Vision Changes and the Elderly: Is Your Law Firm an Accident Waiting to Happen?

“Come quick! A woman fell in the hallway!” When your secretary bursts into your office, your heart sinks. Are people at risk for injuring themselves at your law firm? Have you made the necessary changes needed to accommodate the visual changes of the workers and clients who walk up your stairs, come through your doors, or use your bathrooms? Have you considered the coming epidemic of visual loss associated with the aging of the population?

Age-related macular degeneration (AMD) is the number one cause of vision loss and legal blindness in adults over 60 in the U.S. As our population ages, and the baby boomers advance into their 50s and 60s, we will see a virtual epidemic of AMD. Perhaps 14-24% of the U.S. population aged 65-74 years and 35% of people aged 75 years or more have the disease. Although it rarely causes total blindness, age-related macular degeneration robs those affected of their sharp central vision and can dim contrast sensitivity and color perception. It destroys the clear, “straight ahead” central vision necessary for reading, driving, identifying faces, watching television, doing fine detailed work, safely navigating stairs and performing other daily tasks we take for granted. Peripheral vision may not be affected, and it is possible to see “out of the corner of your eye”.

The impact of developing AMD can be devastating to those who were independent and active prior to the onset of this cruel impairment. Their visual world gradually diminishes into a vague blur, making ordinary daily activities challenging. ¹ Cataracts, glaucoma, diabetic retinopathy, stroke, and retinal tears also impact vision. Any of these conditions may be present in the elderly with whom you interact.

Up until about six years ago, there was no treatment for AMD. It is currently treated with vitamins, argon laser, light sensitive laser, or injections into the eye. The vitamins are specific to eye health and include beta-carotene, Vitamin C, Vitamin E, zinc, and copper. Argon laser cauterizes abnormal blood vessels and lesions close to the optic nerve. This treatment may provide the only temporary improvement or may worsen vision by creating an area of scar tissue. Light sensitive laser, or photodynamic therapy, is performed five minutes after a dye is injected intravenously. The patient remains sensitive to light for five days and is unable to be outside, sit near a window, or be under a halogen light. This is a serious restriction—third-degree burns will result from exposure to bright lights.

The concept of intravitreal injections into the eye sends shivers up most people’s spines. Kenalog and Avastin are both being used off-label for this purpose, and Lucentis, which was approved for use in June 2006, is also employed. Kenalog injections are associated with major risks, including infection, steroid induced glaucoma, and retinal detachment if the needle is put in the wrong spot. Avastin injections cost about $50 per dose compared to $1950 per dose for Lucentis. Lucentis must be injected every 4 weeks for 4 months, and then quarterly. ² Macugen has been approved for treatment and is injected into the eye every 6 weeks. Given the expense, complexity, and low success rates for treatment of AMD, the best method is a prevention of eye damage.

Walk around your law firm viewing it as if your next visitor had impaired vision. What do you see?

• Are the hallways highly polished, creating a glaring surface? Carpeting or nonglare finishes are safer. Is there extra lighting in the hallway and stairwell?
• Is the furniture in the waiting room beige, pink or gray, making it difficult for the older eye to see? Bright contrasting colors—red, orange and yellow—are easier to distinguish.
• Are there redwells on the floor in the way of traffic?
• Do the stairs lack hand railings?
• Are there large picture windows open to the view outside, but allowing glare to overwhelm the scene? Better, keep the shades or blinds closed.
• Are the forms you frequently hand to people to read printed in a small (10 or 12) font or do you have a large print version available? Are magnifying glasses available?
• Are the doorways of the rooms painted in the same color as the wall, or are they in a contrasting color to make them easier to see?
• Do your lamps have glare? Do you have small lamps that can be focused on paper that you want your client to be able to read?
• Do you have a dimmer switch attached to overhead lights that permit an increase in light or use bulbs that have three settings?
• Is the switch plate the same color as the wall, or is it a contrasting color or have a light built into the switch?
• Do you serve coffee or tea to older clients in cups with contrasting rims?

Med League provides Medical expert witnesses and medical record summaries for cases involving injuries to the elderly, as well as plain English explanations of medical issues. Contact us for details.

References

1. www.amd.org

2. L. Samorski, “Emergent Therapies in Macular Degeneration”, National Gerontological Nurses Association Annual Conference, October 6, 2006.

Tips for attorneys: What you can do to protect your eyesight:

1. Stop smoking. Tobacco seems to interfere with the absorption of lutein, an antioxidant that protects the eyes from ultraviolet light.

2. Wear sunglasses when exposed to blue light or sunlight and use caps with brims to protect the eyes, even on cloudy days.

3. Control blood pressure. The link between high blood pressure and AMD has been the subject of much research.

4. Eat a healthy diet low in saturated fats and high in fruits and vegetables.

5. Keep your blood glucose under optimum control if you are diabetic.

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