Download Case Study – Macular Degeneration

Case Study – Macular Degeneration (Age-Related and Juvenile)
CASE 1
Name: Robert Claire
Age: 63 years old
Condition: Age-related Macular Degeneration (AMD)
Narrative:
Robert Claire is a 63 year old man who has developed a visual impairment due to macular
degeneration. At the age of 51, Robert began noticing that his vision was not as clear as it used
to be. His vision seemed a bit blurry and he was not seeing details as clearly as he once had.
The blurriness was only present when he was looking straight ahead, so he attributed these
symptoms to just needing new glasses. As the months passed, Robert realized that his ability to
see worsened during the day, but seemed to improve at night. He found that certain lights, such
as those from his television and computer screen, began to bother him and he noticed that colors
did not seem as bright and vivid as they had in the past. Robert finally decided that he would
make an appointment with his ophthalmologist to see about getting new glasses. During the eye
exam, the ophthalmologist performed several tests including a visual acuity test, the Amsler Grid
(a test resembling a piece of graph paper with a dot in the middle used to test the macular area),
and an ophthalmoscopy procedure in order to view the back of the eye. The ophthalmologist
found deposits of drusen (accumulations of waste products in the tissues underneath the macula)
which lead him to the conclusion that Robert had dry macular degeneration in both eyes. The
ophthalmologist explained to Robert his condition being a progressive eye condition affecting
the macula of the eye, where the sharpest central vision occurs. This was the reason Robert was
only noticing blurriness when he was looking straight ahead. Robert also learned that the macula
has the highest concentration of cones (the cells that provide color vision) which clarified why he
was not seeing colors as clearly. The ophthalmologist also informed Robert that the macula is
responsible for daylight vision which was why his vision was worse during the day. The doctor
explained to Robert that there was no treatment for dry macular degeneration. The doctor also
wanted Robert to begin monitoring his vision at home on a regular basis and to continue with
routine eye examinations. As time passed, Robert’s ability to see details continued to diminish.
Robert found activities such as reading, driving, watching television, and recognizing faces were
becoming difficult to do. Robert’s sensitivity to light was worsening as well, so he often wore
sunglasses to cope with bright lights. He also began noticing new symptoms. Straight lines and
edges began to appear as wavy lines and blurry edges. It often appeared that straight edges of
buildings were curved. Then, one morning when Robert woke up, he saw “dirty spots” on the
ceiling. These “dirty spots” were like smoky, circle areas that he could see through, but
wouldn’t go away. This is when Robert returned to his ophthalmologist who referred him to a
retinal specialist. The retinal specialist concluded that Robert’s right eye had now developed
occult choroidal neovascularization, a form of wet macular degeneration. The retinal specialist
explained to Robert that with this form of wet macular degeneration, abnormal blood vessels
grow beneath the retina (the back, inner part of the eye where the macula is found) and slowly
leak blood and other fluids causing the retina to become elevated and uneven. Robert also
learned that the “dirty spots” he was seeing were called scotomas which are blind spots in the
central vision caused when a large area of cells stop working. Robert’s retinal specialist
informed him about some different treatment options available to help slow or stabilize his vision
loss. After consideration of the options, Robert began taking injections to help stabilize his
macular degeneration. He also began receiving services from the Division of Services for the
Blind to help him adapt to his visual impairment.
CASE 2
Name: Annie Smith
Age: 10 years old
Condition: Juvenile Macular Degeneration (JMD) / Stargardt’s Disease
Narrative:
Annie Smith is a 10 year old, fifth grade student who attends Summersville Elementary School.
She lives with her mother, father, and younger brother, Ronny. Annie has been diagnosed with
Stargardt’s Disease, also called fundus flavimaulatus or macular dystrophy, which is a form of
Juvenile Macular Degeneration. When Annie was in second grade, she began complaining to her
parents that she was having a difficult time seeing. She explained that everything she looked at
directly in front of her appeared blurry. She was having a hard time seeing the blackboard at
school and reading books and materials. Right away, Annie’s parents made an appointment with
the local ophthalmologist. During the eye exam, the ophthalmologist found Annie’s visual
acuity to be 20/40 OU, so he prescribed eye glasses to help correct this issue. After getting her
new glasses, Annie continued to notice that her vision was blurry. She thought that she was just
having a hard time getting used to her new glasses, so she didn’t bother saying anything to
anyone. Annie also knew that her parents had spent a lot of money on her new glasses, so she
wanted to use them since everyone kept telling her the glasses were going to help her see better.
Eventually, Annie began noticing some other changes with her eyes and vision. She noticed that
her eyes were very sensitive to the sunlight when she was playing outside at recess and it took
her eyes a while to adjust when she went back inside. She noticed when she walked into her
bedroom at night, it took six or seven minutes for her eyes to adapt to the darkened area. When
Annie went to third grade, her teacher placed her right in the center, front of the classroom since
Annie had some past vision issues. Annie noticed that being close to the blackboard made it
even more difficult for her to see. Schoolwork began to become very difficult for Annie, who
had always been an honor roll student. Things were just getting too hard to see because they
were so blurry. Annie didn’t understand why her glasses were not working the way everyone
told her they would. Soon, Annie began seeing grayish, hazy spots in her central vision that just
would not go away. This really scared Annie, so she told her parents about this and all of the
other things she had been noticing. Once again, Annie’s parents quickly made an appointment
with the local ophthalmologist. Annie’s ophthalmologist was surprised to find that her visual
acuity had decreased to 20/100. It was during an ophthalmoscopy procedure in order to view the
back of Annie’s eye, that the ophthalmologist noticed yellow-white spots in and around the
macula, the part of the retina (the layer of tissue lining the back of the eye) responsible for
central vision. The ophthalmologist explained to Annie’s parents that Annie had a condition
called Stargardt’s Disease, a form of Juvenile Macular Degeneration. He told them that this
genetic form of macular dystrophy is the result of both parents carrying the recessive gene which meant they did not know that they were carriers. He informed Annie’s parents that
presently there is no cure for Stargardt’s disease and there is very little that can be done to slow
its progression. The ophthalmologist referred the Smith family to genetic counseling and also a
support group for families of children with visual impairments. Annie, now in fifth grade,
receives services from a Teacher of the Visually Impaired (TVI) who works with Annie and her
teachers to make adaptations and modifications needed to make Annie as successful as possible.
Annie’s TVI is teaching her to use a wide range of specialized equipment such as magnifiers,
large print books, electronic reading devices, and braille. Annie also wears sunglasses to help
minimize her exposure to bright light. Because of a severe loss of depth perception, Annie is
also receiving Orientation and Mobility (O&M) services to learn how to use a cane to travel
safely in her school and community. Through these specialized services, Annie and her family
are learning day by day how to cope and live with JMD.