Volume 5 Issue 4

Volume 5 | Issue 4

Education and Research from Envision

Stargardt Disease: The View From 2011 Janet S. Sunness, MD

targardt disease is the most of this condition that begins later and unlike age-related macular Scommon cause of macular in life and tends to progress more degeneration, it is often difficult to degeneration and central visual loss slowly. determine just by looking at some- in young people. Stargardt disease one how much of a blind spot the often develops in the teens or twen- DIAGNOSING STARGARDT patient may have. The fluorescein ties, but may develop in younger DISEASE angiogram (when dye is injected into children (the youngest child I have Patients with Stargardt disease the arm and pictures of the retina seen is 5) or somewhat later in life. have findings that are different from are taken) often shows an unusual It affects both eyes at the same patients with age-related macular appearance called a “dark choroid,” time, though one may be somewhat degeneration, and some terminology meaning that the initial flush of dye worse than the other. In most people is worth knowing. Many patients with which goes through the blood vessel it affects only central vision (read- Stargardt disease have yellow flecks system beneath the retina cannot be ing, recognizing faces and other in their retina. In these patients, the seen. Some patients with Stargardt fine tasks), but in certain more rare disease is also known as fundus disease start out with a bullseye types, peripheral vision may be flavimaculatus (the retina with the appearance to the macula, in which affected as well. Vision loss tends yellow spots). The macula, the cen- there is a small island of spared to progress rapidly at first, but for ter of the retina, often has a shiny vision surrounded by a donut- many people it tends to stabilize at appearance, which is referred to shaped blind spot. In other patients, about 20/200. There is also a form as a “beaten bronze appearance,” or later in the course of the disease, 2 | Table of Contents

Feature Article Stargardt Disease: The View From 2011 1 Janet S. Sunness, MD

Continuing Education Utilizing Red Contact Lenses for Retinal 6 Dystrophies William Park, OD, FAAO Case Study Case Report: How the Amber-Red Contact 8 Lens Changed My Life Marica Harris, CLVT, St. Louis Veterans Medical Center

Disease Etiology Cataracts: An Overview for the Low Vision 12 Professional Dasa V. Gangadhar, MD Professional Education Envision Conference 2011: Resounding 17 Success! Focus on Research Envision Conference Research Session 18 Highlights

GUEST CONTRIBUTORS Janet S. Sunness, MD Marica Harris, CLVT William L. Park, MD Dasa V. Gangadhar, MD is a quarterly publication Visibility To submit an article or case study to be considered for publication in of the Envision Foundation. Visibility, please contact Michael Epp, Director of Professional Education, 610 N. Main, Wichita, KS 67203 at (316) 440-1515 or [email protected]. (316) 440-1600 The viewpoints expressed by the guest authors of Visibility do not necessarily reflect the viewpoints of Envision or its staff. www.envisionus.com Servicios bilingües disponibles: ABOUT ENVISION FOUNDATION (316) 440-1660 The mission of the Envision Foundation is to secure funding for the successful delivery of services offered by the Envision Vision Rehabilitation Center and EDITORAL STAFF the education programs of the Foundation. Envision Foundation focuses on Michael Epp, MS, Director of fundraising to ensure that no patient is ever turned away—regardless of ability Professional Education to pay; public education to help prevent blindness; and professional education to Kelsey Rawson, Professional determine best practices in order to serve patients who are blind or low vision. Education Associate REQUEST COPIES OF VISIBILITY Shannon Riley, MA, Research If you would like to share Visibility with a colleague, please request a copy from and Analytics Associate Michael Epp, Director of Professional Education, at michael.epp@envisionus. Kathi A. Buche, Graphic Design com or call (316) 440-1515. Visibility is also available online at www. Manager envisionus.com/Visibility. Copyright © 2011 Envision Foundation. Individual articles are Copyright © 2011 of the indicated authors, printed with permission. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage or retrieval system, without written permission of Envision Foundation.

ENVISION Feature Article | 3

Stargardt Disease: The View From 2011 continued from front page there is a solid area of blind spot competitor. They have rewarding Some patients with Stargardt which does not spare the very personal and professional lives. disease are able to drive. Each state center. Improved low vision interventions in has different rules in terms of the mini- the future will help patients to adapt mum visual acuity required to get a DEALING WITH BLIND SPOTS even better to this condition. It is restricted license. Patients who meet IN THE CENTRAL VISION important to remember that a loss this vision requirement can work with It is critical for any patient with of vision is a real loss to the indi- special driving instructors who can blind spots in or near the center vidual, and some people may react instruct them and determine whether of vision to learn how to move the to this with anger and depression. they can drive safely. GPS systems are eye so that the object of interest While these are normal stages many probably the best device for drivers is imaged onto a seeing part of the retina. Most Stargardt patients do this quite well and tend to look slightly above what they want to see. This has the effect of moving the blind spot up and out of the way. The difficulty is that as one uses retina farther from the center of the macula, larger letters are needed in order to see; magnification, using a variety of low vision devices, can be very helpful. A diagnostic device called a microperimeter can allow us to plot out the exact location of the blind spot directly on a video image of the macula. This information helps us to advise patients on strategies for using the remaining seeing retina in the most effective way. Other specialized imaging, using infrared and Many patients with Stargardt disease have yellow flecks in their retina known as autofluorescence imaging, allows us fundus flavimaculatus. to determine the stage and progres- sion of the condition more compre- patients go through, these emotions with somewhat reduced central hensively. may interfere with the person’s abil- vision. Patients can also learn how ity to adapt and see around the blind to use a bioptic telescope to read LIVING WITH STARGARDT spot. If there is difficulty in working street signs and traffic signals. DISEASE through these emotions, support Most patients whom I see with groups and counseling may be THE GENETICS OF STARGARDT Stargardt disease have adapted beneficial. Support groups are very DISEASE quite well; they lead busy and active helpful in general for understanding Stargardt disease is an inherited, lifestyles. Among these patients is a the symptoms of central visual loss or genetic, disease; that is, it is scientist, radio announcer, a social and for learning different ways of caused by a mutation of a gene. worker, and a tandem bike racing coping. Most patients I see with Stargardt

Visibility | Vol. 5, Issue 4 4 | Feature Article

are the only ones in their family to ported, it leads to an accumulation has serious complications such as have the condition, and they are of a material called lipofuscin that birth defects and psychiatric side ef- likely to have the autosomal reces- may be toxic to the retinal pigment fects) slowed down the accumulation sive form, meaning that both copies epithelium, the cells under the retina of the abnormal material. Research of the gene (one from the mother needed to sustain vision. The high is ongoing to find safe therapies that and one from the father) are abnor- levels of accumulation begin at birth; may help in this condition. mal. The children of these patients it is not clear what triggers the cells In the last few years, the first in all likelihood will be carriers of the to start degenerating. successful animal and human gene disease (have one abnormal gene) therapy trials have been conducted but will not be affected, assuming ADVANCES IN POTENTIAL for a severe retinal degeneration that the other parent is not a car- TREATMENTS FOR STARGARDT that begins at birth (Lebers Con- rier. Patients may have siblings who DISEASE genital Amaurosis, associated are affected, but their parents and The ABCA4 gene responsible for with an RPE65 mutation). Normal children are not likely to be affected. Stargardt disease was discovered in copies of the gene are attached to There is also a rarer autosomal 1997.1 A great deal of progress has virus vectors, which help to gain been made since entry of the genetic material into the that time. Scientists cells of the patient. This is injected have been able underneath the retina. Similar gene to develop mice therapy, using normal copies of the that are missing ABCA4 gene and a different virus the ABCA4 gene vector, has been successful in the (so-called knockout knockout mouse model. Since there mice). These mice is no naturally occurring Stargardt accumulate large disease known in animals, scientists amounts of lipofus- have used dogs that do not have a cin, as do people. mutation to test that the gene can A student with Stargardt disease uses a computer with But since mice enter the desired cell type. These assistive technology retinas do not have studies have gone well.2 In 2011, the dominant form, meaning that only the specific structure of a macula, StarGen study of gene therapy for one copy of the gene has to be they do not undergo the degenera- Stargardt disease began. The first abnormal. In the dominant form, one tion seen in people. Scientists have phase is a safety study. It will involve parent of the patient also has the studied whether various drugs or follow up of patients for about a disease and other siblings or family other interventions can slow or stop year to look for any evidence of members may have it as well. the accumulation of the abnormal side effects or complications affect- Researchers have found that material in these mice. They have ing the eye or any other part of the mutations in a gene called ABCA4 found that if you do not expose the person. For this phase, only patients are responsible for at least 75 mice to light, there is less lipofus- with very severe vision loss will be percent of the cases of Stargardt cin accumulation. It is difficult to enrolled.3 disease. This gene is responsible know how this applies to people, but A second clinical trial that began for helping transport vitamin A some investigators recommend that in 2011 uses stem cells to treat derivatives (retinoids) from the visual patients wear sunglasses when they Stargardt disease (NCT01345006; cycle, so that these retinoids can be are outdoors. They also found that Advanced Cell Technology; see clini- regenerated and reused. When the giving the mice Acutane (a vitamin A caltrials.gov). Stem cells are trans- retinoids cannot be properly trans- derivative used for severe acne that formed into retinal pigment epithelial

ENVISION Feature Article | 5

cells. These cells are then injected with a severe type of retinal degen- replace the photoreceptors with under the retina. The initial phase is eration, whether cell death can be an electrical or other type of light to assess safety with various num- slowed by growth factors. They have sensor, and could send the signal to bers of cells injected (beginning with made a small reservoir containing the nerve network in the retina, the 50,000). Since this has not before cells that have been genetically patient would be able to see. The been performed, it is not known to engineered to make a growth factor. development of artificial retinas is what extent there will be an inflam- They will implant this reservoir in the still in the early stages5, but prog- matory reaction to or rejection of the eye, and, like an internal factory, the ress continues to be made. cells, or what other side effects will growth factor that is made will be occur. This study is therefore only able to diffuse out of the reservoir CONCLUSION enrolling patients with very severe and into the eye. Stargardt disease, for the vision loss at this time. While the ul- Investigators are working on dif- foreseeable future, will remain the timate goal would be for the injected ferent types of “artificial retinas” that primary cause of central vision loss cells to replace the degenerated could take advantage of the fact that in young people. With appropriate cells of the patient, this will be very the nerve connection system from low vision intervention, these patients difficult to achieve. A more modest the retina to the brain is still normal generally do well, and they are goal would be for the injected cells in patients with Stargardt disease. generally open to using new high- to secrete growth factors that slow What are diseased are the retinal tech options. There is great potential down cell death.4 pigment epithelium and the photo- for future treatment of Stargardt Researchers are also studying receptors, the cells that “catch” the disease in clinical trials that are ways to slow down cell death in gen- light and send a signal to the other beginning now. eral. They are studying, in patients nerve cells in the retina. If one could

References: Dr. Sunness is a leading international expert in macular 1. Allikmets R, Singh N, Sun H, et al. A photoreceptor cell-specific ATP-binding degeneration and in methods of measuring macular transporter gene (ABCR) is mutated in recessive Stargardt macular dystrophy. Nat. Genet., 1997; 15(3), 236–46. function, with particular emphasis on

2. National Eye Institute; University of Pennsylvania. Phase I Trial of Ocular dry age-related macular degeneration Subretinal Injection of a Recombinant Adeno-Associated Virus (rAAV2- and Stargardt disease. She is an oph- CBSB-hRPE65) Gene Vector to Patients With Retinal Disease Due to RPE65 Mutations (Clinical Trials of Gene Therapy for Leber Congenital Amaurosis). thalmologist, with specialties in medical ClinicalTrials.gov http://www.clinicaltrials.gov/ct2/show/NCT00481546?ter m=NCT+00481546&rank=1. Bethesda, MD: National Library of Medicine. NLM retinal disease and low vision. She has Identifier: NCT00481546. Published May 31, 2007. Updated on May 23, 2011. pioneered the use of the scanning laser Accessed October 4, 2011. ophthalmoscope to learn more about 3. Oxford BioMedica. A Phase I/IIa Dose Escalation Safety Study of Subretinally Injected StarGen Administered to Patients With Stargardt Macular Degeneration. macular disease and how patients use ClinicalTrials.gov http://www.clinicaltrials.gov/ct2/show/NCT01367444?ter their peripheral retina when they have a m=NCT01367444&rank=1. Bethesda, MD: National Library of Medicine. NLM Identifier: NCT01367444. Published June 3, 2011. Updated on June 10, 2011. central scotoma. She was awarded the Gass Medal Accessed October 4, 2011. for outstanding work on macular disease at the 2011 4. Advanced Cell Technology. A Phase I/II, Open-Label, Multi-Center, Prospective Study to Determine the Safety and Tolerability of Sub-retinal Transplantation annual meeting of the Macula Society. Dr. Sunness of Human Embryonic Stem Cell Derived Retinal Pigmented Epithelial is the Medical Director of the Richard E. Hoover Low (MA09-hRPE) Cells in Patients With Stargardt’s Macular Dystrophy (SMD). ClinicalTrials.gov http://www.clinicaltrials.gov/ct2/show/NCT01345006?ter Vision Rehabilitation Services at the Greater Baltimore m=NCT01345006&rank=1. Bethesda, MD: National Library of Medicine. NLM Identifier: NCT01345006. Published April 28, 2011. Updated on May 16, 2011. Medical Center and a member of the Foundation Fighting Accessed October 4, 2011. Blindness working committee on Stargardt disease.

5. Artificial Retina Project. US. Department of Energy. http://artificialretina.energy.gov.

Visibility | Vol. 5, Issue 4 6 | Continuing Education

Utilizing Red Contact Lenses for Retinal Dystrophies William Park, OD, FAAO

A retinal cone disorder is a correction in one family, compound general term used to describe myopia/astigmatism (CMA) in the a group of rare inherited ocular other family; each patient was disorders characterized by the loss legally blind. All four were diag- Release Date: December 2011 or dysfunction of cone cells, the nosed and validated to have cone photoreceptors responsible for both dystrophies (achromatopsia) based Expiration Date: December 1, 2014 central and color vision. The most on electro-diagnostic testing, objec- Instruction Level: Introductory common symptoms of cone dys- tive clinical findings and subjective Goal Statement: Retinal cone trophy are visual loss, sensitivity to history. All four demonstrated nys- dystrophy affects the quality of life bright lights, and poor color vision. tagmus, BCVA ranging from 20/200 with debilitating photophobia and Achromatopsia is cone dysfunction to 20/400 and high refractive error decreased visual acuity of thousands that begins at birth. A cone dystro- greater than 5 diopters of hyperopia of people in the United States. No phy is a disease that progresses or myopia along with 3 diopters or treatment for retinal dystrophies is available, but low vision aids, gradually over time, with an age of more of astigmatism with dark 500 including red-tinted contact lenses, onset ranging from the late teens series CPF lenses incorporated can be helpful in selected patients. into the forties. Color vision HHR in spectacles to counteract the This educational activity reviews the testing (Hardy, Rand and Rittler, incapacitating aversion to normal diagnosis, evaluation and therapeutic Pseudoisochromatic Plate Test illumination. interventions via contact lens fitting Series) reveals many errors on both The four children were 6, 9, 10 available to patients with retinal 1-2 dystrophies. Post-fitting management red-green and blue-yellow plates. and 12 years of age; they were self- and patient experience will also be Patients with cone disorders conscious because of their appear- presented. often have debilitating photophobia ance which consisted of high pre- over and above their decreased scription, brown-tinted lenses and a Faculty/Editorial Board: William L. Park, OD visual acuity. This prevents them hat (being worn in the classroom – from optimal visual functioning in unlike their peers). The contact lens Target Audience: Optometrists the daytime and even in ordinary was originally designed with a 6 Credit Statement: This course is indoor illumination. Patients often mm pupil “to hide” the red tint rela- COPE approved for 1 hour of CE need to wear a baseball cap or tive to peer pressure (all had blue credit. COPE ID is 33197-CL. Please visor in addition to light-absorbing irises). Upon routine CL follow-up, check with your state licensing board to see if this approval counts towards glasses; even then, they may still one of the children asked for a full your CE requirement for relicensure. find it difficult to function. tint to block out light further, stating, No treatment for the disease “she had even more boyfriends as Sponsorship Statement: This is available, but low vision aids, a result of her red eye presentation.” continuing education course is sponsored by Envision. Envision including red-tinted contact lenses, is a COPE-approved administrator/ can be helpful in selected patients. RESEARCH INTO RED CONTACT provider of CE courses. In the early 1990s, this author LENS USE 3 Disclosure Statement: Dr. Park has became perplexed with two brother In 2004, Park and Sunness no financial interest. and sister pairs who had a high reviewed 23 patients with cone dis- compound hyperopic astigmatic orders and significant photophobia

ENVISION Continuing Education | 7

not ameliorated with standard glasses was 20/200 (range, 20/80– a motor vehicle license, with visual methods. Two patients had cone- 20/400). The mean age was 17 acuity of 20/100 or better. rod degeneration, one had cone years (range, 4–55 years). Mean All patients were fitted with soft dystrophy, and the remaining 20 visual acuity with the red contact contact lenses of 55 percent water patients had achromatopsia. lenses improved to 20/125. Eight content, methafilicon material The mean visual acuity with patients became newly eligible for (Kontur Kontact Lens, Hercules, California, USA) using a translucent red (K21/20) 11-mm zone in a 15-mm overall diameter. These lenses allowed for approximately 30 percent light transmission. The tint density prescribed (medium, dark or very dark; percent transmission was not available from the company) depended on the degree of alleviation of photophobia indoors and outdoors. The use of red contact lenses to alleviate photophobia capitalizes on both the tint of the lens and the advantages of a contact lens versus spectacles. Contact lenses are advantageous, in that complete pupillary coverage limits peripheral glare, reduces optical surfaces, and eliminates rear surface reflections. Furthermore, due to the nystagmus present in all the patients with achromatopsia, the visual axis is never aligned with the optical center of the spectacle lens, resulting in degradation of vision. Therefore, contact lenses are the primary mode of obtaining best- corrected visual acuity if tolerated subjectively.4-6

MANAGING EXPECTATIONS FOR SUCCESS My philosophy for successful fitting and long-term wear is that I do Before and after. After being fitted for contact lenses, this patient went not fit patients whom I do not think on to complete her GED, obtain two undergraduate degrees and became gainfully employed with the Social Security Administration. will be successful. The success is continued on page 9

Visibility | Vol. 5, Issue 4 8 | Case Study

Case Report: How the Amber-Red Contact Lens Changed My Life William Park, OD and Marcia Harris, CLVT, St. Louis Veterans Medical Center

As a Certified Low Vision Thera- makes that difficult. I often thought Patient Ocular History pist and a person with Stargardt to myself, “It would be great if disease, I’ve learned there are someone could make me a pair 28 YO AAF many myths about visual impair- of tinted contact lenses.” I did Occupation: MS, ED, CLVT at ment: that people will some investigating and St. Louis VA eventually go blind, learned Dr. Park and his CC: Extreme photophobia prescription eyewear fellow researchers were Allergies: PCN will not help, and doing just that. As I read enhancing contrast on, I discovered tinted FOHx: AMD – Grandmother will not improve a contact lenses were VAsc: OD 20/300 patient’s visual acu- ideal for patients like OS 20/125-1 ity. Those of us in me who have difficulty VAcc: OD 20/100+2 the field know most looking directly through OS 20/100+1 patients maintain the center of their eye- K’s: 43.50 x 44 @ 076 a useful amount of glasses. For example, 43.25 x 45.00 @ 092 vision and prescrip- my blind spot, or central EOMs: WNL/Full & Smooth tion eyewear can scotoma, requires me Color/Isihara 2/17 improve a patient’s visual function- to look off to the side to see objects red/green deficiency ing. Interestingly, contact lenses when the prescription is actually Anterior Segment NAP OU are rarely considered as viable in the center of the eyeglass lens. IOP OD 13 options for improving the low vision I scheduled an appointment with OS 15 patient’s visual acuity. In my per- Dr. Park and was anxious for my Dilated Fundus Exam sonal journey, I found prescription contact lens evaluation. Posterior Pole Beaten Bronze glasses without contrast enhance- In October 2010, Dr. Park presentation with ment offered little benefit. However, performed a thorough evaluation, circumscribing flecks OU Peripheral Retina NAP OU the combination of both improves which included a scanning laser Optic Nerve NAP OU my visual acuity, decreases the ophthalmoscope (SLO) visual field Prescribed contacts appearance of my blind spot and test, checking my eyeglass pre- 1 month later reduces light sensitivity. Fortunately, scription, and a tinted contact lens Kontur Kontact Lenses low vision specialists are now evaluation. He noted a change in Narcissus Red after 20 recognizing tinted contact lenses as my prescription and my 5-8 degree minutes wear time a valuable therapeutic intervention central scotoma. I tried several 8.6 15.0 -1.50 20/70 for photophobic low vision patients shades of contact lenses and 8.6 15.0 -1.25 20/80 like me. That’s how I met William selected an amber-red tint. Dr. Park OU 20/70 Park, OD. and his staff had me evaluate the Let’s be honest; as a young contact lenses indoors and out- professional, I don’t want my visual doors before making my final selec- impairment to be the first topic of tion. The amber-red contact lens conversation when I meet someone is the best low vision aid I’ve ever new. Unfortunately, wearing polar- experienced. My blind spot is less ized amber sunglasses indoors noticeable, I am no longer affected

ENVISION Continuing Education | 9

by indoor glare, and I can navigate social and professional situations with greater confidence. Since the contact lenses stay on the center of my eye, that means I am always looking through the best part of the lens. When I wore prescription sunglasses, my blind spot covered a person’s entire face when I looked directly at them. I had to look slightly to the right to read a person’s facial expression. With my contact lenses, the blind Pictured: 6mm vs. 14.5 mm red contact lens button on green iris eye spot appears smaller, so I can look directly at the person to whom I’m derived from a three- to five-hour visual acuity, contrast sensitivity, talking. The blind spot is still there, trial in the outside environment binocularity, stereopsis, activities but it’s so small that it only covers a (based on the initial low vision of daily living (ADL) function and small part of their face. For those examination) with lenses fabri- quality of life (short and long term) of us in the field, this means my cated according to the findings of are considered. preferred retinal locus (PRL) is that visit. It is my opinion that the Contact lenses should be an closer to central fixation. I no longer contact lens trial should always be important consideration for best- have to wear sunglasses to reduce scheduled at a second visit, with corrected visual acuity for high the glare from my television or subjective environmental appraisal refractive errors and/or anatomical computer screen. I can also recog- of the contact lenses as the primary ocular disease manifestations such nize coworkers from farther away focus. as aniridia (prosthetic iris contact and perform work-related tasks Activities encouraged are: travel lens). They can be critical as a with more ease. As a result, I have in an automobile, going to a mall or component of short and long-term less visual fatigue after a full day’s shopping, eating a meal at a res- BCVA considerations for infants work. The lenses are light enough taurant, attending a movie, visiting a due to nystagmus and their high that they do not significantly affect museum or outdoor play. The sole refractive error. Contact lenses may my color vision and I can typically objective is to have the support also be instrumental in enhancing wear a pair of store-bought sun- team interact with and evaluate the daily visual function for persons glasses outdoors. The dramatic likelihood of the patient’s successful with retinal dystrophies. difference tinted contact lenses has wear based on “real ADLs.” This is made in my life makes me wonder especially important with pediatric how many other patients could patients as indicated in other stud- 7, 8 References: benefit? My hope is that tinted ies. 1. The University of Arizona, College of Medicine, contact lenses are considered as a All my patients have suffered Hereditary Ocular Disease. Available at: http:// disorders.eyes.arizona.edu/category/alternate- potential therapeutic intervention for moderate to high degree of visual names/retinal-cone-dystrophy. Accessed October 21, 2011. any low vision patient with severe impairment or worse. Substan- 2. Ryan SJ, ed. Retina, 4th ed. Philadelphia, PA: light sensitivity and poor contrast tiation of the subject’s motivation Elsevier; 2006:394-485. 3. Park WL, Sunness JS. Red contact lenses for sensitivity. (regardless of age) for potential of alleviation of photophobia in patients with cone disorders. Am J Ophthalmol 2004;137:774-75. improved outcome measures in continued on page 11

Visibility | Vol. 5, Issue 4 10 | Continuing Education

Utilizing Red Contact Lenses for Retinal Dystrophies

Directions: To obtain 1 hour of continuing education credit, complete the exam by recording the best answer to each self-assessment question on the Examination Answer Sheet. Mail answer sheet to Envision-CE, Attn: Michael Epp, 610 N. Main, Wichita, KS 67203. A minimum score of 70% is required to obtain a certificate of completion. There is no fee for this course.

1. Cone disorders ______. 5. Using red contact lenses to alleviate 9. Which of the following is NOT a a. Often manifest in patients photophobia capitalizes on ______. factor that would affect a patient’s as a debilitating photophobia a. The tint of the lens candidacy to be prescribed red contact b. Is a group of rare inherited b. Advantages of contact lenses lenses? ocular disorders versus spectacles a. Non-compliance c. Both a and b A c. BCV b. Active eye disease, injury or d. None of the above d. All of the above any abnormal state of the cornea, conjunctiva or eyelids 2. A common symptom of retinal cone 6. The use of red contact lenses is c. A diagnosis of Stargardt disease dystrophy is poor color vision revealed advantageous for ______. d. Both b and c by testing errors with a ______. a. Hyperopia control a. Congenital stationary night b. Myopia control 10. The patient in the Case Report blindness test c. Changing iris color experienced ______as a result of b. HHR series color vision test d. Limiting peripheral glare being fitted with red contact lenses. plates a. Alleviation of central scotoma c. Distance visual acuity of count 7. According to the author, successful b. A preferred retinal locus (PRL) fingers test fitting and long-term wear of contact closer to central fixation d. Both a and b lenses is achieved by ______. c. Less visual fatigue a. A successful BCVA result on the d. Both b and c 3. In the Park and Sunness study3 the initial low vision examination mean visual acuity with glasses of the b. A second patient visit lens trial, subjects was______. with subjective environmental a. 20/400 appraisal b. 20/200 c. Pre-fabricated red contact lenses c. 20/100 d. All of the above d. 20/80 8. During the post-fitting management 4. One therapeutic intervention for pa- phase of a red contact lens patient, tients with cone dystrophy is ______. which activities should be evaluated? a. Accommodative spectacles a. Evaluation of a three- to five- b. Multifocal IOL hour trial in the outside c. The use of red contact lenses environment d. Video magnifiers b. ADLs c. Interaction with the support team d. All of the above

ENVISION Continuing Education | 11

4. Apte RS, Sunness JS. Goldstein BG, Park Examination Answer Sheet WL, Raden RZ, Ellman MJ. Bilateral macular staphylomas in a patient with cone dystrophy. Br J Valid for credit through December 1, 2014 Ophthalmol 2003;87:1049-1051. Utilizing Red Contact Lenses for Retinal Dystrophies 5. Park WL. Specialty contact lenses an important treatment for the visually impaired. Primary Care Directions: Select one answer for each question in the exam and completely darken the appropriate Optometry News 1997;2: 39–46. circle. A minimum score of 70% is required to earn credit. 6. Schiefer U, Kurtenbach A, Braun, et al. Centrally tinted contact lenses: a useful visual aid for Mail to: Envision CE, Attn: Michael Epp, 610 N. Main, Wichita, KS 67203 patients with achromatopsia. German J Ophthalmol COPE approved for 1 hour of CE credit. COPE ID is 33197-CL. 1995;4:52–56. Please check with your state licensing board to see if this approval counts towards your CE 7. Young RSL, Krefman RA, Fishman GA. Visual requirement for relicensure. improvements with red-tinted glasses in a patient with cone dystrophy. Arch Ophthalmol This continuing education course is sponsored by Envision. 1982;100:268–271. Envision is a COPE-approved administrator/provider of CE courses. 8. Zisman F, Harris MG. Therapeutically tinted contact There is a six- to eight-week processing time for this exam. lenses: In: Harris MG, London R, editors: Contact lenses: treatment options for ocular disease. St. Louis: Mosby, 1996:105–122. 1. A B C D 6. A B C D 2. A B C D 7. A B C D 3. A B C D 8. A B C D 4. A B C D 9. A B C D 5. A B C D 10. A B C D

11. The goal statement was achieved: How long did it take to complete Very Well Adequately Poorly this course

12. The information presented was: Very Useful Useful Not Very Useful William L. Park, OD, FAAO, 13. The difficulty of the course was Comments on this course: is in private practice in Complex Appropriate Basic Wichita, Kan. Dr. Park is committed to outreach efforts 14. Your knowledge of the subject was increased Topics you would like it he in stemming the epidemic Greatly Somewhat Hardly future CE articles: of diabetes. 15. The quality of the course was: He works Excellent Fair Poor exclusively with

Please retain a copy for your records. Please print clearly. patients referred You must choose and complete one of the following three identifier types: for low vision 1 SS# evaluation, 2 Last 4 digits of your SS# and date of birth 3 State Code and license #: (Example: NY 12345678) low vision First Name rehabilitation Last Name and neurological vision E-Mail loss. He is a past Director of The following is your: Home Address Business Address Low Vision Services, Lions Business Name Research & Rehabilitation Address Center, Wilmer Eye Institute- City State Johns Hopkins University.

Zip – Dr. Park can be reached at

Telephone # – – William L. Park, OD, LLC,

Fax# – – www.parklowvision.com., 610

By submitting this answer sheet, I certify that I have read the lesson in its entirety and completed the self-assessment exam N. Main, Suite 201 Wichita, personally based on the material presented. I have not obtained the answers to this exam by any fraudulent or improper means. KS 67203, (316) 440-1690 or Signature Date [email protected]. Lesson 111201.1 EU-VISI-5:4

Visiblity | Vol. 5, Issue 4 12 | Disease Etiology

Cataracts: An Overview for the Low Vision Professional Dasa V. Gangadhar, MD

Low vision rehabilitation is, by nature, a collaboration of medical professionals and other low vision specialists. Not all involved with the continuum of care know the exact science of cataract formation or removal. For this reason, the basics are necessary in order to fully understand the etiology and treatment options for patients who may have vision loss due to cataracts.

NORMAL EYE ANATOMY Vision is a complicated process with light rays passing through various structures of the eye (cornea, pupil and lens) before becoming focused on the retina, which serves much like film in a camera. The lens is one of the primary focusing structures of the eye, and sits just behind the colored part of the eye.

WHAT IS A CATARACT? A common myth is that a cataract is a growth or film that forms on the eye’s surface. However, a cataract is the clouding of the normally clear lens inside the eye. The normal lens is formed of neatly however, can play a role in how SIGNS AND SYMPTOMS arranged protein fibers that allow early or late in life a patient develops OF CATARACTS light to pass easily and become a cataract. The word cataract is derived focused clearly. In a cataract, from the Greek word for “waterfall.” these fibers clump together to form Risk Factors: Certain risk factors, If a cataract becomes advanced opaque clusters and the entire lens alone or in combination with age, enough, a patient’s vision can fail becomes cloudy and disrupts the can increase the risk of developing and they may feel like they are passage of light into the eye. This cataracts as an adult. seeing everything through a sheet can make images seem dull or • Smoking of rushing water. Today, it is rare blurry and interfere with a patient’s • Excessive exposure to UV for a patient’s cataract to advance ability to see clearly. rays (sunlight exposure) that far because treatment is usually • Significant eye injuries sought at a much earlier stage. WHAT CAUSES CATARACTS? • Poorly controlled diabetes For the vast majority of individu- • Long-term use of certain Classic symptoms include: als, cataract development is part of medications, primarily • Blurred vision: Fuzzy vision the normal aging process. Heredity, corticosteroids is a common first symptom

ENVISION Disease Etiology | 13

of cataracts. Street signs are • Increased eyestrain: more difficult to see and For many cataract patients, reading becomes a challenge. reading, working on a “Even in individuals Many patients even present computer, or using their eyes with low vision, the complaint that they can for daily activities can create no longer see the golf ball. strain or fatigue. cataract surgery may • Night vision difficulties: • Double vision: Patients may still be appropriate. Patients with cataracts may see “ghost” images or an out- feel unsafe driving at night. of-focus shadow effect. At minimum, cataract Glare from oncoming head- lights can become blinding CATARACT TREATMENT surgery can improve and streetlights can take on There are no non-surgical medi- a halo effect. cal treatments for cataracts. No peripheral vision, eyedrops, exercises, medications, • Excessive brightness and or glasses will cause cataracts to brightness and glare: Even sunlight can be regress or disappear. Surgery is blinding and create intoler- the only definitive treatment for colors.” able glare for patients. cataracts. The surgical technique has progressed so much that the appropriate lighting, patients can • Prescription changes: incision can be as small as two continue to utilize their remaining Frequent eyeglass prescrip- millimeters and a patient’s return functional vision. tion changes are needed. to excellent vision can often occur When a patient’s cataract pro- With early cataract formation, within a few days. Cataract surgery gresses to a point where it is signifi- it is appropriate to change a has become the most commonly cantly interfering with daily living or patient’s prescription in order performed surgery and one of the compromising their lifestyle (driving, to improve vision. However, most successful. Surgery can have cooking, reading, performing their with more advanced cataracts, a life-changing impact for many job, sewing or golfing) it may be eyeglass changes are no patients. time to recommend surgery. longer beneficial. Not everyone that has a cataract Several decades ago, doctors needs surgery. “If it is not broken, waited until a cataract became • Dimness of colors: don’t fix it.” If a patient is not yet “ripe”– when the lens became fully Cataracts cause colors to struggling or limited in their daily opaque – before surgery was per- become washed out and activities, treatment may not be formed. With modern surgical dull. Because cataracts usually necessary. Patients may be able to techniques and excellent surgical develop slowly, patients are compensate by changing glasses, results, it is better to proceed earlier often unaware of this color using magnifying lenses or utilizing than was customary in the past. change. It is only after cataract improved lighting when reading or surgery that many patients working. SURGICAL TECHNIQUE realize the profound impact Patients can be trained on these Modern cataract surgery is per- that the cataract had on color simple modifications through low formed on an outpatient basis, perception and brightness. vision rehabilitation. Through train- either in an ambulatory surgical ing in activities of daily living, assis- center or in a hospital. Surgery is tive technology, adaptive aids and performed with anesthetic eye

Visibility | Vol. 5, Issue 4 14 | Disease Etiology

drops or local anesthesia. Patients place. A man-made do not need to undergo general artificial lens is then anesthesia. Surgery is typically pain- implanted into the less, both during and after surgery. eye to replace the Using an operating microscope, tiny natural lens that was surgical instruments are used to removed. break apart and remove the cloudy Visual recovery is cataractous lens from the eye. usually very rapid and Ultrasonic techniques (called patients can resume normal daily blurs a patient’s vision, a laser pro- phacoemulsification) are the most activities almost immediately. cedure (posterior capsulotomy) can modern techniques of cataract The lens capsule (the membrane be painlessly performed to make removal. Lasers are not used in that holds the artificial lens in place) an opening in the capsule, thereby cataract removal. The back mem- can become cloudy several months restoring normal vision. brane of the lens (called the or years after the original cataract posterior capsule) is usually left in operation. If the cloudy capsule LENS IMPLANTS Modern lens implants are usually made of a foldable material (acrylic or silicone) that can be implanted into the eye via very small incisions. The power of the lens must be individually calculated for each surgery. Lens implants today can correct near-sightedness and far-sightedness. The most modern specialized lenses can even correct astigmatism and can have multifocal powers for best uncor- rected distance and near vision. Surgery can make one much less dependent on glasses, but often reading glasses or glasses with a low prescription are still needed for patients to obtain their best vision.

LOW VISION AND CATARACTS There are many causes of com- promised vision beyond cataracts. Macular degeneration, inherited ocular disorders, glaucoma, and other eye diseases can create uncorrectable visual compromise. Individuals with these diseases can, and will, still develop cataracts. Even

ENVISION Disease Etiology | 15

in individuals with low vision, cata- Envision Seeks Subjects to Participate ract surgery may still be appropriate. At minimum, cataract surgery can in National Clinical Research for the improve peripheral vision, bright- BrainPort® Vision Device Clinical Study ness and colors. The Envision Foundation recently announced that the Envision Vision SUMMARY Rehabilitation Center (EVRC) has been chosen as a site for a clinical trial Today’s surgical innovations research study to evaluate the safety and efficacy of the BrainPort® vision have effectively eliminated the fear device in subjects who are blind. The EVRC is one of seven sites across of vision loss from cataracts. Mod- the nation, selected by Wicab, Inc., the study sponsor, to participate in ern cataract surgery is performed this clinical trial research study. This 12-month study allows subjects to on millions of patients annually and use the device at home after completion of initial clinic screening and is successful in over 95 percent of training. cases. Even patients with low vision The BrainPort® vision system consists of a postage-stamp-size elec- from other causes may still benefit, trode that is placed on the tongue, a base unit, a digital video camera and to a limited extent, from cataract a hand-held controller for zoom and contrast inversion. Visual information surgery. Regular eye exams are is collected from the user-adjustable head-mounted camera and sent to necessary to diagnose and treat the BrainPort® base unit. The base unit translates the visual information eye diseases before they become into a stimulated pattern that is “displayed” on the tongue. The tactile more serious. Modern medicine image is created by presenting white pixels from the camera as strong continues to expand the boundaries stimulation, black pixels as no stimulation, and gray levels as medium lev- of eye care and eye surgery. els of stimulation, with the ability to invert contrast when appropriate. Users This article was originally published in Visiblity 2009: 3(3):6-8 often report the sensation as pictures that are painted on the tongue with Champagne bubbles. Thus far, study participants have been able to recognize high-contrast Dasa V. Gangadhar, MD, is an objects, their location, movement, and some aspects of perspective and ophthalmologist practicing with depth. Trained participants use information from the tongue “display” to Grene Vision Group, Wichita, augment their understanding of their immediate environment. Kan. Dr. Gangadahr’s areas of Eligible subjects must be between the ages of 18 and 79 years of age, clinical inter- and have had a medical diagnosis of blindness for at least six months. est include Blindness may not be a result of cortical injury, such as a traumatic brain cataract and injury or stroke. Subjects must have completed rehabilitation (such as implant sur- orientation and mobility training with a white cane or guide dog). Previous gery, corneal use of the BrainPort® vision device, pregnancy, regular tobacco use and transplanta- allergies to nickel or steel exclude participation in this study. Participants tion and cor- should be able to easily commute to and from downtown Wichita, and are nea, refractive required to make four quarterly clinic visits in addition following their initial and external training sessions. diseases. He is also the Medical Director for the Kansas Eye Potential study participants for this clinical trial should be referred to Bank and Cornea Research http://vision.wicab.com/index.php, and contact Shannon Riley, Center. Research & Analytics Associate, Envision Foundation, at (316) 440-1528

or email [email protected].

Visibility | Vol. 5, Issue 4 16 | Professional Education

2012 Visibility Guide for Authors SUBMISSION CATEGORIES Lead Article Theory, themed focus, or general article highlighting relevant issues facing the vision rehabilitation field. Length: Approximately 1,500 words Figures and Tables: May include up to 2 photos, figures or tables

Disease Etiology or Diagnosis General article outlining new findings in the diagnosis and etiology of vision-related diseases. Length: Approximately 1,500 words Figures and tables: May include up to 2 photos, figures or tables

Case Study Presentation of a patient case study (HIPAA compliant, de-identified patient information) that shows how a presenting problem was approached with vision rehabilitation interventions, follow-up and/or referrals. Length: Approximately 1,000 words Figures and Tables: May include up to 3 photos, figures or tables

Research Research Review: Review of past and/or current vision research and its potential for vision rehabilitation clinical applications. Research Abstract: An early concept, short research abstract that encompasses the exploratory stages of vision research and its potential for vision rehabilitation clinical interventions, technology applications, or surgical, pharmaceutical or gene therapy interventions. Include hypothesis, purpose or objective, research methods, results/expected results, discussion, conclusion, and future directions of research and acknowledgement. Human Subjects Research: IRB and HIPAA compliant, de-indentified patient information. If animals are used in study, the acknowledgement section should describe the animal care protocol that was followed, name the institution that sponsored the study and identify relevant IRB approval. Biomedical research involving animals must conform to generally accepted principles of animal maintenance and care, such as those of the Association for Research in Vision and Ophthalmology (ARVO). Length: Approximately 1,000 words Figures and Tables: May include up to 4 photos, figures or tables

Product Advertorial Article highlighting a company, product or service of significance to the vision rehabilitation and research fields. Each issue of Visibility will publish only one advertorial. Advertorials are sold on a first come, first served basis. All advertorials will be marked as paid advertisements. Length: Up to 800 words Figures and Tables: May include up to 2 photos, figures or tables Price: $1,000 SUBMISSION DEADLINES Issue Number Submissions and Advertorial Deadline Issue Publish Date Volume 6, Issue 1 11/18/2011 2/3/2012 Volume 6, Issue 2 2/17/2012 5/4/2012 Volume 6, Issue 3 5/18/2012 8/3/2012 Volume 6, Issue 4 8/10/2012 11/9/2012

For more information regarding submission requirements, visit www.envisionus.com/visibility.

ENVISION Professional Education | 17

ENVISION CONFERENCE 2011: Resounding Success! Thank You to everyone that made Envision Conference 2011 a resounding success for vision rehabilitation and research! Many hours of planning and executing went into designing the leading venue for low vision clinical education and research.

Nearly 300 low vision clinicians, Gold Fellow of the Association for researchers, educators and advocates Research in Vision and Ophthalmol- gathered at the Hilton St. Louis at the ogy and an Honorary Fellow of the Ballpark, St. Louis, Missouri, for the College of Optometrists in the UK. In sixth annual Envision Conference addition to publishing more than 100 September 21-24. Fifty-six clinical scientific papers and book chapters, education sessions and 10 low vision some of his more noted research research sessions were presented includes reading and face recogni- by leaders in the field. A total of 130 tion in people with impaired vision, a hours of continuing education units study sponsored by the National Eye were offered representing the multi- Institute. He has also researched the disciplinary nature of the conference: effect of visual impairment on older ACCME, ACVREP, AOTA, COPE people’s daily lives, a study spon- and CRCC. sored by the National Institute on Aging. Rubin has devoted consider- “This conference is unique in able time to the development and its focus on low vision. The validation of new clinical vision tests combination of research and used in a wide range of eye diseases workshop platforms is critical including cataract, macular degen- to those of us in the teaching eration and diseases of the optic helped to make this year’s program field who are required to use nerve. In addition to being this year’s the best to-date. Additional thanks go information and strategies keynote speaker, Dr. Rubin also to the Envision peer review com- that are ‘research based’.” moderated a vision research sym- mittees who reviewed the hundreds – Envision Conference posium titled “Clinical Trials for Low of clinical education and research 2011 Attendee Vision Rehabilitation: Interventions & abstracts that ultimately lead to the Methodologies.” first-rate program. For a review of The focus of Envision Conference this year’s program, see the “Previ- 2011 was “Excellence in Research.” EXCEPTIONAL SPEAKERS ous Conferences” page at www. The plenary “Excellence in Research” Many thanks are also due to the envisionconference.org. Keynote was delivered by Gary skilled presenters in clinical educa- continued on page 20 Rubin, PhD, FARVO. Dr. Rubin is a tion and low vision research who

“This was my first experience with Envision. It was a very rewarding experience and will help me in my efforts to provide the best low vision services to my patients. The team effort of disciplines was embraced by this conference and it was a great opportunity for networking and professional growth! The Envision Conference will be on my list of ‘must attend’ conferences!” – Shirley Anderson, OTR/L, CLVT, Envision Conference 2011 Attendee

Visibility | Vol. 5, Issue 4 18 | Focus on Research

ENVISION CONFERENCE 2011 RESEARCH SESSION HIGHLIGHTS

Envision Conference 2011 took place in St. Louis, Missouri, September 21-24 with pre-conference educational workshops taking place on Wednesday, September 21. The Envision Conference is one of the largest and most respected gatherings of multi-disciplinary professionals engaged in clinical practice and research related to low vision and blind rehabilitation. The presentation of eight pre-conference workshops, 10 research panel sessions and 56 clinical education sessions ensured that there were topics of interest for all professionals present. Below are just some of the highlights from this year’s research sessions.

WEDNESDAY, SEPTEMBER 21 by Olga Overbury, PhD, presented research on the Wednesday provided intensive workshops on a timely and previously unconsidered issues related to the number of diverse topics for those arriving early to the relationships between sleep disorder and visual impair- conference. The first of the workshops presented was ment. A few of the presentations included Eyes Wide Workshop on Prism Adaptation Therapy for Hemis- Shut: Lens Properties and Sleep Disturbances, patial Neglect Associated With Brain Injury or Stroke, presented by Walter Wittich, PhD, and Prevalence of presented by Kevin Houston, OD, and Kia Eldred, OD. Circadian Rhythm Disorders Among Blind People The complex relationship between diabetes and vision With and Without Light Perception, presented by rehabilitation was addressed by Emilie Hagan, ARNP- Erin Flynn-Evans, PhD. Presentations that also gener- CNS, MS, CDE, William Park, OD, and Karen Kendrick, ated a great deal of interest were found in Dual Sensory OTR/L, CLVT, in Diabetes and the Low Vision Reha- Impairment, moderated by Walter Wittich, PhD. These bilitation Team: The Great Escape, while Adding Low included The Relevance of Providing Both Auditory Vision Services in Your Private Practice was presented and Visual Speech Cues to Older Adults With Dual by Kendall Krug, OD, and Lori Grover, OD. Five other Sensory Loss Impairments by Jean-Pierre Gagne, diverse workshops completed the day’s activities. PhD, and Psychosocial Adjustment for Persons Aging With Hearing and Vision Loss, presented by THURSDAY, SEPTEMBER 22 B.J. LeJeune, CRC, CVRT. The first day of concurrent sessions for Envision Conference 2011 got off to a great start with research FRIDAY, SEPTEMBER 23 Health States of Patients Seeking Outpatient Low Vision On Friday, the high quality of research sessions Rehabilitation Services Within LOVRNET, moderated by continued, beginning with research Mobility Panel Judith Goldstein, OD. This session provided presenta- moderated by Shirin Hassan, OD, PhD. Included in this tions on the health states of nearly 800 patients within session was a very interesting presentation entitled, the Low Vision Research Network (LOVRNET), includ- Enhanced Orientation and Mobility in the Visually ing The Relationship Between Physical Ability and Impaired Using Virtual Audio-Based Environments, Functional Ability in Patients Seeking Outpatient by Erin Connors, and a pair of presentations by Pradeep Services Within the Low Vision Research Network Ramulu, MD, MHS, PhD: Restriction of Travel Out- (LOVRNET), by Kim Schoessow, OTD, Functional side the Home in Glaucoma and AMD: Direct Mea- Ability and Depressed Mood Among Patients in the surement Using a Cellular Network-Based Tracking Low Vision Research Network (LOVRNET) by Judith Device and Objective Measurement of Real-world Goldstein, OD, and The Measurement of Personal- Physical Activity in Glaucoma and Macular Degen- ity and Social Support Systems Among Patients in eration Using Accelerometer Devices. the Low Vision Research Network (LOVRNET) by K. Gary Rubin, PhD, this years’ winner of the Envision Bradley Kehler, OD. In the Afternoon, Trouble Seeing... Award in Low Vision Research, moderated Difficulties Trouble Sleeping: How Are They Related?, moderated in Designing Clinical Trials: Finding Solutions with

ENVISION Focus on Research | 19

presentations by Alan Morse, JD, PhD: The Efficacy of J. Vernon Odom, PhD; Effect of Bilateral Macular Clinical Trials in the Context of Public Policy; Joan Scotomas From AMD on Reach-to-Grasp Hand Stelmack, OD: Recruitment and Retention in Clinical Movement, by George Timberlake, PhD; and A Test Trials; and Graham Strong, OD, MSc: Abandonment of Face Discrimination Ability in Aging and Vision of Assistive Devices at the Completion of a Clinical Loss, by Ronald Schuchard, PhD. Trial. The research session Diagnostics and Assistive In the afternoon, Ronald Schuchard, PhD, moder- Technology, moderated by Robert Massof, PhD, was ated Functional and Performance Outcomes. A few of next and included presentations by Joshua Pratt, OD: the presentations included Impact of Glaucoma on The Retinal Locus for Reading: What We Can Learn Activity Participation, by Monica Perlmutter, OT, CLVT, From Text Location on the Retina Just Before and Anjali Bhorade, MD, Key Life Stages and Transi- Word Enunciation; Maria Enzo Vingolo, MD, PhD and tion Points for Young People With Sensory Impair- Serena Salvatore, MD: Evaluation of Fixation Stabil- ments Between Birth and Age 25 Years, by Carolyn ity by Bivariate Contour Ellipse Area (BCEA) Using Palmer, PhD, and Increased Visual Field Variability the MP-1 Microperimeter in Mild Visually Impaired in Newly Diagnosed Glaucoma Patients is Partly Patients; and Lisa Mauney, MS: Developing a Model Related to Increased Depressive Symptoms or to Predict Low Vision Users’ Performance When Worry About Blindness, by Eva Bittner, OD, PhD. Operating Small Visual Displays. Friday closed out, with an applied research session Low Vision and Psychological Functioning, mod- Research on Employment, moderated by Deborah Gold, erated by Laura Dreer, PhD, closed out the day and PhD. Presentations addressed varied topics related to another successful Envision Conference, with research employment of people with visual impairments, includ- on the impact of low vision on various aspects of ing Pre-employment Skills for Children Aged 5-14 psychological functioning. Presentations included The With Vision Loss: An Evidence-based Model for Impact of Depression on the Actual and Perceived Resource Development, presented by Biljana Zuvela, Effects of Reading, by Patricia Grant, MS, Vision MA; Transition Services that Lead to Competitive Impairment: The Impact on Social Cognition and Employment Outcomes for Transition-age Individu- Social Ability, by Carolyn Palmer, PhD, and On-Road als With Blindness or Visual Impairments, presented Driving Performance of Moderate/Advanced Glau- by B.J. LeJeune, CRC, CVRT; and Supervising People coma Patients, by Anajali Bhorade, MD. Who Are Blind or Visually Impaired: A Qualitative Study of Employer Attitudes, presented by Deborah As can be seen from these brief highlights, the quality, Gold, PhD. relevance, variety and number of this year’s research sessions were the best to date, and next year promises SATURDAY, SEPTEMBER 24 to be even better as Envision Conference 2012 returns The excellent research sessions on the last day of to St. Louis, Missouri, on September 12-15. Make your Envision Conference 2011 provided plenty of reason to plans to attend and present at this one-of-a-kind growing, stay to the end, as some of the most intense interest multi-disciplinary, low vision research event. and animated discussions took place on Saturday. Low Vision Research: Hot Off the Press, presented late- breaking low vision research findings. Moderated by Submissions for clinical education and research George Timberlake, PhD, and Ronald Schuchard, PhD, sessions are open now through March 19, 2012 this session provided an early start to the last day of the via the online submissions form. conference with presentations on Barriers to Vision Visit www.envisionconference.org Rehabilitation: The Montreal Study, by Olga Over- bury, PhD, and Walter Wittich, PhD; Does Improving to register and submit. Vision Reduce the Risk of Falls? A Review, by

Visibility | Vol. 5, Issue 4

Envision Conference 2011: Resounding Success! continued from page 17 Important Dates ONE-STOP-SHOP FOR LOW VISION March 19, 2012 RESOURCES AND SERVICES Deadline for Clinical Education and Thanks to our exhibitors and sponsors, Research Submissions the Envision Conference 2011 Exhibit Hall was the place to be for special June 29, 2012 Deadline for Early Bird Registration events and breaks. Leading-edge low vision technologies were on display for July 6, 2012 attendees to experience and add to their Deadline for Advance Price Exhibitor Registration practices. August 17, 2012 Ready Yourself for Envision Confer- Hotel Room Block Deadline ence 2012. Registration for attendees, September 12-15, 2012 exhibitors and sponsors is already Envision Conference 2012 at the underway as we make plans to return to Hilton St. Louis at the Ballpark St. Louis, Missouri, September 12-15, 2012. See you in St. Louis for Envision To register, or learn more about Conference 2012! Envision Conference, visit the web- site at www.envisionconference. “This is the only annual meeting where low vision researchers org or contact Michael Epp, Director, and clinicians from all disciplines can come together and spend Professional Education, at michael. [email protected]. For updates four days discussing low vision rehabilitation as committed from Envision Conference, follow us professionals, without time pressure, distractions or competing on Twitter (@EnvisionConf) or find agendas. It is a must-attend meeting for me.” us on Facebook. – Robert W. Massof, PhD, Envision Conference 2011 Attendee Envision Professional Education Calendar

January 12, 2012 July 12, 2012 Low Vision Grand Rounds – New Treatment Low Vision Grand Rounds – What’s New and Exciting Strategy (Bevacizumab) for Advanced Retinopathy of in Corneal Surgery. Wichita, KS. CE – ACCME, AOTA, COPE Prematurity. Wichita, KS. CE – ACCME, AOTA, COPE September 12-15, 2012 March 15, 2012 Envision Conference 2012. Hilton St. Louis at the Early Intervention and the Role of Occupational Ballpark, St. Louis, MO. CE – ACCME, ACVREP, AOTA, Therapy. Wichita, KS. CE – AOTA CRCC, COPE April 12, 2012 October 11, 2012 Low Vision Grand Rounds – Update on AMD. Low Vision Grand Rounds – Research on Contact Wichita, KS. CE – ACCME, AOTA, COPE Lenses. Wichita, KS. CE – ACCME, AOTA, COPE November 9, 2012 June 15, 2012 Assistive Technology. Wichita, KS. CE – ACVREP, AOTA, Neurological Vision Loss. Wichita, KS. CRCC, COPE CE – AOTA, COPE For more information, visit the Education and Resources page at www.envisionus.com.