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‘What a Long, Strange Trip It’s Been’

By Greg Jackson, PhD, FAAO

Van driving off into the distance

A few months ago, I was reading an article that ran in Review of Optometric Business with a headline that read, “From ‘Nice-to-Have’ to ‘Must-Have:’ Why Everyone’s Talking about Dark Adaptation.” I suddenly found myself humming the Grateful Dead as I reminisced about what a long strange trip it’s been watching dark adaptation take hold and enter mainstream optometry. What was it that happened between 1998 and 2021 that initiated the shift that’s inspired adoption on this much larger scale?

The launch of the original AdaptDx® automated dark adaptometer in 2014 obviously helped, but there was so much more that transpired in the last seven years. If I had to pick the one thing that tipped the scales, I’d say the answer lies in the evolved approach to implementation. After years of collaboration with our earliest converts and optometry’s thought leaders, it became evident that dark adaptation didn’t yet easily fit into every practice workflow. This is how the AMD Excellence Program® was born and […] optometrists all across the country are now changing the AMD standard of care in their practices. Here’s a little background on how this journey unfolded.

‘Sometimes the light’s all shinin’ on me’

As a graduate student at the University of Alabama at Birmingham, I had the privilege to work in Dr. Cynthia Owsley’s laboratory, where I was assigned to study the impact of aging on night vision. My first project was to evaluate whether older adults had more difficulty seeing a dim spot of light in the dark compared with young adults. You know how that story ends: the average older adult has a reduced light sensitivity in the dark. But as a twenty-something year old with no appreciation of what aging feels like, I thought this was novel enough to be the focus of my dissertation, which looked at whether dark adaptation speed decreased as a function of age.

‘Other times, I can barely see’

I started by collecting data on young patients. Everything was going well until I brought in a 72-year-old. The participant had excellent acuity, no visual complaints, and no history of any ocular or systemic disease that would affect his vision. I predicted that, in this case, the rod-cone break might be slightly longer than it was with the younger participants, but nothing prepared me for what was to come. As the minutes ticked by, I thought I had done something wrong. Thirty minutes passed, then 40—and still nothing happened. I thought about giving up and assumed my machine wasn’t working. My finger hovered over the abort button. Then it happened. The patient hit his rod-cone break at 45 minutes. My test worked. Had I given up, I would have missed the discovery of a lifetime.

I sent the participant to two retinal specialists, both of whom said he had a normal retina and no sign of any disease that would compromise his night vision. Fundus photographs were sent to a special reading center in Wisconsin, but these too came back as normal. It wasn’t until four years later that I discovered that this participant— and others like him—had developed clinical AMD. Eureka! I wondered: could impaired dark adaptation prove to be the earliest functional biomarker of AMD?

‘Lately, it occurs to me’

It took us many years to fully understand what’s now common knowledge—namely, that AMD is present before drusen are clinically visible,ii and that patients who have impaired dark adaptation are twice as likely to develop clinically evident AMD and eight times as likely to advance beyond the earliest stage of AMD.ii

It also took several years—and a lot of grit—to develop, market and sell a device that was affordable and easy to use. We achieved that with the first-generation tabletop AdaptDx. But that wasn’t enough. We had to make it more seamless in the practice flow. Hence, the AdaptDx Pro® headset was born. This made dark adaptation testing so much more practical because it creates a personal dark room anywhere and features an artificial intelligence-driven onboard technician. Her name is Theia™ and, trust me, technicians and patients love her!

Finally, we had the complete package, but there was still work that needed to be done. By and large, most doctors already have a very firm understanding of how the device works and what a difference it makes in patients’ lives. But this wasn’t enough to create the large-scale public health shift that was needed to elevate standard of care and save patients the unnecessary agony of avoidable vision loss. To do that, we needed to offer a blueprint of best practices. You’ll learn all about that in the Practical Implementation of Dark Adaptation in Optometric Practice, an annual report that is now in its fifth year.

As a company, MacuLogix® is so grateful for optometry’s guidance throughout this journey. Without you, we would not have seen the forest through the trees and we would not have been able to develop this guide to practical implementation of dark adaptation. Thank you!

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Practical Implementation of Dark Adaptation in Optometric Practice

This resource goes beyond explaining why dark adaptation is so important in optometric practice. Having already established the reasons why functional testing is essential, this year’s report outlines the practical strategies for how to make routine testing a reality in your own eye care practice.

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Gregory R. Jackson

About the Author

Dr. Jackson is the principal inventor of the company’s AdaptDx® technology. He previously held joint appointments in Ophthalmology and Neural & Behavioral Sciences at the Penn State College of Medicine and was Director of Clinical Research for Ophthalmology. Dr. Jackson has specialized in dark adaptation for the past 20 years, publishing a dozen journal articles on this topic. He earned a BS in psychology from Clarion University and a PhD in behavioral neuroscience from University of Alabama at Birmingham.

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