Like many other ODs, Donna
Shotwell, OD, spent years
believing that she and others
could do very little to prevent
or accurately predict the progression
of age-related macular
degeneration (AMD). Almost all of
the patients in her Sarasota, Florida,
practice are over the age of 50; in
fact, 80 percent of her patient base
is geriatric.
With AMD patients or suspects,
setting follow-up schedules
was challenging. There was not
a real way to gauge how quickly
a patient’s macular status could
turn from dry to wet. “At some
times it felt like it was just a shot
in the dark because we really
couldn’t follow it. I had no idea
how to answer the question: How
often should I see this patient?
The patient might have very early
changes, maybe a couple of drusen
here and there and I’d think, ‘Oh,
a year should be fine.’” She’d take
the patient’s family and clinical history
into account, but “I had really
no pathway to say, ‘Okay, we need
to see you this often now.’”
Groundbreaking Information
Acquiring the AdaptDx from
MacuLogix is changing the way Dr.
Shotwell and many other optometrists
care for their AMD patients.
AMD is the most common cause of
blindness in this country, so having
the ability to detect AMD at its
earliest stages and then proactively
manage the condition is groundbreaking,
she says. By measuring
the patient’s dark adaptation, she
is able to get a better sense of the
patient’s retinal function. It’s such
a difference from in the past where
she typically had to deliver the
sobering news: “By the time you
have vision problems, it’s going to be a little bit late.” Now, she says,
with the ability to track patients’
progress every three-to-six months
as opposed to every year, this
technology has become the new
standard for care, as far as she is
concerned.
The test measures how quickly
the patient’s eyes adapt from bright
light to the dark and provides
one simple output called the rod
intercept (RI). For patients with
an RI of 6.5 minutes or less, she’ll
reschedule for the following year.
She asks patients who adapt in
nine or 10 minutes on a first test
to come back in four or six months
to repeat it, and for those who
require 18 or 19 minutes to adapt
and have clinical signs, an immediate
appointment at the ophthalmologist
often is warranted.
Plus, the RI number is something
concrete she can discuss with each
patient and monitor over time for
changes.
When medically necessary, initial
and ongoing AdaptDx testing
(CPT 92284 for dark adaptation)
has been reimbursed by Medicare
and private insurance companies
since she began doing it, she says.
MacuLogix is working to get the word out about AMD.
Patient Education
Patients who are concerned
about their own visual health
because of family history are also
feeling more hopeful. “I have so
many patients who say, ‘My mom
has macular degeneration,’ or ‘My
dad has macular degeneration.’
Once they find out that they can
have a test done that might give
them that three- or four-year
advance notice, they jump at the
chance and are willing to pay out
of pocket,” she says. If she detects
subclinical AMD, these patients
tend to follow her counsel to quit
smoking, change their diet or add
nutraceuticals and protect themselves
from exposure to harmful
light.
She appreciates both the
ability to explain to patients their
own possible trajectory and give
them hope for being able to avoid
anti-VEGF injections. “We’ve been
able to delay the onset of symptoms
associated with late-stage disease
for these patients,” she says.
When necessary, with patients
showing dark adaptation function
(which is 90 percent sensitive to
the presence of AMD), she works
with them to create some lifestyle
modification plans. “The first thing
you need to do is stop smoking,”
she tells them. “‘Do you think
you can change your diet? Do
you think you can add kale and
spinach and all those green leafy
vegetables and sweet potatoes and
anything that’s yellow, orange or
red?’ And if they say, ‘No,’ then I’ll
say, ‘Well, I think we need to add
some nutraceuticals.’”
Being able to include the
AdaptDx into the exam process
and discussions has been tremendously
helpful for her practice
and her patients. “When you have
cutting-edge technology like the
AdaptDx, it would be a shame to
not be able to use this for your patients.
Earlier detection and more
proactive disease management will
give us the best chance of halting
the disease—or catching choroidal
neovascularization before irreversible
vision loss occurs.”