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| Division of Occupational Therapy - OT Connect Macular Degeneration
Macular degeneration is the progressive deterioration of the macula resulting in loss of central vision (Trombly, 1997). Age-related macular degeneration is the most common form and is divided into a dry (atrophic) form and a wet (exudative) form. The dry form is a result of the thinning of the macula over time and the wet form is a result of new blood vessels growing underneath the retina resulting in distortion of the retina (Linge, 2002). Common Symptoms/ Course of Disease Changes is central vision which can include:
Age of Onset: Adult. Macular degeneration is the most common cause of legal blindness in persons 60 years of age and older in the United States. The prevalence of macular degeneration increases after age 65 (Newell, 1996). People who smoke and have a diet rich is saturated fat have increased chances of developing macular degeneration (Linge, 2002). Sex Bias: Macular degeneration is slightly more common in women than in men (Linge, 2002). Cultural Biases: Macular degeneration is more common among Whites and Asians and is rare among Blacks (Linge, 2002). Current Medical Treatment: To determine a diagnosis of macular degeneration, a visual field test can be conducted to look for blank spots in the central vision. An intravenous injection of fluorescent dye and a photograph of the back of the eye are also used to determine if blood vessels are leaking (Linge, 2002). The purpose of medical treatment for macular degeneration is not to improve a person’s vision but to prevent further deterioration (Kanski, 1994). Treatment for the wet (exudative) form include:
Treatment for the dry form is not available but cell transplantation studies are under study (Linge, 2002). A diet rich in antioxidants is an alternative treatment that may help prevent macular degeneration. These antioxidants include vitamin A, vitamin C, vitamin E, zinc, and selenium (Linge, 2002). Occupational Therapy Involvement Occupational therapy is prescribed to address safety and will make modifications for a barrier-free environment. Occupational therapy will address activities of daily living such as self-care, work, and leisure using compensatory strategies to help promote independence. Occupational therapy will also address the psychosocial aspect of adjusting to the loss of vision. References
How OT Makes a Difference: Evidence-Based Practice Dahlin Ivanhoff, S., Son, U., & Svensson, E. (2002). A health education program for elderly persons with visual impairments and perceived security in the performance of daily occupations: A randomized study. American Journal of Occupational Therapy, 56(3), 322-330. A longitudinal study was conducted to compare a newly developed health education program for elderly persons with age-related macular degeneration to a group of individuals who participated in a standard individual intervention program. The health education program consisted of groups that were led by occupational therapists who provided information and skills training in areas that include self-care, meals, food preparation, communication, orientation, mobility, shopping, financial management, and cleaning. An instrument was developed and used to evaluate the health education program where the participants assessed their performance in each area. Individual intervention measures were conducted by occupational therapists with training in low vision. The participants in this group were provided with optical aids to help improve near and far viewing as well as reading. Follow-up evaluations took place at four months, one year, and two years after the intervention was completed. The results indicate that the participants in the health education group maintained or improved in several areas and those who participated in the individual intervention group declined to a lower level in several areas. This study supports the effectiveness of the health education program in effort to provide evidence that educational programs are effective in providing individuals with security based on their needs and to help delay, hinder, and prevent the onset of future problems. An elderly woman diagnosed with age-related macular degeneration received occupational therapy services from a licensed occupational therapist who is specialized in low vision. This home care service was provided one day a week from October to December of 2002. The needs of the patient were considered and were established as part of her therapy as they were indicated in the patient’s goals in her treatment plan. The patient stated that she wanted to be able to read again as well as be able to watch television and eventually return to her leisure pursuits. The patient identified several interventions that were used and taught by the occupational therapist. These intervention strategies included: reading with a special magnifying glass and teaching how to use her side vision, placing red marks on the stove knobs to indicate the temperature of the oven for cooking and baking, darkening lines to write her signature, and the use of magnifying glasses to read prices on items at the store. The occupational therapist educated her on these and several other interventions and how they would help aid her with her vision. She understood why these interventions were used and how they would help provide her with success in being able to adjust to the effects of her diagnosis. The patient stated, “Since receiving occupational therapy, I am able to watch the television, read menu’s at restaurants as well as price tags on items at the grocery store. I feel more comfortable and safer in the kitchen as well as other parts of my house. I recommend occupational therapy for anyone who has my macular degeneration because I have learned a lot from the experience. There are many changes that can be made and anyone would benefit from occupational therapy service.”
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