A new piece of technology has transformed the eye care industry called the AdaptDx. Dr. Bob Consor of shares how his practice has achieved new heights in early detection of macular degeneration with this new instrument.
Backed by 20 years worth of research and technology, the AdaptDX monitors dark adaptation to detect the very first sign of macular degeneration.
What is dark adaptation?
Dark adaptation is the speed at which your eyes adapt from a bright room into a dark room. Picture going from the street into a movie theater and having to navigate to find your seat. The faster you go, then the faster the cells in your macula adapt. This rate shows the health of the macula.
How does the AdaptDX work?
The AdaptDx is an in-office, non-invasive device that measures dark adaptation with 90% accuracy and assesses your risk factor for macular degeneration. The test itself takes no more than 7 minutes. If you take longer than 6 1/2 minutes to adapt from light to darkness, that means you have macular degeneration.
Among the various studies, research was published just last month (February 2019) by the University Alabama Institute of Ophthalmology showing, yet again, medical-based evidence again linking macular degeneration and dark adaptation. Although this has been established long before, we know now that reduced dark adaptation equates to the very first functional loss of integrity of the cells in the macula.
AdaptDx is an instrument that we're proud to say that Texas Macular Degeneration Associates is the only practice in Dallas that carries it. We're one of the few practices in North Texas with this technology, which is still one of the few practices in the United States that have it.
So we're very proud of what we can do for people.
It's an opportunity to discover macular degeneration sooner with the AdaptDx. We can empower our patients to make changes in their lifestyles and minimize the effects of the disease. In addition to that, the AdaptDx allows us to retest patients over intervals of time. We can tell if their dark adaptation is getting prolonged. The speed at which dark adaptation gets prolonged is how fast your macular degeneration is progressing.
I had a patient yesterday in the exam room who said, “Well, if you stop the disease, why bother coming back and checking my dark adaptation if I had a prolonged one, one that was beyond the normal range?”
I said, “Well, it will help you take the disease more seriously. Especially, if you're not doing all of the lifestyle changes and modifications as you should be. One of the lifestyle modifications is to exercise 30 minutes a day, five days a week. If you're only exercising two days a week, and you're not pushing yourself hard enough, maybe you'll start doing exercise more often if you notice that your dark adaptation or retired dark adaptation is becoming prolonged. Or, if you're not taking your supplements, maybe you will start taking them. Or, if you're taking supplements, maybe you should double up on your supplements. If you're a smoker who's only smoking less because you're trying to modify your lifestyle because we told you to, maybe stop smoking.”
So, he was satisfied after I told him that.
When do you start recommending the test?
There are two aspects of the macula. The structure, which is the layers of the macula, and the function, which is the integrity of the cells in the macula to fire or to process information.
The first thing that becomes compromised in the early stages of macular degeneration is the structure: the cellular layer, the rods, and the cones in the macula. These layers oxidize, and they become sick. They no longer process light and information as quickly, which prolongs dark adaptation. After those cells start to lose their functional abilities, then one can notice tissue changes in the macula and other structural changes.
Now, with the AdaptDx, we can predict when you're going to have the disease. We don't have to wait for the macula to swell, become wet, or the blood vessels to leak to indicate some wet macular degeneration. In the case of dry macular degeneration, we don't have to wait to see the cholesterol given off by these cells, which start to structurally manifest as drusen — yellow deposits in the macula. The Adapt DX can detect macular degeneration several years before it is noticed in a routine dilated eye exam.
Monitoring dark adaptation avoids clinical error as well. Optometrists without the AdaptDx among their technology will fail to capture macular degeneration symptoms until years later.
The fact is, and studies have been done, that macular degeneration is missed 25% of the time in a dilated eye examination because you don't see it yet. Or they're not looking for it carefully enough. So, macular degeneration is being missed one-fourth of the time when it's there.
Having the technology is not enough.
You've got to take a good case history, you've got to ask the right questions of your patients and listen to what they're telling you.
One of the earliest symptoms on the patient side of the coin is night vision issues, glare at night, blur at night, problems of readapting, etc.
For example, if you’re driving at night and another car’s headlight shines into your eyes. As you pass that other car on the road and fall back into darkness, some people don't even see the road for a couple of minutes after that or see the road very poorly. If a patient complains of any night vision problems, that’s a sign.
Mind you, there are other reasons for night vision problems, and it could be you simply need a change in your glasses prescription. Maybe you have big pupils that let more light in and it's disturbing. Still, it is a hallmark symptom of macular degeneration if the patient has the right profile or you're not finding things in your exam that makes sense why they have impaired night vision. Then, you got to turn to technology that measures dark adaptation and there comes the Adapt DX.