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    Support Groups for the Visually Impaired

    It is the role of all of us in ophthalmology to lift a portion of the burden of those who are losing—or who have lost—vision. We do this with increasing efficiency and success. There are, however, those patients who still descend into situations in which they can no longer meet their life goals.

    That said, all of us would do well to watch the Academy’s video on low vision featuring the Academy CEO, David W. Parke II, MD. It, cou­pled with the Academy’s handout “Low Vision”, is tremendously important. But there comes a time when we clinicians are at our wits’ end, and the tendency might be to say that “nothing more can be done.” That is not true: Something can be done.

    Neither the video nor the low vision brochure mention support groups for the visually impaired. At the Detroit Institute of Ophthalmology (DIO), we have had successful support groups for over 4 decades. Some believe these to be the largest such groups in the United States, which would attest to their value to those who attend. If they are run properly, support groups for the visually impaired give hope, create a compassionate and understanding community, and have tremendous social and psychological importance.

    The DIO would be happy to discuss such groups with anyone who is interested—please call 313-824-4710.

    Philip C. Hessburg, MD
    Detroit

    CRAO: Further Thoughts

    In “Diagnosis and Management of Central Retinal Artery Occlusion” (Pearls, August), the authors correctly em­phasize the systemic evaluation as critical for identifying embolic sources. Many of the emboli that cause CRAO are platelet thrombin emboli that are related to damage of the blood cells and platelets by trauma at a site of calcified and noncalcified plaque in the carotid artery. Neither carotid duplex ultrasound nor cervical magnetic resonance imaging can resolve these areas as well as computed tomography an­giography can; thus, the latter should be the initial study. If such areas are found in a patient with a documented embolic event, carotid endarterectomy may be considered despite clinically insignificant narrowing. By the same reasoning, the increased resolution of transesophageal echocardiography is preferred to identify small valvular vegetations or intracardi­ac thrombi. This should be performed even if imaging of the major arteries has disclosed a problem area.

    Michael A. Rosenberg, MD
    Chicago