Low Vision News

For low vision specialists and those who consult them

Monthly Archives: April 2010

ARVO 2010 preview

Sorry for this being a brief post: I have been busy making preparations for next week’s ARVO meeting (the annual meeting of the Association for Research in Vision and Ophthalmology), which is being held in Fort Lauderdale, Florida.

ARVO is by far the biggest vision conference, with around 9,000 presentations and 12,000 delegates. It encompasses all types of research: from genetics and cell biology through to clinical trials. The programme seems to have a fair number of good low vision presentations: I will report back on my personal highlights next week.

For those of you who use Twitter, you can also read my updates at @lowvisionnews and other tweets from the meeting using the hashtag #ARVO. Apologies to those of you who found the last sentence to make no sense.

Strategies for overcoming depression in visual impairment

A reader of this blog recently wrote to me asking for advice for their son, who has recently been diagnosed with retinitis pignentosa and who was suffering from depression. Whilst this is primarily a research blog, and I have no research experience in this area, I thought I would share some of my clinical experience from working in low vision clinics for 12 years.

First, it is important to make sure that appropriate medical intervention for depression has taken place. It is important that the family doctor is aware of the problem, and that suitable counselling and/or medical treatment has been started. Depression is a common condition and whilst it is easy to assume that someone who is depressed and has recently lost vision is experiencing a reaction to their loss of sight this depression could well have other causes.

My second suggestion would be to make contact with a local or national charity for people with visual impairment. In my experience it can be particularly helpful for younger people, and those with newly diagnosed eye disease, to meet people with similar conditions who can act as role models. Meeting people with a similar condition who are in an interesting and rewarding job, or who are successful local business owners, or who are great parents, can be very therapeutic. It can also be extremely helpful to have a forum to discuss the practical and emotional aspects of visual impairment: to learn that you’re not the first person to make a certain embarrassing mistake, or to learn strategies to overcome a particular difficulty can be helpful. It’s also nice to have somewhere to moan and complain to people who really understand: the online forums on the (UK RNIB website are good for this.

Finally, ensure that hobbies can still be performed. It’s easy to concentrate on work and education activities when looking at low vision aids and assistive devices but if someone loves computer games, make sure they have a large TV for their games console. If they love football, look at local partially sighted teams.

It is often stated that people suffering from visual impairment go through a similar grieving process to those who are bereaved. Depression can be a consequence of this process and in my experience people can and do overcome this.

Lutein for RP – hope or hype?

There is an important article in the new Archives of Ophthalmology discussing the use of lutein supplements as a means to slow the progression of retinitis pigmentosa (RP). In it the authors find that mid-peripheral visual field loss is less likely to occur in people with RP taking Vitamin A + 12mg lutein than in people with equal levels of RP taking Vitamin A + a placebo.

Lutein is a naturally occuring carotenoid which is present in vegetables such as kale, spinach and broccoli. Along with zeaxanthin, it is found in the healthy retina and is a macular pigment. The 12mg dose is relatively small: about the same as half a potion of spinach.

In the same edition of the journal there is a very interesting editorial by Bob Massof and Gerald Fishman discussing the study. A major limitation which Massof and Fishman discuss is that there was no significant change on the primary outcome measure of the trial (visual field loss on a 30º visual field test). The difference which is reported in the paper (changes on a 60º field test) was a secondary outcome measure. In other words, the study was designed to measure change on a 30º field test, which did not occur. Massof and Fishman state that the study has not “convincingly proved that the treatments put on trial are effective in slowing the rate of progression of RP and, therefore, do not warrant mandating a change in how patients with RP are treated”.

I think that the Massof & Fishman argument is strong and eloquent, but I disagree with their final conclusion. I would agree wholeheartedly with them if lutein supplements had significant side effects, or were extremely expensive, or if the study was performed by someone who stood to profit out of lutein supplementation. None of these are the case.

I agree that more research is needed into the role of lutein in retinitis pigmentosa – in particular, a dose/response trial would be very useful – but pragmatically I think there is little to lose by suggesting that people with RP ensure their diet is rich in lutein (or take lutein supplementation).

European Congress on Visual Impairment

I am looking forward to the European meeting on vision impairment to be held in Valladolid, Spain, this October.

Apart from Spain being a nice place to visit, there are many good speakers at the conference, from a variety of backgrounds. They include vision scientists (Aries Arditi from New York; Bob Massof from Baltimore); rehabilitation professionals (Krister Inde from Sweden, Duane Geruschat from Johns Hopkins); clinicians (Bruce Rosenthal from New York); and people who mix clinical work and practice (Eli Peli from Boston, Mary-Lou Jackson from Boston).

One thing which slightly concerns me as a European is that for a European conference only a small proportion of the invited speakers (5 of 14) are European: two working in Sweden and three in England. Whilst there is good low vision research going on in Europe (and Australia, Hong Kong, Canada and elsewhere), most of the ‘big names’ in this field still work in the USA. Is this because research funding is more generous in the States, or because they are better known from speaking at more conferences, or because American research centres are better than those in the ‘Old World’?

I think that the meeting should be interesting and will be a good showcase for the research being performed in this area in Europe. And I’m sure the Rioja and Tapas will beat the food and drink at most American conferences too!

[Disclaimer: I am on the scientific board of this meeting. However I will not profit from people going to the conference and have no financial interest in whether you attend or not.]