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June 13- International Albinism Awareness Day

Albinism is a group of genetic disorders resulting in little or no pigment (melanin) in the skin, hair and eyes. As a result, individuals with albinism are at an increased risk for skin cancer and vision problems. Through a review of statistics, it was found that 40% of all persons with albinism require refractive correction over +4.00D in magnitude, most commonly high myopia (with or without astigmatism). Other common vision issues include light sensitivity, rapidly oscillating eyes (nystagmus) and eye turns (strabismus).

According to traditional beliefs, individuals with albinism in sub-Saharan Africa are believed to be the result of infidelity with a white man, ghosts or a by-product of bleaching from a venereal disease. Commonly, they were either killed upon birth or ritualistically buried alive. Today, witch doctors continue to propagate the belief that people with albinism are spirits whose body parts could be used to obtain wealth and good fortune. Since 1990, there have been 300 reported attacks resulting in 190 deaths. These attacks have occurred most frequently in Tanzania, where albinism is widespread, occurring in one in 1,400 people. Sadly, only 21 convictions have been secured, due to lack of cooperation from victims’ families, as well as preconceived notions that people with albinism are blind and unable to identify their attackers. For their safety, many children with albinism have been removed from their families and placed in schools for blind and disabled children.

In honor of International Albinism Awareness Day, OCOS is proud to highlight the work of one of our members, Dr. Rebecca Kammer, who has dedicated a significant portion of her professional career to drawing attention to and empowering individuals with albinism in Tanzania.

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Dr. Rebecca Kammer owns a consulting firm and a part-time low vision practice. Her consulting projects primarily involve the development of outcome measures for clinical trials for vision impairing eye diseases. A secondary emphasis is related to her PhD in higher education and involves speaking at health professions universities and providing faculty and curricular coaching related to active learning and critical thinking. In 2016, Dr. Kammer started her low vision practice in Irvine after previously serving as Chief of Low Vision Rehabilitation at the Southern California College of Optometry. Throughout her professional career, Dr. Kammer has been involved in medical mission trips, mobilizing optometrists, optometry students, opticians, members of her church and other health professionals to projects in Honduras, Mexico, Kenya and Tanzania. As stated previously, she is a strong advocate for human rights and healthcare for people with albinism in Tanzania.

 In 2009, Dr. Kammer was watching a documentary on geneticist Dr. Murray Brilliant and learned about the killing and maiming of people with albinism for their body parts in East Africa. As a health professional familiar with providing care in remote settings and well versed on the vision issues of individuals with albinism, she felt compelled to contact Dr. Brilliant immediately. Dr. Kammer was directed to Under the Same Sun, a nongovernmental organization (NGO) dedicated to promoting the rights of individuals with albinism, and was shortly thereafter leading teams to provide glasses, telescopes and magnifiers for sponsored individuals with albinism throughout Tanzania.

 In the years that followed, Dr. Kammer continued to develop relationships, including to the Tanzanian Optometric Society, United Nations and the United Kingdom-based NGO Standing Voice. In 2014, she started a Tanzanian low vision program with Standing Voice, educating and empowering optometry and ophthalmology to provide low vision clinics and care to over 1,000 individuals with albinism annually. The program also provides education and advocacy to teachers and political leaders about albinism, while developing a model that is aimed at supporting other African countries with high prevalence of albinism. Dr. Kammer writes and speaks for international conferences in efforts to provide ongoing global awareness and has a book chapter on albinism in Africa through Elsevier on track for publication in late 2017.

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 Read more about Dr. Kammer’s journey helping patients with albinism in Tanzania.

Q&A:

Q. Can you provide us with the story of a particularly memorable patient?

One particular young girl about 16 came into one of our early clinics. She was guided in by friends and obviously had severe vision impairment–much more than is obvious in type II albinism commonly seen in Tanzania. She sat down in our exam area and the students I was overseeing were not able to help her; she kept her eyes closed and would not interact with us. This was her first time in school, equivalent to about 1st grade level. After working with her for a bit I got a glimpse of her radical retinoscopy reflex and could tell she was over -20.00 D. I sat there, stunned for a minute, doubting what I had seen. I decided to put -16.00 D in trial lenses and sit her on the side of the room for a while and see what happened. Sure enough, 20 minutes later, I noticed her looking around with her head up. Then she picked up her bare foot and started to hold it up about a foot away from her eyes and examined it. I sat there thinking, “I bet she’s never really seen her feet.” I became very emotional and reflected on how much need existed and how no one had ever examined or appropriately prescribed for 90% of the people with albinism in Tanzania. In addition to the lack of clinical expertise to do an exam on someone with nystagmus, photophobia, low vision, high refractive error and strabismus, there was so much societal discrimination and persecution.

 I had the pleasure of seeing this young lady (with a final prescription of -26.00 D OU) for several follow-up visits and revising the power of the prescription over the years. In the beginning, our team replaced the glasses twice due to breakage and noticed she didn’t wear them full-time in spite of re-education and reduction of prescription strength. Finally when she was 20 and had advanced several grades in school, but still struggled with integration and inclusion at her older age, I noticed she was wearing her glasses constantly. I asked her what had changed. She said she had been embarrassed of her small eyes and no one in her village had glasses, but a year prior she had returned to her village and her uncle had told her firmly that she must wear them and that she looked beautiful with them on. She never took them off after that and said that she was excelling in school and life was improving for her and that she had finally decided to adjust to the “strong” glasses.

 The societal and cultural norms have been the most challenging aspect of providing vision care and have created an enormous learning curve. Partnering with existing Tanzanian eye care providers and organizations is crucial to improving access and uptake of health care.

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 Q. What is the best way for a member of OCOS to support your work in Tanzania?

In the beginning, and still occasionally, I take suitcases of materials (pre-made glasses, sunglasses, low vision monoculars and magnifiers, etc.), but now the program has taken on much greater reach and the materials are shipped direct to Tanzania. We have found ways to reduce the cost of monocular telescopes to $12 each and glasses as low as $20 thanks to partnerships with Essilor Foundation. As the program grows, the Tanzanian government is starting to help by paying the doctors in our program but the devices and glasses will unlikely ever be covered due to the severe poverty and limited budget.

One goal I have for the future is to offer an all-Africa conference for optometry and ophthalmology to attend and learn the unique issues and skills needed to effectively manage patients with albinism. There is such a lack of critical clinical skills, prescribing strategies and transferrable knowledge for patient education (even in the US) that educating and training others is an urgent calling. This conference would be costly and your support is needed.

Support in the way of monetary donations is the most pressing need at this time. Standing Voice, the primary program provider, is a UK based organization without a US tax identification number for tax deduction purposes. Under The Same Sun, a Canadian organization with a US arm and tax identification number can be the easier donation route and they will support the goals that I outlined above. Just write in the memo or notes section “Dr. Kammer, conference” or “Dr. Kammer, glasses” under donations on the UTSS web page. Your contributions can make a substantial difference!

Learn more about the human rights and health issues surrounding albinism in Tanzania.

Learn how you can help.

Under the Same Sun http://www.underthesamesun.com/, https://www.facebook.com/underthesamesun/

Standing Voice http://www.standingvoice.org/about, https://www.facebook.com/standingvoice/

Other sources

http://www.mayoclinic.org/diseases-conditions/albinism/basics/definition/con-20029935

Steven Wang, OD
OCOS Public Relations

 

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Getting to Know Sjogren’s Syndrome

Sjogren’s Syndrome is an autoimmune disease that causes excessive dryness throughout the body.  It affects nearly four million Americans, with nine out of 10 Sjogren’s patients being female.  Common symptoms include dry eye, dry mouth, fatigue and joint pain.  These symptoms can range from mild discomfort to functional debilitation.  In the most serious cases, Sjogren’s can result in organ dysfunction or the development of lymphomas.  Approximately fifty percent of the time Sjogren’s is associated with another autoimmune disease such as rheumatoid arthritis or lupus.

Sjogren’s Syndrome results in a specific type of dry eye that is caused by damage to the tear producing lacrimal glands associated with each eye.  The tear film becomes unstable, causing a sandy/foreign body sensation, pain, intermittent blurry vision and redness.  Without treatment, the tear film becomes progressively less stable resulting in additional damage to the ocular surface and worsening symptoms.

An eye care professional can run a battery of tests to determine whether you have dry eye and coordinate additional tests through your primary care physician to determine a diagnosis of Sjogren’s Syndrome.  Your eye care professional can initiate dry eye treatment, which can include artificial tears, warm compresses, prescription eye drops and/or punctal occlusion.

Sources:

http://www.sjogrens.org/home/about-sjogrens

http://www.hopkinsmedicine.org/wilmer/conditions/dry_eye.html

Steven Wang, OD
OCOS Public Relations

 

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February is Age-Related Macular Degeneration Awareness Month

February is Age-Related Macular Degeneration Awareness Month

Age-Related Macular Degeneration (ARMD) is a disease that affects the central part of vision (i.e., the macula) resulting in blurriness, distortion, changes in color/light perception and, ultimately, loss of vision. Peripheral vision is not affected. Vision loss often goes undetected, as these changes are usually gradual and affect one eye at a time. Nonetheless, ARMD is the leading cause of vision loss in people over 50 years of age, currently affecting over 1.8 million individuals in the United States.

Risk factors for ARMD include the following:

  • Smoking
  • Caucasian ethnicity
  • Female gender
  • Family history of ARMD

Currently, vision loss as a result of ARMD can not be recovered, but treatment such as supplements, laser, or injections can be administered to prevent additional loss of vision. Lifestyle changes that can make a big difference in terms of disease prevention and stopping progression include quitting smoking, exercising regularly, maintaining healthy blood pressure and cholesterol levels, and eating a diet abundant in green, leafy vegetables and omega-3 fatty acids.

Common issues faced by people with ARMD include difficulty recognizing faces, spotting signs and objects while driving, or performing near activities such as reading, writing, or cooking. Low vision devices and training can be used to dramatically improve these and other activities of daily living.

If you are at risk for developing ARMD, it is crucial that you receive an annual eye exam including dilation. If you have ARMD, it is even more important that you receive regular monitoring of your condition, as only proper treatment and management can prevent additional vision loss. A multidisciplinary team consisting of a low vision optometrist, a retinal ophthalmologist, an occupational therapist, and orientation and mobility specialists can provide you the best possible outcomes and maximize your independence.

If you are an eye care provider and have patients who have been diagnosed with ARMD, please consider referring them to a new study that can compensate them for their time.

Sources:
https://nei.nih.gov/health/maculardegen/armd_facts
http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/macular-degeneration?sso=y
https://www.aao.org/eye-health/diseases/amd-macular-degeneration

Steven Wang, OD
OCOS Public Relations

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Age Related Macular Degeneration (AMD) Clinical Study

Name of Project:  Proposal for a Follow-on Age Related Macular Degeneration (AMD) Clinical Study.

Dr. Ridder, Dr. Comer, Dr. Oquindo and Dr. Yoshinaga are currently recruiting normal and age related macular degeneration volunteers for a study at the Southern California College of Optometry/Ketchum Health, Marshall B. Ketchum University.

Inclusion Criteria for Normal subjects:

  • Approximate age: 65+
  • Vision close to 20/20 OD/OS

Exclusion Criteria for Normal subjects:

  • Significant cataract that affects vision
  • Glaucoma, strabismus, amblyopia
  • Diabetes, Uncontrolled hypertension

Inclusion Criteria for AMD subjects:

  •  Visual acuity in one eye 20/60 or better

Exclusion Criteria the same as for Normal subjects

In this research project, there will be three arms of testing to be completed initially:
1. Clinical Testing (approx. 1.5 hours, no compensation, but exam is free)
2. Vision Testing (approx. 2 hours, Compensation: $25/hour)
3. Blood Draw at lab in Cypress (Compensation: $50/blood draw)

This is a two year study that will repeat testing either every 6 months or annually for each subject during the two years.

If you have a potential subject, please contact one of us and please ask your patient if they are interested at the time of their visit if possible.

wridder@ketchum.edu (714-449-7494)
gcomer@ketchum.edu (ex 7405)
coquindo@ketchum.edu (ex 7851)
pyoshinaga@ketchum.edu (ex 7843)

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January is Glaucoma Awareness Month

Many of the tests in a standard eye exam are designed to detect glaucoma, a collection of disorders involving progressive damage to structures at the back of the eye (including the optic nerve head and retinal nerve fiber layer) and resulting vision loss. Over 3 million Americans have glaucoma with nearly half unaware that they have the disease. Glaucoma is the leading cause of blindness in both the African-American and Hispanic/Latino communities, and it is the leading cause of preventable blindness for all Americans.

Risk factors for glaucoma include the following:

  • African-Americans over 40 years old
  • All people over 60 (especially those of Hispanic/Latino descent)
  • Asians (for Angle Closure Glaucoma)
  • Elevated intraocular pressures
  • Family history of glaucoma
  • Diabetes
  • Hypertension
  • Prior eye injury

In early stages of the disease, there are no symptoms. Without routine eye exams, glaucoma can go undetected until significant, irreversible vision loss occurs. Studies indicate that up to 40% of vision can be lost before any symptoms develop. With proper detection and management, glaucoma can be treated with minimal loss of vision.

Schedule your annual eye exam today to make sure that you do not have this potentially blinding disease! And help spread the word to all your family and friends, especially those who are at risk for developing glaucoma.

Additional resources:
http://www.glaucoma.org/news/glaucoma-awareness-month.php
https://nei.nih.gov/nehep/gam/

-Steven Wang, OD

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Adult Amblyopia Treatment Study

Adult Amblyopia Treatment Study

Amblyopia is characterized by a reduction in visual acuity, contrast sensitivity, and binocular visual functions.  There is very little published on adult amblyopia therapy. This is because clinicians initially believed that amblyopia could not be treated after the end of the critical period.  However, recent studies have suggested that adult amblyopia can be treated. Patching combined with active, near, threshold-training tasks and continuous feedback was employed in these studies.

The purpose of the current study is to use standard amblyopic therapy in addition to an oral supplementation to determine if there is an enhancement in visual performance in the amblyopic eye.

Inclusion criteria/Study specifics:

  • Age > 18 years
  • Best corrected acuities between 20/60 and 20/400 (with E-ETDRS chart)
  • Amblyopia due to anisometropia and/or strabismus
  • A standard amblyopic work up will be performed on all patients to determine if they are eligible for this study
  • Visual acuity and contrast sensitivity function will be measured at each weekly visit
  • Data collection will take approximately six months per subject
  • Prior amblyopia therapy is not an exclusion criteria
  • Subjects will receive amblyopia therapy at no cost

Exclusion criteria:

  • Significant cataract that affects vision
  • Glaucoma
  • Diabetes
  • Uncontrolled high blood pressure
  • Pregnant or expecting to become pregnant during the study period
  • Ocular/systemic diseases that affect contrast sensitivity
  • Renal impairment, liver damage

If you have a potential subject for this study, please contact:

Dr. William Ridder x 714 449 7494                         Dr. Reena Patel x 714 992 7873

(wridder@ketchum.edu)                                         (rpatel@ketchum.edu)

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Pathways in Medical Optometry Bootcamps

The Southern California College of Optometry at MBKU is pleased to serve as the host of Allergan’s Pathways in Medical Optometry Bootcamp. The Orange County sessions are scheduled for Saturday, February 28th.  The program is open to ODs practicing full scope optometry and their staff members as an opportunity to enhance their medical practices. Click here for an informational brochure about the offering.

While SCCO serves as the host of the event, registration takes place online at www.AllerganODPathways.com. For questions, please call 844.750.2020.