Who Can Bioptics Help

Mild changes in pigmentation in the macula area of an individual with achromatopsia.

Achromatopsia and Cone-Rod Dystrophy

The retina, the rear membrane of the eye that converts the image inside the eye into neural impulses that are transmitted to the brain, contains photoreceptor cells called rods and cones. Rods, which work most well in low light and are sensitive to motion, are mostly concentrated in the periphery of the retina. Cones, which are mostly concentrated in the central macular area, are most sensitive in bright light and provide our color and detail vision. We read using the macula.

Individuals who are born with achromatopsia (a lack of color vision), which is also known as stationary cone dystrophy and rod monochromatism, have cones that do not function properly, leaving them with reduced visual acuity, reduced color vision and difficulty seeing in bright light. The degree of visual impairment can vary between “incomplete achromatopsia” where some color vision is retained and visual acuity may be as good as 20/80, or “complete achromatopsia” where none of the cones are functioning, there is no color vision, and visual acuity may be 20/200 or worse.

Individuals with achromatopsia often show mild to moderate changes in the macula area of the retina. However, especially early in the disease there may be no obvious changes in the appearance of the retina. Individuals with achromatopsia often have a pendular oscillating movement of the eyes called nystagmus. Symptoms of achromatopsia do not worsen over time and do not typically lead to blindness. Researchers have discovered several genes that may cause achromatopsia, however the CNGB3 is known to cause approximately 50% of known cases.

As referenced above, individuals with either of these low vision disorders may benefit from using Ocutech bioptic telescopes to regain a significant amount of their ability to see clearly.  

How Ocutech Bioptics Make a Big Difference for Individuals With Low Vision

Low vision care can be very effective in helping individuals with achromatopsia to lead very normal lives. Vision loss caused by achromatopsia responds very well to magnification, which can make reading, seeing signs, faces, the computer, TV, and even driving a possibility.

There is a wide range of optical, electronic and software magnification options, including Ocutech bioptic telescope lenses, to address many visual impairment needs. Every individual with achromatopsia should have a low vision examination by a doctor skilled in low vision rehabilitation to help identify the most appropriate options to enhance their visual functioning, academic and vocational potential and their personal quality of life.

Albinism

Albinism is a genetic defect that doesn’t allow the body to produce or distribute melanin, a natural pigment that gives color to hair, skin, and the iris of the eye. About one in 17,000 people have albinism. One form of albinism, called oculocutaneous albinism (OCA)  causes individuals to have white or pink hair and skin, a very light blue iris, as well as difficulty seeing. Much more rare than OCA because it only affects the eyes is ocular albinism (OA). Someone diagnosed with OA will have a skin and hair color that’s similar to other family members or just slightly lighter than theirs.

 Individuals with albinism do not have clear vision due to an underdevelopment of the central part of the retina called the macula. The macula is responsible for sharp, detail vision which works most well in bright light. The retina has a notably pale-colored appearance because of the lack of pigment someone with albinism produces.

How Individuals With Albinism Respond Well to Low Vision Aids Like Ocutech Bioptics

Fortunately, individuals with albinism respond very well to receiving low vision care; especially if that involves their eye doctor, such as an opthamoloist or optometrist, prescribing bioptic telescopes. Bioptic telescopic lenses may provide individuals with albinism with close to normal vision, allowing them to see friends and family at a distance, the teacher and blackboard in school, read signs at a distance, and even see what’s on a computer screen. Ocutech bioptic lenses may even offer a person with albinism with a way to obtain a driver’s license!

Coloboma

When the eye is developing, the fetal neural eye structure wraps around and joins together in what eventually becomes the bottom of the eye. If the two sides do not combine completely, there can be gap in the iris (the colored part of the eye) called a coloboma. This congenital eye condition produces a keyhole-like appearance in the pupil. This incomplete closure can also affect the layers of the back of the eye (choroid and retina) and the optic nerve. The disorder can occur in one or both eyes. It is estimated that coloboma occurs in 0.5 to 0.7 per 10,000 births.

Vision loss from colobomas may vary from mild to severe depending upon its size and location. Occasionally other ocular malformations or disorders may be associated with coloboma including microphthalmia (a very small eye), glaucoma, nystagmus,strabismus (turned eyes or crossed eyes), or blind spots in the visual field.

How Low Vision Treatment Options Like Ocutech Bioptics Help Individuals With Coloboma

While there are currently no medical or surgical treatment available to treat the eye disorder coloboma, visual aids available to individuals with low vision, including bioptic telescope lenses, can provide significant functional gains for individuals with eye conditions like these. 

Generally, the magnification and illumination control that Ocutech bioptic telescopes allow for are used to enhance visual functioning for individuals with colobomas. Bioptic lenses may be customized (uniquely prescribed and formulated) or used in conjunction with other visual aids to help individuals with colobomas with: 

• Reading

Strong reading glasses, optical and electronic magnifiers, and software to enlarge text on computer screens can  help an individual with coloboma read.

• Illumination Control

Proper lighting that increases contrast but reduces glare can be very helpful in many circumstances. Specifically tinted wrap-around sunglasses that reduce brightness but increase contrast are often helpful outdoors. These are also available in versions that fit over prescription eyewear that may also be required.

• Distance Vision

Conventional eyeglasses, while maximizing the focus on the back of the eye, may not provide adequate vision for seeing at a distance. The only options are to move close or to use telescopic devices to bring things closer optically. Bioptic telescopic lenses can be either handheld or spectacle mounted (bioptics). These bioptic telescopes can be very helpful to improve distance vision for watching TV or reading signs, or viewing a board in the front of a classroom, recognizing faces as part of everyday social engagement, and even for driving.

• Special Artificial Iris Contact Lenses

In addition to the range of magnifying devices available for the visually impaired, special contact lenses with an artificial iris can produce a normally sized pupil that can help make vision sharper and reduce glare and light sensitivity that individuals diagnosed with coloboma often face.

Diabetic Retinopathy

Individuals who have received a diabetes diagnosis also often receive a diabetic retinopathy one. Diabetic retinopathy causes progressive damage to the retina, the light-sensitive lining at the back of the eye.

Macular Degeneration

There are many other types of eye disorders that can be called “macular degeneration,” including juvenile macular degeneration (Stargardt’s Disease), macular holes, Best’s Disease, and epiretinal membranes (macular pucker). 

Fortunately, macular degeneration is limited to the central retina, so the peripheral retina, which is responsible for side (peripheral) vision and motion detection, remains intact. Individuals with age-related macular degeneration never experience complete blindness. In fact, individuals with this condition can usually walk and engage in most domestic activities with little difficulty due to their vision.

Learn more about Macular Degeneration from the National Eye Institute

Why Regular Eyeglasses Don’t Help Individuals With Macular Degeneration

When macular degeneration damages central vision, a person’s ability to see details is reduced, making print and signs difficult to read and faces difficult to identify. While at first, one might assume that an eyeglass prescription may need updating,  the eye’s focus is not the problem. The retina, which is the “screen” at the back of the eye that receives the image and converts it into neural impulses, is the portion of the eye that is not working properly.

Imagine visiting a movie theater and seeing the picture perfectly well. Now imagine that someone spreads black paint across  the actor’s face. Will changing the focus get rid of the black paint? Of course not. Now imagine that the camera zooms in for a close-up and now an actor’s face is 4 times larger. Now the black paint will cover just the actor’s nose, or cheek or eye, and, as a result, much more of the face becomes visible. So, what helps individuals with macular degeneration see better is making things larger. Ocutech’s Bioptic telescopes can offer a great visual solution for making such visual improvements.

Macular Holes

A macular hole is a small break in the macula, located in the center of the eye’s light-sensitive tissue called the retina. The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail. A macular hole can cause blurred and distorted central vision. Macular holes are related to aging and usually occur in people over age 60. The size of the hole and its location on the retina determine how much it will adversely affect a person’s vision.

Is a Macular Hole the Same as Age-Related Macular Degeneration?

No. Macular holes and age-related macular degeneration are two separate and distinct eye  conditions, although the symptoms for each are similar. Both conditions are common in people 60 and over. 

What Causes a Macular Hole?

Most of the eye’s interior is filled with vitreous, a gel-like substance that fills about 80% of the eye and helps it maintain a round shape.

The vitreous contains  fine fibers that are attached to the surface of the retina. As we age, the vitreous slowly shrinks and can pull away from the retinal surface. This is normal. In most cases, there are no adverse effects that result from this natural aging process. However, some patients may experience a small increase in floaters, which are little “cobwebs” or light specks that have a star-like appearance that seem to float about in your field of vision. 

However, if the vitreous is firmly attached to the retina when it pulls away, it can tear the retina and create a macular hole.  Macular holes can also occur with other eye disorders, such as high myopia (nearsightedness), injury to the eye, retinal detachment, and, rarely, macular pucker.

Is My Other Eye at Risk for a Macular Hole?

If a macular hole exists in one eye, there is a 10-15% chance that a macular hole will develop in your other eye over your lifetime. 

How Bioptics Improve the Vision of Those With Macular Holes

Since the size of the macular hole is small and it’s edges are usually sharply defined, magnification can be very effective in helping individuals with macular holes see better. While conventional eyeglasses usually do not offer significant visual improvement. Very strong reading glasses, optical magnifiers and electronic magnifiers can also be very helpful. Ocutech bioptic telescopes are particularly useful for helping individuals with macular holes see at a distance and also when they engage in arm’s-length visual activities.

Myopic Degeneration

People with severe nearsightedness (high myopia) are at greater risk for myopic degeneration. Myopic degeneration commonly occurs during young adulthood and can lead to a gradual decrease in central vision. Vision can decrease more abruptly in a small percentage of patients.

Although central vision may be lost, side (peripheral) vision usually remains unaffected. Remaining sight can still be very useful, and with the help of low vision optical devices, people with this  myopic degeneration can continue many of their normal activities.

The causes of myopic degeneration are not clearly understood, but they may include biomechanical abnormalities or hereditary factors.

How Bioptics Allow Individuals With Myopic Degeneration To Lead Normal Lives

Vision loss caused by myopic degeneration responds very well to magnification.  Ocutech bioptics especially helpful for seeing at a distance can also make reading, seeing signs, faces, the computer, TV and even driving a possibility. 

Nystagmus

Nystagmus is a term to describe fast, uncontrollable movements of the eyes (fluttering) that may be:

• Side to side (horizontal nystagmus)
• Up and down (vertical nystagmus)
• Rotary (rotary or torsional nystagmus)

The term “dancing eyes” has been used to describe nystagmus. Perhaps the most famous individual with Nystagmus is flutist James Galway. It hasn’t seemed to hamper him!

Involuntary eye movements associated with nystagmus are caused by abnormal function in the areas of the brain that control eye movements. The part of the inner ear that senses movement and position (the labyrinth) helps control eye movements.

There are two forms of nystagmus:

Congenital Nystagmus: Individuals are born with this condition, such as in albinism

Acquired Nystagmus: Develops later in life because of a disease or injury.

Nystagmus eye movements can either be pendular (roughly equivalent speed in each direction) or jerk (where there is a fast movement in one direction and a slower recovery movement in the opposite direction). Pendular nystagmus is usually found in congenital nystagmus, while jerk Nystagmus is present in acquired nystagmus.

Improving a Nystagmus Patient’s Quality of Life With Distance Vision Aids Like Bioptics

Telescopes (monoculars) and versions mounted into eyeglasses (bioptic telescopes) can make distance vision very close to normal, allowing individuals with nystagmus to see their teacher, classmates and blackboard in class, read signs while shopping and traveling, read the computer, and play music, cards and board games at normal distances. For many individuals, bioptic lenses may also make them eligible to drive (see your state’s regulations to determine your eligibility and requirements).

Nystagmus does not usually interfere with the effective use of telescopic devices. 

Optic Nerve Disorders

Optic nerves, which contains 1.2 million fibers each, carry the neural impulses created by the retina to the brain to enable us to see. Disorders of the optic nerve are caused either by developmental (genetic or abnormal development) or acquired factors (trauma or disease). 

Optic nerve disorders will always impact vision in some way and can affect one or both eyes. The optic nerve fibers from each eye combine at the optic chiasm located above the pituitary gland, located in the skull about an inch behind the bridge of the nose. 

Defects to the optic nerve in front of the chiasm will affect vision in only that eye, while defects at the chiasm and beyond (toward the back of the head) will affect vision in both eyes. Optic nerve atrophy can be diagnosed during an examination of the eyes. In optic atrophy patients will show a:

• Reduction in visual acuity
• Loss or reduction in color vision (especially to red)
• Abnormal pupil response (the pupil of the affected eye will not perform normally- called an afferent pupillary defect)
• The optic nerve will appear pale in color

How Low Vision Care and Bioptic Lenses Can Help With Optic Nerve Disorders

Low vision care can be very effective in helping individuals with optic nerve disease to lead very normal lives. Vision loss caused by an optic nerve disease responds very well to magnification which can make watching TV, viewing details on a computer sceen, seeing street signs, reading, and operating a vehicle a possibility. 

Retinitis Pigmentosa

This retina has Retinitis Pigmentosa. Note the dark "Bone Spicule" deposits in the peripheral retina.

Retinitis pigmentosa is a disorder of the rods. It reduces night vision and the ability to see to the side (peripheral vision), resulting in tunnel vision. Macular vision can remain near normal for a long period of time so often individuals with retinitis pigmentosa can read and walk in bright sunlight. Devices that expand the visual field (such as image minifiers and field viewers) can help individuals with their tunnel vision see more easily to the side, helping with mobility and other activities.

How Tunnel Vision Affects a Retinis Pigmentosa Patient’s Life and How Visual Aids Improve Their Plight

A normal visual field of each eye extends to approximately 80 degrees nasally (to the nose) and 90 degrees temporarily (to the ear). With both eyes together, a normally sighted individual can see an almost 180 degree field of view. (To understand what a degree is, extend your arm fully at shoulder height and bend your hand upward to the ceiling at the wrist—the width of your hand is approximately 10 degrees in diameter.) 

The peripheral retina is most sensitive to motion and sees best in low light (scotopic vision). It does not have the resolving power (highest visual acuity) of the macula (which is designed to provide our sharp, detail vision and works most well in bright light (photopic vision).

Individuals with tunnel vision from disorders such as retinitis pigmentosa, choroideremia, glaucoma, and strokes of the optic nerve (ischemic optic neuropathy) will note that they see more poorly at night and tend to bump into objects (for example door jams and low hanging branches) in their side vision. Tunnel vision usually develops slowly and individuals can learn to scan more to help them walk move safely. When fields of view become very narrow (perhaps 10 degrees diameter or less), sighted guides, long canes, and guide dogs become very helpful.

Optical devices that minify the image (like hotel room peep holes), sometimes called reversed telescopes, may also be of value. These make the image smaller, allowing more to be seen in the same amount of space. Ocutech makes three versions of optical minification devices—the Image Minifier, Field Viewer, and the Field Expander. As compared to reversed telescopes that produce barrel distortion and an unnatural image, Ocutech minification systems are designed to provide a sharp, flat image that is more natural, and easier to use.

Retinopathy of Prematurity

Retinopathy of prematurity (ROP) is an eye disease affecting prematurely born babies who have received intensive neonatal care, and more specifically, situations in which oxygen therapy is used due to the premature development of their lungs. It is thought to be caused by disorganized growth of retinal blood vessels, which may result in scarring and retinal detachment. 

ROP can be mild but it also may lead to a significant visual impairment. 

Low Vision Care Like Bioptic Lenses Can Make a Big Difference for Those with Retinopathy of Prematurity

Like most eye conditions that affect visual acuity, optical magnification aids including Ocutech bioptics offer magnification options to address virtually every seeing need.  

Stargardt’s Disease

Retinal Photograph of Stargardt's Disease.

Originally described by German ophthalmologist Karl Stargardt in 1901, for whom this eye condition is named, Stargardt’s disease, which is also known as fundus flavimaculatus, is a retinal disorder that affects the macula early in life and hence is often also called juvenile macular degeneration or early onset macular degeneration. Unlike age-related macular degeneration, there is never a leakage of blood or fluid, though the same area of the retina (the macula) is affected.

The macula is the central part of the retina that is responsible for providing sharp detail and color vision. As in age-related macular degeneration or macular dystrophy, Stargardt’s disease does not affect the peripheral retina and, as a result, individuals do not lose all of their vision. They can usually walk and engage in general activities with little difficulty. Reading and seeing details, such as signs and faces at a distance, are, however, reduced. Stargardt’s disease affects over 30,000 individuals in the US and occurs in approximately one in 10,000 persons.

Stargardt disease is the most common cause of macular degeneration and central visual loss in young people. It often develops in the teens or twenties, in both genders, but may develop in younger children and even sometimes later in life. It affects both eyes, though one may be worse than the other. Vision loss tends to progress rapidly at first, but usually stabilizes at about 20/200 (6/60) visual acuity.

Visual Aids Like Bioptics Can Improve a Stargardt Disease Patient’s Sight 

Vision loss from Stargardt’s disease responds very well to magnification which can make reading, seeing signs, faces, the computer, TV and even driving a possibility. Ocutech’s bioptics are very popular with individuals with Stargardt’s Disease.