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Maculopatía: Otra Forma de Ver: Cómo llevar una vida normal con baja vision

Chou, Brian

Optometry and Vision Science: April 2004 - Volume 81 - Issue 4 - p 231-232
Book Review

Carmel Mountain Vision Care San Diego, California

Maculopatía: Otra Forma de Ver: Cómo llevar una vida normal con baja vision, Erwin H. Voss. Buenos Aires: Letemendia, 2003. Pages: 203. Price: $28.05.ISBN 987-98986-7-2.




This is the first book written in Spanish about living with age-related maculopathy (ARM). Intended for the layperson, the translated title and subtitle is:Maculopathy: Another way to see: How to live a normal life with low vision.

The book is divided into two parts. The first part introduces the reader to basic eye anatomy, then to ARM, including the dry and wet forms. In Spanish, ARM is denoted by the acronym, DMRE (degeneración macular relacionada con la edad).

One particularly useful chapter is “Salir de Dudas” (literally, meaning “To Leave Doubts”), which sets the record straight on common patient misconceptions. For example, it addresses the fallacy of believing that individuals with ARM should limit use of their vision so as not to “expend” all their useful vision. It also corrects the idea that ARM causes total blindness. The chapter goes on to explain why a doctor cannot simply prescribe stronger glasses to restore vision.

The chapter “Tratamientos Disponibles” (Available Treatments) goes over different alternatives for ARM, including photodynamic therapy, laser photocoagulation, and transpupillary thermotherapy. There is even mention of recent investigative procedures such as macular translocation and anecortave acetate (under development by Alcon).

A discussion ensues regarding risk factors for ARM, categorizing uncontrollable factors together such as age, family history, and race. Controllable factors such as smoking, poor diet, and sun exposure are addressed as well. The chapter “Autoexamen Periódico” includes an Amsler grid with instructions on how to use it for monitoring visual changes.

The following chapter, “Tambien Los Ojos Se Alimentan” (The Eyes Are Also Fed) discusses the findings of the Age Related Eye Disease Study and the importance of a balanced diet with antioxidants.

“Ayudas Ópticas” (Optical Aids), covers magnifiers, telescopes, CCTV’s, and other computer aided devices. Proper emphasis is given to how partially-sighted patients should seek a low vision practitioner to prescribe these devices. The first part of the book is finished by a look into rehabilitation and training for orientation and mobility, giving encouragement to take the processes step-by-step.

The second part of the book delves into specific strategies for daily living, including taking medicines, driving a car, personal safety and hygiene, using the telephone, managing money, shopping, and sports. In general, the author provides practical information and encourages those with ARM to stay active and involved in society. These elements are no doubt important for anyone to maintain a high quality of life.

Near the end of the second part is the chapter “Historias de Vida” (Life Stories), where four patients with low vision give personal accounts of living with their impairment. These stories are moving and resonate with the reader. The stories collectively show how overcoming visual loss is challenging, yet how affected patients can still lead rich and productive lives with the assistance of a low vision practitioner.

Preceding the index is a glossary and some information on useful patient resources like Books on Tape, Lighthouse International, Macular Degeneration Foundation, and the National Eye Institute Information Office.

Upon receiving my copy, one of my first thoughts was how many people might benefit from this book? Within my own practice, I have several Hispanic patients with pterygia and diabetic retinopathy— but not maculopathy. Therefore, what is the prevalence of ARM among U.S. Hispanics? Looking in PubMed, I found a cross-sectional study that randomly sampled 4774 Hispanic residents of Santa Cruz and Pima Counties in Southern Arizona aged 40 years and older. 1 ARM accounted for 15% of all visual loss in this population. Another population-based study comparing the participants of the San Luis Valley Diabetes Study and the Beaver Dam Eye Study found that while late-stage ARM appeared to be rare among Hispanics, there was no difference in prevalence of any ARM compared to non-Hispanic whites. 2 This data suggests that a modest number of Spanish-speakers in North America with ARM could benefit from this book’s information. The author, Dr. Erwin Hermann Voss, may have a patient base with an even greater prevalence of late-stage ARM because he practices in Argentina, where a larger number of Hispanics have a European ancestry.

As I read through the book, I was impressed by the accuracy and scope of the information. Dr. Voss has done a marvelous job in distilling technical information into practical and patient-friendly sentences. The tone of the book is positive, yet it does not promote unrealistic hopes or expectations so often sought by those affected by ARM.

I will recommend this book to Spanish-speaking patients with ARM, along with their friends and family. The information has the potential to positively change the life of an ARM patient. Too often in busy clinical practice, practitioners may overlook mentioning some of the sound advice in the book.

While I have no substantive criticism for the book, I would hope that Dr. Voss and his publisher consider printing a large-type edition and an audio cassette version as well. The book is printed in 12 point font and some patients with ARM, including the ones that need the book’s information the most, may find difficulty resolving the text.

Dr. Voss has done an excellent service to the Spanish-speaking community by publishing this well-written book.

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1. Rodriguez J, Sanchez R, Munoz B, West SK, Broman A, Snyder RW, Klein R, Quigley H. Causes of blindness and visual impairment in a population-based sample of U.S. Hispanics. Ophthalmology 2002;109:737–43.
2. Cruickshanks KJ, Hamman RF, Klein R, Nondahl DM, Shetterly SM. The prevalence of age-related maculopathy by geographic region and ethnicity. The Colorado-Wisconsin Study of Age-Related Maculopathy. Arch Ophthalmol 1997;115:242–50.
© 2004 American Academy of Optometry