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What You Do..Don't Do...When You Meet a Person with a Guide Dog.AND, What To Do When You See A Blind Person

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Low Vision Coverage

By LAURIE MCGINLEY...December 2, 2007

When Congress created Medicare in 1965, it excluded from coverage items considered routine and low cost, including hearing aids, dental care and most eye care, including glasses. Now the "eyeglass exclusion" is at the center of a debate over whether Medicare should cover a variety of devices for people with low vision.

Millions of Americans over 65 have low vision, and the numbers are set to rise as aging baby boomers develop age related problems such as Macular Degeneration. Assistive devices range from simple magnifiers to powerful illuminated magnifiers, which can cost hundreds of dollars, to closed-circuit television systems, which can cost thousands of dollars and project type onto a big computer screen.

Proposed Rule
Over the years, Medicare has generally refused to cover the devices, but some courts have supported coverage. Last year, to clarify the issue, the government's Centers for Medicare and Medicaid Services proposed denying coverage for all devices "that use one or more lenses to aid vision or provide magnification of images for impaired vision."

"We aren't saying that the devices aren't useful," says Laurence Wilson, director of CMS's chronic care policy group. But, he says, the agency "needs to apply the law in a consistent way." He says the agency is reviewing public comments on the proposal.

Advocacy groups say it's unfair to deny coverage for the devices. "If someone loses a limb, Medicare pays for a prosthesis," or an artificial arm or leg, says Cynthia Stuen, senior vice president for public policy at Lighthouse International, a New York based nonprofit group that helps people with vision loss.

Dr. Stuen says that Medicare Advantage plans -- private managed care plans that are an alternative to traditional Medicare -- generally don't pay for low vision aids. Medigap plans, which many people buy to supplement traditional Medicare, don't cover items that aren't covered by Medicare.

What Is Covered
Medicare covers some eye care, when related to disease. It covers an intraocular lens, which replaces the patient's clouded lens during cataract surgery. It also pays for a pair of glasses or contact lenses after surgery.

Medicare covers screening for glaucoma, in which excess pressure damages the optic nerve, for people at high risk. That includes people with diabetes, a family history of the disease and older African Americans. It also covers a treatment for some patients with age related macular degeneration, in which the central part of the retina deteriorates.

Some nonprofit groups, including Lighthouse International, will provide low vision aids at reduced rates or free, depending on a patient's needs. The Web site also lists organizations around the country that help the visually impaired.

Columbia Lighthouse for the Blind, which serves the Washington, D.C., area, also helps people pay for some devices, and will refer people in other parts of the country to groups in their areas.

Columbia Lighthouse got Margaret Green, a 76 year old Washington resident who has diabetes related vision impairment, glasses with magnifiers built into the lenses, for no cost. "The glasses help a whole lot," she says.

Highlights by page author


If your eye doctor says you have cataracts, don't rush into treatment. To make sure you're choosing the best correction for you, experts suggest:

• Wait for visual symptoms to become severe enough to bother you.
• Check out a surgeon's education and certification with the American Academy of Ophthalmology or the American Society of Cataract and Refractive Surgery (703-591-2220:
• Let your surgeon know how you spend most of your time and what your work or hobbies are.
• Stop wearing rigid contact lenses at least three weeks before your pre­operative testing: stop wearing soft : contacts at least one week before.
• Take home any informational brochures and read them without rushing. Ask your surgeon to explain anything you didn't understand.
• Tell your surgeon if you're on medication to prevent stroke, such as aspirin,Plavix, or Coumadin. You may need to stop this medication before surgery.
• Tell your surgeon if you have ever been on Flomax for prostate or urinary retention problems. If so,he or she will need to have special equipment on hand during surgery.
• Inform your surgeon about any serious health problems. These could require that your surgery be performed in a hospital.
• Rule out or treat the "wet" form of macular degeneration, which can be aggravated by cataract surgery.
• If you have had complex retinal surgery (including detached retinas), tell your doctor, and avoid IOLs...(*)Intraocular lenses, (IOLs)are the artificial lenses that replace the eye's natural lens...(*)of Silicone which can hamper future treatments. • Wait at least a week after your first surgery before treating the other eye.
• Use the prescribed antibiotic and anti-inflammatory drops religiously, to minimize the threat of swelling or infection.

(*) Are You (*)Bugged by those annoying floaters

BY MATTHEW BARAKAT...Associated Press...Posted Monday, February 05, 2007

FALLS CHURCH, Va. - Some people call them floaters. Eye doctors call them "vitreous opacities."

Emily Flynn called hers "a little fuzzball," and she flew halfway around the world to have it removed.

After more than 100 pinpoint zaps from a laser beam during a half-hour visit to a northern Virginia office park, the fuzzball was gone, obliterated within the clear, gelatinous goo that fills the eyeball.

The surgeon, John Karickhoff, has done the same procedure more than 1,400 times over the past 15 years and claims a success rate of better than 90 percent, with minimal risk of complications. Still, many ophthalmologists have never heard of the procedure - and most would recommend against it. The procedure has drawn regulatory scrutiny in Florida.

Nearly everybody has floaters or will develop them at some point in life, especially older and nearsighted people. Sometimes shaped like specks or snakes, they float through a person's field of vision, and are most easily seen when you look against a light background like a blue sky or a white wall.

They are harmless, usually just bits of membrane that have become dislodged from other parts of the eye. Karickhoff estimated that 95 percent of people who have floaters ought to leave them alone. But for that 5 percent, they can be a legitimate problem.

"I've had musicians who couldn't read the sheet music quickly enough because the floater would get in the way," said Karickhoff, who has tried for years to get the procedure accepted into the medical mainstream. "It can ruin a patient's quality of life."

Only a handful of doctors in the United States - perhaps as few as two - regularly treat floaters with laser surgery.

Richard Bensinger, a spokesman for the American Academy of Ophthalmology, said most ophthalmologists believe the procedure is unnecessary. He acknowledged the laser treatment is often successful and carries little risk, but most doctors believe any risk is unacceptable for treating a benign condition like floaters.

If patients insist on treatment, Bensinger said the laser treatment can be a better choice than the more common alternative, a vitrectomy, which involves removing most or all of the eyeball's internal fluid.

In Flynn's case, her optometrist in New Zealand told her that floaters were common and not harmful and that she should learn to live with it. She learned about Karickhoff from his Web site,

Karickhoff said he knows firsthand that floaters can be troubling - he had what he called "a whopper" of a floater in his own eye.

He was skeptical when, on a Florida vacation, he saw a newspaper ad touting laser surgery for floaters. But he sat in on a surgery performed by Fort Myers ophthalmologist Scott Geller and later allowed Geller to operate on his eye. The procedure was a success.

Not long after, Karickhoff began performing the procedure himself. Both Geller and Karickhoff have since operated on thousands of patients.

Last year, the Florida Board of Medicine investigated a complaint against Geller filed by a 72-year-old woman who complained that the surgery merely broke up one large floater into a bunch of smaller floaters. But the board dismissed the complaint after hearing testimony from Karickhoff on how the procedure works.

Karickhoff, who has a clean record with the Virginia medical board, said he can tell by examining the patient's eye if the floater is a serious distraction or a minor annoyance. He declines to treat those "who are making a mountain out of a mole hill" because such patients will almost never be satisfied.

There is little peer reviewed literature about the procedure. What does exist shows the procedure to be generally safe, but the results about its effectiveness are mixed.

Karickhoff said there is a theoretical risk of serious complications, including a detached retina, but that he has never seen it happen. He said his own rate of complications is about a tenth of a percent, usually involving increased pressure within the eye.
<*> Added by page author

Important Information

Key Facts You Should Know About Age-Related Macular Degeneration

Macular degeneration is a major cause of visual impairment in the United States, and for people over age 65, it is the leading cause of legal blindness.

At least one (1) in ten (10) people over age sixty (65) suffer from macular degeneration, and as many as one in four in this age group exhibit early signs of the disease.

Approximately 3.6 million Americans have macular degeneration and of those, 1.8 million experience serious visual impairment. The government estimates that by the year 2030, with the aging of the baby boomers, this disease could visually impair 6.3 million Americans.

Risk factors for macular degeneration include smoking, age (risk increases with age), gender (women appear to be at slightly higher risk), and family history. High cholesterol may also increase the risk of developing macular degeneration.

African Americans are much less likely to lose vision from macular degeneration than Caucasians.

Macular Degeneration Research is working hard to find a cure and better treatments for macular degeneration.

At ( ) you, your loved ones or friends can learn more about macular degeneration. Ask them to visit the "Ask An Expert" section to have their questions about this horrific vision killer answered.

Facts you should know copied from "Better Health Through Research" flyer

What Is "AMD"?  Age related Macular Degeneration (AMD) is a loss of the "sharp Central" vision, necessary for every day tasks, such as driving and reading.There are two types *of AMD*: Dry AMD ( which affects 90% of those with the condition and Wet AMD.

What Is Glaucoma? Glaucoma is caused by a gradual rise in fluid pressure in the eye. Uncontrolled, it can damage the optic nerve, impairing vision or causing blindness.

What are Cataracts? Cataracts occur when the proteins that make up the eyes lens begin clumping together, leading to cloudy vision.

"What Is/Are"-Copied from Medzine Magazine

The following has been copied from a recent "Dear Abby" article that pertains to the "Dangers" of AMD

Dear Abby: As your readers mature,some of them will be among the (9) (*)nine million older Americans who have some signs of age related macular degeneration.Nearly two 2)million struggle to read because of It.

AMD is a painless disease. It sometimes develops so slowly that people notice little change in their vision. But! AMD blurs the sharp, central vision needed for "straight"ahead" activities, Such as reading, sewing and driving

There are two forms of AMD: Wet and Dry. Wet AMD is the more serious form.

It's caused by new blood vessels that grow at the back of the eye and then bleed.Usually the first symptom is straight lines begin to look wavy. 

If you have dry AMD, the most common symptom is a slight blurring. You might also have trouble recognizing faces, and you may need brighter light to read or perform other tasks.

The good news is, recent clinical trials show that a combination of high dose vitamins and minerals can slow AMD and vision loss.

Many advances in technology are also providing effective solutions to AMD and other age related vision problems.

Please encourage readers who suspect they may have AMD or other vision problems, who are over the age of 60 or have diabetes, to consult an eye healthcare professional as soon as possible.

Paul A. Sieving, M.D., PhD, director, National Eye Institute

Dear Dr. Sieving: I'm pleased to spread the word. The subject may not be "sexy," but it's important.

Readers, any change in vision should be immediately reported to your doctor. This includes blurring of vision, "flashing lights" or an increased number of "floaters."

Before buying vitamin supplements to maintain your vision, ask your doctor which kind is most helpful.

Eye Institute provides a wealth of information to help people of all ages maintain healthy vision via its Website:  Click to access site


Following has been copied...without pictorials...from American Foundation for the blind (AFB) flyer

As Baby Boomers mature and encounter the vision problems typically associated with aging, the number of severly visually impaired older people is expected to double to nearly ten (10) million by the year 2030.

Most blind or visually impaired older americans suffer from age related degenerative diseases.
Few visually impaired older people lose all their vision. But many lose enough to make life dangerous,boring and isolated.

The following list depicks what people will see despite eye conditions associated with aging

  • CATERACT: ...There is an annoying "glare" around lights and a general loss of detailelsewhere
  • GLAUCOMA: ...If not treated soon enough, glaucoma can destroy peripheral ("side")vision, leaving "Tunnel Vision"...a small area in which a person can still see
  • MACULAR DEGENERATION: ...Centrel vision is lost, making it difficult to read or docloser work,but objects can still be detected with side vision
  • DIABETIC RETINOPHY: ...This condition can leave blind spots, but some visionremains intact

    For More On Macular Degeneration see below

    Highlights and (*)added by page author

    I Can See Clearly Now, At last, therapies improve vision lost to macular degeneration

    By Robert Cooke...October 2005

    Among revolutions, this may be a quiet one, yet it's dramatically changing the lives of people with one of the most heartbreaking disorders associated with aging failing eyesight.

    After years of frustration, scientists are developing treatments that can slow the inevitable descent into darkness caused by "wet" macular degeneration, an eye disease that strikes 200,000 Americans a year.

    Macugen, a drug on the market since January, may in some cases reverse vision loss. And clinical trials are showing that a second drug, Lucentis, which could be available within 18 months, may be even more effective.

    "For the first time we have a treatment where visual acuity is actually improved," said Robert D'Amato, M.D., an ophthalmologist with Harvard Medical School and Children's Hospital in Boston. "People can actually see better than they could when the [Macugen] trial started."

    Macular degeneration is the most common cause of blindness after age 50. The dry form of the disease occurs when pigment cells beneath the retina deteriorate, diminishing eyesight.

    The more serious but less common wet form accounts for only about 10 percent of the more than 1.75 million cases of age related macular degeneration in the United States.

    Wet macular degeneration is caused by the abnormal growth of leaky blood vessels in the retina, the eye's light sensing organ.

    The new drugs stop the action of VEGF, a natural substance that stimulates such growth and gradually damages the macula, the central area of the retina that allows fine detail vision needed for reading or sewing.

    Most patients are left with only peripheral vision, and many can no longer recognize faces, read signs or do ordinary chores.

    "I went from being quite dependent on my husband to being able to drive legally" as a result of Macugen treatments, says Charlotte Warner, 83, of Strongsville, Ohio. When she joined the drug trial three years ago, vision in her right eye was gone and her left eye was deteriorating.

    "I'm an avid reader, but I was having to use a magnifying glass even to see the big print," she adds.

    "I started to improve gradually," she says, "and after three doses I was elated" because some vision was returning. Now the vision in her left eye is 20/25, and she can read and watch TV.

    Macugen, made by Eyetech Pharmaceuticals Inc. in New York, won approval from the federal Food and Drug Administration last year. Genentech Inc., of South San Francisco, the manufacturer of Lucentis, reported in July that monthly injections of the drug benefited most of the 716 patients in a one year clinical trial, with 34 percent of those who got a higher dose (5) milligrams instead of (3) reporting improved vision: They were able to read smaller type three lines lower on an eye chart.

    Ironically, the discoveries leading to treatments for eye diseases came from cancer research, not eye research. Lucentis, in fact, is an altered version of Avastin, a colon cancer drug that some eye doctors use to treat wet macular degeneration.

    Philip Rosenfeld, M.D., of the University of Miami Bascom Palmer Eye Institute in Florida, says of his experiments with Avastin, "I'm seeing in these patients something I've never seen before: they are getting better. This is a "Gee whiz!" "Wow!" experience."

    The medication drains fluid from retinal tissue, he says, and returns the retina to its normal shape. He says its benefit seems to last longer than that of Macugen or Lucentis, usually up to six months or more in two-thirds of his patients. Rosenfeld hopes to start a large clinical trial with Avastin soon and expects to report current results at a scientific meeting in February.

    Until now, the most effective treatments have used laser beams to burn leaky blood vessels in the retina, preserving sight temporarily. But eyesight does not improve, and over time vision loss continues.

    Macugen and Lucentis are injected directly into the eye, an off-putting notion to some. But side effects,inflammation, eye irritation, reduced clarity and discomfort after treatment are minimal, experienced by less than (*)one (1) percent of patients.

    Some doctors have expressed concern about price, worrying that Lucentis may cost as much as $4,000 a dose. But a Genentech representative, Dawn Kalmar, said a price has not been set. It isn't known yet if Medicare and insurers will cover the drug.

    Macugen injections, given every six weeks, cost $995 a dose, and are covered by Medicare and some insurance companies.

    The drug makers are setting up programs to help people on limited incomes pay for the medications.

    The possibility of curbing eye damage by blocking VEGF was discovered by Anthony Adamis, M.D., vice president and chief scientific officer at Eyetech, and his fellow ophthalmologist Joan Miller, M.D., of the Massachusetts Eye and Ear Infirmary in Boston. Such developments are propelling eye research into an exciting new phase. Adamis likens it to the Sputnik era, at the dawn of the space age. "We're right at the beginning."

    For more on this articleClick Here
    Highlights & (*) added by page author

    Eye Problems resulting from having Diabetes...Be sure to visit for information vital to your vision The Age-Related Eye Disease Study (AREDS)- has found that taking high levels of antioxidants and zinc can reduce the risk of developing advanced age-related macular degeneration (AMD) by about 25 percent. Clinical trial closely followed 3,600 participants with varying stages of AMD. Results showed that the AREDS formulation, while not a cure for AMD, may play a key role in helping people at high risk for developing advanced AMD keep their remaining vision...Check if it's right for you. Nutrition Helps Prevent Age-Related Eye Diseases...Macular Degeneration, etc....See Lutein below for more
    Eye Care...Fast Facts...Vision Test and more...MSN's site To learn more about EyeCare America's public service programs or to see if you, a family member or a friend qualify for a free referral, click on one of the links on sidebar. About Macular Degeneration...Infomation all should know...If you have questions about the research and science concerning macular degeneration, fill out and submit the information on the "Ask an Expert" form
    Eye Tests for Glaucoma American Foundation for the Blind.Material provided on is intended for information use only and is not a substitute for professional medical advice. If you have any concerns about your health, contact your health provider Eye Conditions
    Pharmacutical Products For Your Eyes...Drops..Ointments..Washes & More Healthcenter's "Extensive " Listing Relating To Eye Problems & More General Health Encyclopedia Eyes, bloodshot...Click--A to Z -- And Select the Condition In Which you Have An Interest Or Concern
    Visudyne: new hope for age-related vision loss...Healthgate Com's Medication Site National Eye Institute 1-800-869-2020 Dr. Edell's -- Eye & Vision Site
    Macular Degeneration -- The How's & Why's Macular Degenerationfruits and vegetables - not the vitamin pills - may be capable of slowing, stopping, and possibly reversing macular degeneration. & More Infoseek Com's Listing Of -- Macular Degeneration Sites
    Excite Com's Listing Of Macular Degeneration Sites Yahoo Com's List Of Macular Degeneration Sites Lyco's Listing Of Macular Degeneration Sites
    What is Macular Degeneration? & more...Harvard School of Medicine site Webcrawler Com's Listing Of Retinal & Macular Degeneration Sites Mayo Clinic's Macular Degeneration Site
    Age Related Macular Degeneration What causes macular degeneration in the eyes? Have there been any advances in curing this condition? Macular Degeneration Foundation
    Macular Degeneration - Dry, Wet, Age Related, AMD, ARMD Antioxidant Vitamins And Zinc Reduce Risk Of Vision Loss From Age-Related Macular Degeneration -- Same Nutrients Have No Effect on the Development of Cataract Macular Degeneration Sites...Google Search Engine site
    About Macular Degeneration...FAQ's...Risk Factors..Symtoms...Research View an Anatomy of the Eye illustration and more American Academy Of Ophthamology... Latest Research News & More Infoseek's-- Ophthamology Site's Listing
    The American Optometric Association (AOA), represents more than 32,000 doctors of Optometry Consumer Guide To Health Eye care..A wealth of Information that all should know Seniorhealth Vision Health Page
    Vision Loss of America's Site...Abstracts on Eye Problems & Progress Doctor Guide site on Myofascial Pain If You Have Problems Reading  ( Visual Impairments)
    Nutrients For Your Eye Eye Diseases Directory of Low Vision Services
    Got a medical Question? Ask the experts and get an answer Dry Eyes Need Special Artificial Tears Here's what you need to know about some common conditions that can adversely affect sight -- and how you can protect your vision.
    Google's " Cataract" Site Listing Facts About Cataract...Information for Patients St.Luke's " Cararact" Site...What it is...Surgery...FAQ" and more...If your Diabetuc Visit this site...Extensive Information contained here!!!
    American Optometric Association 314-991-4100 Fax: 314.991.4101 For "Free" Vision Check for "Children, Seniors, Adults"  For Low Income Americans. For specfics call1-800-766-4466 Application Forms can be obtained from " VISON USA, 243 Lindburgh Blvd. St. Louis. MO 63141 or from this site Prevent Blindness In 2001, close to 10,000 children under the age of 14 were treated in U.S. hospital emergency rooms for eye injuries caused by toys and sporting equipment Foundation Fighting Blindness...Much help and information
    AMD...Age Related Vision Loss...Antioxidants may help prevent it... study found .Age related macular degeneration is a disease that blurs the sharp, central vision you need to read, sew and drive, according to the National Eye Institute (NEI) Laser Vision Correction...using Lasik, the latest advance in vision correction Network for Eye Physicians,Ophthalmology...& Surgeons
    The University of Iowa, Department of Ophthalmology & Visual Sciences is ranked one of the top 6 eye hospitals by U.S. News and one of the top 5 ophthalmology programs by Ophthalmology Times Lutein is an important natural antioxidant that may help your eyes stay healthy while maintaining the health of your skin. Eye & Vision problems...and much, much more...A visit to this link will be worth your time.

    What is Glaucoma? How Is Glaucoma Detected...Can It Be treated...What does the eyes see if Glaucoma is present...Scroll down page to each subject. Information for designed to help people with glaucoma and their families better understand the disease. It describes the causes, symptoms, diagnosis, and treatment of glaucoma.It is mainly about open angle glaucoma, the most common kind in the United States
    About Gloucoma..FAQ's, Symtoms, Risk Factors, Research...View an Anatomy of the Eye illustration and more The Glaucoma Foundation Glaucoma 2001...American Academy of Ophthalmology
    If you have questions about the research and science concerning glaucoma, e-mail your questions to Types of Glaucoma  A Patients Guide Guarding Against Glaucoma
    Glaucoma Research Foundation...FAQ's...Research & much more Glaucom online interactive You may either participate in the discussion areas by registering, (Click the "Register" button or you may browse by clicking the "Guest Access" button. Registration is brief, simple and absolutely FREE Google " Search Engines" Glaucoma Links
    Yahoo's " Low Level Glaucoma " Links Glaucoma Information site.

    What to do when you see a blind person:

    •  When you address a blind person, identifY yourself immediately so there is no mystery as to who you are.

    •  When guiding a blind person offer your arm for assistance. A blind person can anticipate your movements by walking slightly behind you.

    •  Offer assistance when you see a blind person trying to cross a busy intersection, but don't be discouraged by a "No thank you."

    •  Don't distract a guide dog from his main purpose of safely leading his master. Ask permission before petting...See below for specifics about "What You Do..Don't Do...When You Meet a Person with a Guide Dog."

    Copied from Blind Veterans flyer...No restrictions noted

    Blinded Veterans Association 477 H Street, NW Washington, DC 20001-2694... 1-800-669-7079...Click to access site

        What You Do..Don't Do...When You Meet a Person with a Guide Dog.

    Guide dogs should not be petted or disturbed while working in harness. Even when guide dogs are not,working, do not pet them without first asking for permission.

    If you wish to assist a person with a guide dog,first ask, "May I help you?" If your offer is accepted, thenoffer your left elbow. Do not grab the guide dog, the leash, the harness, or the persons arm. Doing so mayplace them in danger.

    Do not feed a guide dog. Guide dogs are given a prepared diet at home, and additional feeding may disturb their work schedule.

    For further information regarding speakers,literature, annual reports, and additional support opportunities,contact:

    Guiding Eyes for the Blind... 611 Granite Springs Road...Yorktown Heights, NY 10598...Tel: (914) 245-4024...Toll Free: (800) 942-0149 or visit the web site by  Clicking left mouse button here


    The Author of this page is not a health care professional  and assumes " no liablity " for any opinions or statements derived from within this page's links. Always consult a health care professional for health advice.

    This Page Of Links Is Provided As A Public Service, And Does Not Provide Any Warranty, Statement Of Quality," Implied Or Otherwise, " About Any Of The Products, Businesses,Statements Or Services Listed.

    Page Author assumes " No Responsibility ... Now Or In The Future "...For Products, Services Or Other... Offered By Any Of The Entities Listed On This and subsequent Pages. Links On This Or Other Pages Are Intended To Be Informative And Does Not Imply An Endorsement By Page Author.

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