A Mediaplanet Guide to Caring for Your Sight and Speech
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Access to Vision & Speech Health
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Read about Kidmunicate and the importance of speech therapists for young children Discover the shocking truth about your eyedrops and what Nanodropper is doing about it MARCH 2021 | FUTUREOFPERSONALHEALTH.COM
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She doesn’t know she’s going blind. You could be losing your vision long before you realize it. The Glaucoma Foundation is dedicated to saving your sight.
Opening Up the World With Speech Therapy Speech language pathologists help millions of children navigate a challengingly verbal world.
early 1 in 12 children in the United States are dealing with some form of speech disorder. The impact of a speech-language pathologist (SPL) can be nothing short of miraculous. “I don’t know what I would have done without the two speech therapists who worked with my son,” said Beverly, mother of Cooper. “They have
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made a huge difference in both our lives.” Cooper was diagnosed with autism at a young age and was completely non-verbal. “We were looking for a speech-language pathologist who used the Picture Exchange Communication System (PECS), and that led us to Pam Drennen.” PECS uses pictures and writing to encourage people with speech challenges to take the initiative in communication.
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“PECS promotes interaction between people instead of devices,” said Drennen, M.S.M., CCC-SLP, director of clinical services speech at Kidmunicate, a leading pediatric speech therapy organization. After about a year, Cooper spoke his first sentence. “It was mind-blowing,” said Beverly. “He said, ‘I see cat’ and he was reading the PECS with Pam, looking at a photo of a cat.” When Cooper entered kin-
dergarten, Drennen brought in Sandi Spuhler, M.S., CCC-SLP, a specialist in social communication at Kidmunicate. Spuhler began working with Cooper using a methodology called “Social Thinking.” “The Social Thinking methodology delves into these unwritten social rules so that it can become more accessible to people who process social information in a different way,” explained Spuhler.
Today, Cooper is in high school, and Beverly reports that far from being non-verbal, he’s constantly talking to friends. “He’s learned so much from Pam and Sandi,” she said, noting that the SLPs who worked with her son made the difference. “Parent advocacy is huge, but I could not have done this on my own.” n. Jeff Somers This has been paid for by Kidmunicate.
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When Treating Speech & Language Disorders in Children, Earlier Is Better
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he sooner parents and caregivers seek help for their children, the better. Treatment is generally most effective, and takes less time and expense to provide, when it begins at the earliest signs of delay. Some disorders can be mitigated or even prevented with timely intervention. Early identification and intervention are critical in the early years because speech and language problems are not limited to communication. They can impact literacy and learning during the early school years, and negatively impact different aspects of children’s lives, including social interactions and peer relationships, their ability to handle stress, and their participation in daily life activities, such as reciting the Pledge of Allegiance or being invited to a birthday party. A communication disorder can have long-term consequences on educational and employment outcomes, so speech and language problems are not confined to early childhood or to communication. A common concern Speech and language disorders
are among the most common disorders that young children experience. According to the National Institute on Deafness and Other Communication Disorders, 11 percent of children ages 3 to 6 have a speech, language, voice, or swallowing disorder. While each child develops at their own rate, there are expected milestones within each age range. Treatment by speech-lan-
guage pathologists (SLPs) is widely available, often for free or at low cost, nationwide through state early intervention programs. Raising awareness with families The first step is noticing that something may be not quite right. Parents and caregivers often know this intuitively and should trust their instincts.
Those with questions or concerns about their child’s skills should talk to their pediatrician or child care provider. They can also learn the signs of a possible speech or language disorder through trusted organizations. Two leading sources of information about early identification are the American Speech-Language-Hearing Association’s (ASHA) Identify
the Signs campaign and the U.S. Centers for Disease Control and Prevention’s Learn the Signs, Act Early campaign. An especially timely resource for families of children ages 2 to 6 years is a new text messaging service offered by ASHA and another nonprofit organization, Bright by Text. Families who want information on expected speech and language milestones, warning signs of a speech or language delay or disorder, activities for encouraging speech and language development at home, and ways to get connected with professional help can sign up to receive regular, free messages by texting TALK to 274-448. Messages are available in both English and Spanish. Due to the pandemic, more children are out of traditional childcare and preschool programs. Consequently, parental awareness is more important than ever as families may have less opportunity to interact with educators, health professionals, and even other parents who may alert them to a possible speech or language disorder. n A. Lynn Williams, Ph.D., CCC-SLP, President, American Speech-Language Hearing Association
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Important Ways Speech Therapy Can Help People With Autism
For children with autism, speech-language therapy can be a critical early tool in building communication skills. Here are five ways speech-language therapy can help someone with autism.
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Learning to produce speech Speech delays are common in children with autism, and speech-language pathologists (SLP) can help children learn to use spoken language. Producing spoken language is a complicated process, and speech-language therapy services can address the motor movements needed to make sounds, or articulate sounds and words more clearly.
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Finding alternative ways to communicate As many as a third of people with autism are nonverbal or produce minimal spoken language. But that doesn’t mean they can’t communicate or understand what others are saying. Speech-language pathologists can help children find the ways of communicating that work for them. For some, that may be sign language or gestures, while for others it may be a communication system that uses pictures. Some may use technology to communicate, such as an augmentative and alternative communication (AAC) device.
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Building language skills Speech-language therapy does much more than help someone produce sounds and words. For some people, the challenge is less about producing the words themselves as it is about how to put words together to communicate a variety of wants, needs, and thoughts. The ability to combine two ideas — such as naming an object and an action — is a skill that can predict later success with language, and speech-language pathologists can help children develop this important skill.
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upporting underS standing of language Someone with autism may need support with specific types of social communication, such as the back-and-forth of a conversation with a classmate or understanding a coworker’s gestures or facial expressions. For others, speech-language therapy could focus on understanding that words have more than one mean-
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ing, such as the difference between “Send me the bill” and “The duck has a bill.” Idioms and figures of speech, like “It’s raining cats and dogs,” can be confusing for someone with receptive language challenges.
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Improving social communication Challenges in social (pragmatic) communication are one of the two groups of symptoms used to diagnose autism. (The other is restrictive and repetitive behavior.) A speech-language pathologist can help someone with autism learn how to use and interpret social communication, depending on what the person finds challenging. Someone may need support learning to match their language or nonverbal cues, like body language or facial expression, to different settings, such as at a social event or in the workplace. n Donna Murray, Ph.D., CCCSLP, Vice President, Clinical Programs Autism Speaks
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When Speech Therapy Goes Online, Everyone Benefits Lockdowns and technology have made online speech therapy the new normal for many children, adults, and even corporate teams — and that’s a good thing. Concerns about speech affect millions — about 8 percent of children, and 18 million adults reported problems last year. And in companies with diverse workforces, working remotely means clarity of speech is key. For many, help
has come from a cutting-edge source: online speech therapy. “Speech therapy” is only part of what an SLP (speech-language pathologist) actually does. “We like to say we work on everything from the neck up,” says Michelle Lachman, CCC-SLP, founder of Better Speech, a leading provider. “Speech therapy can help people with difficulties communicating, dealing with cognitive abilities, and even accent reduc-
tion for more professional clarity.” The online, one-onone availability of this therapy means more people can get help. Online speech therapy, is as effective as in-person therapy — possibly more effective. “Online therapy can be more beneficial,” notes Sheri Stein-Blum, Ph.D., CCC-SLP, “because parents and caregivers are actively involved and not in a waiting room.” It is also more accessible and affordable
to those who might otherwise be unable to find providers due to distance or cost. As remote work increases, teams are looking for ways to increase communication and collaboration among a diverse and international workforce that has different accents and English proficiency. When employees have confidence that they are being heard and understood, their productivity and work satisfaction increases.
The COVID-19 pandemic led to a surge of interest in online speech therapy for employees, adults, and children. “In today’s world, it is important to meet the individual’s needs,” notes Stein-Blum. “Speech therapy that is affordable and easily accessible does just that.” Lachman couldn’t agree more. “It saves time and money and offers access to therapists who are experts in the client’s needs. Companies, families, and individuals now have an excellent choice with speech coaching and therapy online.” n Jeff Somers
To learn more about Better Speech’s speech therapy options, visit
www.betterspeech.com
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Bringing Quality Online Speech Therapy to All Who Need It As a speech therapist living and working in the Navajo Nation in Arizona, Diana Parafiniuk was traveling hundreds of miles each week to offer her services. This taught her firsthand the challenges schools, students, and teachers face when receiving and offering speech therapy, especially in rural areas. “To get therapists to travel long distances consistently to serve these students is a stretch, to say the least,” Parafiniuk said. This struggle inspired her to create a way to bring schools, therapists, and their students together virtually, ensuring any program that needs support offering speech therapy can receive it. In 2009, Parafiniuk launched E-Therapy, one of the world’s first teletherapy solutions. When the COVID-19 pandemic began, E-Therapy was in a unique position. Not only did demand for its own direct therapy services increase, but school districts across the nation — big, small, urban, rural, charter, public, and private alike — were looking for how to best serve their students remotely. “We built a platform solution that allowed schools, in an organized, safe, and effective way, to support their own therapists to deliver speech therapy services,” Parafiniuk said. “Our solution and our services brought order to the chaos.” Dustin Brennan This has been paid for by E-Therapy.
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Using Technology for Language Development Too much screen time and not enough face time can have a negative impact on your child’s speech development, so here are my expert tips to use technology to your advantage. Face-to-face with you is where a child learns to participate in backand-forth exchanges, taking the turns that establish good communication and allowing them ample practice understanding and using sounds and words. It’s also how your child learns to read expressions, understand emotions and tone of voice, and maintain eye contact, which are all important social skills to help them get along with peers and function in society. In contrast, a child watching a screen is a quiet child in a one-way exchange. The screen does all the talking, without opportunity for your child to react, get input, and react again, as they would when playing with, or talking to, a person.
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Due to the potential harm that screens can cause, many professionals suggest avoiding technology. However, as a speech language pathologist in our modern world, I recommend making screen time smarter rather than eliminating it altogether. Here are three ways to use technology to advance your child’s language development. Watch together When you choose educational content and then sit down next to your child to play or watch together, apps and shows can be a great jumping-off point for conversation by introducing new vocabulary and concepts for you to teach your child. Co-viewing with your child adds that two-way, interactive element that is missing from unguided screen time. You can carry over what your child learns by helping them connect what they see onscreen to their own daily experiences.
Connect with the world The American Academy of Pediatrics (AAP) considers video chat to be separate from its daily screen time recommendations. Video chat helps your child form social connections — an integral piece of language development — especially when they may be otherwise largely confined to their home environment. A live person onscreen mimics many of the social language benefits your child gains from in-person time. A bit of creativity goes a long way; help your child sing a song with their screen partner, have an on-screen picnic and chat about your food, or take turns giving each other directions to build a structure with blocks. Educate yourself Research shows that parents who know more about language development help their children take more turns in conversation, improving their expressive language more quickly. Plus, using screens to educate yourself adds no screen time for your child. The information out there can be overwhelming and confusing. Look for websites and apps that share “evidence-based practice” to help you gain the tools you need to help your child communicate effectively at any stage. n Kyla Ettinger, Founder and SLP, SpeakEasy: Home Speech Therapy
or young children suffering from swallowing disorders such as pediatric gastroesophageal reflux (frequent regurgitation) and oropharyngeal dysphagia (difficulty swallowing), feeding interventions can be beneficial. But care must be taken to ensure the right approach. “Pediatric feeding disorders are often complex,” says Lindsay M. Stevens, MA, CCC-SLP, medical facilities manager at Healthier Thickening by Parapharma Tech, “and should involve a team of multiple professionals from various disciplines.” Reading the signs Signs that feeding intervention might be warranted include foods or liquids entering the breathing tube, poor weight gain, vomiting, and stressful mealtimes as perceived by the caregiver. One of the most effective treatments for swallowing disorders is the introduction of a thickening agent like Gelmix Infant Thickener to the child’s food. “Thickening feeds to reduce regurgitation and vomiting in infants is the preferred first-line therapy approach,” says Stevens. “Increasing the viscosity of the liquid by thickening helps to keep the food in the stomach and reduces the
An Expert View on Swallowing Disorders and Communication
Speech-language pathologist Lindsay Stevens discusses the benefits of pediatric thickening agents.
likelihood of the food moving from the stomach back into the esophagus.” Additionally, thickening creates a denser bolus of food that moves more slowly to the throat. This enhances sensory input, which can benefit those suffering from dysphagia.
Thickening and communication Swallowing disorders sometimes indicate communication difficulties, as they often involve weakness in the tongue, hard palate, lips, jaw, and cheeks, which can impact the ability to
accurately produce speech sounds. “Treatment of swallowing disorders may focus on improving movement and strength of these parts of the mouth,” notes Stevens, “which may, in turn, facilitate oral sensory processing and movement skill for
speech sound development and production.” If a thickening agent is recommended by a pediatrician to address spit-ups or more serious swallowing disorders, choosing a healthy thickener is crucial, Stevens says. “Caregivers should select a thickener that has natural ingredients that have demonstrated safety of use.” Additionally, choosing a thickener that is smooth, tasteless, and odorless will reduce the chances that the child will refuse the thickened food. Stevens recommends the USDA-certified organic thickeners Gelmix Infant Thickener for breast milk and formula and Purathick Natural Thickener for hot and cold liquids. “Most thickening products contain corn starch and/or xanthan gum and include allergens that can be poorly tolerated,” notes Stevens. “Gelmix is free of arsenic, genetically modified ingredients, corn starch, xantham gum, and major allergens including gluten, corn, and soy. It’s the only USDA Organic, Kosher-certified thickener specifically designed for pediatric use in the USA.” n Jeff Somers This has been paid for by Gelmix.
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My message to other women who shop my collection is this: Embrace where you are in life now. So what if you need readers now? You can look beautiful and amazing. Readers are an easy solution to make your quality of life so much better.
A Q&A With Sofia Vergara About Her New Line of Reading Glasses
The “Modern Family” actress says she resisted getting readers for a long time, now she’s all about using pairs that fit her personal style. When did you know it was time to see an optometrist/see a need for reading glasses? I noticed as I’ve gotten older that reading scripts, books, labels, and more have caused a bit of strain. Words started looking fuzzy. I tried squinting. Holding things at arm’s length. Asking people what things say. It was crazy. I had never in my life needed to wear glasses, so for a long time I was fighting it. I don’t have an issue with wearing readers now — I just want
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Have you seen a drastic increase in screen time since the current pandemic? Have you ever been affected by digital eye strain? I’ve definitely spent a lot more time reading and on my screens in quarantine. My Multi Focus Blue readers have been a huge saving grace. I hate taking my readers on and off when I go from one thing to the next. Now, I can do it all with just one pair, because the readers also have the added bonus of blocking potentially harmful blue light with a clear coating. It’s a win-win. PHOTO: FOSTER GRANT
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Spotlight: "Èyes Are The Story" Founder Amy Gallant Sullivan
ones that fit my personality and my wardrobe! So, I wanted to create a collection of eyewear that would make women want to wear their glasses, in a way that is sexy and stylish, empowering women. How can we encourage caregivers, patients, and others to seek vision care before you continue to damage your eyesight? Aging eyes are natural! As we get older, our eyes lose the ability to focus, causing blurry vision. A visit to your optometrist and simple reading glasses can help correct that, and you don’t need to break the bank!
What inspires you as a designer for your eyewear brand? My design philosophy is all about expressing yourself proudly and boldly. It’s about combining designs and patterns and colors in unexpected ways. Every day I want to look and feel smart, sexy, and confident. Like I’m ready for anything. And this is what I brought to each of my designs. What I wanted was to make a beautiful collection that called attention, using colors and materials that are comfortable and light, and shapes that are going to look good on every face. Are you a fan of the new direct-to-consumer method of getting glasses? Of course. I think accessibility is key. We tried to make this collection both easily accessible and affordable, a great solution for everyone. n
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The Billions Around the World Whose Lives Could Be Changed With Glasses When was the last time you thought about your eyesight? Probably not unless there was something wrong with it, and if there is a problem, it’s generally not too hard to get it fixed with a visit to an optometrist. However, there are over a billion people around the world for whom this problem is not so easily fixed, even in the United States, where vision care is relatively easy to access. We know that a simple pair of glasses can have long-term, life-changing benefits. No one needs glasses more than children. Right now, approximately 1 in 4 students has an undiagnosed visual impairment. That has huge implications for our educational system. Kids who can’t see the board or their textbooks risk falling behind and only learning about half as much as they could be. That’s like missing half of a school year. Couple that statistic with millions of students now learning remotely and spending hours staring at screens, and you have the potential for a major setback for the youngest generation. So, what’s a parent to do? The biggest step is an eye exam every 1 to 2 years after age 6. That may not be possible or practical right now with restrictions due to COVID-19, but there are other ways to tell if a child is having problems seeing. Organizations like OneSight have created online vision screening tools to help. It’s important to note that this is not a substitute for an eye exam, but it can help uncover any obvious issues. This is also just as true for adults. While the problem is more urgent for children in their prime learning years, there are also many adults who can’t get the glasses they need. That means limited prospects for them in terms of both earning potential and productivity. One estimate puts the total cost in terms of lost productivity around the world at around $244 billion a year. Think of all we could be accomplishing with everyone able to see their work, their lessons and their world clearly. K-T Overbey, President & Executive Director, OneSight
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Glaucoma Can Be Treated — But Only If It’s Caught in Time Just as yearly physicals can help detect something like high cholesterol before it leads to a heart attack, regular eye exams can ensure we preserve our sight. Many blinding eye conditions can be reversed or slowed, but only if they’re caught early. As a doctor who treats glaucoma, the No. 1 cause of irreversible blindness, I’ve seen firsthand what putting off an eye exam can do. Some patients, thinking they were at low risk of developing glaucoma or of their glaucoma progressing, delayed coming in. All the while, the disease was silently worsening. Unfortunately, with the way glaucoma works, the damage can’t be undone. That has been a real challenge. Glaucoma is caused by damage to the optic nerve, which is like a cable connecting the eye to the brain. As it becomes damaged, it doesn’t send as strong a signal for sight. Because this damage often happens slowly, affecting peripheral vision first, patients don’t notice the vision loss immediately. By the time the damage affects the main field of vision and becomes noticeable, it’s often too late. That’s why getting a vision exam is so critical. Only a doctor can detect the early signs of the disease and start a course of action to slow its progression. Routine exams are even more critical for anyone who is at higher risk of glaucoma, including people who are over the age of 50, have a family history of the
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disease, or are African American or Hispanic. Patients are understandably nervous about making a trip to the doctor for something other than an emergency while the pandemic is ongoing. But hopefully people will be motivated enough to preserve their sight to overcome those fears in some part. At my office, and in those of my colleagues across the country, we’ve introduced extensive safety measures, including questionnaires to identify anyone with potential symptoms or recent exposure, temperature checks,
increased sanitization, and allowing fewer patients into a facility at one time to maximize social distancing. Doctor’s offices really are one of the safest places you can visit. For now, I’m holding onto hope and continuing to remind my patients to get their 2021 eye exam on the books, even during a pandemic. n Dr. Annette Giangiacomo, Associate Professor, Ophthalmology, Eye Institute – Froedtert & The Medical College of Wisconsin Health Network, OneSight Volunteer
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Solving the Eyedrop Problem Some companies in the healthcare industry are responding to the costly waste caused by eyedrops that are too big for your eyes. For decades, the eyecare industry has known that eyedrops are too big for the human eye — five times too big. This means that about 80 percent of every drop is wasted due
to overflow onto your cheek, or drainage by the tear ducts where the medication is absorbed into the rest of your body. Clinical research shows that smaller drops are as effective, and in many cases, safer than current drops — yet you are still forced to pay for this wasted medication. After reading about this problem in a ProPublica article titled, “Drug Companies Make
Eyedrops Too Big, and You Pay for the Waste,” CEO Allisa Song began designing the Nanodropper adaptor — a new invention that attaches to the tip of an eyedrop bottle and reduces the drop size to the ideal volume. This eliminates the waste from your typical eyedrop, stretching the life of each bottle by three to four times. With the goal of bringing power back to the patients,
Nanodropper’s mission is to reduce medical waste, increase access to vision-saving medications, and promote eye health. As a big step in this mission, Nanodropper recently launched their Give the Gift of Vision program where individuals can donate Nanodroppers to those struggling to afford their medications. For just $14.99, you can purchase a Nanodropper for yourself or
donate one to someone in need and Nanodropper’s team will ship it to a recipient at no cost to them! n Robbie Spencer, Marketing Manager, Nanodropper
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One Ophthalmologist Explains Why Glaucoma Is No Laughing Matter Ophthalmologist Dr. Jay Katz explains how glaucoma can turn the old joke about going blind as we age into a terrible reality, which is why it’s important to get regular exams and understand the treatment options. As humans age, we become susceptible to a wider range of illnesses and disorders, including glaucoma — which damages the optic nerve and is one of the leading causes of blindness in people over 60. So while we may joke about losing our eyesight as we get older, the truth is that glaucoma is no laughing matter. Dr. Katz is a practicing ophthalmologist, the director of glaucoma service at Wills Eye Hospital in Philadelphia and a
professor of ophthalmology at Jefferson Medical College at Thomas Jefferson University. Dr. Katz breaks down some of the risk factors for glaucoma, how to test for the disease, and treatment options. According to the doctor, also the chief medical officer at Glaukos, glaucoma risk factors include elevated eye pressure, family history, a thin cornea, diabetes, low blood pressure, and sleep apnea. Near-sighted and older people are also at elevated risk. A person’s race may also be a risk factor, as Black and Hispanic people seem to be more susceptible. In order to check for glaucoma, your doctor will measure the eye pressure, examine the internal eye drainage
The Benefits of Low Vision Therapy According to one optometrist, your vision doesn’t have to have deteriorated to a specific level in order to benefit from vision rehabilitation. A recent presentation from Dr. Delaram Shirazian O.D., assistant clinical professor at SUNY College of Optometry, at a
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Glaucoma Foundation webinar argued that low vision rehabilitation does not require a specific level of vision loss. While eligibility for some state services may require a patient to be legally blind, Dr. Shirazian stressed that when low vision begins to interfere with daily activities, that’s the time to have a low vision exam.
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system, and note any damage to the optic nerve by scanning pictures of tissue thickness and performing a visual field test. “These tests also determine the stage or severity of the disease,” Dr. Katz said. Fortunately, if the glaucoma is detected, there are a variety of treatment options, including medications taken at home, in-office procedures, and surgery. “All treatments have a common goal — to lower eye pressure to an acceptable level that will halt progressive, irreversible vision loss.” You could be prescribed daily eyedrops or pills or asked to come into the office for a laser treatment. There are also a variety of surgical operations, according to Dr. Katz, such as micro-invasive glaucoma surgery (MIGS). “MIGS operations are used often in combination with cataract surgery in glaucoma patients or alone to better control the eye pressure and reduce the glaucoma drug burden,” said Dr. Katz, referring to possible side effects of glaucoma drugs or concerns about a patient’s ability to comply with their
“I may see a patient who has 20/20 vision but has enormous sensitivity to light or glare, and needs help with determining what tint is best for glare control,” she said. “Or, someone who needs to read small print, or does needlework, and may be struggling with acuity loss.” A low vision exam is different from a regular eye exam for glaucoma, which focuses on making sure your disease is well-controlled. “We want to know how you are functioning with the vision that you have — it’s a goal-based exam,” she said. The exam looks carefully at the patient’s medical and ocular history, and at how the patient deals with activities of daily living: Can you read your mail, cook without burning yourself, take public transportation? It also measures different facets of acuity, with charts for contrast sensitivity, various distances, etc.
medication regimen. The procedure involves “micro-incisional approaches” using an operating microscope to improve fluid flow patterns and lower eye pressure. Katz notes that among the procedure’s advantages are the high safety level, minimal trauma, and rapid visual recovery which allows you to quickly return to daily activities. While the existence of effective and minimally invasive treatment options for glaucoma is great news, the even better news is that Dr. Katz anticipates even better treatment in the near future. “Rapidly evolving technologies have delivered novel, sustained drug delivery methods [such as] injectable micropolymers, tiny drug elution devices, that will decrease the burden placed on many patients who find daily eyedrop administration challenging,” he said. “[And] positive clinical experience with lasers will increase the adoption of earlier laser treatment.” n Lynne Daggett
This has been paid for by Glaukos.
Beyond eyeglasses, there are many devices available today to help meet a patient’s needs. These include everything from iPhone apps to high-tech appliances. Dr. Sherazian noted built-in magnifiers on IOS smartphones that can change contrast and font size; VoiceOver, a built-in screen reader on iPhones; and Seeing AI, a free iPhone app that uses artificial intelligence that enables reading text out loud. Devices range from hand-held and standing magnifiers with adjustable magnification and contrast levels for prolonged reading to the hands-free Optivisor headband magnifier, glasses with a telescope attached, and handheld monoculars for spot reading and spot tasks. n Gay Bamberger, Freelance Public Relations Representative
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G PREDICTABILITY.
Featuring a wide flange at its base, the new precision-engineered iStent inject ® W is designed to: • Safely and effectively control your patient’s glaucoma1 • Optimize stent visualization while maintaining a truly micro-scale footprint • Streamline implantation • Deliver procedural predictability Don’t miss the opportunity to make a once-in-a-lifetime difference for your cataract patients with mild-to-moderate glaucoma. TransformMIGS.com | 800.GLAUKOS (452.8567)
REFERENCE: 1. Samuelson TW, Sarkisian SR, Lubeck DM, et al. Prospective, randomized, controlled pivotal trial of an ab interno implanted trabecular micro-bypass in primary open-angle glaucoma and cataract. Ophthalmology. Jun 2019;126(6):811-821. INDICATION FOR USE. The iStent inject ® W Trabecular Micro-Bypass System Model G2-W is indicated for use in conjunction with cataract surgery for the reduction of intraocular pressure (IOP) in adult patients with mild to moderate primary open-angle glaucoma. CONTRAINDICATIONS. The iStent inject W is contraindicated in eyes with angle-closure glaucoma, traumatic, malignant, uveitic, or neovascular glaucoma, discernible congenital anomalies of the anterior chamber (AC) angle, retrobulbar tumor, thyroid eye disease, or Sturge-Weber Syndrome or any other type of condition that may cause elevated episcleral venous pressure. WARNINGS. Gonioscopy should be performed prior to surgery to exclude congenital anomalies of the angle, PAS, rubeosis, or conditions that would prohibit adequate visualization of the angle that could lead to improper placement of the stent and pose a hazard. MRI INFORMATION. The iStent inject W is MR-Conditional, i.e., the device is safe for use in a specified MR environment under specified conditions; please see Directions for Use (DFU) label for details. PRECAUTIONS. The surgeon should monitor the patient postoperatively for proper maintenance of IOP. The safety and effectiveness of the iStent inject W have not been established as an alternative to the primary treatment of glaucoma with medications, in children, in eyes with significant prior trauma, abnormal anterior segment, chronic inflammation, prior glaucoma surgery (except SLT performed > 90 days preoperative), glaucoma associated with vascular disorders, pseudoexfoliative, pigmentary or other secondary open-angle glaucomas, pseudophakic eyes, phakic eyes without concomitant cataract surgery or with complicated cataract surgery, eyes with medicated IOP > 24 mmHg or unmedicated IOP < 21 mmHg or > 36 mmHg, or for implantation of more or less than two stents. ADVERSE EVENTS. Common postoperative adverse events reported in the iStent inject ® randomized pivotal trial included stent obstruction (6.2%), intraocular inflammation (5.7% for iStent inject vs. 4.2% for cataract surgery only), secondary surgical intervention (5.4% vs. 5.0%) and BCVA loss ≥ 2 lines ≥ 3 months (2.6% vs. 4.2%). CAUTION: Federal law restricts this device to sale by, or on the order of, a physician. Please see DFU for a complete list of contraindications, warnings, precautions, and adverse events. ©2020 Glaukos Corporation. Glaukos and iStent inject are registered trademarks of Glaukos Corporation. PM-US-0202
Kids, Screen Time, & Keeping Eyes Safe Check out these tips for protecting kids’ eyes from too much screen time. The 20-minute rule Ophthalmologists recommend taking a 20-second break from near work every 20 minutes. Set a timer, alternate reading an e-book with a real book, encourage children to look up and out the window every two chapters or simply shut their eyes for 20 seconds. The importance of ergonomics Make sure they view laptops at arm’s length, about 18-24 inches from where they are sitting. Ideally, they should have a monitor positioned at eye level, directly in front of the body. Tablets should also be held at arm’s length. To reduce glare, position the light source behind the back, not behind the computer screen and don’t use a device outside or in brightly lit areas; the glare on the screen can cause eye strain. Avoid using a device in a dark room. As the pupil expands to accommodate the darkness, the brightness of the screen can aggravate after-images and cause discomfort. Getting outside Arguably the easiest way to protect your children’s eyes is to make sure they spend some time outdoors. Studies show that sunlight is beneficial to eyesight. American Academy of Ophthalmology
The Cost of COVID You Might Not See
H
ere in the United States, we’re seeing how missed routine eye exams can lead to blinding conditions not being caught early enough to treat them, or how halted school screenings can lead to children’s vision problems going undetected. For many vulnerable communities around the world, the effects are even more dire. A serious problem Globally, 1.1 billion people live with vision loss, the overwhelming majority of them in low- and middle-income countries. But 90 percent of vision loss in the world is completely avoidable. Often, a lack of access to quality eye care, something as simple as a routine cataract operation or even a pair of glasses, is what causes someone to lose their sight to avoidable causes. Eye care teams normally hone their skills by working with patients, but many of those opportunities have disappeared as health systems focus on preventing the virus’s spread. Now eye care professionals are at risk of falling behind
in their training or continuing medical education. Looking to the future Simulation devices like virtual reality, artificial model eyes, and lifelike manikins allow eye care teams to practice surgeries and other critical skills, even when they can’t see patients. It’s also safer, allowing teams to build their skills and confidence in a risk-free way before progressing to real-life procedures.
Trust EyeSmart ®, not Dr. Google. Ophthalmologist-approved eye care information. Visit aao.org/eyesmart 14
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From boardrooms to classrooms, and even operating rooms, the world is rethinking how important work gets done safely by going virtual and leveraging technology. The same is true for the future of eye care. Getting training to eye care teams gets us closer to a world without avoidable blindness. n Dr. Hunter Cherwek, Vice President of Clinical Services, Orbis International
The Epidemic Hiding In “Near Sight” Today, a child in the United States has nearly a coin flip’s chance of being nearsighted. Thankfully, we’re learning more about how parents can help their children and limit the spread of this vision epidemic. Childhood nearsightedness can seem like the kind of problem patched up with little more than a basic pair of prescription eyeglasses. Glasses are part of the solution, but many parents — for varying reasons — wait too long to have their child’s vision examined and aren’t informed that nearsightedness is easily treatable. Myopia, the medical name for nearsightedness, causes distant objects to appear blurred, while nearby objects can still be seen clearly. It happens when a slightly misshapen eyeball causes light to be focused in front of (rather than directly on) the retina, the thin layer that processes light in the back of the eye. Unlike adults, young children often don’t realize their eyesight is blurry. They tend not to speak up, because they don’t think anything is wrong. Instead, the first signs and symptoms of undiagnosed nearsightedness are often secondary in nature: squinting, headaches, and difficulty playing sports. In the long term, misconceptions about myopia can cost valuable time during a critical period of a child’s visual development. Without care, their nearsightedness can worsen. If
nearsightedness progresses enough without correction, it can increase risk of developing conditions like cataracts, glaucoma, retinal detachment, and macular degeneration. Most long-term risks stem from what is called high myopia — a very high level of nearsightedness. While young children can develop high myopia early in life, it’s much more likely to be the result of many years of unmanaged myopia that begin during early childhood. On our current course, it’s believed that 1 in every 10 people will have high myopia by 2050. But there’s a silver lining. With proper diagnosis, possible medical treatment, and a few lifestyle changes, parents can slow or stop myopia’s progression and limit both shortand long-term side effects. Increasing kids’ time in sunlight and limiting their digital screen time are two simple ways to promote healthy eye development. Instead of being seen as a oncea-year doctor’s visit, a global movement is underway to completely transform the way we think about childhood nearsightedness. Organizations like the Global Myopia Awareness Coalition (GMAC) are working to make myopia awareness and management a mainstay in the public mindset. This is no small task, and GMAC is collaborating with governments, healthcare groups, and other nonprofits to see it through. Before myopia can be addressed, it needs to be diagnosed. According to a 2019 GMAC survey of more than
4,000 parents, only 57 percent made regular eye doctor appointments. Just 27 percent had taken their child to an eye doctor in the past year. The survey also confirmed another misconception: that kids don’t need an eye exam until they’re old enough to start school. Nearly 9 in every 10 survey respondents agreed, so you can certainly be forgiven for holding that belief. GMAC, however, advocates that children should have their first comprehensive eye exam between the ages of 6 and 12 months, giving eye doctors a head start to spotting early signs of myopia and putting a treatment plan in place. This guidance is backed by the American Optometric Association (AOA) and the American Academy of Ophthalmology (AAO), both prominent organizations of eye doctors in the United States. When detected early, myopia can often be managed and controlled, and mindful management can promote healthy habits in other areas of kids’ lives too. But myopia can occur anytime during childhood, and it’s never too late to take action to slow its progression. Remember, almost half of American kids today are nearsighted, so parents with myopic children are in good company. For now, public awareness efforts will continue, teaching parents about an easily misunderstood condition and looking ahead to lifetimes filled with healthy, clear eyesight. n Adam Debrowski, AllAboutVision.com
Family Caretakers Need the Telehealth Protocols for Vision Care to Change The industry-wide shift to video appointments with medical providers has streamlined and improved many aspects of healthcare. However, telehealth can present challenges for family caregivers, especially those caring for a loved one with a visual impairment. It has always been important to include family caregivers in visits to the eye doctor. When their loved one has low vision, the family caregiver may be the person responsible for assisting with activities of daily living, such as dressing and bathing. Depending on the severity of vision loss, transportation and shopping may all be coordinated through the family caregiver. Caregivers are important observers of symptoms or side effects that their loved one is experiencing and they are critical to seeing that their loved keeps up with their medications and practices appropriate eye care. All too often, unfortunately, policies won’t allow the family caregiver to be in a separate location from their loved one and still participate in the telehealth appointment. They need to be physically sitting in the same room with their loved one during the tele-visit. This is one thing that needs to change. Health insurance, including Medicare and Medicaid, needs to allow family caregivers to connect to virtual visits from a third location if necessary. These telehealth challenges to family caregivers are piled on top of the care they are already struggling to provide for their loved one. Telehealth is here to stay. Even after the coronavirus is behind us, telehealth could very well be the new reality for patients and family caregivers so let’s make sure we get it right. John Schall, CEO, Caregiver Action Network
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