Macular Degeneration attacks the central vision of those with the eye disease and macular translocation surgery can be used to lift the macula away from the underlying blood vessels and attach it to a new and more healthier portion.  This will restore the central vision that is damaged by macular degeneration.

Macular translocation surgery is only meant to treat patients with wet macular degeneration.  In this form of macular degeneration leaking blood vessels have formed beneath the retina and moving the macula to a more healthier spot will improve central vision.  This eye surgery is not recommended for every patient who has macular degeneration and best results have been shown for those people who are in the early stages of the eye disease.

In macular translocation surgery, the eye surgeon will pinch the outer part of the eye called the sclera.  With the sclera pinched, the surgeon will place a suture into the wall of the eye to keep it pinched.  This will shorten its length as well as buckle the retina.

Once the suture is in place, the eye surgeon will inject a saline solution into the eye under the retina, causing it to lift up, allowing it to be moved approximately 0.3 and 0.4 mm without detaching it.  After the retina is moved, a gas bubble is injected into the eye to hold the retina in location until it heals.

Another side benefit of relocating the retina during macular translocation surgery is it provides access to the previously covered blood vessels thus allowing treatment without harming the retina.

Duke Eye Center have refined macular translocation surgery into a technique called macular translocation surgery with 360 degree peripheral retinectomy (MT360).  This is a two-stage surgery that involves rotating the retina to move the macula away from the abnormal blood vessels associated with macular degeneration and then correcting the tilted visual field by rotating the eye.

Macular translocation surgery does have some risks associated with it including retinal detachment, bleeding, double vision, and residual tilting of vision.  All of these risks can be either corrected surgically or with special glasses.

Avastin (bevacizumab) and Lucentis (ranibizumab) were compared in a double-masked, randomized controlled trial.  Lucentis is the preferred macular degeneration treatment and is approved by the FDA.  Avastin is an off-label macular degeneration treatment and was originally approved to treat colo-rectal cancer.

Until this recent study, there was no data supporting which macular degeneration drug was effective.

In this study, the Veterans Affairs Boston Healthcare System funded a study where patients were enrolled by a 2 to 1 randomization to either the Avastin or Lucentis treatment.  Patients were given intravitreal injections of either Avastin or Lucentis every month for the first three months of the trial and evaluated after the third injection to determine if subsequent macular degeneration treatments were required.

It was shown that at six months, there was no difference in those patients treated with Avastin or Lucentis.

This adds fuel to the debate over which of the two drugs should be used to treat macular degeneration.  Genentech refused to conduct any trials of Avastin as a macular degeneration treatment stating that Lucentis is the FDA approved treatment for the eye disease.

However, Avastin costs approximately $40 per treatment while Lucentis costs approximately $2000 per treatment.  With some patients requiring multiple injections to treat their macular degeneartion, the costs associated with Lucentis treatments can be enormous.

Macular Degeneration Support Canada has released a version of the amsler grid eye test that people can download and use at home if they are concerned about the health of their macula or if they are at a high risk of being diagnosed with the AMD.

The central black dot on the amsler grid test is used for fixation or a place for the eye to focus.  With normal vision, all lines surrounding this black dot will appear straight, with no portions of the lines missing or distorted.  However, if a person is suffering from and eye disease such as macular degeneration, the lines may appear wavy or distorted.  People who monitor their eye health can detect changes in the lines, having them appear bent, distorted or missing.  New distortion in noticed by the patients may indicate a problem with the macula and patients should seek immediate care from their eye care professional.

Using the Amsler Grid Eye Test is extremely simple.

Patients who wear eye glasses should also wear them while using this eye test and the grid should be held about the same distance away as normal reading material.  It is also important to use the same lighting conditions that would normally be used in well lit room.

To begin, cover one eye and focus on the dot in the center of the Amsler Grid.  Take note of any wavy, broken, blurred or distorted lines.  If all lines appear straight, with all intersections of the lines forming proper right angles, there doesn’t appear to be any problem in that eye associated with eye diseases such as macular degeneration.  Examine the grid for missing areas or dark areas which may also signify a problem with your eye.  Ensure that you can see all corners of the Amsler Grid.  Repeat with the other eye.

It is important to remember that if any lines do not appear straight, or if there are any missing areas on the grid, notify your eye care professional immediately.  It does not necessarily mean that you have macular degeneration or another eye disease, but it could signify a problem.  Using an OCT Test, the eye care doctor will examine the back of the eye (macula) very closely and determine if there is a problem or if there is presence of some eye disease.

Using the Amsler Grid on a regular basis, a patient can monitor their eye health on a regular basis.  This is the simplist of all eye diagnostic tests and can help when

The Braille Alphabet card can be freely distributed and made available to any person or organization wishing to use it.

According a Macular Degeneration Support Canada spokesperson “This free braille chart is our first attempt to give something back to the visually impaired community.  It is our initial release and as we receive feedback on the actual quality of the braille alphabet card, we will continue to make improvements and make more free braille resources such as this available.”

To download and print this Free Braille Alphabet Card, users will require the free Adobe Reader.

The discussion forum is 100% free and is available for anyone to use.

Sections of the Macular Degeneration Discussion forum include:

• General Eye Care
• Wet Macular Degeneration
• Dry Macular Degeneration
• Stargardt’s Disease
• Other Eye Diseases

The Macular Degeneration Discussion Forum is available at the following URL – http://www.amdsupport.ca/forum/.

We would like to encourage all visitors to visit the discussion forum, book mark the URL and continue to make this a resource for Macular Degeneration that is second to none on the Internet.  This forum will allow us to keep every post available for all users throughout the Internet, and will provide all those who are seeking information on Macular Degeneration a mechanism to freely discuss and share their stories, findings and resources.

It only takes a second to register!  Come join us on the Macular Degeneration Discussion Forum.

Macular Degeneration Support Canada will provide an ongoing series of articles in the near future that will provide information on free braille resources or low cost braille resources it finds on the internet.

Free Braille Alphabet Card
The National Braille Press offers a series of free braille alphabet cards.  These can be obtained by filling out a contact form with your name, address, and the quantity of cards that you would like to receive.

While each braille card costs $0.10 each, these are provided for free.  The only request is that people requesting these cards respect the limited resources and request only the number of cards required.  International requests are limited to 2 cards.

To request your free braille cards, you can visit the National Braille Press website.

Free Braille Bible
Bibles for the Blind offers a braille Bible for the blindand visually impaired.  The mission of Bibles for the Blind and Visually Handicapped International is to provide the Bible in braille t othose blind people around the world who cannot afford it.

If a person wishes to receive a braille Bible, the can contact the organization at the address below.

Bibles for the Blind and Visually Handicapped International
3228 E. Rosehill Avenue
Terre Haute, Indiana 47805-1297
Phone: (812) 466-4899

Free Braille Books Program
The American Action Fund for Blind Children and Adults began providing blind children with free braille books from a popular children’s reading series.  The books are for the children to keep and collect as long as they want them.  These titles are the same titles that are available in bookstores and libraries but are in braille to assist visually impaired children.

For details on the free braille books program, visit the AAF website.

LowBrowse is a program allows visually impaired users to create their own preferences for font, text size, color contrast and letter spacing. Working with Mozilla Firefox under Windows, MacOS and Linux. Lighthouse International has announced that this will be available as an add-on for Firefox by early fall 2008.

Aries Arditi, senior fellow in vision science at Lighthouse International states “This technology enables all the text on a web site to be presented in the same readable format — size, color, font and spacing — regardless of which page is being viewed without having to navigate to the next line.”

While other programs help visually impaired and blind people people access the world wide web, LowBrowse is designed for individuals with some vision. It is a part of the research being conducted by Lighthouse International in designing interfaces for users with poor vision.

Funding for the project was provided by a grant from the National Eye Institute.

The WebbIE accessible browser includes the necessary software components to allow visually impaired or blind computer users to browse the Internet and read web pages.  It also includes the necessary components that allow visually impaired and blind users to receive news feeds through RSS and listen to radio stations online through an accessible radio tuner.  In addition to these components, WebbIE includes an accessible podcaster that allows visually impaired and blind users to listen to podcasts and recordings over the Internet.

This accessible web browser has brought the Internet to those people suffering from some form of visual impairment.  It has brought entertainment, shopping and research into the homes of the visually impaired and the blind.

When a visually impaired or blind user browses a web page on the Internet, WebbIE repackages the page in an accessible format that is more compatible with the various screen reader software packages being used.  Web pages are presented in plain text format, stripped of any visual content by the accessible web browser.  This allows the screen reader software to speak the content to the visually impaired or blind user.

WebbIE parses through the underlying HTML code in the web page and discards any images or visual aspects that cannot be presented in an accessible format.  The new page is then presented in the accessble web browser.  The screen reader software can easily interpret the plain text and provide a verbal representation of what was included on the page.

Even with the way that the WebbIE accessible browser works, there are still some problems with the software.

The most obvious problem with the accessible browser is being able to represent a non-visual representation of web pages that are designed for visual users.  The current technology used to develop websites utilize many different components and the content is often generated dynamically.  Graphic images and embedded technologies such as Java make it more difficult, if not impossible for the accessible browser software to provide a fair representation of the web page to the visually impaired or blind computer user.

Many web designers and developers fail to keep visually impaired and blind users in mind when developing web content.  Images do not include descriptive tags that the WebbIE accessible web browser uses to identify an image to the visually impaired, make it difficult once again to provide a fair representation of the web page.

With further developments underway and a deeper understanding of the visually impaired and blind user, WebbIE may overcome its limitations.

For more information or to download the WebbIE accessible web browser and its associated software components visit http://www.webbie.org.uk.

What is this free screen reader software?  The screen reader software is named Thunder and it is being offered free by ScreenReader.netCIC, a not for profit company.  According to the ScreenReader.net website, “Thunder is a free gift to the blind and visually impaired from the people at Sensory Software Ltd.”  A quick search on the Internet shows that Sensory Software Ltd. is a software development company that provides software applications for the disabled computer user.

The screen reader software Thundar is free only for personal home use.  Commercial uses are permitted but there is is a fee for using the screen reader software in a commercial setting.

What exactly is Thunder?

Thunder is a free screen reader software application that will read the text from the screen to the visually impaired or blind computer user.  In addition to this screen reading capability, Thunder will speak letter by letter or word by word as the computer user types.  It has the ability to speak slower or faster, to repeat what it has just said.  What is unique about this free screen reader software is it enables full speech feedback in most text based word processing packages, including Microsoft Word, WordPad or NotePad.  In fact, the screen reader program Thunder is being promoted as working “extremely” well with Microsoft Word, Microsoft Outlook Express and Microsoft Internet Explorer.  These applications provide most visually impaired and blind people the functionality to write emails, letters and be functional on the Internet.

This screen reader program is compatible with Microsoft Windows 2000, XP and Vista.  It is not compatible with earlier operating systems such as Microsoft Windows 95, 98 or ME.  The Thunder screen reader program does require a multimedia enabled computer with a soundcard and virtually all soundcards are supported.

While this screen reader program is free, there are limitations in the software applications that it will work with.  The ScreenReader.net website indicates that the following software applications are functional with the Thunder screen reader:

MS Calculator
MS Excel
MS Internet Explorer (using WebbIE Internet text browser)
Listen-again radio
Nod32 Anti-virus
MS Notepad
MS Outlook Express
MS Sound recorder
MS Vista
MS Windows2000
MS Windows 
MS Word XP
MS WordPad

This does not mean that other software will not work with the screen reader.  As funding becomes available, Thunder is being expanded to be more compatible with more and more desktop applications.  This screen reader does however, open a whole new world for those computer users that are visually impaired or blind.

In recognition of this contribution to the visually impaired and low vision computer community, this project has received the International Centre of Excellence for Local E-democracy Ministerial Award in London, England.  This was recognition for providing a valuable software resource to those who may not normally be able to afford a screen reader application.

The Thunder screen reader program can be downloaded free of charge from the ScreenReader.net website.

While these online eye examinations may indicate problems, they are no substitute for regular eye examinations that are imperative to healthy eyes.

The amsler grid test is a relatively simple eye exam that looks like a piece of graphing paper.  The amsler grid test has dark lines that form a series of grid squares.

When a person stares at the amsler grid test, line that appear wavy, broken or distorted may indicate the first signs of macular degeneration.  If a portion of the amsler grid is missing or blurred in any way, it could indicate that a person has early stage macular degeneration.  Using the amsler grid test, an individual can spot symptoms early in the eye condition.  Early detection of macular degeneration is critical to treating wet macular degeneration where vision loss can occur rapidly.

Why is early detection of macular degeneration important?

Wet macular degeneration can be treated with laser treatments and anti-VEGF drugs such as Lucentis, Macugen and Avastin.  Quite often these treatments will not only halt further progression of the eye disease but in some instances can reverse the damage already caused preventing permanent damage to the eyes.  Dry macular degeneration often leads to the development of wet macular degeneration.

Using a simple amsler grid test patients who are at risk of developing macular degeneration or who have already been diagnosed with the disease to monitor their eye health.

One of the free amsler grid tests available online is at www.myvisiontest.com.  This site is designed for people with macular degeneration and other macular eye diseases.  Using this online amsler grid test, people can test their vision online.  This online site is designed to be accessible by the visually impaired but requires that individuals register to take the free amsler grid test for macular degeneration.

My Vision Test offers a complete tutorial for using the amsler grid test.

Overall, this is a great online resource for monitoring eye health.  This should not be used as a substitute for regular eye examinations and if you are experiencing difficulties with your vision, a proper eye examination conducted by an eye care professional is essential.

If you use an amsler grid test and suspect that you may be suffering from macular degeneration or any other macular eye disorder, consult a physician immediately.