Eye Diseases

This page is meant to provide a brief insight into some of the more common eye diseases encountered in routine optometry practice.

It is not meant to be comprehensive, there are many excellent sites devoted to these conditions. However I hope that you will find the information here of interest.

Cataracts

A cataract is clouding of the lens in the eye. This is a common occurence as we get older, in fact a majority of people over 60 have a degree of cataract formation. The clouding can take place in various parts of the lens, which will also have a different effect on vision. For example clouding in the middle of the lens can be associated with an increase in myopia (short-sightedness), clouding at the back of the lens can severely reduce vision for what appears to be a minimal cataract.

Cataracts are associated with many causes. The main cause is simply increasing age, although there is an increased risk in certain medical problems eg diabetes, and also when some medications are taken for a long time eg steroids. There is also an increased risk of cataract development after an eye injury, particularly if the eye is penetrated.

Although there can be many causes, there is really only one treatment and that is surgery. Normally the cataract is allowed to develop until it is significantly affecting the persons sight before surgery is suggested. With modern techniques the results of surgery are very good, restoring sight mostly to what it was before the cataract developed. Often not needing optical correction for distance vision. However, because the lens is required to focus for near and it is the lens that is removed during the operation, an optical correction for near will be required.

Glaucoma Disease

The term Glaucoma actually refers to a number of closely related conditions that medically are referred to as the Glaucomas. It is beyond the scope of this page to cover all the conditions involved, so we will mainly cover the type of glaucoma most commonly seen in Optometric practice i.e. Primary Open angle Glaucoma (POAG). Primary because it isn’t associated with any other eye condition and open angle as opposed to closed angle which is a very sudden onset and often painful condition

POAG is a slowly progressive condition from which we are all at risk, although there are some factors that increase the risk namely: Increasing age (it is very rare below 40), if there is a direct family history of glaucoma, certain medical conditions increase the risk e.g. diabetes. Asians and Afro-caribbeans also have an increased risk of developing glaucoma.

The onset of POAG can be very insideous, often taking many years to develop to a point where the patient becomes aware of vision problems. It is painless and slowly restricts the peripheral vision. As it occurs so slowly it is amazing how much peripheral vision can be lost before you become aware that there is a problem. Clinically, we see a change in the appearance of the optic nerve at the back of the eye, which will also be associated with a change in the visual field. The pressure in the eye may also be raised, but that is not always the case.

The only way to detect POAG early is by someone skilled assessing your eyes, e.g. during an Optometric eye examination. During this, the back of your eyes will be assessed, including the optic nerve, as well as the pressures being measured and where appropriate, the visual fields assessed. This is a picture of an advanced glaucomatous disc, note the size of the pale area in the center compared to the normal disc shown on the eye examination page.

We are now one of the few optometry practices in the UK to also be able to assess the thickness of the nerve fibre layer at the back of your eye using the new GDx VCC scanning laser ophthalmoscope. This can provide even more information as to your risk of developing Glaucoma. If you are suspected of having POAG you will be referred to see an eye specialist (ophthalmologist) for further investigation. If POAG is confirmed, treatment is mostly with eye drops to reduce the pressure in the eyes.

POAG is most successfully managed if it is caught early, especially as any damage that has occured is irreversable, therefore regular eye examinations are advised for everyone, especially if you have an increased risk.

Macula Degeneration

Or AGE RELATED MACULA DEGENERATION (ARMD) is again a variety of conditions all under the same heading. This is a frustrating condition where the macula region (the area at the back of the eye with which we see most clearly) degrades. This results in reduced vision, sometimes to the point where the sufferer just sees a black hole in the middle of the vision. It is frustrating to the patient as it can severely affect their ability to undertake everyday tasks such as reading, TV, driving etc. and frustrating to the eye care professionals as it is a condition about which very little can be done.

There are 2 main types. Firstly a form characterised by a slow and progressive reduction in middle vision. This form is by far the most common and the vision loss is often less in this type. Although there is actually no cure, there are suggestions that vitamin and dietary supplements can help to reduce progression of early changes. Lutein, zinc and vitamins A, C and E have been found to be the most beneficial. There are now a number of vitamin supplements available, formulated specifically to prevent macula degeneration. Examples are Nutrof and Preservision.

The other form is much more sudden in onset, the patient often becoming aware of a sudden distortion in the middle vision. This is due to new blood vessels growing under the macula and then leaking. Clinically we may see haemorrhaging and leaking fluid at the back of the eye. It is sometimes possible to treat this type of ARMD with a laser and more recently with injections to destroy the new vessels. However not everyone is suitable and treatment has to be undertaken soon after the onset of the problem but unfortunately the treatment is not always successful.

On the bright side, this condition will not cause blindness as it can only affect the middle vision, all patients retain peripheral vision which allows them to get around. There is also alot of research being undertaken into the causes and treatments for this all too common problem. So in the future the outlook for patients with this problem may not be so bleak.

Diabetic Eye Disease

People who suffer from diabetes are at risk of developing problems with their eyes. In the early days just before and for some time after diagnosis, or if their control is poor, patients may suffer from alterations in the optics of their eyes. This presents as blurred vision, correctable by different spectacles. This however is transient and vision normally returns to a stable level once good control is achieved. It is therefore not a significant problem.

The more serious changes are caused by the small blood vessels at the back of the eye becoming leaky. This has a number of different effects, if the leakage is near the macula then it can obstruct the vision (diabetic maculopathy). If this occurs in the periphery, then ultimatley new blood vessels grow, these are structurally poor, are likely to leak or develop scar tissue, and can lead to retinal detachments and complete loss of vision.

Luckily only a small percentage of diabetics will develop such sight threatening disease. It is known that the risks of this occuring increase the longer someone has been diabetic and how well they have controlled it. In general, younger patients with insulin dependant diabetes with Type 2 (even if they are insulin requiring) are at greater risk of the maculopathy changes.

The good news is that the risk of developing sight threatening disease is drastically reduced if the early changes are detected and if developing beyond a certain level are treated, usually with a laser, to stop progression. This is why all people with diabetes should have at least an annual eye examination. There is now a national screening program for diabetic retinopathy where patients are screened by digital retinal photography. This should normally be undertaken annually to enable detection of early changes.

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Email: info@ocopticians.co.uk 

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