Different vision for
the senior population

By Tom Waring
Times Staff Writer

George Donahoe has some difficulty hearing, and recently began to notice that his eyesight was beginning to fail.
That’s when he made an appointment at Eye Surgical-Medical Associates, which has offices at 8118 Bustleton Ave. in Rhawnhurst and at the Frankford Hospital-Torresdale Medical Building.
"When I first came here, I couldn’t read the subtitles on television," he said.
Donahoe, a 74-year-old from Bensalem, had his initial appointment on Jan. 2. The blurred vision in his right eye was caused by a fluid accumulation. It was soon diagnosed as age-related macular degeneration, the leading cause of blindness for Americans over 60.
There is no cure for AMD, which occurs when the macula — the part of the retina that lets a person see color and fine detail — becomes damaged.
Doctors recommended that he consider a relatively new treatment: a series of monthly injections in his eye that can improve vision, not simply halt the deterioration.
Drs. Dennis J. Khoury, Mustapha Shayegan and Benjamin A. Kauffman endorse the injection of Lucentis, approved last year by the Food and Drug Administration, but only after careful consideration by the patient.
In Donahoe’s case, he needs good eyesight to keep up his active lifestyle. He drives and likes to watch TV and go fishing, camping and hunting.
"Turkey season is coming up soon," he said gleefully.
At first, he was leery of being injected in the eye, in part because he had seen a horror movie in which a character had his eyeballs gouged out.
But, after thinking about the potential benefit, he agreed to proceed. He was satisfied because his eye would be sterilized and numbed and he was secure in knowing that the doctors would be a lot more caring than a madman in a movie.
Now, after three low-dose injections, a procedure that lasts about five seconds on each visit, he has 20/30 vision in his right eye. The costly procedure is covered by Medicare.
"This thing’s working out pretty good," he said. "I’m seventy-four years old. I can’t complain."
Donahoe said he feels some pressure during the injection and a little bit of irritation for about 12 hours, but the outcome is worth it.
"In the morning, I’m fine as a fiddle," he said.
Kauffman said Donahoe is lucky because doctors caught his condition early.
"He’s doing fantastic," he said. "You can take a big step in a fairly quick period of time."
In clinical studies, about 95 percent of patients treated with Lucentis found that their vision stayed the same, and up to 40 percent found that their vision improved.
An estimated 200,000 elderly people are blinded every year in the United States. Because of the aging of the U.S. population, the number is expected to rise to 500,000 by 2030.
Eye Surgical-Medical Associates, which has been on Bustleton Avenue for more than 40 years, wants to spread the word to the Northeast community, home to a large elderly population.
Most older people with some eye problems know all too well the seriousness of AMD, according to the local doctors.
"When you tell them they don’t have macular degeneration, they exhale," Khoury said.
Before Lucentis, so-called "wet" AMD patients were given laser treatment, which was not as successful as the new injection. Many eventually became legally blind, which is considered vision of 20/200 or worse.
Lucentis has been shown to improve vision by about 15 letters (or three lines) on an eye chart.
"It’s not perfect, but it’s an exciting treatment," Khoury said. "We’ve had some pretty good success. Bottom line, it’s working."
According to Khoury, the results vary. Some people unable to drive because of poor vision are able to get behind the wheel again. Others avoid falling down steps. And others are merely able to see the letter "E" on an eye chart.
"Everything’s relative as to what patients get out of it," he said.
The first challenge for the doctors, they say, is to convince an older person with declining vision to make an appointment.
Many fear that they will be forced to give up driving or enter a care facility.
"They want to maintain their independence," Khoury said.
Once the patient makes an appointment, he must be certified as eligible for a Lucentis injection. Doctors use high-tech imaging equipment.
In general, the injection is for people whose vision has recently declined, not someone who has had long-term problems.
Then, there’s an extensive discussion with a doctor about the whole process. The patient fills out a variety of forms.
Ideally, all patients will enjoy the same results as Donahoe.
"If you catch it early, there’s a better chance of getting better vision," Khoury said. "That’s like any disease, to catch it early."
Kauffman recommends that all people over age 65 schedule a yearly eye examination. He also cautions people to stay away from age-related macular degeneration risk factors such as smoking and sun exposure and actively try to avoid the disorder by consuming green, leafy vegetables.
"Eat your vegetables, don’t smoke and wear sunglasses," he said. ••
To learn more about the new treatment for macular degeneration, call Eye Surgical-Medical Associates at 215-342-8118.
Reporter Tom Waring can be reached at 215-354-3034 or twaring@phillynews.com