does not drain probably due to the buckle and he has developed glaucoma. During this time the doctors have felt he would get good usuable vision back after removal of the cataract and installation of a new lens. They are hoping the retina is in good condition since they have not been able to check it due to the large cataract. They are hoping to perform surgery soon but have now told him that due to damaged “xaneoles” which hold the lens on, his vision may not be that good.
It is difficult to find any information since this is a trauma case.
My husband feels confident in these doctors. I question that how do we know that we shouldn’t fly to a state of the art facility for this surgery. What would the differences be? How do we know his doctor is highly qualified in this area, especially because his (the doctors) confidence level in the outcome has dropped.
Are there any other resources for trauma damage you could refer us to?
Dear Mspitz,
It is not unusual for an eye to have all of these complications after a traumatic accident. Even with the best of surgeons this scenario is likely to occur. I cannot comment on the skill of your current doctor but if you are concerned, a second opinion is always a good option. At least you will be reassured that you have done everything possible to save the vision in that eye. Good luck.
I have a hole in one macular. Is there any hope that one day it could be cured? Perhaps with stem cells?
TIA
A macular hole is a small break in the macula, the part of the retina that provides clear central vision. Macular degeneration and a macular hole are not the same condition although they both occur most often in people over age 60 and result in blurred, distorted vision.
In most cases, the cause of a macular hole is due to the aging of the vitreous, or gel, in the eye. The vitreous contains fibers that are attached to the retina. As we age, the vitreous shrinks and pulls away from the retina. This is normal and usually causes no adverse effects other than an increase in floaters in the vision. However, in some cases the vitreous can tear the retina as it pulls away causing a macular hole.
Some macular holes can seal themselves and do not require treatment. However, surgery is often needed to improve vision. The vitreous is removed in a procedure called a vitrectomy to prevent further pulling on the retina and is replace by a gas bubble or silicone oil. The bubble or oil acts as an internal, temporary bandage that holds the edge of the hole in place while the macula heals. Following surgery, the patient must remain in a face down position for several days to weeks. This allows the bubble or oil to press against the macula to help it heal. The improvement in vision varies from patient to patient and is more successful in patients who have had a macular hole for less than 6 months. Most people with bilateral macular holes respond well to low vision aids and glasses.
Currently there is research being conducted on other treatments for the repair of a macular hole. The use of stem cells is being used in several research projects for various eye diseases; however, it is not at present, an acceptable treatment for a macular hole.
My friend’s son is 5 years old, his VA is OD: DS +1.00 1.0 OS: DS +5.00 0.2
He is eccentric fixation, OS Exotropia -10 deg.
The problem is that he has gone through vision therapy for over a year, but the OS VA has not even a bit improvement, they have visited several famous eye doctors and tried computerized vt, Haidinger’s brush treatment, and some other exercises. Hope we can get good advise from you, thanks.
Dear GZFLY,
Without knowing the exact cause of the childs exotropia or eye turn, it is difficult to know if this childs vision is expected to approach to near normal with vision therapy or if the eye doctor justs expects a slight improvment in visual acuity. If the child simply has an eye turn, without other pathology, the vision should improve to near normal with vision therapy as long as the child follows the eye patching (or other technique) of the right eye that forces him to use his left eye. A child will not do well with vision therapy if they do not follow this patching or if they constantly look under or over the patch with their good eye.
The child may also have a pathology such as optic atropy that caused the decreased visual acuity and then the eye turn. In this case vision therapy may or may not help the visual acuity in that eye.
The child’s mother should ask the eye doctor the following questions:
1. What is the cause of the eye turn? Is ocular pathology a posibility?
2. Why hasn’t my childs vision improved through vision therapy?
3. What else can be done to improve the visual acuity?
where can i find some information about teoris of low vision mobility? i need tree teoris for my exam. tanck you.
Dear Patricia,
I am trying to understand your question and believe you are asking about theories of mobility instruction. You may find the answer at the American Optometric Association Library. They can be reached at (800) 365-2219 X 4117 or at ilamo@AOA.org.
Dr. Noon,
I have had poor vision all my life. I’ve been wearing hard lenses for 34 years and am currently 39. I had a detached retina 7 years ago and can’t see the big E in that eye. I was diagnosed with myoptic degeneration in my good eye 20/70 with correction. It’s getting harder to do things such as reading, computer work etc. I think I was in shock and didn’t ask the right questions. What is Myoptic degeneration? What’s the prognosis? I know that there isn’t any treatment. I’m trying to use reading glasses, magnifiers etc. I get tons of headaches and the eye strain becomes very painful. Anything I can do to make the transition a little easier and what should I expect? Any info would be greatly appreciated. Thanks,
Eileen
Dear Eileen,
Myopia or nearsightedness is a condition where light focuses in front of the retina of the eye causing blurred vision. For most myopic people, myopia is corrected with glasses or contact lenses. Myopia results from the eye being either to long or from the curvature of the cornea being too curved or a combination of both. (See anatomy of the eye under the ?Information on Eye Conditions? tab on this website).
In degenerative myopic, the cause is generally due to the excessive length of the eye. As the eye grows and lengthens it becomes extremely nearsighted. This excessive growth of the eye causes stretching and thinning of the retina and other tissues in the back of the eye leading to damage to these tissues. If the retina tears, a retinal detachment is likely to occur. While the nearsightedness of an eye with degenerative myopia can be corrected with either glasses or contacts, the vision will still not be clear because of the damage that occurred to the retina. This damage cannot be reversed and is often progressive as the eye continues to grow and stretch. There have been recent studies showing that a procedure called Scleral Buckling may help decrease further stretching of the retina in adults. You should be under the care of a retinal specialist who can discuss this procedure or any other procedure that may be beneficial to you.
Eileen, even though ?regular glasses? or contact lenses cannot fully correct your vision, special low vision glasses and other magnification products will be helpful and will allow you to continue to read and do the other activities that you wish to pursue. Seek out the care of an eye doctor that specializes in Low Vision Rehabilitation. He or she will prescribe special glasses and other low vision aids that will help maximize your remaining vision. An eye doctor who does not practice low vision rehabilitation will not prescribe these glasses for you. A doctor who specializes in Low Vision Rehabilitation does not take the place of your retinal specialist. Either ask your retinal specialist for a referral to an eye doctor who specializes in low vision rehabilitation or call your state?s optometric association for a referral.
Dear Dr.Noon:
I have an anamalous optic in the right eye. It has been discribed an d photgraphed as a hole in the back of the eye. The photo had a light shining through. I can see from the eye but not very good. What treatments are available from low vision . Would glasses help?
Dear Carol,
Most people need low vision rehabilitation if they have uncorrectable blurred vision in both eyes. If you have blurred vision in both eyes, then you should definitely see a low vision specialist. If you have good correctable vision in your left eye, then you probably do not need to see a low vision specialist.
Low vision glasses will help you use the remaining vision in your right eye by magnifying the image that you see. However, if your left eye can see without needing magnification, you will not be able to use both eyes together when your right eye is using glasses with magnification. Because the brain cannot process similar images in different sizes the result will be double vision. In this case it is best to get a detailed image of what you are looking at with your left eye only.
Two of my sons have red-green color blindness. Is there any special help they can get from our school system? Their ages are 5 & 7 yr. Thanks, Debbie
Dear Debbie,
The normal retina contains two types of photoreceptor cells, rods and cones. The rod cells help with night vision and the cone receptors help distinguish colors. Color blindness or color deficiency is defined as the inability to perceive the differences between some or all colors. As with your sons, a color deficiency is usually genetic but it may also occur because of optic nerve or brain disease. There are many types of color blindness with the most common being a red-green hereditary (genetic) photoreceptor disorders.
There is no treatment to cure inherited color deficiencies; however, certain types of tinted lenses may help an individual distinguish colors more easily. Your son’s eye doctor will be able to determine if your child responds to different tints.
Although people with this color deficiency may not perceive colors correctly, they will have 20/20 vision and full visual fields. Therefore, the color deficiency should not interfere with the ability to learn in school. Your child’s teacher should be aware of the color deficiency so that he or she may help with projects that require color discrimination. As your child ages, the color deficiency may affect vocational choices such as an electrician who has to identify the different color of wires. I know of no other help that is provided in the school system and do not believe that your sons will need further help.
I developed optic neuritis in my left eye last august. (and got diagnosed with MS in january) I’ve had at least 3 doctors (a neuro-opthalmologist, a regular opthalmologist, and a neurolgist) all tell me that my eye would return to normal vision within 4 months. So, needless to say, I’m a bit miffed that my vision in that eye is still blurry. (I did have ginormous blind spots covering 2/3rds of the vision for about a month)
My regular family doctor is the only one who told me that he thought I’d probably be stuck with poor vision in my left eye for life…and I tend to believe him more than the other three.
Is there anything that I can do to help the optic nerve heal? I know with MS, sometimes they can give you an IV steroid, but now that it’s at least 6 months since the initial optic neuritis, I’m wondering if it would be too late to take steroids, or is it still possible that steroids would work for me?
Thanks…
Erin
Erin,
Any time that your vision changes it is important to contact your eye doctor. A decrease in vision may indicate that you are beginning another episode of optic neuritis. If so, there is a good chance that your vision will return after this episode.
Thanks… I made an appointment with my eye doctor, but cant get in to see him until early June. (argh!) But, I’m seeing my neurologist in a couple of days. If he thinks I’ve started another round of optic neuritis, maybe he can get me in to see another opthalmologist quickly.
Wouldnt I have pain on eye movement like I did in august when I first developed ON??? Or is optic neuritis sometimes painless?
Dear Erin,
Optic neuritis is an inflammatory disease of the optic nerve often associated with Multiple Sclerosis. After an episode of optic neuritis, the prognosis for recovery of vision is often good, although most people have some remaining damage to visual function. Unfortunately, after 6 months, you most likely will not see a large improvement in the vision of the effected eye.
Two studies, the Optic Neuritis Treatment Trial and the follow-up study, the Longitudinal Optic Neuritis Study have tried to determine treatment guidelines for optic neuritis. The studies compared the effects of the use of oral prednisone, intravenous prednisone and a placebo in the treatment of optic neuritis. The results of the study so far show that treatment with oral prednisone in standard doses should be avoided, but treatment with intravenous methylprednisolone should be considered, particularly if a brain MRI demonstrates multiple abnormalities consistent with multiple sclerosis or if a patient needs to recover vision rapidly. The decision as to whether to prescribe this treatment must be made on an individual patient basis. Prescribing no treatment for acute optic neuritis also is a viable option. The longitudinal portion of this study is ongoing. Additional information regarding the studies can be found in medical libraries or on the internet.
I’ve noticed in the past few weeks that whatever improvement I had seems to be regressing. (things are getting more blurry) I’m calling my opthalmologist tomorrow to see if I can get in to see him sometime within the next week or so.
It’s just disturbing that I seemed to be having improvement, and now it seems to be getting worse. Today I was looking at myself in a mirror. I was probably 2 1/2 feet from the mirror and could barely tell it was me in the mirror just looking thru the bad eye. I can barely read printed text in a book with just that eye now, and it was just weeks ago that I could still read fairly clearly with that eye. It’s really quite disturbing to sit and watch your vision go. Hopefully the vision in my right eye will be ok. It’s just that now I’m paranoid that something will happen to my good eye. I dont think I’d make a very good blind person.
Erin
hi doctor,
I recently went to a Laser eye doctor over the weekend and was advised that I would not be a good candidate to get the surgery due to the fact that I only have one good eye. And he was surprised that my regular optometrist never declared my right eye as “Legally Blind.” If this is the case-who can I talk to about this. Can I get help or assistance such as Disability or something.
Dear Lani,
Fortunately for you, you are not legally blind by definition as you have one eye that is able to see clearly with eye glasses. The term legal blindess, implies poor, uncorrectable visual acuity in both eyes. Therefore, you are not entitled to disability benefits. I also agree that you should not risk the vision that you have in your good eye by having Lasik surgery.
In the United States, where normal vision is considered to be 20/20, legal blindness is defined as visual acuity with best correction in the better eye worse than or equal to 20/200 or a visual field extent of less than 20 degrees in diameter. Most states use these standards to provide rehabilitation services and benefits to people who are visually impaired. Some of these benefits and services include an IRS income tax exemption, free telephone directory assistance, free Talking Book Library Services through the National Library Service and Vocational and Independent Living Servic