A new and improved version of MyVisionTest was released about 2 weeks ago. Changes are being made to improve the sensitivity of the test and make it more user-friendly. Below is a round-up of a few of the changes in this version.

Afterimage effect: For users that have difficulty visualizing their defects, researchers have found that an afterimage of your vision defects can be elicited by periodically halting the static. Often the afterimage is more easily visualized than the defect itself. This feature can be turned off by users that do not find it helpful.

Blind spot monitor: Everybody has a normal blind spot in their vision. We can take advantage of that fact to assist with maintaining proper head and eye position while testing your vision. This too can be turned off by users that do not want to use it.

Dynamic sizing: Regardless of the size of your computer monitor, the vision test will attempt to maximize itself to take full advantage of your monitor real estate.

Instruction screens: If you would like to review the instructions or practice using the test, you can review these interactive introductory screens prior to plunging into the test itself.

Enhanced navigation: You can now easily navigate back and forth between the right and left eye test screens. Great for folks that want to recheck their results before exiting the test.

Many thanks to the helpful comments from our users and the diligence of our beta-testers in helping us to continually improve the vision test. We always welcome feedback from our users. Please let us know what you think of the new version. We would love to hear from you.

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Genentech announced on October 11th that it will stop making its cancer drug Avastin available to compounding pharmacies as of November 30 in an effort to curb its use in treating macular degeneration. After meeting with eye specialists who complained that the action might interfere with treatment of their patients, the company agreed to postpone restrictions on Avastin sales until January 2008 to give eye doctors additional time to find alternative ways to obtain the drug.

Avastin is not approved by the Food and Drug Administration (FDA) for the treatment of macular degeneration, but has been widely used ‘off-label’ for this purpose. Avastin is chemically similar to Lucentis, another drug produced by Genentech, which was approved last year for the treatment wet macular degeneration. Compounding pharmacies, which are licensed to mix and repackage drugs, have been putting Avastin into syringes for use in the eye at a cost of about $40 per treatment. A similar dose of Lucentis costs about $2,000. Genentech has a program in place to help patients who have trouble paying for Lucentis.

Genentech faced some legal risks by allowing sales of Avastin to compound pharmacies because it could be perceived that the company was facilitating off-label use of the drug. Doctors are allowed to use drugs off label but drug companies cannot promote such uses. The company announced on October 29th that it will reinstate its supply of Avastin to compounding pharmacies if the FDA gives the company legal and regulatory authorization to do so.

Genentech specifically designed Lucentis for use in the eye, believing that Avastin would not work there. But eye doctors started using Avastin and found it worked very well. The relative effectiveness of the two drugs have never been formally studied, but many retinal specialists believe, based upon their experience, that they are equally effective.

The announced change in Avastin distribution has angered many, and this has raised concerns among some Wall Street analysts. “In my opinion, this policy is the type of negative publicity a corporation doesn't need and is a great example of the cliché penny-wise but pound-foolish,” reported a stock analyst at TradingMarkets.com. “I think the retinal community is deeply saddened by the decision Genentech has made to restrict the availability of Avastin in the United States,” said Dr. Philip J. Rosenfeld, a professor of ophthalmology at the University of Miami. He said the move would have a “profound” effect on retinal practices. An anonymous retinal specialist states “I believe that the recent decision regarding Avastin will actually backfire and result in more and more physicians dropping Lucentis simply out of anger with the company.”

WHAT IT MEANS TO YOU: A doctor weighs a variety of factors before deciding which drug to prescribe for a given patient. Cost may be one factor, but it is usually not the most important. That drug which, in the doctor’s opinion, will most benefit to the patient is the one that should be prescribed. Currently, we know that Lucentis is probably more effective than Macugen (see last month’s newsletter), but we do not yet know how Avastin and Lucentis compare. If it turns out that Lucentis is the more effective drug, then it would become the drug of choice, regardless of cost. If, however, Avastin is superior, or should there not be any significant difference, then rest assured that doctors (and insurance companies) will continue to obtain Avastin for their patients.

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“People don’t know that acupuncture can help macular degeneration,” says Nawei Jiang, doctor of Chinese medicine and owner of Nawei’s Acupuncture Clinic in Colorado Springs, Co.

In Chinese medicine, internal organs correspond with outer body parts; for example, an eye problem is connected to the liver and kidneys, Jiang said. Needles are placed along the “liver meridian,” an invisible energy line from the organ down to the big toe, to stimulate blood and energy flow, said Jiang, who’s treated hundreds of macular degeneration patients since she established her practice in 1998.

Cathy DiMaggio, acupuncturist, said the goal of acupuncture is to balance the body, which allows the body to heal itself.

“It’s a whole-person approach,” DiMaggio said. “We don’t just treat the symptoms, we treat the cause.”

But acupuncture is not a cure for macular degeneration. Some patients have reported improvement in vision after acupuncture, but more often they say the disease is stabilized.

Many traditional doctors remain skeptical of acupuncture for treating macular degeneration. Two studies have been conducted on acupuncture and AMD, both at Santa Fe Medical Acupuncture in Santa Fe. One study included 10 patients; the other studies 108. The majority of patients in both reported improved vision after acupuncture. No large-scale clinical trials have been conducted.

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A diet rich in antioxidant vitamins and minerals (vitamins A, C, and E, various carotenoids, and zinc) does not prevent the onset of age-related macular degeneration (AMD), according to a large scientific literature review and meta-analysis.

Researchers reviewed 4192 randomized clinical trials and prospective cohort studies investigating the role of antioxidants in the primary prevention of AMD. Of these, 12 met selection criteria and were included in the meta-analysis.

The data indicated that vitamin A, vitamin C, vitamin E, zinc, lutein, zeaxanthin, alpha-carotene, beta-carotene, beta-cryptoxanthin, and lycopene have little or no effect in the primary prevention of early AMD.

The only nutrient that showed any protective effect was vitamin E, which had a protective effect of almost 20%. This protective effect was present only in the cohort data, not in the randomized controlled trials.

The researchers concluded that there is not enough evidence to support the role of dietary antioxidants, including the use of supplements, for the primary prevention of early AMD.

Discussing the possible protective effect of vitamin E, the investigators noted that vitamin E may be associated with a reduced risk of early AMD. An accompanying editorial states that further studies are need to confirm the relevance of the vitamin E findings.

This research stands in contrast with the 2001 AREDS study that found high dose antioxidant supplements reduced the risk of intermediate-stage AMD progressing to advanced AMD by 28%. Unlike the current study, the AREDS study did not examine whether antioxidant supplements were effective in preventing the onset of early AMD.

The investigators note that cigarette smoking remains the only widely accepted modifiable risk factor for primary prevention of AMD

WHAT IT MEANS TO YOU: Research has shown that both genetic and environmental factors are important in deciding who will get macular degeneration. While there is good evidence that nutrition plays an important role in the development of this disease, there may be other factors at work that are even more important. While there are many benefits of a diet rich in fruits and vegetables, but the ability of such a diet to prevent the onset of macular degeneration is questionable.

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Eleanore Stoppel, 85, struggles to explain the vision problem that has taken root in her eyes.

"You can see a coin on the floor, but by the time you bend over to pick it up, you can't see it," she says.

Stoppel has macular degeneration, a progressive worsening of vision that eventually leads to an inability to see what's the middle of the person's line of sight. Things around the periphery of vision remain visible.

"I actually have a blank spot right where I look, and if I look straight at anything, it just plain disappears," said Grant Cocker, 74, of Rochester.

Cocker, like Stoppel, used the Minnesota Low Vision Store to get equipment to help him read.

Store operators Don and Carol Hint go out of their way to help address their customers' vision problems, customers said. Don Hint is a retired IRS accountant.

Cocker, for example, is re-selling his video magnifier, which originally cost about $2,500, on consignment at the store. That's because he got new equipment from the Veterans Administration.

"Don Hint, the operator of the store, is basically in the same boat as I am vision-wise. He doesn't see very well either. He has the same kind of vision problems I do, so he understands my situation," Cocker said.

Hint, like many of his customers, has macular degeneration. But he said the Low Vision Store includes products for the visually impaired and blind who have a variety of vision problems.

Don and Carol Hint got the idea to open a store when they couldn't find the equipment in Rochester that he needed.

"It's kind of hard to get used to using your peripheral vision. But that's what we have to do," Hint said.

He reads using a video magnifier, and sometimes a compact hand-held magnifier with changeable background color that makes letters stand out better. So he keeps going, despite the change in his vision.

"I guess I just decided I wasn't going to let this slow me down or stop me," Hint said.

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Eating fewer refined carbohydrates may slow the progression of age-related macular degeneration (AMD), according to a new study.

Investigators analyzed diet questionnaires completed by 4757 non-diabetic participants that had mild or moderate stage AMD in the Age-Related Eye Disease Study (AREDS). The researchers examined the participants’ carbohydrate intake over a one-year period and used this data to calculate a dietary glycemic index.

Dietary glycemic index is a scale used to determine how quickly foods are broken down into sugar. Foods with a high glycemic index are associated with a faster rise and subsequent drop in blood sugar. Refined carbohydrates like white bread and white rice have high glycemic indices. Whole wheat versions of rice, pasta and bread are examples of foods with low glycemic indices.

Those people with a high glycemic index were at greater risk of AMD progression, especially those already in more advanced stages of the disease. Participants with moderately severe AMD who consumed the most refined carbohydrates were 17 percent more likely to develop advanced AMD.

“Dietary changes may be the most practical and cost-effective prevention method to combat progression of AMD,” says researcher Allen Taylor. The current study builds on a recent analysis by Taylor and colleagues that found men and women older than 55 who consumed diets with higher-than-average dietary glycemic index foods appeared to have an increased risk for both early and later stages of AMD.

“We feel we have identified a risk factor that could postpone the debilitating loss of vision with very little economic or personal hardship,” says Taylor. “Based on our data, limiting refined carbohydrate intake, such as by limiting sweetened drinks or exchanging white bread for whole wheat, in at-risk elderly could reduce the number of advanced AMD cases by 8 percent in five years.”

WHAT IT MEANS TO YOU: There are many health benefits of a low carbohydrate diet. One such benefit may be decreasing your risk of developing macular degeneration, and slowing it’s progression. In selecting foods, choose those that are lowest in refined carbohydrates to decrease your risk from macular degeneration.

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Elevated levels of C-reactive protein were associated with the development of age-related macular degeneration (AMD) in this large population-based study.

All inhabitants age 55 or older living in a suburb of Rotterdam, the Netherlands, were invited to enroll in a study of chronic diseases in older persons. The researchers examined serum C-reactive protein levels and fundus photographs of 4604 persons.

The researchers found that if a person's level of C-reactive protein was above average (greater than 1.73 mg/L), then there was a greater risk of developing AMD. The higher the C-reactive protein level rose, the higher the risk of developing AMD. This trend was noted for both early and late stages of the disease.

Because C-reactive protein is a nonspecific marker of systemic inflammation, the investigators believe that their findings supports the theory that inflammation plays a role in the development of AMD. Smoking, obesity, and the toxic effect of light may all induce AMD through a state of chronic inflammation, they said. Evidence is also accumulating that inflammation is involved in other age-related degenerative diseases, such as atherosclerosis and Alzheimer's disease.

This study confirms results from three earlier studies indicating that C-reactive protein levels were associated with AMD, with the highest risks for patients with more advanced stage disease.

It is possible that reducing C-reactive protein levels might lower the risk for the eye disorder, the researchers said. However, a drug that can selectively decrease C-reactive protein levels has not yet been developed. Smoking and high body mass index increase C-reactive protein levels. Moderate alcohol intake, diets with a low glycemic index and statin and multivitamin use reduce C-reactive protein levels.

"We consider C-reactive protein level a potential useful biological marker in profiling the risk of aging macular degeneration for individual persons," the authors concluded.

WHAT IT MEANS TO YOU: There is growing evidence that inflammation plays a role in the development of AMD, and C-reactive protein is a useful way to measure the level of inflammation in your body. There are many reasons why your C-reactive protein may be elevated, it is not specific to any one cause. Knowing it is high, and then taking steps to lower it by adopting a more healthy lifestyle can decrease your risk from AMD.

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The North County Times of San Diego reports that goji berries are showing up in natural food stores. Goji (pronounced GO-gee) berries, also known by a variety of other names, including wolfberries, lycium fruit, and matrimony vine fruit, have become popular in large part because of their remarkable nutritional profile – boasting anti-oxidants and vitamins galore. Goji berries are very tasty, offering a tart and sweet taste. In the dried form, the size and texture of goji berries are not unlike those of a raisin, although a little crisper. Goji berries are rich in calcium, potassium, iron, zinc, selenium, riboflavin (vitamin B2), and vitamin C. The fruit also contains phytochemicals, particularly beta-carotene and zeaxanthin. The health benefits of phytochemicals, which are naturally occurring compounds found in plants, are increasingly recognized. According to the American Macular Degeneration Foundation, a diet high in zeaxanthin (and lutein) may slow the progression of age-related macular degeneration. Other foods containing zeaxanthin include corn, spinach, collards, lettuce, oranges and tangerines. Kale, turnip greens, and broccoli also contain lutein.

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Pipex Pharmaceuticals is involved in transitioning research regarding metal dyshomeostasis into new therapies for patients with dry macular degeneration. Pipex is currently in the process of developing a therapy involving their proprietary zinc-based moiety, zinc-monocysteine (Z-monocys). Zinc-monocysteine complexes (Z-monocys) increases the activity of antioxidant enzymes catalase and glutathione peroxidase, and the antioxidant protein metallothionein in cultured retinal pigment epithelial cells more efficiently and potently than currently available zinc formulations. Z-monocys also has the potential to overcome some of the inherent limitations of existing high dose oral zinc therapies. Z-monocys has completed an 80 patient, double-blind, placebo-controlled, clinical trial demonstrating a statistically significant improvement in visual acuity and other parameters of dry AMD. A manuscript describing these results has been submitted for publication in leading peer-reviewed publication.

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The Daily Mail of London reports that eccentric viewing can greatly improve the lives of people with macular degeneration. Eccentric viewing involves changing one's angle of vision to make use of healthy parts of the eye that can still see. The technique works by helping people to find and use peripheral parts of the retina where the tissue is healthy, instead of the central part, which is damaged. This might mean having to look above, below, or slightly to one side of a word to focus on it most clearly. Learning the technique requires dedication and concentration. "You have to re-educate your brain to read differently, and your eyes to look differently," says Richard Elliott 66, a retired civil engineer, who has macular degeneration. He underwent eccentric viewing training in July and is now able to read again. "The technique is very simple, yet incredibly effective," he said. Eccentric viewing can benefit not only those with age-related macular degeneration, but people with many other conditions affecting the macula can be taught to see more clearly, too.

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The North Jersey Record reports on Charles Bonnet syndrome in a person with macular degeneration. A Swiss-born French philosopher, Bonnet lived from 1720 to 1793. In 1760, while caring for his blind 89-year-old father, Bonnet described a condition, now known as Charles Bonnet syndrome, in which otherwise sane, blind or partially sighted people experience vivid hallucinations. These people routinely see animals, pastures, dead people and little people. Apparently, when the eyes and optic nerves are still functioning, but the brain is not receiving enough information, it creates images for the person to see. It usually lasts 12-18 months, sometimes longer. The condition may be hereditary. When Charles Bonnet aged, he got it too. Some patients are too embarrassed to tell the doctors about their symptoms because they're afraid they're going mad.

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