- [Announcer] Support for "Keystone Edition Health" is provided by the Moses Taylor Foundation.

- [Announcer 2] Live from your public media studios, WVIA presents "Keystone Edition Health", a public affairs program that goes beyond the headlines to address issues in Northeastern and Central Pennsylvania.

This is "Keystone Edition Health".

And now moderator Tonyehn Verkitus.

- Good evening and welcome to "Keystone Edition Health".

I'm Tonyehn Verkitus.

Thank you for joining us tonight.

Maintaining good eye health is essential, not only for clear vision, but also for overall wellbeing.

As you age, you might notice that it becomes harder to read small print, or perhaps you're more sensitive to glare or experience dry eyes.

These are all common signs of aging, but there are also more serious conditions like cataracts, glaucoma, and macular degeneration that can affect your site.

Tonight we'll talk about how age impacts eye health and share expert advice on managing these changes.

But first, WVIA's Lydia McFarland has more.

(air whooshing) - [Lydia] As we age, our eyes undergo several changes that can affect vision.

The lens of the eye becomes less flexible over time, leading to difficulties focusing on close objects, a condition known as presbyopia.

The retina also becomes more sensitive to light, and the pupil's ability to dilate decreases, making it harder to see in low light conditions.

According to an article from the Pennsylvania Association for the Blind, looking into a project analyzing standardized Pennsylvania data and national reports of people who are blind or have low vision, looking at the state of Pennsylvania, the overall prevalence of visual impairment is 6%.

The county's prevalence ranges from 2.5% to 10.4% within the state.

Additionally, the risk of developing eye conditions such as cataracts, glaucoma, and age-related macular degeneration or AMD increases.

These changes may lead to blurry vision, difficulty reading, or problems with glare.

But regular eye checkups and a healthy lifestyle can help manage these effects and preserve vision for as long as possible.

For WVIA news, I'm Lydia McFarland.

- Joining us tonight, we have Dr. Julie Nastasi an associate professor with the University of Scranton, Mary Ann Iezzi, executive Director for the Lackawanna Blind Association, and Dr. Allie Wylam, an optometrist with Nanako Eye Specialist.

Thank you all for joining us.

- Thank you.

- Thank you.

- I would love for you to tell us a little bit about the vision clinic at the U that you head up.

How long has it been there and who are you serving?

- So this September coming up, we'll approach 10 years at the University of Scranton, having a low vision clinic through Lehe Clinic.

And so it's a free service for older adults in the community who have macular degeneration, glaucoma, cataracts, diabetic retinopathy.

I perform evaluations and then interventions as an occupational therapist in order to allow folks to do the things that are important to them.

So a lot of them will teach them techniques for reading, for writing, if they need help with cooking, how to adapt cooking.

So they're able to do that.

Whatever's important to them is what we do to keep them independent in their lives.

- Allie, I'm sure you see all age ranges, but when we're talking about older adults and vision loss, how many people are you seeing and what types of services are you offering?

- So we usually see somewhere between 15 to 25 a day in my office.

I, like you said, right?

I see kids from six months old to adults as old as 106 years old.

So evaluating, like you said, low vision, such stuff like glaucoma, macular degeneration, trying to get them the best corrected visual acuity so that way when they do go to services like occupational therapy or we give them devices, they're more successful to use those devices.

- And at the Lackawanna and Blind Association, you're not only servicing the blind.

Can you tell us a little bit about the history?

- Sure, we are actually in our 113th year.

So we started in 1912 serving the blind and visually impaired.

And I think a lot of people aren't aware of the fact that we just don't serve those who are blind.

There's a very low population of people who are actually totally blind, which I'm sure Dr. Allie would be, you know, better qualified to speak to that.

But the majority of the people that we serve have some sort of vision loss.

So you don't, and it can range from, you know, anyone who can still be driving, ironically, to someone who really has a very short field of vision in that they can see a very short distance in front of them.

So our services range from life skill services to prevention of blindness services.

We do vision screenings for the, you know, for the youth.

And we'll go into senior centers and community centers to do vision screenings.

We do a lot of in-home services as far as support with reading mail, maybe writing, helping write checks.

We'll take them to the grocery store if they don't have a family member or support network that can help do that.

We take them to doctor's appointments, and in particular their eye doctor's appointment, because, you know, that's the service that we offer.

And we also have our a radio reading service, which people are aware of too.

- So when we're talking about different types of vision loss, you mentioned macular degeneration or glaucoma.

Can either of you give me an example of what that might look like or feel like symptomatically for the patient?

- Especially with macular degeneration, that vision loss is very slow.

So in early stages, it's really difficult to say, oh, that's what this is.

You're just like, hmm, I just need stronger glasses, things just aren't the way that they used to be.

And then they come in for their eye appointment, and we look at everything, and we say, you know, if you really focus in on that, is it easier to see maybe if you look above it or below it, especially in more severe forms of it.

You're almost unaware that you're missing that piece of the vision.

It just feels blurry.

- By the time the folks come to me, the vision is really a big issue.

So for the folks in the audience, if you made a fist with your hand and you look through the fist as I'm looking over your here, I see everything around our host, but I can't see her face, and I can't see what's going on.

So if your family member has macular degeneration, make that fist, look directly at what you're supposed to look at, and you can't see it.

So what we do, we train folks then to use their vision, as you were saying, looking above, look below, look to the left, look to the right.

And then with magnification that's prescribed by the optometrist or the ophthalmologist, I'll train the person how to use their vision effectively.

Moving that spot out of the way so they can read, and they can do their writing, which are the two huge ones.

'Cause when we think about reading, it's medication management, it's doing food management reading recipes.

It's reading your mail and your bills.

It's easy to guess letters, but it's not easy to guess numbers.

And if you're paying your electric bill, or you're paying your gas bill, you don't wanna have that as an error.

So being able to help those folks use their vision more effectively is really helpful to keep them independent.

- Yeah, you're talking about the at-home care, right?

And you're saying that that's some of the service that you provide?

So what would that look like as someone sitting in a person's house with them throughout the day going through mail?

Do they just show up for an hour or do they practice skills?

- It depends on, it really depends on the level of care that the individual needs.

So we go in, we get a referral.

We go in, we do the intake, we do an evaluation.

And at that evaluation, we really sit there and determine what sort of level of care they need.

And the client, and this is where the potential client comes really into play here, is that they let, they're telling us where they feel that they are at functioning in their daily lives.

So, and then we'll send for an eye evaluation.

And then at that point, you know, depending on the service that they need, they may need us to go in once a month to help them pay their bills.

So, and that can take an hour, that can take two hours, if they need to go to the grocery store, if they need to go to the eye appointment, some low vision appointments can take up to four hours.

So it really depends.

It's, everything is individualized based on the care that's really needed at that time.

- And you said your practice kind of started with occupational therapy, but there is a specialty that's vision care.

- So I specialize in low vision.

So I'm an occupational therapist by trade, but I have a graduate certificate in low vision rehab.

My clinical doctorate focused in vision.

And then my research doctorate also focused in vision.

In fact, I do a lot of research at the Lackawanna Association.

We partner together to help them get the research they need for funding and working with the clients that are down there to help meet their needs, which is really a nice thing to be able to do.

- And when we talked, you mentioned that your mentor is legally blind.

- Yeah, so for my research doctorate, Dr. Regina Stevens Ratford was an amazing woman.

She was born blind.

She went through the public schools.

Her mom advocated for her to allow her to succeed because when we look at folks with visual impairment and blindness, there's a high unemployment rate.

So for somebody to reach the stage of having their PhD, she had a mom who advocated for her.

And Regina really changed the way I looked at things because she said, you know, it's not a level of dependence.

I delegate things to folks.

I will say to them, hey, can I borrow your eyes for a second?

Scan my room, find this for me.

Or she went downhill skiing with her husband in front of her in an outfit that had contrast so she could do it.

She went bike riding following her husband.

So I was lucky to have her as a mentor for my doctorate because not only was she this highly achieved occupational therapist with her PhD, but she had that experience in visual impairment.

So it gave me- - It gave you a good idea of what people can actually achieve.

Right?

- Definitely.

- What's so important too is connecting patients to people like that so they know that they can achieve that.

- And that's really the important part.

So as I see folks at the Lahey Clinic, I refer to Lackawanna Blind Association, I've had younger patients coming in, I refer them over to vocational at the state and the Bureau of Blindness.

So that way they can help them be able to continue to work if that's what they'd like to be able to do.

So having that connection and working together with the eye doctors and our local community resources like the Lackawanna Blind association and the state is really important for the folks.

- Yeah, so if people come to you, do you ever have someone come in, and they're complaining about their vision, but they're way past a point where they can have simple help?

You know, maybe visiting Maryanne over here?

- No, I think a lot of times it comes to, people come in, and they don't realize maybe quite how bad it is.

I do my very best to get them as functional as possible.

And then it's my job to connect, you know, connect to the local blind association, the closest to their house, or an occupational therapist who can help them with their ADLs.

You know, it's a team, it's a team effort.

- And what about glaucoma?

I feel like every day I turn around and some older person is getting surgery for their glaucoma.

- Yeah, glaucoma's one of those quiet things.

It's one of those things you don't realize you have until you're nearly blind, which is why your annual eye appointment is so important.

Because one of the things we check on absolutely everybody is their eye pressure and the appearance of their optic nerve.

And those two things together, along with some other in-depth testing, can help us diagnose somebody with glaucoma.

And what happens in glaucoma is you actually lose your peripheral vision first.

So similar to how you described it before with macular degeneration, right?

If you look at your fist, that's what it looks like with macular degeneration, with glaucoma, it's almost like creating a little hole.

And you put that up, and that's really all you can see.

You get tunnel vision from it.

- So that's probably why people don't recognize it because they feel like they can still see, and they don't recognize the sides.

- Most severe glaucoma patients still have 20/20 vision.

- That's amazing.

- And it's pain free.

So a lot of times pain's what brings you to the doctor, but because there's no pain associated with it, and think about it, if your vision here starts going away, you're not noticing it right away.

It's not until you start bumping into things or you lose things, you put them down, you can't find them.

Those are the difficulties we see with folks who have glaucoma, that they'll be bumping into things.

They get lost.

They don't like being in large crowds because people are bumping into them 'cause they can no longer see on the sides.

- Wow.

And you also do some in-house services at the Lackawanna Blind Association so people can come in for the day.

Is that correct?

- Yeah, so we have day programming.

We offer it three to four days a week.

Mondays are our exercise days.

So today we have an exercise instructor that comes in that a chair exercise program that he walks through with that he goes through with all the clients.

Some of our clients are all are participating.

Now another study with the University of Scranton in the ham radio, they're learning to be amateur ham radio operator.

So they'll be taking their test this September.

The university's been wonderful with this.

Julie's been part of that study also.

But it gives them an opportunity to, you know, to connect with other people in the community and throughout the world.

And then we have, after that we usually have a community speaker come in, someone who maybe might be a dietician to talk about healthy lifestyle or different things that are happening in the community to really help them to remain involved.

Tuesday is our sensory program day, and that's what Julie was also talking about earlier, where we're making sure that we are doing activities that really focus on the senses that that really need to remain heightened with them in addition, you know, to trying to keep their eyesight as level as possible.

Wednesdays, you know, we have support groups, we have an advocacy group.

We do bingo once a month.

We do descriptive movies once a month.

We do bowling once a month.

We have a book club.

So our book club is this Thursday coming up.

So we try to keep their activities, we try to keep them as active as we possible as possible.

And they're their own support group too, because they're all going through something very similar, and it's important for them to have that community and have that connectedness.

You know, it's not only, because it's not only the client that's affected, it's also the family that's affected.

And, you know, having that, the resources of being with their peers and helping them navigate through those very difficult times are important for them.

- I can speak to that, having done research down there.

The clients there, Lackawanna Blind Association is their life.

That's what gets them out of their house.

That's where they're socializing with other folks.

They learn from other folks who have visual impairment.

And the support factor is really important of having the support of folks who have the same type of condition that you have.

Because we use our vision, 90% of what you and I do is through our vision.

So it doesn't matter how bad your vision gets, you're gonna still try to use your vision.

So to be around other folks that are having a similar situation who understand what they're going through becomes really important for them.

- Yeah, I would imagine.

Because you can provide them tools, but you don't have lived experience, whereas someone with the lived experience might have a few tricks that they've been using to help them get on.

- And many of our clients, if you're speaking to them, some of them lost their vision relatively suddenly.

And they'll tell you that when they're speaking now about it, they didn't conceptualize things at the way they conceptualize now.

When you have your vision, you take a lot of things for granted.

And when they lost their vision, they're realizing now what they've actually taken for granted and how they have to adapt as well as their family members have to adapt.

And that's what we all try to do when, you know, we're all sharing our resources and partnering together is to help them adapt as well as we possibly can.

- Recently, WVIA's Tim Novotny met with Lisa Godfrey, a client of Northeast Site Services, who shows us how a typical day goes for her living with eye conditions.

(air whooshing) - If I'm looking here, I turn this, I'm prepared.

I first started noticing changes in my vision, I probably was about 62.

I would walk into someone's house and say, "Why are your lights so low?"

I could see this now, but if I have a pod on it, I can't.

So I sit there and I go like this.

The moment I realized I had a problem was I was driving back from Philadelphia, visiting my parents.

The lines were starting to wiggle.

So I knew that there was something wrong.

So when I found out that I had macular degeneration in addition to the low vision, I was really devastated.

First thing I thought is I'm not gonna be able to see my grandchildren when they grow up.

The changes that I made in my life with the diagnosis of this disease, I had to either give into it or learn how to adapt.

And I chose to learn how to adapt.

The white keyboard works better for me because it gives me contrast.

And that's what I need is the contrast.

I love to cook, it grounds me.

It's very satisfying.

I did not want to lose that.

This is a new microwave.

I had to put ones on.

So I have it on 1, 2, 30 second.

When I went to go see my eye doctor, who's a retina specialist, she realized that I had already had some damage in my right eye from the macular.

And she put my name in for this program called Northeast Site Services.

When they first came here, I was so taken back and so surprised.

I had no idea that this organization existed.

They opened up a new world for me to get resources and to add things to my toolbox in order to live every day and function.

One of the most important pieces was the probe that goes inside the cup.

So I use this a lot.

You put this little device right here.

(device beeping) I use that every night.

I use it when I make myself a cup of tea before bed.

Don't wait.

Seek out a doctor that's gonna listen to you.

Don't let it go.

Because the longer you let it go, the worse it's going to get and the harder it's gonna be the correct.

You want to get to it before it gets bad.

You know, you have to embrace life, and you know, this comes with it.

So you either give into it or you adapt.

And I'm not giving in.

- I noticed all of you nodding during that segment.

So a lot of these things seemed familiar and looked familiar.

I have a question for you.

Is there anything that can be done preventative for any of these conditions we're talking about, like let's take macular degeneration for instance.

- That's a great question.

We talked earlier that specifically about glaucoma and your yearly eye exams being the biggest form of prevention for that.

But was as far as macular degeneration goes, in earlier stages, you can, or if you know you have a family history, you can take vitamins that that help to supplement, especially vitamins that have things like cretinoids in it.

Lutein, zeaxanthin are very supportive for macular health.

Omega threes have also been shown in a lot of research to be very good for the eyes as well.

- And we haven't really spoken about diabetic retinopathy.

Do you want to touch on that a little bit because it seems to be something that came up a lot in conversation.

- So diabetic retinopathy, folks who have diabetes, it's the leading cause of blindness in the United States, 18 and older diabetic retinopathy occurs.

So if we can keep blood glucose levels under control, we know we can prevent diabetic retinopathy from happening.

What's dangerous about diabetic retinopathy is you have bleeding that occurs on the macula and on the retina of the eyes.

So not as just the central vision, but also peripheral vision gets affected as well.

So for these folks, they may be looking like they're looking through a piece of Swiss cheese.

As that bleeding gets worse and worse, the retina can actually detach leading to total blindness.

So again, maintaining good blood glucose levels, making sure you're seeing a nutritionist, making sure that you're taking care of that is one way to help prevent that from happening.

- Is there anything that can support improving the vision?

I mean, I assume once you have that detachment, you can't do anything about that.

But leading up to it.

- For that, no, but when we looked at the clip that we just saw, the woman had a lot of lighting.

And so for folks just in general health overall, when we're in our sixties, seventies and eighties, we need six to eight times as much light as a 20-year-old to see the same quality.

That's a lot of light.

And you saw all those lights that are in her house.

With macular degeneration, the area that's damaged is called a scotoma.

And you can have a relative or a dense scotoma.

When you have a relative scotoma, if you increase the amount of light on the object that you're looking at, that will actually allow your eye to process that vision and see it.

So you can see by putting in the light, so if you have somebody who's right-handed, you'll put a disc lamp on the left-hand side.

So the shadow of their hands outta the way.

If they're left-handed, we put the light on the right-hand side so it goes down onto their hand and the shadows out of the way.

With the eye exams, we'll take a look at, which is your dominant eye.

The dominant eye is gonna process your vision.

So if they're sitting in their favorite recliner, we're gonna put a light with a hood on it.

You saw all those hooded lights.

The reason for the hood is we don't want light going directly into the eyes.

If we have light go into the eyes, it's actually gonna be glaring blinding to them.

But by putting on the surface they're looking at, we can actually increase what they're able to see if it's a relative scotoma.

And a few years ago, I actually did a study down at the Lackawanna Blind Association.

When we did preferred lighting levels for the folks there, we were actually able to increase their visual acuity a couple lines on a vision chart.

So they're able to see smaller print, which is really amazing.

So that use of light and knowing how to use light correctly becomes really important.

They may go out on a sunny day and the sun actually hurts their eyes because of the glare of the lights.

So wearing a visor, wearing sunglasses that have a piece over the top or on the side, so that helps decrease the light from going into their eyes.

But again, knowing how to use light to your advantage, have the sun behind you so the light is going onto what you're looking at, but not into your eyes.

- I love the fact that you mentioned that someone at age 20 is going to need less night light than someone my age, for instance, because I often tell my kids they're reading in the dark, but now that makes absolute sense.

So some of the tools she was using in her house are obviously similar items that your caseworkers are taking into homes for the folks you're working with.

- Yeah, so if someone during our evaluation, we identify someone who might need a low vision appliance, we have things that we will take into the home to help them, you know, to let them review them.

And if they need them, we'll we can help them get them.

We also, we can order things for them.

We do bring catalogs in to show them the different items that are in the catalog.

So that's all part of the evaluation process.

In particular, when we get the eye report from the doctor, we have a better idea of what we're working with and what kind of level of care that they actually need and what kind devices that we might actually end up recommending for them.

- And as someone like you communicating directly with Lackawanna Blind Association?

- Yeah, a lot of times, I mean, I've haven't worked with Lackawanna Blind specifically, but Community Services for Site or Northeast Site Services, worked with both of them.

And we usually send the chart notes over, and, you know, oftentimes in my assessment I'll recommend products or a certain magnification, or, you know, prism half eyes, let's say, which is a specific device to help low vision patients with reading.

Just make it a little bit more comfortable and better magnification.

So yeah, I mean, I'll send the chart notes over.

Sometimes if I have a direct contact, I'll even give a call and say, hey, so-and-so's coming, be ready.

- And for the Low Vision Clinic, do folks have to have a referral or can they just call you directly?

- So folks, I need to have a prescription from an eye doctor, whether it's an optometrist or ophthalmologist so they can do the referral.

I do have folks that just call me outta the blue, and then I'll say, okay, let's get you in touch with your eye doctor.

Here's the form that we use as a prescription that comes over, and I wanna stress the importance of, you do need to see your eye doctors, and you need to get your care through the appropriate venues.

'Cause a lot of folks will just buy magnifiers off the shelf.

They're only 3X magnification.

The ones that we go, go up to 12X magnification.

But it's an injustice if you're using the wrong type of magnification.

So having that referral from the optometrist who their skill at refraction and determining that right power, then to work with me to be able to use that right power in the right way to train the person.

With macular degeneration, we do something called PRL, preferred retinal locus.

Again, that's that looking above, below, to the left or the right of what the person's looking at.

We train them to use their eyes the right way.

If you just use a magnifier on your own, you're not gonna help yourself to use your eyes effectively.

- Yeah, so at some point I should probably stop just buying my own cheater readers.

- Yes, please.

- I mean, I do.

(group laughing) I do go to my eye doctor, but I don't listen to what he says unfortunately.

Well, thank you all.

Thank you to all of our guests for their insights and to all of you for joining us.

This and every episode of "Keystone Edition" is available on demand on your YouTube channel and now as a special audio podcast, so you'll never miss an episode.

Visit wvia.org/keystoneeditionhealth to stream episodes or subscribe to the podcast.

for "Keystone Edition Health", I'm Tonyehn Verkitus.

Have a good evening.

(bright music) (bright music continues) - [Announcer] Support for "Keystone Edition Health" is provided by the Moses Taylor Foundation.