Tuesday, August 25, 2015

Updates on Clinical Trials

There are numerous clinical trials and research projects happening all over the globe for Stargardt's in different scientific and technological fields giving us great hope for the future. Here are the current clinical trials taking place:

Drug Trial of ALK-001
Alkeus Pharamceuticals are conducting a phase 2 trial of an oral drug in the United States. A phase 2 trial looks at the safety of the drug, what side effects it may have, how long it stays in a person's body and the dosing required. This study will also look at whether it affects the progression of Stargardt's. The trial will follow participants over two years assessing these key factors. For more information click here. If you are located in the United States and are interested in finding out more about participating in the trial visit their website here.

Phase 1 Trial using Gene Therapy in the US and France
This is a gene therapy trial currently recruiting in the US and France. It is a phase 1 trial thus the main focus is on looking at the dose of the sub-retinal injection and the effects it may have. If you are interested in participating, the two centres involved are the Casey Eye Institute in the US and the Centre Hospitalier Nationale d'Ophthalmologie des Quinze-Vingts in France. For more information on the specifics of the trial click here.

Stem Cell Trials
The stem cell trial using human derived embryonic stem cells (hESC) I have previously mentioned is still in progress. This trial is run by Ocata over three sites in the US (California, Florida and Pennsylvania). The trial involves an injection of the stem cells into the retina. The researchers will be observing the participants over a 15 year period to monitor the progression of the stem cells, whether they become retinal cells, how this affects vision and if there are any long term complications. More information can be found here and here.

Investigative Research
There are a couple of research projects taking place looking at different aspects of Stargardt's Disease such as its progression. It is important that researchers continue to look at the how, what, where and why of SD to better understand the disease as we don't have a lot of information about it. This information can then be used for targeted treatments and even prevention of disease progression. These projects are always good to participate in because they involve little risk (unlike treatment trials) as they simply gather information, test results and images. The more participants these types of studies get the more information can be gathered and learnt about a condition. 
The National Institute for Health Clinical Centre in Maryland, USA, is currently recruiting for a natural history study of SD. If you are interested in participating check out their website.
The other project is the Inherited Retinal Degenerative Disease Register which is not only for SD but other inherited retinal diseases. This is run by the Foundation Fighting Blindness and more information can be found here.

Wednesday, July 8, 2015

We are all unique

A phrase I seem to be continually hearing goes something along the lines of "another person who is legally blind could do it". The most recent time was in reference to attending a residential school for my university course located in another state.

I want to get something straight, just because people are classified as 'legally blind' it DOES NOT mean that they have the same level of vision, experiences, confidence or abilities as the next person. The assumption that we all share the same experience is incorrect.

Now I understand that I can't expect everybody to understand what I am going through, but I at least expect from people in certain positions to have a degree of empathy and knowledge that people with disabilities needs differ. No two people's experiences are the same. There a so many factors that come into play.

Stargardt's Disease and other inherited retinal diseases such as Retinitis Pigmentosa are degenerative diseases. Vision deteriorates over time. Progression may be rapid or slow, it may start when you're in school or when you're an adult. Vision can stay stable for a period of time and then deteriorate dramatically. No two people share the same experience of vision loss. 

In my case, I have been losing my vision for five years. My vision has decreased from 6/15 to 6/60 in that time. When you start to lose your vision you go through a process of adaptation; adapting to the world, viewing it in a new way and finding different ways of doing things. There is also a grieving process (I've written about it here) and each time my vision deteriorates, I go through it all again. 

Every person has a unique experience, has developed different coping mechanisms and is at a different stage of acceptance. To assume that because two people are both 'legally blind' that they share a common experience is untrue.

Never assume a person's ability and experience. Ask questions. Be open to suggestions. Be helpful. Listen. Be empathetic and not sympathetic. Be positive. Be part of changing the perception of people with a vision impairment.

Image source: http://www.google.com.au/imgres?imgurl=http://www.zen-mama.com/wp-content/uploads/2012/07/shutterstockTime-for-Change.jpg&imgrefurl=http://www.zen-mama.com/2012/07/dear-friend-its-time-to-change-your-life/shutterstocktime-for-change-2/&h=675&w=1000&tbnid=salx-oGQeDo4-M:&zoom=1&docid=olymHlLRJOxzfM&ei=wAOdVZbLDcXk8AWp15rgCA&tbm=isch&ved=0CIEBEDMoTzBP

Saturday, June 27, 2015

When to use a mobility aid

A common question that arises amongst people with Stargardt's Disease and other vision impairments is whether I use a cane, a guide dog or neither. The question then  asked is visual acuity, how it helps and why some people use aids and others don't. I've been thinking about this question a lot lately and hope to help others with a vision impairment and without to understand why I choose to use a cane and what factors influenced my decision, and hopfeulyl help others to decide, whether to use a mobility aid.

As I've previously written, my cane and I have a love-hate relationship. I went through a period of using it to not wanting to know there were three in existence in my house, to becoming best friends with it once again. For the past few months I have made a conscious effort to get used to using it and taking it whenever I'm out. 

There were two main reasons I chose to use the cane:
  • Crossing roads: My ability to cross a road is absolutely terrible. I'm an avid walker and love to get out in the fresh air and walk to calm my mind. Every time I found myself curbside, I felt vulnerable, clumsy and even more vision impaired. I couldn't make out whether there were cars coming, if near a busy road there was no auditory break in the traffic and I felt like I was walking into an abyss. Then came the anxiety from the feeling of vulnerability and the loss of control. When I walked with another person, I would solely rely on them to usher me across the road. I knew this wasn't healthy and I couldn't rely on others. So Mr Cane came back into my life once again like a clingy, annoying boyfriend although this time he had gotten his act together and we were actually getting along. I found just having the cane in my hand to indicate brought a sense of calm and confidence to crossing a road, it let others know that my vision sucked and they should be patient and careful if I start to cross. More than anything it was security. It was a way of announcing to the world I'm vision impaired. People's reactions were (mostly) helpful, they would stop and let me cross and some even reversed to let me pass. It restored my faith in humanity and made me feel like the world isn't such a scary place. 
  • Pavement problems: I'm a klutz on the best of days and now I'm a super klutz. The pavement around where I live seems to be really bad, the huge eucalyptus and gum trees' roots have made the footpaths cracked and uneven. Since using the cane I haven't had any stacks or tripped over where I normally would. Just to reinforce this, I went for my usual walk the other day without my cane and I tripped numerous times and realised it was my karma for leaving the cane at home. It's actually quite surprising how helpful the cane is when on the street. I never noticed how much I was concentrating on where I was going and what I was walking into. When I started using the cane I found I could relax a lot more and take in my surroundings using my other senses rather than staring intently at the ground in front of me.

Choosing to use a mobility aid such as a cane or guide dog is a highly personal choice and isn't solely based on visual acuity or degrees of vision. Each person is different, has different experiences and different needs. Here are some of the things that are usually taken into account when deciding on an aid:
  • Confidence: This is extremely important. Being confident with your surroundings, with the amount of vision you have and the way you use it will impact whether you decide to use a mobility aid.
  • Lifestyle: This includes work - how you get there and what you do at work ie whether you need to navigate a great deal, leisure activities such as sports or running and social situations. Use of a mobility aid may not be needed in all areas of a person's life. It is pretty much impossible to run with a cane (yes I've tried and looked like a clown running down the street) and sometimes it's better left at home.
  • Location: Where you live can also play a part. If you need to travel far on public transport or have access to lifts from others will influence the decision to use a mobility aid.
  • Perception: How you perceive mobility aids plays a huge role, not so much for the positive. I personally have struggled with, and still do, the stigma surrounding using a cane. There tends to be a little less stigma associated with a guide dog as they are far more cuter than a cane! As much as I'd like to say how you perceive using a mobility aid doesn't attribute to whether you use one or not, it really does play a major part. I avoided using my cane for a very long time because I was embarrassed as to what people think and I still have times where I feel like people are staring and talking about me. 

The one thing I have learned is that if I need help to not be ashamed and to use it. If a cane, guide dog or anything else helps me navigate, feel confident and improve my quality of life I should use it. I also know personally and from others with a vision impairment that because we have some sight we don't 'deserve' a guide dog. This is utter rubbish. As I mentioned before, if it helps us in life, we deserve it. Be open to trying mobility aids, sometimes you find a use for them that you had never considered.

 Image source: http://www.google.com.au/imgres?imgurl=http://4c1lions.files.wordpress.com/2012/06/white-cane-day.jpg&imgrefurl=http://district4c1lions.org/about/white-cane-safety-day/&h=399&w=600&tbnid=ELquhjxngEcDHM:&zoom=1&docid=XQcXF0wr-QH-OM&ei=44aOVb_HA9P68QWVnYDQDQ&tbm=isch&ved=0CDoQMygXMBc and https://www.pinterest.com/pin/274578908507893730/

Sunday, June 7, 2015

My Fear Vs My Optimism

Over the past few years I have had numerous thoughts that provoke fear and sadness about things in my future. From having my whole life seemingly planned (yes I know I'm slightly OCD) and my goals within my reach to all of it taken from underneath me. I sometimes look back at the day of diagnosis and the weeks following it and the feelings and thoughts I had - they were grief-stricken and quite frankly irrational. I'm thankful that at the time I did not make any rash decisions, most likely because I had no idea what to do.

I've gathered some of my most personal and distressing thoughts I've had about my diagnosis with Stargardt's and how it will affect my life. For each of them, I've tried to take a positive spin and find the reality in each to help me cope and see the glass half full. I hope this can help others who are having the same thoughts.

My Fear: How will I ever see my babies faces?
My Optimism: I can still see faces up close, and let's be honest I'll be in my babies' faces constantly! From being around other babies I won't lie and pretend I haven't noticed that I need to get closer to see their cute little eyes and smiles, but from the experience I've been able to find a certain peace in it and know that I will still be able to see them to a degree up close. It won't hinder my bond with my children. They will also learn to adapt to my situation and become strong, positive little beings who are sensitive to people with a disability.

My fear: I won't be able to live independently. I won't be able to get where I need to go in an emergency and especially if I have kids.
My optimism: I live at home with a huge family and enough animals to have our own zoo. I have lived out of home previously but this was the early stages of my disease and I could still drive. I'm hoping to move into my own place in the near future and have realized that there is a lot I need to consider - I need to make sure I live walking distance from shops, doctors etc, close to public transport and my work. I also want to be a short distance from my family so I can travel alone to them. When I tell people that I want to stay living locally I am frequently questioned and told there are so many other beautiful places to live. The reality is - I need support. Is that a bad thing? No. Do people without a vision impairment need support? Yes. So what is so bad? Nothing. I may need to plan my location a little more than the average person but that really doesn't matter. In the end I will still be able to find a home with accommodations to support my independence. 

My fear: I won't be able to find a partner who will accept me for me.
My optimism: If someone can't accept I have a vision impairment and see my worth as a person, then they aren't worth another minute of my time! This is something I have grappled with numerous times and it is hard to actually truly believe it. My generation is focused on possessions, selfies and everything is disposable. There is always something better (apparently). This has really broken me down. I have thought I now have a 'flaw' and 'who would want to be with someone who can't see or drive?' I've realized how untrue this is. My vision doesn't affect my worth as a person, in fact it increases it. It has given me knowledge, strength and resilience. It has given me a whole new outlook on life, taught me empathy, taught me determination. These are all qualities that are positive and can bring wealth to a relationship. So if somebody doesn't appreciate that, to be cliche, it is their loss. I would never be the strong woman I am today without this experience.

M fear: I won't be able to work doing a career I enjoy.
My optimism: Of course I can! Never say never (sorry, I hate to quote Justine Beiber but he is actually right!). I've said this from the start, I may just have to take a different route to get to the end goal. For instance, I wanted to do medicine, I wanted to be able to help people. What did I do instead? I studied psychology. I'm still doing what I love and will be able to sustain this career despite my vision. It could be anything you want to be (with the exceptions of anything driving related but driver-less cars could change this!).Don't listen to people who tell you otherwise. It may be tough at times but what in life isn't. The most important thing is to do something you love and enjoy every day and do something that gives you meaning. Don't settle for anything that doesn't make you happy. 

I hope that others can find the optimism in their fears. I am still battling with these ideas but over time it becomes easier and I become more positive. It is always scary at the start but once you really think about the truth in the thoughts they don't seem as overwhelming. 

Most of all never think you are alone. Sometimes speaking out about your feelings and emotions can be beneficial. It is cathartic. Whether it be family, friends or a counselor. Vision loss is not just a physical condition, it affects every aspect of one's life. Don't be afraid to acknowledge that. 

 Image source: https://www.pinterest.com/pin/362328732497745408/


Monday, June 1, 2015

What's all the talk about Optogenetics?

In the past couple of months there have been several news articles talking about optogenetics and its use as a treatment for eye conditions including Stargardt's, Retinitis Pigmentosa and Macula Degeneration. I hadn't come across the term so I thought I'd do some research into what exactly it is, since I am known to have to know everything about everything!

Optogenetics is a new technology, first discussed in 2004, using the ideas of neuroscience and microbial biology. The basic idea of optogentics is that light can activate and deactivate cells. It was observing algae that led to the lightbulb moment (excuse the pun). Algae would swim towards light, and scientists found a protein that was activated by the light and causing its behaviour.

Scientists then came up with the idea to remove the DNA (protein)  from the algae, use gene therapy (attach it to a virus so it can be put into other animals) and then inserting into the animal cell. Once it was in the cell, it would replicate and fill the cell with these light sensitive proteins. They could then manipulate the cells using different coloured light. They also had the ability to add these viruses only to certain cells.

This technology is being investigated for brain diseases but also for vision conditions. Below is a TED talk that explains the discovery of optogenetics, how it is being researched and describes its use for vision conditions. Basically what it says is that even though the photoreceptor cells are damaged, light can still get into the retina. Optogenetics installs cells to act as a 'camera'. The video shows an experiment they have done with mice that, I must admit, got me a little emotional thinking about the possibility of seeing things again!

Below are links to optogenetics and vision articles.

Medical Daily, 11 May 2015 

Science News, 15 May 2015 

PLOS Biologue, 7 May 2015 

Daily Mail, 11 May 2015 

Image source: https://www.sciencenews.org/article/how-rewire-eye

Monday, May 18, 2015

Real People #4

Today I'd like to share another story from someone I have been able to become good friends with. Janet is another young lady who I have watched flourish and grow and I am so proud of the positive attitude she has adopted that also helps me stay positive. 

Janet Ngan, 24, Phoenix, Arizona, USA

When were you diagnosed with Stargardt's disease and how did it affect you at that time?

I was first officially diagnosed with Stargardt's disease when I was 15 years old.  It feels much longer than that because I remember getting my first pair of glasses when I was in first grade (age 6). I always had vision problems and I spent most of my childhood going to different doctors and getting new glasses. I remember never being able to read the board at school and having issues adjusting to light from the sun after recess. However, after seeing so many doctors and getting new prescriptions for my glasses I felt like it should help so I started pretending like it really worked. I would go to school early or stay late so I could copy notes from classmates and sit in the front of the classroom as close to the board as possible. I would even pretend to forget my glasses so I could get someone to read me what was on the board. This worked out okay for a couple years but then as schoolwork started getting more difficult it got really hard to hide my vision. When I was a sophomore in high school, we had our annual health fairs to test your vision, hearing, etc and I did so bad on the vision part that they sent a letter home to my parents saying that I needed to see a doctor. When I went to see my doctor, she didn't understand what was wrong with me so she sent me to a “special doctor” (ophthalmologist). I remember it was the summer of 2006 and I was sent to about six or seven different doctors performing special tests on my eyes. Finally, when I saw my ophthalmologist again, he told me that I had a rare eye disorder called Stargardt's disease. The rest of that summer was so hard and I had so many emotions. I cried almost everyday, blaming myself, feeling like the biggest failure in the world, and just could not bring myself to accept it. But after awhile things cleared up and I learned to find the positivity inside of me. Even though I was healing from my emotions I still felt ashamed to tell my friends about it at the time. I hid the secret from my friends, classmates, and teachers. This only lasted for a little while because when I started doing very poorly in my algebra class I knew I had to tell someone. Thankfully, my algebra teacher at the time had noticed that something was wrong with me and I confronted her about my vision. She contacted the school and found two faculty members who worked with students with disabilities such as those with a visual impairment to work with me. They provided me with different resources such as using a CCTV, magnifiers, enlargement my textbooks/exams, extra time to complete my exams, and a note taker to help me in class. This was like being in a new world for me. I was still kind of embarrassed by all the attention of carrying textbooks that were almost three times its size. But I did find that these accommodations were helping me tremendously in my classes. I worked really hard and my grades were finally picking up and it actually didn't feel dreadful to go to class everyday. So at the time I was diagnosed I felt like the disease made me weaker but I've realized that it was what I needed to make me stronger. It was definitely a struggle and some days it still feels rough but I've learned to not give up and try my very best in everything I do. I've learned to ask for help when I need it even though I don't want to. Most of all, I learned that Stargardt's doesn't define me, it is my attitude and how I choose to react to it that makes me who I am. I can't change something that is beyond my control but I do have control on how I live my life.

What parts of your life have you adapted because of this disease?

I think Stargardt's has affected many aspects of my life but the most recent and hardest part was the inability to drive a car. I was diagnosed at the age where I was supposed to get my instruction permit to start learning how to drive but I was unable to because I failed the eye exam portion of the test. So I never really had that experience of driving throughout my teenage years and having a car during college. When I was in college, I lived close to campus so I could ride my bike or take the shuttle to school so it wasn't a big deal. When I went out with my friends, they usually picked me up so I didn't have an issue until after I graduated. I learned that a driver's license was the ticket to EVERYTHING from going to places on your own to getting a job! I did not prepare myself for this struggle when I was in school so I felt super lost at the time. I thought I could just ride the bus but I didn't realize how scarce, unreliable, and time consuming the public transportation system can be. So I ended up talking to my doctor/low vision specialist and they told me I was able to drive with bioptics. Bioptics are these lenses that have a telescope on top that magnifies like a binocular. I was really excited for this and I felt like I was finally able to drive and be more independent. I spent my year off from school doing the bioptic training and it was just a huge struggle. At some moment I was really happy and felt like I was doing a good job. However, because of the safety and how my vision fluctuates I had to give up the driving. This was probably the second biggest hurdle I had to overcome since my diagnosis and it left me devastated. I didn't know what I was going to do with my life if I couldn't drive and get a job. It almost felt like the summer of 2006 again. But I didn't let it get to me as I picked myself back up and I talked to the local vocational rehabilitation about resources for the visually impaired. My vision hasn't gotten bad enough to the point for me to use some of the resources. I found a part time job working in retail and learned how to take the bus there by myself to work. This was my way of feeling like I could be independent no matter the challenges that Stargardt's brings. During this time I also reached out to people about my issue and explored the different options for me to find success. I knew I didn't want to move back in with my parents for them to take care of me for the rest of my life. I was passionate with public health and helping people improve their quality of life which was what I studied for my undergraduate degree but jobs were incredibly hard to find since I needed to be able to drive in order to perform the job in the community. So in a way I had to adapt my career to fit me as well. During this time period I worked on classes and applications for graduate school for occupational therapy. So in the beginning, not being able to get my driver's license felt like the end of the world to me because so many things I wanted to do revolved around that. But I was able to find a way to make it work and continue to grow stronger and adapt to the hardships that Stargardt's brings.

What are your goals and where do you want to be in ten years time?

This is a very good question! I know time goes by fast but I have no idea where I will be a whole decade from now! A lot can happen in that period of time and life is just unpredictable. So it is hard to imagine me at 34 years old (ew I'm going to be OLD!) when I barely know what is happening tomorrow. However, my biggest goal right now is to make it into graduate school and get my Master's in Occupational Therapy. I expect that in ten years I should be an occupational therapist and loving my job. I really want to be able to make an impact in people's lives. I want to help the visually impaired and other people with disabilities be able to find the independence and fulfillment in their lives. I want to reach out to people who may feel as lost and confused as I once was and show them that anything is possible and nothing is worth giving up on their dreams. Also, in ten years’ time I hope to have traveled more (hopefully meet you in Australia!) and cross off more things on my bucket list. I guess I'm pretty simple. In ten years’ time I just want to be someone that I can look at and be proud of. I want to be happy and make everyone around me happy. Sounds cliché, I know.

What inspired and motivated you to get you to where you are now on your journey?

Honestly, I feel like this disease itself has impacted me so much to become who I am today. Yes, it did bring me a lot of stress and challenges to get over. But what is life without these experiences that make you different from everyone else? Being able to go through each hurdle that comes my way and ending up here is super inspiring to me. There were actually times where I felt like I could never make it this far but I continue on this journey learning so much. I spent some time being angry at why out of the billions of people in the world it had to be me, but I don't think I would be the same person as I am without Stargardt's. It has really taught me to cherish life and to put in 110 percent in working harder to achieve my goals. I never wanted to take things for granted and just want to make use of all the vision I have to create a spectacular vision for the future. It has also given me the compassion to want to help others who may have similar problems get through it because I understand what a pain it can be. This was a huge reason why I want to pursue a career in Occupational Therapy and stay in the healthcare field. I used to think Stargardt's was the biggest curse of my life but I've learned to see it as a blessing. It makes me unique, I mean how many people have awkward stories of walking in the wrong car or not recognizing someone instantly while you're having a conversation with them?  Maybe that part is not much of a blessing but to people who know me and understand, it gives us something to laugh about later. Having Stargardt's also gives me the drive and determination to do anything and turn the “impossible” into “I'M Possible.” I know I'm always going to have those days where I feel depressed that I'm not living up to where I should be based on where I see other people but this just makes me want to try even  harder to get to where I want to be. Also, I think the more I understand this disease (such as from my diagnosis), the better I feel because I realized it is just a part of me and that I wasn't going crazy because I didn't have the same vision as everyone else. I actually found it very inspiring when I first read your blog and found that there was someone in the world who felt and experienced exactly what I endured. Even though we literally live on opposite sides of the world and we've never even had a cup of tea together, I feel this sense of closeness and energy with you because of the one thing we do have in common. I'm the type of person where I can get easily motivated and enthusiastic at life because I get my energy off of other people. So being able to share our experiences with each other has helped me significantly because I know that I'm not alone. I know that I can continue growing stronger than ever no matter what comes my way.

If you would like to connect with Janet on Facebook click here.

Thank you for sharing your experience. Despite our distance, you have been a huge support for me and motivate me to keep doing what I'm doing. 

The Stargardt's community we have all contributed to is incredible. Thank you to everybody who has been a part of it and keep all the emails, Facebook messages, tweets and Instagrams coming! 

Thursday, May 7, 2015

See Through My Eyes on Facebook

If you are on Facebook and don't already follow "see Through My Eyes - Stargardt's Disease", head over and make sure you 'like' the page here.

On the page I share up-to-date information on clinical trials and research articles, Stargardt's in the news and other information on services and resources available to people with vision impairments.

I also have a very exciting announcement to make in the coming weeks so make sure you stay tuned!