Ocutech Low Vision Research Travel Awards

Ocutech Low Vision Research Travel Fellowship

Three $750 travel grants will be awarded to primary authors of a Low Vision paper or poster abstract selected to be presented at the annual meeting. 

Requirements:

  • Must be a member of the Academy
  • Must submit a CV
  • One-page essay (500 word max) about themselves and why they have chosen the field of low vision
  • Must have an accepted low vision abstract paper/poster
  • Applicant must submit at least one letter of recommendation

The AAO Low Vision Section will invite awardees to present summaries of their work at the Low Vision Section meeting.

Abstracts of papers selected for awards will be provided to Ocutech by the awardee to be placed on Ocutech’s website in a section devoted to research awards.

Interview with Ocutech Founder in Macular Degeneration News

Dr. Henry Greene is the co-founder of Ocutech, a company that specializes in researching and developing some of the most advanced, most comfortable, and easiest to use eyeglass telescopes available. He has found his work very satisfying because of the way this low vision technology can change the quality of life for someone who has macular degeneration and other eye diseases.

“This technology has enabled us to enhance the quality of life among people with vision loss resulting from such conditions as macular degeneration,” said Henry Greene, retired clinical associate professor of ophthamology at the University of North Carolina at Chapel Hill School of Medicine.

“We’ve been able to help some people who have never responded before to conventional low-vision aids, and that’s by far the most gratifying aspect of our work.” Dr. Greene explains how these glasses work and how to use them in an e-interview with WebRN Macular Degeneration readers.

Macular Degeneration Glasses for Distance

Macular degeneration glasses for distance vision are as important as magnifiers are for reading. These glasses make it possible to watch TV, recognize faces, see street signs, enjoy a play, are cheer for your favorite sports team.

The macula, the central part of our retina is responsible for seeing detail—it’s the part of the eye that give us our normal “20/20 vision.” Macular degeneration, diabetes as well as other retinal and optic nerve disorders reduce the ability of the macular to function, and hence sharp central vision becomes reduced. Individuals with reduced vision are said to have “Low Vision” which is usually defined as visual acuity of less than 20/70 that does not respond to medication, surgery, eyeglasses or contact lenses. While new treatments for macular degeneration hold great promise in controlling the progression of the disease sometimes even improving some of the vision loss, treatment is not yet able to return vision to normal.

Structure of the human eyeball with the name and description of all sites. Medical didactic anatomy poster. Vector illustration isolated on a white background.

Despite the vision loss experienced from macular degeneration, the world will not go dark. Peripheral vision remains normal allowing individuals to walk and engage in many normal activities. Our peripheral vision is sensitive to motion and works best in low light but it does not provide the sharp vision needed for reading and other fine detail tasks.

But in addition to allowing us to read, our vision serves also as an important social sense. Distance vision allows us to see faces, make eye contact, read body language and feel connected with the world around us. A reduction in distance vision has been associated with feelings of isolation and recent studies have shown that it can lead to depression.

There is a large range of vision assistive devices (low vision aids) designed to help individuals maximize their remaining vision. These include very strong eyeglasses, optical and electronic magnifiers, special software, and telescopic and digital devices that can be held in one’s hand or attached to conventional eyeglasses (Bioptics) or as virtual reality glasses (Head-Mounted Displays). It is unlikely that one single aid will address all of the seeing needs for an individual. While many low vision aids can be found online and in catalogs the choices can be daunting. Visiting a low vision specialist to assess your vision and determine the appropriate devices is by far the most effective way to maximize one’s vision and independence.

The Ocutech Falcon Autofocus Bioptic provides the most natural telescopic vision possible. They can help individuals with visual acuity of 20/300 and better.

As a researcher and developer in the field of low vision, he has been the principal investigator on National Eye Institute and Canadian Institute for the Blind funded projects to develop vision aids for those with macular degeneration and other eye conditions.

In 2008 he received the William Feinbloom Award from the American Academy of Optometry, given each year to a person who has made a significant contribution to the clinical advancement of visual and optometric service, and thus the visual enhancement of the public.

Perhaps you have never heard of bioptic telescopes and how these special glasses designed for individuals with macular degeneration (and other types of central vision loss) can help you see better. Find out more as Dr. Greene explains how they work and who can benefit from these glasses through this e-interview with WebRN Macular Degeneration readers.

1. Tell us how bioptic telescopes work and how they are useful for distance vision. 

When vision is affected due to macular degeneration, glaucoma, diabetes, optic atrophy, albinism, nystagmus, or other hereditary or acquired visual disorders, central vision, which is responsible for enabling us to see details, is reduced. Conventional eyeglasses or contacts no longer help because the retina or optic nerve cannot produce a clear image, not because the image is out of focus, although it may certainly appear that way.

A manual focusing Keplerian telescope. They are even available in colors to make them more fun to wear.

Not only is reading difficult, but seeing signs, faces, TV and the computer are also impaired. While magnifiers and large print can help reading, only moving closer or using miniature telescopes can help you to see better at midrange distances or beyond. Reading is usually done at home or in isolated situations. Distance vision, however, is often a public activity, and impacts social interaction and hence quality of life.

The loss of the ability to see the world around you, read body language and make eye contact can be isolating and can contribute to depression amongst the visually impaired. Telescopes help by making the image larger, allowing the user to see things further away. For instance, if an individual can only see a loved one’s face no further than 5 feet away, when looking through a 4x power telescope they may now be able to see their face from 20 feet away.

When a miniature telescope is attached to the top of a pair of eyeglasses it is called a bioptic telescope. By attaching the telescope to the eyeglasses, the wearer can switch their sight between their “regular vision” and the “magnified vision” through the telescope by just a slight downward tilt of the head—like ‘upside-down bifocals.’ Bioptic telescopes can be worn just like a regular pair of eyeglasses, are fast and convenient to use, and become automatic in short order.

2. What activities would a person use these telescopes for?

The Falcon autofocus bioptic can allow you to see clearly at any distance so that your hands can. be free to do other things.

In the US, over 45 states allow eligible individuals to obtain or retain their driver’s license with use of a Bioptic Telescope. Consult your low vision specialist and understand your state’s regulations regarding Bioptic driving.

Bioptic telescopic systems can be helpful for viewing television, movies and theater, seeing faces, signs, blackboards in school, shopping, traveling, table-top activities including card and game playing, and mid-range activities such as reading music and the computer. Bioptic telescope users have even used their devices to drive, hike, golf, bowl, paint, fish and mow the lawn.

But, perhaps most importantly, it allows individuals to feel more connected to the world around them, so, when someone says, “Wow, look at that!” you can say “Yes, I can see it too!”

3. Are there different kinds of bioptic telescopes? What features should one look for in selecting telescopic glasses for improving distance vision?

Bioptics can be broadly organized into two optical categories—Keplerian and Galilean. They are available in a range of magnification powers, and are prescribed based upon the level of vision and visual goals of the individual.

1. Keplerian Telescopes

Keplerian telescopes use a complicated combination of lenses and prisms to produce the widest field of view and sharpest edge-to-edge image possible. They are available as both manual focusing and autofocusing versions. They are most frequently prescribed in a 4x power, though powers from 3x to 6x are available.

2. Galilean Telescopes

Galilean telescopes contain fewer lenses and no prisms making them smaller and lighter, but since they provide a narrower field of view and less edge sharpness they are most valuable in lower magnification powers. They are most frequently prescribed in a 2.2x power.

Studies have shown that the most important features of bioptic telescopes are: field of view, weight, appearance and ease of focus.

As telescopes increase in power, they increase in length and their fields of view decrease in size. In lower powers (2x to 3x) Galilean optical designs can provide ample fields of view for most purposes, however above 3x the wider fields of view of Keplerian optical designs are usually preferred.

4. How would someone with macular degeneration benefit from bioptic telescopes? Who is a candidate for distance glasses? 

As mentioned above, telescopes help by making the image larger, allowing the user to see things further away. Many bioptic telescopes can be focused for different distances enabling them to be used for distance, mid-range, and near magnification purposes.

Individuals with visual acuity as poor as 20/400 (6/120) have found bioptics to be helpful. The individual’s specific visual needs, established in consultation with their low vision specialist, will determine which device and power will be most appropriate to achieve their functional goals.

Ocutech has devised a simple questionnaire to help individuals with vision loss determine if they might be a promising candidate for bioptic telescopes.

If they can answer YES to the following questions than an evaluation by a low vision specialist would be the next step:

  • Is your vision loss due to macular degeneration or a similar disorder that causes a loss of central, detail vision?
  • Is vision in the better eye with your best eyeglass prescription (if used) 20/400 (6/120) or better?
  • Can you read headlines on a newspaper with your regular reading glasses?
  • Can you watch TV or recognize people’s faces from further than 2 feet away?
  • Do you understand that this device is designed to help you see better at distance and midrange for faces, signs, TV, computer screens, shopping and traveling?

5. What makes Ocutech bioptic telescopes different from other brands that may be available?

Ocutech’s Keplerian optical designs, called VES systems, are an innovative combination of telescopic and periscopic optics.

Researched and developed with funding from the National Eye Institute (NIH) they are designed to address the needs of users by providing a wide field of view, light weight, bright and sharp optics, and an appealing design.

They are the only Keplerian bioptic telescopes that offer this combination of features that experienced users prefer, and the only product that is available in an autofocus version. Low vision specialists prefer Ocutech bioptics because they are easy and convenient to demonstrate and fit, and they can be readjusted at any time.

6. How can someone with macular degeneration try these glasses to find out if they would be helpful to them? Where can one get them?

They should consult their low vision specialist or contact Ocutech at 800-326-6460 for the name of an Ocutech prescriber convenient to them. Ocutech’s website www.Ocutech.com offers a wealth of information, videos, and personal stories from actual users to help individuals better understand how Bioptics can help maximize vision.

7. What is the cost range of this type of macular degeneration glasses and does insurance or Medicare pay for them?

Ocutech systems range in cost from under $1000 to several thousand dollars depending upon the device, the customization charges, and accessories. These costs may not include professional fees for the low vision evaluation, the fitting and dispensing of the device or training sessions to help users become proficient in its use.

While health insurance often covers examination fees, Medicare does not usually cover the costs of low vision aids, while other private insurance or social service agencies and even employers may. For more information, contact your low vision specialist.

Optics vs. Digital Displays for Low Vision

Link to Article

Review and comments by:

Henry A. Greene, OD, FAAO

Co-founder, President, OCUTECH, Inc.

Preface:

I expect that you’ll think that as a manufacturer of optical bioptic telescopes writing about Digital Head-Mounted Displays, I’m just carping on what might be considered our competition. But, as noted in this paper, HMDs are not yet compelling competition to optical bioptics. That’s not to say that head-mounted digital displays for low vision won’t someday offer compelling vision rehab opportunities. They likely will. There are, after all, limits to what conventional optics can do. It’s just that they’re not there yet. And it’s due largely to the limits of the technology currently available to HMD manufacturers.

HG

4 June 2021


The Paper:

In a recent paper in Optometry and Vision Science, the journal of the American Academy of Optometry, entitled “Measuring Virtual Reality Headset Resolution and Field of View: Implications for Vision Care Applications ” by Lynn, et al, from Harvard Medical School and the Schepens Eye Research Institute, researchers evaluated the Virtual Reality (VR) Head-Mounted Display performance characteristics of devices promoted for use by the visually impaired.

This is the first study to evaluate the technical characteristics of VR systems for use in eyecare settings. The study measured a sample of VR headsets to evaluate eye-to-screen distance and the other physical and optical characteristics needed to calculate minimum angular resolution in logMAR and field of view in determining their feasibility for vision applications.

Minimum angular resolution

The studies found the minimum angular resolution in logMAR of the six different devices they tested ranged from 0.28 (20/39) to 0.79 (20/123). These were measured using the device’s native (non-digitally magnified) image size. When digitally magnifying the image, the logMAR resolutions will be reduced by the magnification factor. For example, when using the device with the highest display resolution (0.28) at 2x digital magnification, resolution would be reduced to 0.56 (20/78) and at 4x, a commonly prescribed telescope power, resolution would be 1.12 (20/156). By comparison logMAR resolution of the equivalent power optical telescopes is -0.2 (20/10) for both 2.2x and 4.0x powers.

Field of View

The fields of view of the headsets were calculated using the lens focal distance and the visible areas of the display. To verify the calculations, fields of view were also empirically measured using a Goldmann perimeter. The manufacturer’s claimed field of view did not match that measured by the researchers. The marketed field of view of VR low vision devices, which all presently use the Samsung Gear VR headset, ranges from 70° to 101°. The researchers found the field of view without magnification was actually 78° and therefore the average field of view when used as a 4x visual aid is only 19°, much closer to that of equivalent power optical telescopes.

Conclusions as a Low Vision Aid

The researchers evaluated these VR devices for use for visual acuity testing, amblyopia, as well as low vision treatment. They report that the minimum angular resolution in logMAR of current VR technology is insufficient [to] provide ample resolution when digitally enlarging the image [for use as a low vision aid]. The fields of view during movie watching or gaming is substantially less than that reported by manufacturers.

Reviewer’s take on this.

Why all the hoopla and patient interest?

Marketing! HMD manufacturers have great emotive testimonials: they can make the blind see; he could see her eyes for the first time in years; she can read, play piano, play cards; they can do things they never thought they’d be able to do again! But one cannot ignore the social acceptability issues of a device that hides the user’s eyes—both for the user, for their companions, and for the general public they may encounter. Since distance vision is a social sense, users seek, among other goals, to make eye contact, read body language, and feel socially connected. Devices as socially disruptive as present HMDs will certainly undermine this interpersonal functional goal.

Registered with the FDA

HMD manufacturers claim that they are registered with the FDA. Registered is not the same as approved by the FDA which the FDA does not do!. Fill out the form, pay your money and your device can be registered too! It’s false credibility. Every manufacturer of any type of medical device is required by law to be registered with the FDA. The FDA is firm in its position that registering a product with the agency does not confer the FDA’s approval nor prove its efficacy. What confers efficacy? Independent clinical trials, not testimonials or marketing.

New Isn’t Automatically Better

Of course, new can be appealing and exciting. But new isn’t automatically better just because it’s new. New is better when it’s clinically proven and well received by the patient. Tried and true as optical bioptics are, they may not be as exciting as HMDs, but you won’t hear that from long-term users. Bioptic users will tell you that their devices have changed their lives. Ocutech’s prescription return rate is less than 0.1%. Instead, we receive products to be cleaned and refurbished almost daily. That’s because they are used. Many are returned to have the carrier lens prescriptions updated. Patients wouldn’t bother spending the money if their bioptics weren’t helpful.

Clinical Data and Implications

What questions should we be asking? Which patients might benefit from HMDs? Which diagnoses might respond best? What range of visual acuities is most appropriate? What display settings are most helpful? While the HMDs are capable of very high magnification, what is the highest magnification that a user can tolerate? It’s usually no higher than 6 or 7x. So, what’s the benefit of claiming higher powers? What is the abandonment rate? HMD manufacturers don’t answer any of these questions.

Why do most HMDs completely surround the user’s eyes? It’s because the display isn’t bright enough to be visible outdoors without enclosing the user’s eyes. Try looking at the screen on your phone or your digital camera outdoors. Can’t see it, can you? HMDs have the same problem.

What is the breadth of functionality of HMDs? Can users drive with HMDs? No. Can users walk with HMDs? Only if they are lifted out of the way or have their magnification readjusted to zero. So, where’s the benefit then? Can users wear them all day? No, they only run for a few hours. Are they comfortable to wear? No, they’re much heavier than optical bioptics, and you may perspire underneath them. Are they easy and intuitive to use? To be determined.

What about optical bioptics? Lightweight, great outside, drive with them (where legal and appropriate), walk with them, and socialize with them. They don’t enclose the user. They are indicated for central vision loss with best-corrected acuities of 20/300 or better. The clinical data and methods are well established. And, they’re easy to use—all you do is look. Do they work for everybody? Nothing works for everybody! They’ve been around a long time, haven’t they? What’s wrong with that? It means they work and are well accepted. Low vision specialists prescribe them all the time. They wouldn’t continue to do that if their patients weren’t successful with them.

The direct to patient sales model

Another important point is that HMD firms frequently use salespersons to demonstrate and sell their products directly to the consumer. No matter how sympathetic, supportive, and engaged these reps are, they are pursuing a one-time sale, not a long-term relationship. As such, they have little or no investment in the customer after the sale is made. They are not eye care professionals who provide ongoing care for their patients and as a result are personally invested in their patient’s long-term support and the appropriateness of the devices they recommend.

In summary, as the authors of the paper conclude…

“…current virtual reality technologies have limitations that should be carefully evaluated and considered before their implementation in clinical settings. When marketing these devices as low vision aids, approaches for reporting field of view should be consistent with industry standards based on existing telescopic aids, allowing informed comparison by clinicians and consumers.”

After a diagnosis of Stargardt’s Disease

What follows is an open letter I wrote to the Stargardt’s Disease Facebook page, which I would like to share with everyone.

Dear Stargardt Disease (SD) FaceBook members,

By Henry A Greene, OD, FAAO Co-founder and President of Ocutech, Inc.

Former Professor in the Department of Ophthalmology, University of North Carolina, Chapel Hill, and director of the Low Vision Service

I have been following the Stargardt’s Facebook page for many months now, and I have begun to feel that after your diagnosis has been made, many of you have been pretty much left on your own—perhaps after being told that there are no cures and nothing else can be done—prompting, for many of you, individual efforts to treat yourselves. The questions that many are asking suggest to me that you are not getting the low vision support that you need, and as a result I have decided that it’s time for me to ‘pipe in.’

I am an optometrist and low vision specialist who has cared for hundreds of individuals with SD over my 40+ year career.  After optometry school, I was trained at the low vision clinic of the Industrial Home for the Blind, which became the Helen Keller Center, in NY. I subsequently ran the low vision clinic at the Blind Association of Western New York, in Buffalo, and then ran the low vision program at the University of North Carolina at Chapel Hill for over 20 years.  I am also the co-founder of Ocutech, a maker of bioptic telescopes for the visually impaired, for which we have in the past received grant funding from the National Eye Institute.  This funding helped us to develop our original manual focus and subsequent autofocusing bioptic telescopes.  So, while I am not a researcher helping to find medical cures for SD (the holy grail), I am very experienced in helping SD patients cope with their vision challenges and in prescribing and recommending options to help them maximize their remaining sight.

I can imagine nothing scarier than being diagnosed with a disease that will threaten your vision (except perhaps for cancer). The lack of information, advice and support that you all clearly desire, need, and deserve is truly disheartening.  Early on, when you began to notice that your vision was changing, there could be very little if any noticeable change on your retina.  So, your eye doctor would understandably look for other causes and maybe even suggest that the issue might be emotional rather than physical. Ultimately, the appearance of the macula does begin to change, and the diagnosis will become more obvious. Usually (but not always) the diagnosis can be confirmed by additional genetic and/or diagnostic testing. 

It’s also understandable that once diagnosed, individuals first seek a cure—medication, injections, diet, supplements, whatever, to regain vision or retard progression.  The reality at this time is that there is no known treatment that helps.  There is no secret somewhere waiting for you to find.  Why would some person or some firm want to keep secret a treatment that might make them wealthy?  And online treatments of whatever kind proposing to help you regain or preserve your sight are more for the seller’s benefit than for yours.  There are ongoing research trials exploring potential treatments for Stargardt’s Disease.  These can be found at: https://clinicaltrials.gov/ct2/results?cond=Stargardt+Disease&term=&cntry=&state=&city=&dist

We cannot predict in SD how reduced your vision may become. However, you will never lose your peripheral (side) vision from SD, it is only the central macula area that is affected, so you will likely always be able to see well enough to walk.  And, I personally have never encountered an individual with SD that progressed to the degree of needing to use braille or a guide dog, though evidently there are some individuals who may have.

You should also know that vision as reduced as 20/200 (and maybe even 20/300) is usually very easy to help with low vision aids, and people with SD respond exceedingly well to both optical and digital magnification options.  There are software programs to conveniently enlarge and modify how computer screen content is displayed, tons of phone apps for all sorts of ways to support the visually impaired, optical and electronic magnifiers to make printed materials easier to read, and telescopic glasses (bioptics) to help you see the world around you better.

Before submitting this note to the SD FB group, I passed it by my colleague, Janet Sunness, MD, an international expert in macular degeneration and Stargardt’s Disease at the Hoover Low Vision Rehabilitation Service at the Greater Baltimore Medical Center (https://www.gbmc.org/lowvision), for her opinion. She agreed with my message and suggested that this letter be shared.

I hope this note is helpful, and I wish you all the best of luck.