Eye diseases
Although eye diseases are relatively rare, they do become more likely as we age. All eye diseases should be taken seriously, even those that appear to be minor can cause significant harm if not treated properly. Many serious eye diseases begin with no noticeable signs and as such, some people are unaware that they have a problem until irreparable damage has occurred. Everyone should see an optometrist every two years until they are 65 years of age, then they should visit yearly. If you're at a higher risk, your optometrist may recommend more regular visits.
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What are Cataracts?
Cataracts are cloudy spots that develop in the eye's lens. Normally, the lens is clear. Since the cloudiness prevents light from entering the eye, poor vision occurs. In the same way that a dirty window scatters light and makes it more difficult to see through, the opacities in the lens scatter light, giving foggy vision.
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Are Cataracts a kind of growth?
No. Cataracts are due to a change in the lens material, they are not an extra part growing within the eye. Cataracts can become worse as more of the previously normal lens material changes.
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What causes Cataracts?
The majority of cataracts are caused by ageing and prolonged exposure to UV radiation. Some are caused by trauma and certain illnesses, while others are caused in rare cases by hazardous compounds and radiation exposure. Cataracts can appear at birth for a variety of reasons, including the baby's mother having had rubella during pregnancy or a genetic defect.
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Do Cataracts get worse?
Yes. The cloudy patches get larger and denser, causing vision to deteriorate. This might take anything from a few months to several years to occur.
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Do Cataracts affect both eyes?
Cataracts usually affect both eyes, although they progress at different rates in each.
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How common are Cataracts?
People older than 65 years often have signs of cataracts and should have their eyes examined regularly. The severity of cataracts varies considerably between individuals of the same age.
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Can Cataracts cause blindness?
If untreated, cataracts can cause blindness. Blindness can be prevented by detecting cataracts early and, if necessary, by having them removed surgically. Your optometrist will refer you to an eye specialist if they consider that you need surgical treatment for your cataracts.
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How well will I see if my lens is removed?
In most cases very well. Most patients have an intra-ocular lens (IOL) inserted at the time of surgery, with excellent results. This is a clear plastic lens that replaces your own cloudy one. Patients may still need to wear spectacles or contact lenses after surgery.
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What are the signs of Cataracts?
Usually, the development of cataracts is gradual with a painless worsening of sight. Other symptoms include blurred or hazy vision, spots before the eyes, double vision and a marked increase in sensitivity to glare.
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How can I be sure I don’t have Cataracts?
An examination by your optometrist will reveal any changes that have occurred in the lens of the eye. Optometrists have special equipment that enables them to see changes in the lens that may lead to cataracts several years before any symptoms appear.
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Can Cataracts be prevented?
There is no proven method of preventing cataracts. Long-term exposure to ultraviolet light is thought to induce cataracts, so a brimmed hat and Australian approved sunglasses should be worn in sunlight.
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When should I have a Cataract operation?
This varies with each patient. Usually, cataract surgery is performed when the patient’s vision interferes with their daily life. Your optometrist will assist you in making this decision.
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Is Cataract removal a major operation?
Cataract surgery is now a relatively minor procedure. Often it is performed under a local anaesthetic. Depending on the patient, the surgery may be performed on an outpatient basis. This means that the patient attends a hospital or clinic for the surgery and can go home the same day. The surgery is performed by an ophthalmologist, a medical doctor who specialises in eye surgery. Your optometrist will refer you to an ophthalmologist when necessary.
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What is Conjunctivitis?
Conjunctivitis is an inflammation of the conjunctiva, the thin, transparent layer covering the surface of the inner eyelid and a portion of the front of the eye. This condition appears in many forms and affects people of all ages.
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What causes Conjunctivitis?
The three main types of conjunctivitis are infectious, allergic and chemical. A contagious virus or bacterium causes the infectious type, which is commonly called "pink eye." Allergies to pollen, cosmetics, animals or textiles can cause allergic conjunctivitis in certain people. In addition, irritants such as air pollution, unpleasant odours and chlorine in swimming pools can cause the chemical form to occur.
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What are the signs/symptoms of Conjunctivitis?
Red eyes, inflamed inner lids, watery eyes, impaired vision and a gritty or scratchy feeling in the eyes are common signs/symptoms of conjunctivitis. There may be a puss-like or watery discharge around the eyelids if the infection is contagious.
Since infectious conjunctivitis is contagious, precautions should be taken to prevent it from spreading. Keep your hands away from your eyes; properly wash your hands before and after applying eye medicine; do not share towels, flannels, cosmetics or eyedrops with others; and get treatment as soon as possible to avoid spreading contagious conjunctivitis.
Small children who may forget to take these precautions should be kept out of school and public areas until their condition is cured.
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What is Diabetic Retinopathy?
Patients with diabetes are more likely to develop eye problems such as cataracts and glaucoma, but the disease’s effect on the retina is the main threat to vision. Most patients develop diabetic changes in the retina after approximately 15 years of the disease.
The effect of diabetes on the retina is called diabetic retinopathy. In this condition the small blood vessels in the retina become weakened and leak, forming small haemorrhages. The leaking of the vessels often leads to swelling in the retina and decreased vision. If untreated circulation problems can occur in these vessels and the retina becomes deprived of oxygen. This leads to the death of the cells in the retina and a permanent loss of vision.
If you are diabetic, the National Health and Medical Research Council recommends yearly dilated eye examinations so that related eye problems can be detected and treated as early as possible. At our practice, we perform detailed dilated fundus examinations on all diabetics. We communicate with your general practitioner (GP) and also ophthalmologists (Eye specialists) to give you the best possible care.
There are two main types of this condition: background retinopathy and proliferative retinopathy. The risk of developing retinopathy increases with the length of time you have had diabetes. The risk is also increased by poor control of blood sugar levels and blood pressure levels. -
Background Retinopathy
This is the more mild form of diabetic retinopathy. This may involve haemorrhages and leaking blood vessels. In many cases patient will not notice changes in their vision themselves. More serious complications include swelling of the retina that may cause vision loss. This stage of retinopathy indicates that the blood sugar levels are not within appropriate levels
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Proliferative Retinopathy
This condition is more serious and requires early treatment to prevent serious vision loss. Your optometrist can recognise signs that this condition might develop or detect it in its early stages. Once proliferative retinopathy has been diagnosed, your optometrist will refer you to an eye surgeon for further appraisal and probable laser treatment. Treatment of this condition has a better chance of success if it is applied very early.
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Managing Diabetic Retinopathy
The time at which diabetic retinopathy begins is not predictable. Some people can have diabetic retinopathy upon being diagnosed with diabetes and others will have no signs of retinopathy even 15 years after being diagnosed with diabetes. The best management is to have regular eye examinations so that changes can be detected and treated early. It is advisable for all people with diabetes to have yearly eye examinations. People who have been diagnosed as having retinopathy should have eye examinations more frequently than once a year.
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Diabetes and Other Vision Conditions
Double Vision: This is a distressing but rare complication of diabetes. The condition is usually temporary, but it may last for a few months. An optometrist can help treat it while it has an effect. Diabetes is not the only cause of double vision.
Glaucoma: The eye disease glaucoma is slightly more common in diabetic people than in the general community. Glaucoma is a condition in which the nerve cells that transmit information from the eye to the brain become damaged, often caused by pressure due to a build-up of fluid in the eye. If untreated, glaucoma can cause blindness.
Cataract: Cataracts are more likely to occur in diabetic people at an earlier age than in non-diabetic people. A cataract is a cloudiness that can form in the lens inside the eye. If present, Glaucoma and cataract will be readily detected at your regular eye examination when your optometrist will advise the best management strategy for the condition.
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What is Dry Eye?
The tears your eyes normally produce are necessary for overall eye health and clear vision. Dry eye occurs when your eyes do not produce enough tears or produce tears that do not have the proper chemical composition.
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What causes Dry eye?
Dry eye symptoms can be caused by the natural ageing process, environmental exposure, issues with proper blinking or medications such as antihistamines, oral contraceptives and antidepressants. Dry eye can also be a sign of underlying health issues, other illnesses or chemical or thermal burns to the eye.
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What are the signs/symptoms of Dry eye?
Burning, stinging, itchy, scratchy, gritty and unpleasant eyes are the most common signs/symptoms; some people also have watering eyes. This is a normal reaction to relieve the discomfort of a dry eye. You may experience increased dry eye symptoms upon waking up.
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How is Dry eye diagnosed?
Your optometrist will ask you questions about your eye comfort, general health, medication usage and home and work environments during the examination to detect any variables that may be causing dry eye problems. This information will assist us in determining whether or not to conduct dry eye testing. These tests allow your optometrist to assess the quality, quantity and distribution of tears to diagnose dry eye symptoms.
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Can Dry eye be cured?
Although dry eye cannot be cured, the sensitivity of your eyes can be reduced and precautions are taken to keep your eyes healthy. Artificial tears or tears replacements are the most often used therapy. An ointment can be used to treat more severe dry eyes, especially at night. Other treatments include; Warm eyelid compresses and massage, Intense Pulsed Light (IPL) treatment to improve your natural tears, omega 3 supplements and small plugs called punctal plugs to reduce tear loss.
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Will Dry eye harm my eyes?
Dry eye can harm your eyes if left untreated. Excessive dry eye can cause tissue damage and possible scarring of the cornea, impeding vision. Due to increased discomfort and a higher risk of infection, dry eye can make using contact lenses more challenging. You and your optometrist will work to keep dry eye problems under control.
Please notify us as soon as possible if you have increased dryness or redness that is not resolved by the prescribed medication. If your discomfort persists, you can take the drops more regularly or as needed. As instructed, you should return for follow-up care.
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What is Glaucoma?
Glaucoma is a disorder that causes damage to the nerve cells that convey information from the eye to the brain. This inhibits visual information from reaching the brain from the retina in the eye. Glaucoma is often linked with a build-up of pressure in the eye. The eye is filled with fluid that is constantly being replaced. If excessive amounts of fluid are produced or if it cannot drain away properly, the pressure inside the eye can increase. The pressure inside the eye can grow exceedingly high in some types of glaucoma, but it can also remain normal in others.
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What causes Glaucoma?
The exact causes of glaucoma are not known. In some cases the drainage network of the eye may not be formed properly, or may become blocked by natural materials or due to injury; in other cases, there is no clear cause.
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Is the damage that occurs in Glaucoma serious?
Glaucoma can lead to blindness if left untreated. The capacity to see objects in different parts of the visual field and your peripheral vision is gradually lost when nerve cells are injured. Although nerve cell damage cannot be reversed, it is often possible to prevent additional harm. This damage can develop until the person's vision is reduced to only central vision or until they are entirely blind. The longer the disease is left untreated, the more serious the consequences become. Modern examination techniques and treatment have made glaucoma a rare cause of blindness in Australia.
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How can I tell if I have Glaucoma?
You may be unaware that you have glaucoma until it is too late - if it goes undetected. Often, no symptoms appear until irreparable harm has occurred. In some cases, the increased pressure in the eye will cause blurred vision, apparent coloured rings around lights, loss of side vision, pain and redness of the eye.
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How does an optometrist diagnose Glaucoma?
To diagnose glaucoma, an optometrist checks the nerve fibres at the back of the eye, analyses the eye's drainage network, and uses a tonometer to measure the pressure in the eye. A peripheral vision test (visual field examination) and an optical coherence tomography (OCT) will be performed if your optometrist suspects glaucoma. These tests are easy to do and do not cause any discomfort.
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How is Glaucoma treated?
Eye drops and medicine are often used to treat glaucoma initially. Surgery may be necessary if the blockage in the drainage system cannot be removed in other ways. Your optometrist will refer you to an eye specialist for treatment if they suspect you have glaucoma.
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Can Glaucoma be prevented?
No. Early detection and treatment is the best way to control glaucoma.
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Who is likely to be affected by Glaucoma?
People over the age of 40 years are far more likely to have glaucoma than younger people. Also, glaucoma tends to run in families. People with a blood relative who has suffered from glaucoma and people over 40 years of age are at risk and should have their eyes checked regularly by an optometrist.
Keratoconus
Keratoconus (literally, ‘conical cornea’) is a thinning and steepening of the cornea, the front clear window of the eye. As the cornea thins, the normal pressure within the eye makes the thinner area of the cornea bulge forward slightly.
Keratoconus can be an inherited disorder but may also happen in individuals without any family history of the condition. It occurs in about one in 3000 people. The condition usually becomes apparent between the ages of 10 and 25 years and is sometimes associated with other conditions such as allergies, infantile eczema, asthma, reduced night vision, double jointedness, and in rare instances, occasional short bouts of chest pain.
Keratoconus cannot be treated with medication, but glasses and contact lenses can improve vision, and surgery can be used to treat progressive or severe cases. Keratoconus does not cause blindness. Interestingly, about 60 per cent of people with keratoconus go on to tertiary education, compared with 15 per cent of the population as a whole.
The initial symptoms of keratoconus are blurred vision, caused by short-sightedness and astigmatism. These are caused by the cornea changing shape as it bulges forward, and are often indistinguishable from shortsightedness caused by other factors. At this stage, good vision generally can be obtained with spectacles.
As keratoconus progresses, the shape of the cornea becomes irregular, and it is not possible to correct the vision with spectacles alone. In such cases, rigid contact lenses can be used to provide good vision. The contact lenses essentially provide a new, regular front surface for the eye, eliminating the distortions caused by the keratoconus.
Because the cornea continues to change shape, people with keratoconus must have regular eye examinations to ensure that their contact lenses fit correctly. A poorly fitting contact lens can cause abrasions and scarring.
In approximately 85 per cent of cases of keratoconus the condition gradually stabilizes by the age of 35 years, although exceptions are always possible. In the remaining 15 per cent, the condition progresses, and vision and tolerance to contact lenses may deteriorate. For anyone with progressive keratoconus, intervention with a relatively new surgical procedure called Collagen Cross-Linking may stabilize the cornea and even halt progression. If your keratoconus is progressing, your optometrist will discuss this surgical option with you and refer you to an ophthalmologist.
In late uncontrolled stages of the disease, a corneal graft may be necessary. A corneal graft or keratoplasty is an operation in which the thinned area of the cornea is removed and replaced by normal tissue transplanted from a donor cornea. Corneal grafting is used only when all other methods for correcting vision have failed to provide good vision. The success rate for corneal grafts is extremely high, although most people will still need to wear glasses or contact lenses.
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What is age-related Macular degeneration?
Age-related macular degeneration (AMD), is damage or breakdown of the macula. The macula is a very small part of the retina, the light-sensitive tissue of the eye, which is responsible for central vision. This is the part of the retina that produces the finest detailed vision.
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How does Macular degeneration affect vision?
As macular degeneration damages the part of the retina responsible for central vision and for seeing fine detail, it becomes difficult to see small details of objects. Vision to the sides is not affected. If both eyes are affected, reading, recognising faces and other tasks requiring fine vision may become very difficult. Because some side vision remains, usually people with macular degeneration can still take care of themselves.
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What causes Macular degeneration?
Macular degeneration is the result of ageing processes in the eye. Some of the layers of the retina thicken and waste material, which is usually removed from the retina forms deposits, distorting the retina. This distortion can cause damage to the other layers of the retina. In about 10 per cent of cases, new blood vessels grow into the macula from beneath. These newly formed vessels are fragile and often leak blood into the retina where the blood causes scar tissue to form. The scarring blocks out the central vision to a severe degree. There are also some other forms of macular degeneration which are inherited and not associated with ageing.
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How common is Macular degeneration?
Macular degeneration mainly affects older people: about four per cent of those more than 40 years old, nine per cent of those over 50 years, 23 per cent of those over 65 years and 31 per cent of those aged 80 years or more. Macular degeneration accounts for up to 45 per cent of legal blindness and up to 70 per cent of seriously impaired vision in people over the age of 70 years.
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How is macular degeneration detected and diagnosed?
People with macular degeneration may notice that their vision has deteriorated. Many patients do not realise that they have a problem until their vision becomes blurred. Optometrists perform several tests in an examination which enables them to detect the presence of macular degeneration in the early stages. The optometrist examines the macula carefully and takes digital pictures of the macular so that any changes can be precisely visible. Sometimes the optometrist may place a drop in the eye to dilate the pupil to get a better view of the internal structures
Through techniques called fundoscopy or ophthalmoscopy, the optometrist will look for changes in the structure of the macula such as accumulations of waste material or new blood vessels. Other scans such as an optical coherence tomography (OCT) scan may be required. This scan gives a cross-sectional view of the macular to better assess and track dry and wet forms of macular degeneration. Another test that may be used involves a grid pattern known as an Amsler grid. This is a regular grid that looks like a piece of graph paper. Patients with macular degeneration often report that sections of the grid appear to be distorted or missing.
Some types of severe macular degeneration need to be monitored by an ophthalmologist (eye surgeon). Your optometrist will refer you if you have this form and the ophthalmologist may perform a test called fluorescein angiography. In this test, a fluorescent dye is injected into the patient’s bloodstream and the ophthalmologist observes the progress of the dye through the blood vessels in the retina. This reveals any leaking blood vessels.
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Can Macular degeneration be treated?
When most body tissues such as a muscle, skin or bone are damaged, the tissues’ cells can regrow and repair the damage. Because nerve cells cannot regenerate, damage to nerve tissue, such as the retina, is usually permanent and irreversible. This is why vision loss in macular degeneration is so difficult to treat, compared with other vision disorders. For example, it is possible to remove and replace the eye’s lens in a person with a cataract, but it is not possible to replace or even repair the retina of a person with macular degeneration.
One possible management which has been shown to decrease the likelihood of macular degeneration worsening in some people who already suffer from the disease include vitamins. A large study (AREDS 2) found that a specific combination of vitamins could reduce the likelihood of the degeneration progressing. Ask your optometrist about whether you may be helped by this treatment.
In cases where new blood vessels have appeared in the macula area, laser surgery or injections may be used. In laser treatment, a focused, intense beam of laser light is used to seal off leaking blood vessels and to prevent new vessels from growing. There are also eye injections that may slow or prevent the formation of new blood vessels. These treatments are most effective when applied in the very early stages of the disease before extensive damage has been done.
While there is little that can be done to prevent or cure macular degeneration, people with the disease can be helped so they can continue living a normal life. Some patients with macular degeneration will eventually come under the classification of being a low vision patient. Special help in the form of low vision devices are available from optometrists and specialist low vision clinics. Low vision devices enable patients to make the most of their vision and include items such as miniature telescopes, high-powered reading spectacles, hand-held and stand magnifiers, closed-circuit televisions and other simpler aids such as large-print books.
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What should you do about Macular degeneration?
For treatment of macular degeneration to be effective, it must be diagnosed as early as possible. Regular eye examinations are the key to the early detection of retinal changes and other signs of disease. If you notice any change in the quality of your vision, have your eyes examined immediately. Regular examinations are particularly important for people over the age of 50 years and people whose families have a history of eye problems.
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What is a Pterygium?
A Pterygium (pronounced te-ri-gi-um, plural: Pterygia) is a triangular-shaped lump of tissue that grows from the conjunctiva (the thin membrane which covers the white of the eye) onto the cornea (the clear central part of the eye). Pterygia often occur in both eyes, usually on the side of the eye closer to the nose. A Pterygium is not cancer. People sometimes confuse Pterygia with Cataracts. A Cataract is a clouding of the lens inside the eye and cannot be seen easily with the naked eye.
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What causes Pterygia?
The exact causes of Pterygia are not known, but they are strongly associated with exposure to ultraviolet radiation and hot, dry environments. Pterygia are more common in the Northern parts of Australia and among people such as farmers and surfers who spend a lot of time outdoors, but anyone can develop a Pterygium.
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Are Pterygia dangerous?
Pterygia are not dangerous, although they can look unpleasant and cause some discomfort. The main problem with Pterygia is that as they grow onto the cornea they distort it, interfering with vision. If the Pterygium grows onto the central part of the cornea it can begin to block light from entering the eye. This can cause vision loss. Although a Pterygium is not dangerous, it should be checked to make sure that it is not something more serious and that it is not progressing. If you have any area of tissue on or around the eyes that changes rapidly you should consult an optometrist or eye surgeon (ophthalmologist) immediately.
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How can Pterygia be treated?
In cases where the Pterygium is not actively growing onto the cornea, protecting the eyes from ultraviolet light often will stabilise its growth. In many cases, provided it is not threatening vision and it remains stable, this may be all that is required. In cases where the Pterygium is actively growing onto the cornea and threatening to distort the vision, the only effective treatment is surgical removal. Fortunately, this is a relatively minor surgery that usually is performed under a local anaesthetic. It is best to have surgery before the Pterygium progresses to the point where it interferes with vision. Your optometrist can assess the Pterygium and refer you to an eye surgeon if it requires removal.
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How can Pterygia be prevented?
The best way to reduce your risk of developing a Pterygium is to protect your eyes from ultraviolet light. UV radiation can also cause cataracts and other eye diseases, as well as skin cancers, so reducing exposure is a wise move. The best ways of doing this are to:
Avoid the sun: in summer, three-quarters of outdoors UV exposure occurs between 10 am and 4pm. Staying out of the sun between those times will significantly reduce your UV exposure.
Wear sunglasses: a good pair of sunglasses will reduce the amount of UV reaching your eyes and cut the amount of glare. Wrap-around sunglasses are best as they block UV radiation that can slip around the sides of conventional sunglasses.
Wear a hat: a broad-brimmed hat will not only protect your head from sunburn but will reduce the amount of UV radiation reaching your eyes by at least half.