VA Palo Alto Notes WBRC for Low Vision Month

Photo: Visual Skills Supervisor Dave Patten demonstrates use of a CCTV

The VA Palo Alto website recently recognized the WBRC for Low Vision Awareness month on their internet page, check out the article below:

Low vision affects millions of Americans every year. When glasses, contacts, or surgery doesn’t help, this is usually a sign of low vision. Many factors contribute to low vision, including eye diseases and health conditions such as age-related macular degeneration (AMD), cataracts, diabetes, and glaucoma.

How do I know if I have low vision?
According to the National Eye Institute, if you suffer from any of the below symptoms even with glasses or contacts, you may be suffering from low vision.

• Recognizing the faces of family and friends
• Reading, cooking, sewing, or fixing things around the house
• Selecting and matching the color of your clothes
• Seeing clearly with the lights on or feeling like they are dimmer than normal
• Reading traffic signs or the names of stores

Where can I get help if I’m living with low vision?
VA Palo Alto Health Care System recognizes the importance of providing vision care and low vision rehabilitation care to Veterans. A regular visit to your Optometrist can help to detect any loss in vision.

For Veterans already experiencing low vision, the Western Blind Rehabilitation Center (WBRC), located at the VAPAHCS Menlo Park Division, is a 27-bed residential facility aimed at helping Veterans with low vision learn ways to adapt to vision loss and manage daily life.

Veterans can receive the necessary skills to Adjust to Sight Loss, or learn how to be more independent in their activities of daily living, computer skills, mobility, and other areas. There is even a program for Family Training.

The Western Blind Rehabilitation Center is an internationally recognized leader in comprehensive vision rehabilitation services by developing and implementing individualized treatment programs, education and research. It addresses the evolving needs of all of our visually impaired Veterans.

CLICK HERE Learn more about the WBRC and the services offered.

VAPAHCS Notes National Glaucoma Awarness Month

Photo: A VAPAHCS Optometrist completes an eye exam with a Veteran

The VAPAHCS Website noted National Glaucoma Awareness Month this January, which is the best time to remind all Veterans to take preventative measures to maintain good eye health. 

Glaucoma is the second leading cause of blindness in the world. As one of the leading causes of blindness, glaucoma affects more than three million people in America and more than 280,000 Veterans. It is also known as the "sneaky thief of sight" because a person may not be aware that they have glaucoma and have lost a significant amount of vision irreversibly before they are diagnosed and treated.

What is glaucoma?

According to the Glaucoma Research Foundation, glaucoma is a group of eye diseases that cause progressive and irreversible damage to the optic nerve. The optic nerve is similar to a cable with millions of connections, carrying images from the eye to the brain. Glaucoma can gradually steal sight without warning. Characteristically, the loss of vision is in the peripheral vision, but if untreated and uncontrolled, the vision loss progresses to “tunnel-vision,” and can lead to total loss of vision in end-stage glaucoma.

There are two main types of glaucoma: primary open-angle glaucoma and angle-closure glaucoma. They are determined by the anatomy of the patient’s eye and treatment is dependent on the type of glaucoma. Secondary glaucoma is the result of another disease that causes or contributes to increased eye pressure that may damage the optic nerve.

Regular Eye Screening is Important

Dr. Patricia Ferrell, an ophthalmologist who specializes in glaucoma treatment at the VA Palo Alto Health Care System, recommends everyone to have your eyes screened regularly, especially if you are at high risk for glaucoma. High risks include a family history of glaucoma, being African-American, and aging. “Having your eyes dilated is an important part of your eye exam, which can help to detect glaucoma early,” says Dr. Ferrell.

While more common among older adults, glaucoma can occur at any age for various genetics or disease-related reasons or from trauma. Early diagnosis and good follow-up in those who have glaucoma or are suspected of having glaucoma are key ways to maintaining vision and preventing permanent loss of vision from glaucoma.

How Does VAPAHCS Contribute to Glaucoma Awareness and Treatment? 

VAPAHCS offers glaucoma treatment along with general and other specialized care within Optometry and Ophthalmology services. 

 

According to Dr. Ferrell, the VAPAHCS services are able to provide full care for the various types of glaucoma. This can be difficult for patients dependent on the private sector to obtain due to costs. However, at VAPAHCS, treatment options are available to the Veteran without worrying if the patient can afford them. This is usually true for many VAPAHCS services because issues of dealing with insurance companies or copays are either minimal or non-existent for most Veterans. 

What Services Are Available if I do have Vision Loss?

If you are a Veteran or Active Duty Service Member who has Glaucoma or any type of vision loss, the VA has a variety of vision rehabilitation services available.  The first step is to contact a Visual Impairment Services Team (VIST) Coordinator to see what services and benefits are the best fit for you and your needs.  The Palo Alto VIST Coordinator, Elizabeth Silowitz, is available by phone at 650-852-3431. 

One of the services provided to visually impaired individuals is the Annual VIST Review. This is a yearly examination to assess the Veteran's adjustment to sight loss, current vision, hearing, and health. Based on information collected during the VIST review, Veterans may be referred for training and/or services to address their needs. The Palo Alto VIST Program also offers benefit reviews, support groups, community activities, and presentations to agencies regarding vision loss. For individuals who have experienced vision loss due to a brain injury or stroke, the Palo Alto Polytrauma VIST program provides referrals to specialty training programs to address vision loss caused by brain injury.
 

Many of the rehabilitation programs offered at the VA assess, train, and issue to Veterans with vision loss adaptive items which may include magnification devices, a large print or talking computer system, adaptive technology, canes, watches, talking paper currency identifiers, audible prescription readers, and adapted recreational equipment and both inpatient and outpatient treatment is available.
 

Referral Services
Referrals for services may include, but are not limited to:

• VA Inpatient Blind Rehabilitation Training (WBRC)
• VA outpatient services (VICTORS & BROS)
• Comprehensive Neurological Vision Rehabilitation (CNVR)
• Low Vision Services
• Adapted Computer Technology Training
• Community/State Agencies
• Library of Congress Talking Book Program
• Paratransit Services
• Adapted Recreational Programs

 
CLICK HERE to learn more about VIST

CLICK HERE to learn more about the WBRC

January is National Glaucoma Awareness Month

January is National Glaucoma Awareness Month.  Glaucoma is a group of eye diseases in which the normal fluid pressure inside the eyes slowly rises.  There are often no noticeable symptoms in the early stages.  Left untreated, it can lead to vision loss and blindness.  It is one of the main causes of blindness in the United States.  Although anyone can get glaucoma, the following people are at higher risk:

•African Americans over age 40

•Everyone over age 60, especially Mexican Americans

•People with a family history of glaucoma



Photo: A picture of two boys as seen by someone with 'normal' vision



Photo: The same picture as it might be seem by someone with Glaucoma

Open-angle glaucoma is the most common form of the disease.  Normally, clear fluid flows in and out of small space at the front of the eye called the anterior chamber. This fluid bathes and nourishes nearby tissues.  If this fluid drains too slowly, pressure builds up and damages the optic nerve.  Though this buildup may lead to an increase in eye pressure, the effect of pressure on the optic nerve differs from person to person.  Some people may get optic nerve damage at low pressure levels while others tolerate higher pressure levels.  Please click on the image below for a short video about the cause of glaucoma:

If you are being treated for glaucoma, be sure to take your glaucoma medicine every day. See your eye care professional regularly.

You can also help protect the vision of family members and friends who may be at higher risk for glaucoma—African Americans over age 40; everyone over age 60, especially Mexican Americans; and people with a family history of the disease.  Encourage them to have a comprehensive dilated eye exam every one to two years.  Remember that lowering eye pressure in the early stages of glaucoma slows progression of the disease and helps save vision.

CLICK HERE to learn more about Glaucoma from the National Eye Institute

The Western Blind Rehabilitation Center (WBRC) is a 27-bed residential facility located at the Menlo Park Division of the VA Palo Alto Health Care System. Approximately two hundred veterans and active duty service members of all ages participate in the program each year. More than three quarters have usable vision for which specialized treatment is provided. Adjusting to and managing visual impairment is the major objective of the program. If you are in the area and are interested in a site visit, please call (650) 614-9952 to make arrangements.

CLICK HERE to learn more about the WBRC

February is Low Vision Awareness Month

Photo: A WBRC Veteran learns to use a CCTV to read printed material. 

Here's eye-opening news: Currently, 4.2 million Americans ages 40 and older are visually impaired. Of these, 3 million have low vision. By 2030, when the last baby boomers turn 65, the number of Americans who have visual impairments is projected to reach 7.2 million, with 5 million having low vision.

For the millions of people who currently live or will live with low vision, the good news is there is help. Vision rehabilitation can make a big difference to a person adjusting to vision loss and should be considered a key part of a patient’s overall care.

Vision rehabilitation can include the following:

• Training to use magnifying and adaptive devices
• Teaching new daily living skills to remain safe and live independently
• Developing strategies to navigate around the home and in public
• Providing resources and support

But, what is low vision? Low vision is when even with regular glasses, contact lenses, medicine, or surgery, people have difficulty seeing, which makes everyday tasks difficult to do. Activities that used to be simple like reading the mail, shopping, cooking, and writing can become challenging.

Most people with low vision are age 65 or older. The leading causes of vision loss in older adults are age related macular degeneration, diabetic retinopathy, cataract, and glaucoma. Among younger people, vision loss is most often caused by inherited eye conditions, infectious and autoimmune eye diseases, or trauma.

For people with low vision, maximizing their remaining sight is key to helping them continue to live safe, productive, and rewarding lives.

The first step is to seek help.

For Veterans and Active Duty Service Members with vision loss there are a wide range of resources available through the VA Health Care System. The first step is contacting one of the VA’s VIST Coordinators.

The Visual Impairment Services Team (VIST) Coordinators are case managers who have responsibility for the coordination of services for visually impaired Veterans and active duty Service Members.  VIST coordinator duties include providing and/or arranging the provision of appropriate treatment in order to enhance functioning such as making referrals to Blind Rehabilitation Centers, Blind Rehabilitation Outpatient Services, VICTORS, VISOR, and low vision clinics.  Other VIST coordinator duties include identifying newly identified individuals who have severely disabling visual impairment, providing counseling, problem resolution, arranging a review of benefits and needed services, and conducting educational and outreach programs relating to VIST and blindness.

Veterans and eligible active duty Service Members should contact the VIST Coordinator in the VA facility nearest their home or by contacting the Blind Rehabilitation Service Program office at 202-461-7317. 

The VAPAHCS VIST Website is also an excellent resource and can be viewed by CLICKING HERE.

May is Healthy Vision Month

Photo: A closeup of a human eye

May is Healthy Vision Month.   Even after vision loss there are things that people can do to take care of their remaining vision.  Here are some tips from the National Eye Institute:

 

Get a dilated eye exam. Getting a dilated eye exam is the only way to catch eye diseases early, because with many, there are no warning signs.  Even after being diagnosed with vision loss, it is still important to monitor your eye health for changes. It is also equally vital to continue to be screened for other potential eye diseases. An annual eye exam is your opportunity to learn from your eye doctor if there have been any recent advances in treatments or rehabilitation that may benefit you.  Talk to your eye care professional about how often you should have an exam.

 

Live a healthy lifestyle. Eating healthy foods, maintaining a healthy weight, managing chronic conditions, and not smoking can lower your risk of eye disease and maintain your current level of vision.  If you have diabetes, closely monitor your blood sugar.  Take all of your medications as recommended, including medications for you ocular health.  Talk to your doctor, especially if you notice any changes in your vision.

 

Know your family history. Talk to your family members about eye health history. It’s important for you and them to know if anyone has been diagnosed with an eye disease, since many are hereditary. This will help to determine if you or they are at higher risk for developing an eye disease.

 

Use protective eyewear. Protect your eyes when doing chores around the house, playing sports, or on the job to prevent eye injuries from happening. This includes wearing safety glasses, goggles, safety shields, and eye guards that are made of polycarbonate.

 

Wear sunglasses. Make sure your sunglasses block out 99 to 100% of both UVA and UVB radiation, so you can keep maintain your vision and eye health.  Be sure to properly care for the lenses as this UV protection is often a coating on the lenses.  Always place sunglasses in a case if you are not wearing them.  If the UV coating is scratched you may be letting UVA and UVB radiation leak through the lenses and damage your vision.  A hat with a brim of at least 3 inches can offer further glare reduction as well.  And remember, if you have been issued a pair of sunglasses from the VA you can contact your VIST Coordinator for repairs and/or replacement as needed.

 

CLICK HERE to visit the National Eye Institute's Healthy Vision Month Website to view the free resources available, including videos, shareable social media content, and more.

 

CLICK HERE to learn more about services through the Western Blind Rehabilitation Center

 

CLICK HERE to lean more about how to locate a VIST Coordinator

 

 

VisionAware Publishes Article About WBRC's CNVR Program

Photo: John Kingston works with a veteran on the NVT light panel for scanning training.

VisionAware has published an article by Mary D'Apice about the WBRC's Comprehensive Neurological Vision Rehabilitation (CNVR) program  for veterans and active duty service members with Traumatic Brain Injury (TBI) related vision loss.  The article included a review of some types TBI related vision loss and some of the specialized treatment that the WBRC provides to enhance the ability of people with TBI related vision loss to use their remaining vision. 

CLICK HERE to read the VisionAware Article

CLICK HERE to learn more about the WBRC CNVR Program

Eyes on Health

By: Shanida Ingalla, O.D., WBRC Optometrist

Photo: A pair of glasses sitting on top of an eye chart

People who have already experienced vision loss due to eye disease often ask me “Do I still need to get an annual eye exam?” In a word, Yes!

A nationwide survey commissioned by Lighthouse International showed that only a small minority of those most at risk get the yearly eye exams that could detect a vision problem and prevent, delay or even reverse its progression. Fully 86 percent of those who already have an eye disease do not get routine exams, the telephone survey of 1,004 adults revealed.

Even after being diagnosed, it is still important to monitor your eye health for changes. It is also equally vital to continue to be screened for other potential eye diseases. An annual eye exam is your opportunity to learn from your eye doctor if there has been any recent advances in treatments or rehabilitation that may benefit you.

It is often said that the eyes are the window to the soul. Certainly the eyes are a window to the body, and a proper eye exam can often alert your doctor to a serious underlying disease like diabetes, hypertension, cancer, cardiovascular disease, and multiple sclerosis.

So if it has been a while since your last eye exam, please call your eye doctor and schedule one today!

VAPAHCS Website Article Reviews Recent Study Connecting TBI and Eye Injuries

VA Palo Alto Health Care System has posted an article on their website regarding a recent study involving veterans with traumatic brain injury (TBI) and resulting vision loss.  The article follows below:


Some Veterans with Traumatic Brain Injury Have Hidden Eye Injuries

Dr. Glen Cockerham examines a patient

'A recent study conducted by the Department of Veterans Affairs (VA) reveals the extent of internal eye injuries (closed-eye ocular injuries) among Veterans who have sustained blast-induced traumatic brain injury (TBI).  Exposure to such blasts is not uncommon in current combat and may result in open injuries to the eyes, which are diagnosed and cared for on scene; however, internal eye injuries are less apparent and may not be detected without more comprehensive examination.

This study, which was conducted from 2006-2009 and is featured in the latest issue of New England Journal of Medicine, evaluated 46 combat Veterans with documented TBI who were injured in Iraq or Afghanistan.  Dr. Glenn Cockerham, one of the lead authors, explains what led to conducting this study. "We started seeing internal eye injuries in a significant percentage of Veterans with TBI due to combat-blast exposure.  In some instances, injuries were not expected by patients."  Twenty of these Veterans, or 43 percent, were found to have internal eye injuries, with no association to TBI severity levels.  Immediate or delayed loss of vision is possible in any of these cases; three Veterans required medical or surgical intervention after examinations.

These injuries were realized only through comprehensive ocular examinations by VA ophthalmologists, prompting VA to implement a 2008 directive mandating such thorough examinations for all inpatients with TBI in rehabilitation centers.  However, many Veterans that were diagnosed with TBI or exposed to blast forces in the past and have returned to civilian life have not received such examinations and may have undetected internal eye injuries.  Most of these injuries – and their related symptoms – go undetected in standard eye exams.  In fact, among Veterans that participated in the study, vision was 20/20 or better in most of the injured eyes.  "The study by Dr. Cockerham and associates clearly shows the importance of comprehensive eye examinations for patients with blast-induced TBI," stated Dr. Mary Lawrence, Deputy Executive Director, Department of Defense/Veterans Affairs Vision Center of Excellence (VCE).

VA is advising physicians of current or former military personnel to inquire about blast exposure, and is encouraging any Veteran who may have been exposed to a blast, even those with normal visual acuity, to be evaluated by an eye care provider.  The study's findings need to be validated in a larger, more representative sample, but underscore the need for immediate ocular screenings for those Veterans who may have been affected.'

CLICK HERE for a Link to the Article posted on the VAPAHCS Website

National Eye Institute Launches On-Line Video Resources

Photograph of an eye chart with a pair of glasses

Nearly 14 million Americans experience vision problems, ranging from nearsightedness to blindness. The National Eye Institute (NEI) recently launched a new series of video resources on the leading eye conditions and diseases affecting many Americans. Users can watch video ‘Vodcasts’ using their computer on topics such as Age-Related Macular Degeneration, Cataract, Diabetic Eye Disease, Comprehensive Dilated Fundus Exams, Dry Eye, and Glaucoma. These video resources could be used by persons wishing to understand their own or a loved one’s vision loss.

CLICK HERE for a Link to the NEI Vodcast Video Resources

WBRC's Dr. Gregory Goodrich Recognized Internationally

Photograph of Dr. Goodrich accepting the 'Tiresias' Award at the

2011 ISLRR 10th Annual International Low Vision Conference

Dr. Gregory Goodrich, Supervisory Research Psychologist and Optometric Research Fellowship Coordinator, received the 'Tiresias' award from the International Society for Low Vision Research and Rehabilitation (ISLRR). The award was presented in Kuala Lumpur, Malaysia, during the 10th International Low Vision Conference. The award, the first time it was given, recognized Dr. Goodrich’s major role in the development of the field of rehabilitation and research on visual impairment.

The award will be given every three years and is named after the mythical character Tiresias, who was blinded by Hera. To compensate him for his loss of vision, Zeus gave him the gift of prophecy. Tiresias is mentioned in the Odyssey, when Odysseus was sent to the underworld to consult him. All in all, an interesting bit of mythology is attributed to him.

Dr. Gregory Goodrich is also the recipient of the 2009 Olin E. Teague Award, a national award that recognizes contributions in an area of utmost importance to VA’s mission: the rehabilitation and improvement in the quality of life of war-injured Veterans. He received the award in conjunction with Dr. Glenn Cockerham, for their ground-breaking efforts in the care of Veterans injured in the Iraq and Afghanistan wars.