Macular Degeneration and other types of macular diseases are very common, particularly in older individuals. Fortunately, it is an exciting time because we are learning more about how these diseases progress and new treatments are being developed.
For people that have macular disease, it is important that they routinely check their vision to see if it has changed or worsened. Most typically, this is done at home with an Amsler Grid.
Dr. Richard Trevino, an Optometrist in Indiana, is currently developing an internet-based technique to monitor macular vision called myvisiontest.com. Not only does the site allow you to test and monitor your macular vision, but there is lots of useful and interesting information.
I recently had an opportunity to discuss My Vision Test with Dr. Trevino:
Dr. B: You have presented professional publications and papers on a variety of subjects during your career. What caused you to become interested in macular function testing?
Dr. Trevino: I have worked at a Veteran’s Administration clinic for the past 11 years, where most of my patients are elderly and macular degeneration is fairly common. Recently, some wonderful new therapies for macular degeneration have become available, making the early detection of choroidal neovascularization more important than ever. I became frustrated at the ineffectiveness of the Amsler grid for home monitoring. I felt there had to be something better. That was my original impetus.
I started researching the topic and encountered a number of technologies that were being investigated experimentally for macular function testing, and which seemed to show promise as an alternative to the Amsler grid for home use.
One technique that I found especially interesting was noise field campimetry. I read research papers that described how people could see their vision defects by staring at television static. I tried this out in our clinic by taking patients with macular degeneration out into the waiting room where we have a television. I would switch to a channel with just static, and ask the patient to tell me what they saw. In many cases they were able to see their defect quite clearly. That lead me to begin adding “monitor vision with television static” to my routine recommendations for patients with AMD.
Although patients could see their vision defects on the television screen, there was no good way for patients to record them for monitoring purposes. That is what lead me to write the computer program. To simulate television static and give people a way to record their defects.
Are you surprised that with the level of personal technology that exists today, the Amsler Grid is still the most common home testing of macular function?
Yes, it was surprising and disappointing to find that there was no good alternative to the Amsler grid. But as I delved more deeply into the topic, I began to recognize the substantial difficulties associated with coming up with a good, affordable home vision test for macular degeneration.
Nonetheless, I strongly believe that it is possible to construct such a test. There are some very smart people working on this problem, and I have been in contact with a few of them. MyVisionTest (MVT) may be the first, but it is definitely not the last word on the subject. Several technologies have been identified as potential candidates for replacing the Amsler grid. Noise field campimetry, the technology that MVT is based upon, is one of them. But more research is sorely needed in this area.
You clearly put a lot of work into MVT . How long have you been developing the site?
It was exactly one year ago, March 2007, that I posted the first version of MVT on the Internet. It has gone through 2 major revisions since that time, and I continue to actively work on it.
In November 2007, I began updating the site daily with news and information about macular degeneration, and information of interest to the low vision community in general. The hope is that this will encourage people to visit the site (and test their vision) more frequently.
One of the biggest problems with any home vision test scheme is getting people to use it regularly. We usually instruct our macular degeneration patients to check their vision daily, and we are lucky if they do it once in a blue moon. I hope that our users, who I believe are Internet-active people, will stop by myvisiontest.com daily as they surf the web to see what’s new, and test their vision while they are there.
Other changes are in the works. I have begun work on a second vision test for macular function testing, one that is not based upon noise field campimetry. Some people have difficulty seeing their vision defects using video static, find the test too complicated, or have problems with the test for other reasons. The new test would be an available as an alternative to the current vision test. I hope to begin beta-testing it within the next few months.
Are you computer savvy enough to do the programming?
Yes. I am a card-carrying computer geek. I have been very actively involved with computers since the mid-1980’s. I began teaching myself computer programming in the early 1990’s, but didn’t really do much with it until 1997, when I started getting involved with computer networking and web site development. Most of my programming experience is related to developing web sites for myself, friends and family, non-profit organizations, and small businesses.
When I decided to develop a vision test for macular degeneration, I consulted some friends that are computer professionals, and asked their advice about the project. But I have done all the programming myself.
Do you have forms of financial support fort or has it primarily been a personal project?
There are Google ads on the site, and I also accept donations to our “Java fund” to help pay the bills. My goal is to have the revenue from ads and donations offset the costs associated with running the site. We got pretty deep in the red last year, and I never expect to make that up. But so far in 2008 we have managed to break even. As long MVT is able to break even financially, then I can continue to offer this service to the public free of charge.
If there was just one thing you'd like all readers to know about macular disease, what would it be?
The single most important thing that I impress upon my patients is that smoking is a major risk factor for the development of macular degeneration. If you or a family member has macular degeneration and you smoke, you are significantly increasing your risk of losing vision to this disease.
Anything else you'd like to add?
This is a very exciting time in the field of macular degeneration research. Almost every day a new research paper is published telling us something new about the disease. There is growing hope that we can understand what causes macular degeneration and discover better treatments or perhaps even a cure for it.
Thanks for your time, Dr. Trevino. Good luck with myvisiontest.com. I'm sure many patients will benefit from the site.
Click here to visit My Vision Test.
Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.