Eyesight do we really notice changes

HI all

As many of you know I work in ophthalmology research and mainly in the area of age related macular degeneration (ARMD), diabetes and other various eye conditions.

It has struck me in a private way from the screening clinic I run and the data we collect that the amsler grid is used a lot in ophthalmic practice to detect changes in vision, mainly metamorphopsia (wavy lines to you and me), but wavy lines do not signify ARMD as the cause can me other visual issues like cataracts etc

Just a really unscientific poll if you will indulge me is to open or print the below amsler chart out and hold it at arms lenght and close one eye then the next and stare at the centre spot and do you see any lines distorted??

https://www.amd.org/downloads/amsler.pdf


I'm really curious as in some instances you may have slight curve to the lines but it could just be tiredness. One of our dept are working on a much more scientific and better test for visual distortion than the amsler grid.

 

Gold star for _nullptr

Yes I should have said a few other things as in:

1. its either one or both eyes
2. do you already know you have an eye condition or not

So when using the amsler grid close one eye look for changes, then alternate with other eye, as visual issues and slight ones may not manifest when both eyes are open as the optic pathway and brain function with both eyes open can compensate for a slight defect in one eye, its only when you close one eye then the other that you may see a defect.

 

Okay...I'll play.

No wavy lines for me.

 

You are ok then, no discernible visual defects.

Why I am asking this is the clinic I run once a week for ARMD, I'm seeing the referral documents stating amsler distortion and immediately ARMD is blames but this current year only 36% have been the other 64% have been other eye conditions or no eye condition (tiredness and stress can cause visual distortion)

What I would say is that if you do notice a distortion in this rough test in either eye is that do get it checked by your optician or ophthalmologist.

 

I wear contacts so get my eyes checked once a year by my ophthalmologist. I've never had any issues other than site, so hopefully things will remain that way. My grandmother had macular degeneration and could barely see by the time she died.

 

Yes without glasses or contacts it will be blurry, the double lines could be an astigmatism but do get it checked as distortion that not attributable to a glasses prescription or known eye condition is worth getting checked out.


I will say in the case of ARMD that it generally affects people in the 60s+ average patient I see with the condition is 79yrs old, but can affect the young if they are highly myopic.

@Laura, yeah going back 20yrs or so there was no treatment for AMD that worked well, and folk just thought it was a getting old thing, but it can be treated and successfully if caught early with anti-VEGF drugs, we are starting a few new studies on alternative treatments based of the current ones.

I kinda think my message is if you see a defect in vision at any age but if you are in your 60s+ do get it checked out.

 

That could likely be the cause of your distortion in that test. Now you bring up a good point on more young having glasses, the easy answer is I have no idea the cause, but I do know that we are treating more young kids with type 2 diabetes than before, so a tenuous link perhaps.

Also I think is more young and a disproportionate amount with glasses a fudge and they dont need them? (my sinister side) is it a fashion thing? or do we have more kids with short or long sightedness? VERY good question Kat

 

Hahhahaha :-D

I have to say I always have a hard time in clinic when folk have no immediate eye conditions when I advise "keep an EYE out for visual changes" cannot think of another phrase.

 

Indeed Wendy a slight decrease in VA is normal with age, my near focus is starting to drift a little, likely as I work on PC monitors and with close focus in stereovision a lot, tend to look over my glasses when reading near things


I'll add a bit to what the amsler grid is looking for as the distortion is generally linked to two things:

1. Metamorphopsia = lines looking wavy which can be a sign of fluid build up in the retina
2. Scotoma = blank patches in vision like someones put a finger in the way of your line of sight

 

Hey Joffa

Indeed and this is the comments I get from patients I see in clinic all the time, its a pity we cannot yet fix all vision issues, the latest research in stem cell treatments are promising as they may fix a retinal pigment epithelium layer issue that sufferers from ARMD and some other retinal diseases have but my slight doubts are on the layers above that in the plexiform and nuclear layers if damage is in these can stem cell treatments fix those as we are getting into complex structures.

If lines are straight then that highlights you have no decernable defect as in fluid within the retinal layers, which basically that test looks for, the failure in that test is that even of you have no retinal defects and just tired you can see slight curves, a bit like those magic eye images.

No on your second part you maybe right as asian population are highly disposed to myopia and in some part a higher diabetes level in the population.

These are one of the types of images I use in clinic and in research to determine eye disease http://www.opsweb.org/?page=RetinalOCT a really good imaging test, its not perfect as at times some can over treat due to the features in this test but its a great diagnostic tool for ophthalmologists

 

Me too and in the main the gold standard is still fluorescein angiography as it is a dynamic test and can show up leakage from the affected area/s, we tend to use all forms of imaging to get a really good diagnosis, well in our hospital anyway, many others do not use all imaging.

No sadly its not a DIY thing, if you have fluid in the retina and diagnosed by an ophthalmologist then likely treatment to reduce the fluid is Anti-VEGF treatment (usually Ranibizumab or Aflibercept), which is an injection into the eye, not (well not that I have had it) as bad as it sounds.

 

You are normal (as much as we all are) but no wavy lines means likelihood of no fluid at back or eye or no media opacity (cataracts) but what you mention is a pitfall of this test and one thing our university and with our clinical side are trying to address with a new more accurate test that's 21st century as you can run it off your phone! needs more testing but we have near 200 patients in the trial so far.

I have high rated stereopsis but I need this with my job of looking at images in stereo but mines a very acute vision as I can see small details. Weirdly I have a slight astigmatism in right eye.

Fred you seem fine as for ARMD or other features of fluid or blood in eye as that test generally shows pronounced features, and as you touched on not slight changes and these tests as you mention need fine tuning for the future as that amsler test is good but over-relied on and crude, we are working on a new test that is smartphone and app compatible so can test yourself at home and get a risk score of developing ARMD or another sight threatening condition.

I agree nothing replaces a Dr but does your doc specialise in eyes? its a huge specialism and my area is only retina, I know bugger all about cornea!

BUT there are great tests theses days that are non-invasive in OCT (optical coherence tomography) that really tell us a HUGE amount of whats going on in your eye, impressive pics and if you ever have one ask your doc to see and explain it.

Me too on Summer! and your are fine and the test is one for glasses too, basically your corrected vision, so glasses or contacts.


HAVE to say folks cheers for the comments as this sort of feedback from the populus really does help me when I have to present data of risk and prevalence and better still knowledge of the public to on eye disease and what to look for.

Thanks and I may ask in future more eye questions if you can tolerate them, as I wish to know what effect it has on Quality of Life (QoL), my main task at present is to educate those at risk and to optometrists in what to look for, that may be a risk of ARMD

 

stereopsis is where you can see images in 3d really clearly and there are degrees of this, basically you need to have tests to acquire your depth perception http://www.ophthalmologyweb.com/Ped...eoscopic-Vision-and-Depth-Perception-Testing/

We all have this to some degree, but some have more heightened depth perception than others.

The eye test off a smartphone is nearly here and once I get the working model I will post here on Majorgeeks again on this topic as I think its a really revolutionary tool, if the team or others and we are working in this, is to automatically scan the image taken for eye disease that alerts you to seek professional help, then that's a SUPERB tool. Cataracts can be a pain some opticians may say you have small start of ones, but we see that not the size but the location of them thats the issue with vision.


To all thanks for posting in this thread I know its not tech and PC oriented but we all have sight and to use a PC vision is core, so this gives me some insight into the population (I'm currently on a study of general population and vision) and what you see, we can then target advice or treatments.


@Booboo58 - superb on your vision but do keep note for subtle changes in straight lines and blurry vision.

@Beth - yeah normal are we all!! I will see if I can get the software we are currently using to test for early ARMD for you to try, its on an iPod or iPhone at present (a hyperacuity test), but will let you defiantly know of what we are working on and if we have visual tests you can use, PM me your email address.

 

I was fine covering my left eye, covered right and tried it and EVERYTHING went blurry. Switched eyes again and very blurry until I regain focus...

 

Hi Jack, no worries on this quick simple tests as you will due to your Corneal Keratoplasty may have distortions for a while, as you say until things in the cornea settle. I wish you well with the next operation and hope things settle down quickly for you.

Emma I will reply in email.

 

Dont know why my eyes focused on this part of your post Mimsy!
or will I now they the frigid death stare...

 

To be honest I wear glasses and do look for fashionable frames or at least ones I like, lucky I work in a ophthalmology dept that has an opticians so I get to seen new frames and choose, need to choose now as ones I have currently are 2yrs old, prescription I again lucky as I get a junior ophthalmologist or optician to test mine in work, randomly do my own while waiting for patients but I know the chart we use backwards! I know what you mean Mimsy in when you have great lenses if the frame breaks or your tired of them its not easy to get good lenses fitted to new frames as they are specific at times due to astigmatisms and the lens shape and size are crucial.

 

I agree with you in that my taste is different to your and none is right or wrong its what you feel looks good, hey I like on women the slanty type library cat eye like glasses as much as I do like large round types. I actually think many folk who dont needed glasses want them as they are a neat fashion accessory!

Me I need them to not walk into doors.

 

Yeah worldwide as a push on diabetic and AMD research, we can with anti-VEGF treatments halt or slow the process down but cure, sadly no, the dry type of AMD has no current treatment unlike the wet type, but some new trials may address this as the dry is the common one, not the aggressive type like wet.