READERS VOICE THEIR OPINIONS

Low Vision, Nutrition and Age-Related Eye Disease

✉ I read the article "Is Your Practice Ready for Age-Related Eye Disease," (Optometric Management, September 2009 issue). I found it interesting, and very disappointing in one aspect. You spend a lot of time talking about detecting/diagnosing eye disease, and co-managing with other professionals who are providing the medical or surgical care, but don't mention the two areas that optometrists can help patients who have vision impairment as a result of disease (ocular, systemic, etc.), namely low vision rehabilitation and nutritional counseling.

Low Vision is an area that was uniquely optometric, but I guess that isn't the case now. In the rush to provide medical care, we are losing this specialty area to other professionals, since optometrists don't really seem to want to do it anymore. And in the case of ocular disease, many patients switch to the ophthalmologist early on to be sure they are getting current and appropriate medical interventions. Nutritional counseling can be important also, especially for patients at risk, and patients would be very interested in this. At least the article following yours discussed this.

I'm not saying that detection and monitoring is not important. It's just a shame that the few things we can offer to help our patients aren't discussed in your article, even if only to refer to someone who can provide these services.

Roy Gordon Cole, O.D., F.A.A.O.
Director of Vision Program
Development
The Jewish Guild for the Blind
15 W. 65th Street
New York, NY 10023

The author replies: I appreciate your thoughtful comments. It is true that the main focus of my paper was early diagnosis and management of age-related eye disease in baby boomers approaching their senior years. Nonetheless, I have to agree 100% with your comments on low vision rehabilitation of patients who have severe vision loss from advanced age-related eye disease.

In retrospect, it would have been quite appropriate for me to include a brief discussion of optometric low vision care as another "tip to prepare your practice" for aging baby boomers. When I write on this subject again, I will be sure to do so.

We are of like mind on the topic of low vision care and the unique role of optometrists. O.D.s provide low vision services better than anyone else because we understand the diseases that cause it, the optics of low vision devices and the various aspects of vision rehabilitation.

You also mentioned the importance of nutritional counseling. I did allude to this in the OM article by discussing the importance of macular protective pigment and the ability to measure MPOD in office using heterochromatic flicker photometry. I did not get into a lengthy discussion of nutrition because I knew that the next article in the same issue would do so, and I did not want to "steal any thunder" from that paper's author, Dr. Ken Young.

Thanks again, for sharing your thoughts. All the best to you in your continued work at The Jewish Guild for the Blind. OM

Joseph J. Pizzimenti, O.D., F.A.A.O.
Associate Professor
Director of Interdisciplinary Clinical
Education
College of Optometry
Nova Southeastern University
3200 South University Drive
Ft. Lauderdale, FL 33328-2018