Study says surgical advances may explain away the link seen in earlier research
Robert Preidt
THURSDAY, Feb. 5 (HealthDay News) -- Cataract surgery doesn't hasten vision loss in people with age-related macular degeneration (AMD).
That's the conclusion of a new study that challenges the findings of several large epidemiological studies that suggested a link between cataract surgery and accelerated AMD progression.
AMD and cataracts are leading causes of vision impairment in the United States. Both are related to aging and share other risk factors. AMD affects the retina and leads to loss of central vision. Cataract is cloudiness in the eye's lens that interferes with clear vision.
For the new study, Dr. Emily Y. Chew, of the U.S. National Eye Institute, and colleagues analyzed data from 4,577 participants (8,050 eyes), ages 55 to 81, who took part in the Age-Related Eye Disease Study (AREDS). The researchers compared the risk of advanced age-related macular degeneration in people who had surgery to remove cataracts and in those who didn't have the surgery.
Chew and her team found little evidence that cataract surgery influences AMD progression. The study was published in the February issue of the journal Ophthalmology.
"These data may provide some reassurance to patients with AMD who are considering cataract surgery," Chew said in an American Academy of Ophthalmology news release.
Several possible factors may explain the conflicting conclusions of this new study and previous population-based research, Chew said. The most likely factor is that earlier studies may have had unintended biases or confounding variables. Chew also noted that cataract surgery and lens replacement techniques have advanced, and the AREDS participants' procedures were performed more recently than people included in earlier studies.
Wednesday, February 25, 2009
Tuesday, February 17, 2009
Hope For Macular Degeneration Patients
By Donna Willis
Web Content Coordinator
Published: February 16, 2009
CENTRAL OHIO—A groundbreaking surgery here in Columbus promised new hope in the treatment of the No. 1 cause of adult blindness.
NBC 4’s Colleen Marshall GETS TO THE HEART OF THE MATTER.
Macular degeneration blinded 500,000 Americans last year, and that number was expected to double during the next five years.
Macular degeneration is a breakdown in the blood vessels in the retina, the tissue lining of the eye, and is caused by the same things that cause heart problems: fatty diets, high blood pressure, sedentary lifestyle, age, obesity and heredity.
The Retina Group, in Downtown, was set be the first in the Midwest or East to surgically insert medicine to the back of the eye through a new catheter system.
The surgery was scheduled for Tuesday morning.
“In between the retina and the sclera, which is the white part of the eye, we pass the catheter all the way back directly to where those abnormal blood vessels are, and we deliver the medicine,“ Dr. Michael Samuel said. Samuel is with The Retina Group.
“This is supposed to relieve me for six to eight months of having to have that needle in the eyeball, which would be heaven,“ said patient Mary Thompson.
Thompson was diagnosed with macular degeneration four years ago.
It was thought the new surgery could provide a cure for some people.
nbc4i.com—Where Accuracy Matters.
Web Content Coordinator
Published: February 16, 2009
CENTRAL OHIO—A groundbreaking surgery here in Columbus promised new hope in the treatment of the No. 1 cause of adult blindness.
NBC 4’s Colleen Marshall GETS TO THE HEART OF THE MATTER.
Macular degeneration blinded 500,000 Americans last year, and that number was expected to double during the next five years.
Macular degeneration is a breakdown in the blood vessels in the retina, the tissue lining of the eye, and is caused by the same things that cause heart problems: fatty diets, high blood pressure, sedentary lifestyle, age, obesity and heredity.
The Retina Group, in Downtown, was set be the first in the Midwest or East to surgically insert medicine to the back of the eye through a new catheter system.
The surgery was scheduled for Tuesday morning.
“In between the retina and the sclera, which is the white part of the eye, we pass the catheter all the way back directly to where those abnormal blood vessels are, and we deliver the medicine,“ Dr. Michael Samuel said. Samuel is with The Retina Group.
“This is supposed to relieve me for six to eight months of having to have that needle in the eyeball, which would be heaven,“ said patient Mary Thompson.
Thompson was diagnosed with macular degeneration four years ago.
It was thought the new surgery could provide a cure for some people.
nbc4i.com—Where Accuracy Matters.
Thursday, February 12, 2009
Vigorous exercise may prevent vision loss
There’s another reason to dust off those running shoes. Vigorous exercise may help prevent vision loss, according to a pair of studies from the U.S. Department of Energy’s Lawrence Berkeley National Laboratory.
The studies tracked approximately 31,000 runners for more than seven years, and found that running reduced the risk of both cataracts and age-related macular degeneration.
The research, which is among the first to suggest that vigorous exercise may help prevent vision loss, offers hope for people seeking to fend off the onset of eye disease.
“In addition to obtaining regular eye exams, people can take a more active role in preserving their vision,” says Paul Williams, an epidemiologist in Berkeley Lab’s Life Sciences Division who conducted the research. “The studies suggest that people can perhaps lessen their risk for these diseases by taking part in a fitness regimen that includes vigorous exercise.”
A cataract, which is a cloudy opacity of the eye lens, is the leading cause of blindness. More than one-half of people in the U.S. over the age of 65 suffer from some form of cataracts. Age-related macular degeneration, which is damage to the retina, is the leading cause of irreversible vision loss in older white Americans, affecting 28 percent of people aged 75 and older.
The diseases have several known risk factors, such as sunlight exposure and diabetes in the case of cataracts, but few interventions. Now, it appears that vigorous cardiovascular exercise may be one way to derail the diseases.
To conduct the research, Williams analyzed data collected in the National Runners’ Health Study, which he established in 1991 to determine the health benefits of running.
In this case, he followed approximately 29,000 male runners and 12,000 female runners for more than seven years. Of these people, 733 men reported being diagnosed with cataracts on a questionnaire filled out at the end of the study. Too few women reported cataracts to track.
Men who ran more than 5.7 miles per day had a 35 percent lower risk of developing cataracts than men who ran less than 1.4 miles per day. The study also analyzed men’s 10-kilometer race performances, which is a good indicator of overall fitness. The fittest men boasted one-half the risk of developing cataracts compared to the least-fit men.
A second study found that running appeared to reduce the risk of age-related macular degeneration. In the study, 152 men and women reported being diagnosed with the disease. Compared to people who ran less than 1.2 miles per day, people who averaged between 1.2 and 2.4 miles per day had a 19 percent lower risk for the disease, and people who ran more than 2.4 miles per day had between 42 percent and 54 percent lower risk of the disease.
“These findings are compelling because of the large size of the study, and the fact that we are looking at something that is fairly well defined: vigorous exercise, as opposed to more moderate exercise,” says Williams.
Most of the runners in the study exceeded the current public health recommendations for physical activity, which is at least 30 minutes of moderate-intensity activities such as brisk walking five days a week, or smaller doses of more vigorous exercise such as running. It is unclear whether people might also lower their risk for cataracts and age-related macular degeneration by walking.
“We know there are important health benefits to walking, including lowering heart disease risk,” says Williams. “It is quite likely that the studies’ results might apply to a lesser extent to smaller doses of more moderate exercise.”
Williams also adds that further research is needed to explore why there is a link between vigorous exercise and a decreased risk for eye disease.
“We know some of the physiological benefits of exercise, and we know about the physiological background of these diseases, so we need to better understand where there’s an overlap,” says Williams.
The studies are published in the January 2009 issue of Investigative Ophthalmology and Visual Science. They were supported in part by grants from the National Heart Lung and Blood Institute.
Berkeley Lab is a U.S. Department of Energy national laboratory located in Berkeley, California. It conducts unclassified scientific research and is managed by the University of California. Visit our website at http://www.lbl.gov.
Additional information:
* More information on Williams’ research can be found at http://healthresearch.lbl.gov.
The studies tracked approximately 31,000 runners for more than seven years, and found that running reduced the risk of both cataracts and age-related macular degeneration.
The research, which is among the first to suggest that vigorous exercise may help prevent vision loss, offers hope for people seeking to fend off the onset of eye disease.
“In addition to obtaining regular eye exams, people can take a more active role in preserving their vision,” says Paul Williams, an epidemiologist in Berkeley Lab’s Life Sciences Division who conducted the research. “The studies suggest that people can perhaps lessen their risk for these diseases by taking part in a fitness regimen that includes vigorous exercise.”
A cataract, which is a cloudy opacity of the eye lens, is the leading cause of blindness. More than one-half of people in the U.S. over the age of 65 suffer from some form of cataracts. Age-related macular degeneration, which is damage to the retina, is the leading cause of irreversible vision loss in older white Americans, affecting 28 percent of people aged 75 and older.
The diseases have several known risk factors, such as sunlight exposure and diabetes in the case of cataracts, but few interventions. Now, it appears that vigorous cardiovascular exercise may be one way to derail the diseases.
To conduct the research, Williams analyzed data collected in the National Runners’ Health Study, which he established in 1991 to determine the health benefits of running.
In this case, he followed approximately 29,000 male runners and 12,000 female runners for more than seven years. Of these people, 733 men reported being diagnosed with cataracts on a questionnaire filled out at the end of the study. Too few women reported cataracts to track.
Men who ran more than 5.7 miles per day had a 35 percent lower risk of developing cataracts than men who ran less than 1.4 miles per day. The study also analyzed men’s 10-kilometer race performances, which is a good indicator of overall fitness. The fittest men boasted one-half the risk of developing cataracts compared to the least-fit men.
A second study found that running appeared to reduce the risk of age-related macular degeneration. In the study, 152 men and women reported being diagnosed with the disease. Compared to people who ran less than 1.2 miles per day, people who averaged between 1.2 and 2.4 miles per day had a 19 percent lower risk for the disease, and people who ran more than 2.4 miles per day had between 42 percent and 54 percent lower risk of the disease.
“These findings are compelling because of the large size of the study, and the fact that we are looking at something that is fairly well defined: vigorous exercise, as opposed to more moderate exercise,” says Williams.
Most of the runners in the study exceeded the current public health recommendations for physical activity, which is at least 30 minutes of moderate-intensity activities such as brisk walking five days a week, or smaller doses of more vigorous exercise such as running. It is unclear whether people might also lower their risk for cataracts and age-related macular degeneration by walking.
“We know there are important health benefits to walking, including lowering heart disease risk,” says Williams. “It is quite likely that the studies’ results might apply to a lesser extent to smaller doses of more moderate exercise.”
Williams also adds that further research is needed to explore why there is a link between vigorous exercise and a decreased risk for eye disease.
“We know some of the physiological benefits of exercise, and we know about the physiological background of these diseases, so we need to better understand where there’s an overlap,” says Williams.
The studies are published in the January 2009 issue of Investigative Ophthalmology and Visual Science. They were supported in part by grants from the National Heart Lung and Blood Institute.
Berkeley Lab is a U.S. Department of Energy national laboratory located in Berkeley, California. It conducts unclassified scientific research and is managed by the University of California. Visit our website at http://www.lbl.gov.
Additional information:
* More information on Williams’ research can be found at http://healthresearch.lbl.gov.
Thursday, February 5, 2009
Ghostly faces and visions of 'little people': The eye disorder that leaves thousands of Britons fearing they've lost their senses
By Morag Preston
Last updated at 8:06 AM on 03rd February 2009
Following his wife's death six years ago, David Stannard has become accustomed to spending quiet evenings alone at his home in Walton-on-Thames, Surrey.
So it came as a surprise to the 73-year-old when he looked up from his television one evening to discover he was sharing his living room with two RAF pilots and a schoolboy.
'The pilots were standing next to the TV, watching it as if they were in the wings of a theatre,' he says.
'The little boy was in a grey, Fifties-style school uniform. He just stood there in the hearth looking puzzled. He was 18 inches high at most.'
Mr Stannard's guests never said a word and vanished after 15 minutes. That night, he says, the walls of his house, which had always been white, looked as though they had been redecorated in patterned wallpaper with a brickwork effect.
The next morning he was caught off-guard again when he found a fair-haired girl standing on his sofa. She also appeared to be from the Fifties, but was life-size, wearing a short skirt and pink cardigan, with chubby knees, white ankle socks and ribbons in her hair.
'I watched her for a while,' he says. 'She didn't move much. Then she was gone.'
It would be easy to dismiss Mr Stannard's story as the bizarre imaginings of an elderly mind. Fortunately, he knew he wasn't losing his mind; neither was his house haunted.
A few weeks earlier he had been registered blind, though he was still able to watch television if he sat at a certain angle. He'd been warned that as his eyesight deteriorated, he might experience visual hallucinations in the form of Charles Bonnet Syndrome (CBS).
'I was lucky enough to know what it was,' he says, 'otherwise I would have thought I was going bonkers.'
An estimated 100,000 people in Britain have Charles Bonnet Syndrome (CBS), which leads to hallucinations. These can include visions of miniature people.
An estimated 100,000 people in the UK have CBS, but many won't realise it because the condition remains something of a mystery.
The real number is probably higher because sufferers are often too ashamed to talk about what they have seen for fear of being considered crazy.
The late historian Lord Dacre of Glanton, formerly Hugh Trevor-Roper, was unusual among CBS patients in that he talked openly about what he jokingly referred to as his 'phantasmagoria'.
He would see horses and bicycles racing, and whole landscapes whizzing by as if he were on a train. On one occasion, he found himself trapped in an apparently endless tunnel.
Hallucinations tend to have common themes: simple geometric patterns, disembodied faces with jumbled features, landscapes, groups of people, musical notes, vehicles and miniature figures in Victorian or Edwardian costume. They can be in black and white or colour, moving or still, but they are always silent.
The condition was named after Charles Bonnet, an 18th-century Swiss natural philosopher whose grandfather had seen people, patterns and vehicles that were not really there. Bonnet was the first person to identify that you could have visual hallucinations and still be mentally sound.
The condition can affect anybody at any age with diminishing eyesight. Even people with normal vision can develop it if they blindfold themselves for long enough.
But most people who have CBS have it as a side-effect of age-related macular degeneration - the most common cause of blindness in the UK. It is thought that up to 60 per cent of patients with severe vision loss develop CBS.
Crucially, CBS is caused by lack of visual stimulation rather than mental dysfunction.
Usually, on opening our eyes, the nerve cells in the retina send a constant stream of impulses to the visual parts of the brain. If the retina is damaged, the stream of impulses reduces, but - rather than lie dormant - other parts of the brain become hyperactive.
So when the brain isn't receiving as many pictures as it is used to, it builds its own artificial images instead from the areas we use every day to process faces, objects, landscapes and colours.
What you hallucinate depends on which part of the brain these increases are located. But why only a proportion of patients with macular degeneration experience hallucinations is still unknown, or why younger patients with macular degeneration are less likely to have CBS than older ones.
Dr Dominic ffytche, a senior lecturer at the Institute of Psychiatry, is a leading expert on CBS. He has been at the forefront of a campaign led by the Royal College of Ophthalmologists and The Macular Disease Society calling for eye doctors to warn patients with macular degeneration that they may develop CBS.
He says: 'In our experience, forewarning and knowledge of the possibility of hallucinations helps patients cope when they occur. It allows them to realise this indicates a functional problem with their sight and not a problem with their mind.'
It is thought that stimulating the fingertips, for example by feeling a dice with dimples, can help sufferers of CBS stop experiencing hallucinations.
In 2003, Sandra Jones, 54, a former TV producer, thought she was losing her mind when she started seeing faces looming towards her out of nowhere.
Having visited various massacre sites, including Rwanda, as part of her job, she assumed it was a form of post-traumatic stress disorder.
'Part of me thought this was payback time,' she says.
The faces would swirl off the pages of the book she was reading, or appear in front of her computer screen. It would happen three or four times a day, usually when she was feeling relaxed or trying to get to sleep.
'Some nights I couldn't lose them and I would only get an hour's sleep,' she says. 'Closing my eyes wouldn't help, so I'd get up and clean my house just to keep moving. I got the feeling that if I was tired, it would help me fall asleep, which would then free up my mind.'
She didn't dare tell friends or anyone at work for fear of jeopardising her job, and found out about CBS only after researching her symptoms online. Earlier that year she had been diagnosed with Sorsby's fundus dystrophy, a rare genetic eye condition which causes early onset macular degeneration, but nobody had warned her that hallucinations might be a side-effect.
'The unpleasant feeling was of not being in control,' she says. 'Once they are identified, they are not a problem.'
If the retina is damaged, the stream of impulses reduces and other parts of the brain become hyperactive.
Hallucinations can last from only a few seconds to several hours. In a minority of unlucky cases, they are continuous throughout the day. Patients usually have several daily before they taper off to once a week, then once a month.
For 60 per cent of patients, they will stop entirely after 18 months. There has not yet been a long-term study, but some patients report having them for at least three years.
Part of Dr ffytche's research involves looking into ways patients can stop the hallucinations. 'There won't be a single recipe for everyone,' he says. 'But hallucinations tend to occur when you are in a state of drowsy wakefulness, so you want to rouse yourself.'
As the condition is caused by a lack of stimulation in the visual part of the brain, one of the techniques he is investigating is stimulating the fingertips.
This is based on the fact that studies of brain scans of sight-impaired people reading Braille show increased activity in that area. The theory is that even feeling a dice with dimples could bring visions to a halt.
Other techniques include holding your breath; turning on a light if it is off, or vice-versa; standing up if you are sitting down; and moving your eyes. In extreme cases, medication is used. But the drugs can have side-effects such as tremors, drowsiness, sickness and diarrhoea.
Dr Winfried Amoaku, chairman of the Scientific Committee of the Royal College of Ophthalmologists and a specialist in macular degeneration, says when they come to visit him, patients do two things: first, they request that nobody else is in the room before mentioning the hallucinations, then afterwards they breathe a sigh of relief.
For Mary Orr, 84, from West Kilbride, the final straw was seeing the walls of her house covered in white fur. In desperation, she started to claw at them. 'It was then I thought: "I can't live like this," ' she says.
After months assuming she had dementia, she was referred to a psychiatrist who recognised the signs of CBS straight away and told her to see an eye doctor.
It explains why she still sees pink squares and snakes rising out of the pavement, but Mary is resolute that the worst is behind her. As she says: 'It's the fear of not knowing what's happening that you can't live with.'
• The Macular Disease Society, www.maculardisease.org, 0845 241 2041; Royal National Institute for the Blind, www.rnib.org.uk, 0303 123 9999.
Last updated at 8:06 AM on 03rd February 2009
Following his wife's death six years ago, David Stannard has become accustomed to spending quiet evenings alone at his home in Walton-on-Thames, Surrey.
So it came as a surprise to the 73-year-old when he looked up from his television one evening to discover he was sharing his living room with two RAF pilots and a schoolboy.
'The pilots were standing next to the TV, watching it as if they were in the wings of a theatre,' he says.
'The little boy was in a grey, Fifties-style school uniform. He just stood there in the hearth looking puzzled. He was 18 inches high at most.'
Mr Stannard's guests never said a word and vanished after 15 minutes. That night, he says, the walls of his house, which had always been white, looked as though they had been redecorated in patterned wallpaper with a brickwork effect.
The next morning he was caught off-guard again when he found a fair-haired girl standing on his sofa. She also appeared to be from the Fifties, but was life-size, wearing a short skirt and pink cardigan, with chubby knees, white ankle socks and ribbons in her hair.
'I watched her for a while,' he says. 'She didn't move much. Then she was gone.'
It would be easy to dismiss Mr Stannard's story as the bizarre imaginings of an elderly mind. Fortunately, he knew he wasn't losing his mind; neither was his house haunted.
A few weeks earlier he had been registered blind, though he was still able to watch television if he sat at a certain angle. He'd been warned that as his eyesight deteriorated, he might experience visual hallucinations in the form of Charles Bonnet Syndrome (CBS).
'I was lucky enough to know what it was,' he says, 'otherwise I would have thought I was going bonkers.'
An estimated 100,000 people in Britain have Charles Bonnet Syndrome (CBS), which leads to hallucinations. These can include visions of miniature people.
An estimated 100,000 people in the UK have CBS, but many won't realise it because the condition remains something of a mystery.
The real number is probably higher because sufferers are often too ashamed to talk about what they have seen for fear of being considered crazy.
The late historian Lord Dacre of Glanton, formerly Hugh Trevor-Roper, was unusual among CBS patients in that he talked openly about what he jokingly referred to as his 'phantasmagoria'.
He would see horses and bicycles racing, and whole landscapes whizzing by as if he were on a train. On one occasion, he found himself trapped in an apparently endless tunnel.
Hallucinations tend to have common themes: simple geometric patterns, disembodied faces with jumbled features, landscapes, groups of people, musical notes, vehicles and miniature figures in Victorian or Edwardian costume. They can be in black and white or colour, moving or still, but they are always silent.
The condition was named after Charles Bonnet, an 18th-century Swiss natural philosopher whose grandfather had seen people, patterns and vehicles that were not really there. Bonnet was the first person to identify that you could have visual hallucinations and still be mentally sound.
The condition can affect anybody at any age with diminishing eyesight. Even people with normal vision can develop it if they blindfold themselves for long enough.
But most people who have CBS have it as a side-effect of age-related macular degeneration - the most common cause of blindness in the UK. It is thought that up to 60 per cent of patients with severe vision loss develop CBS.
Crucially, CBS is caused by lack of visual stimulation rather than mental dysfunction.
Usually, on opening our eyes, the nerve cells in the retina send a constant stream of impulses to the visual parts of the brain. If the retina is damaged, the stream of impulses reduces, but - rather than lie dormant - other parts of the brain become hyperactive.
So when the brain isn't receiving as many pictures as it is used to, it builds its own artificial images instead from the areas we use every day to process faces, objects, landscapes and colours.
What you hallucinate depends on which part of the brain these increases are located. But why only a proportion of patients with macular degeneration experience hallucinations is still unknown, or why younger patients with macular degeneration are less likely to have CBS than older ones.
Dr Dominic ffytche, a senior lecturer at the Institute of Psychiatry, is a leading expert on CBS. He has been at the forefront of a campaign led by the Royal College of Ophthalmologists and The Macular Disease Society calling for eye doctors to warn patients with macular degeneration that they may develop CBS.
He says: 'In our experience, forewarning and knowledge of the possibility of hallucinations helps patients cope when they occur. It allows them to realise this indicates a functional problem with their sight and not a problem with their mind.'
It is thought that stimulating the fingertips, for example by feeling a dice with dimples, can help sufferers of CBS stop experiencing hallucinations.
In 2003, Sandra Jones, 54, a former TV producer, thought she was losing her mind when she started seeing faces looming towards her out of nowhere.
Having visited various massacre sites, including Rwanda, as part of her job, she assumed it was a form of post-traumatic stress disorder.
'Part of me thought this was payback time,' she says.
The faces would swirl off the pages of the book she was reading, or appear in front of her computer screen. It would happen three or four times a day, usually when she was feeling relaxed or trying to get to sleep.
'Some nights I couldn't lose them and I would only get an hour's sleep,' she says. 'Closing my eyes wouldn't help, so I'd get up and clean my house just to keep moving. I got the feeling that if I was tired, it would help me fall asleep, which would then free up my mind.'
She didn't dare tell friends or anyone at work for fear of jeopardising her job, and found out about CBS only after researching her symptoms online. Earlier that year she had been diagnosed with Sorsby's fundus dystrophy, a rare genetic eye condition which causes early onset macular degeneration, but nobody had warned her that hallucinations might be a side-effect.
'The unpleasant feeling was of not being in control,' she says. 'Once they are identified, they are not a problem.'
If the retina is damaged, the stream of impulses reduces and other parts of the brain become hyperactive.
Hallucinations can last from only a few seconds to several hours. In a minority of unlucky cases, they are continuous throughout the day. Patients usually have several daily before they taper off to once a week, then once a month.
For 60 per cent of patients, they will stop entirely after 18 months. There has not yet been a long-term study, but some patients report having them for at least three years.
Part of Dr ffytche's research involves looking into ways patients can stop the hallucinations. 'There won't be a single recipe for everyone,' he says. 'But hallucinations tend to occur when you are in a state of drowsy wakefulness, so you want to rouse yourself.'
As the condition is caused by a lack of stimulation in the visual part of the brain, one of the techniques he is investigating is stimulating the fingertips.
This is based on the fact that studies of brain scans of sight-impaired people reading Braille show increased activity in that area. The theory is that even feeling a dice with dimples could bring visions to a halt.
Other techniques include holding your breath; turning on a light if it is off, or vice-versa; standing up if you are sitting down; and moving your eyes. In extreme cases, medication is used. But the drugs can have side-effects such as tremors, drowsiness, sickness and diarrhoea.
Dr Winfried Amoaku, chairman of the Scientific Committee of the Royal College of Ophthalmologists and a specialist in macular degeneration, says when they come to visit him, patients do two things: first, they request that nobody else is in the room before mentioning the hallucinations, then afterwards they breathe a sigh of relief.
For Mary Orr, 84, from West Kilbride, the final straw was seeing the walls of her house covered in white fur. In desperation, she started to claw at them. 'It was then I thought: "I can't live like this," ' she says.
After months assuming she had dementia, she was referred to a psychiatrist who recognised the signs of CBS straight away and told her to see an eye doctor.
It explains why she still sees pink squares and snakes rising out of the pavement, but Mary is resolute that the worst is behind her. As she says: 'It's the fear of not knowing what's happening that you can't live with.'
• The Macular Disease Society, www.maculardisease.org, 0845 241 2041; Royal National Institute for the Blind, www.rnib.org.uk, 0303 123 9999.
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