The following information is intended to be used as a guide only as each patient’s eye condition and treatment plan will be individualized. The Doctors at City Eye Centre will perform comprehensive examinations and have discussions with you at the time of your consultation.
- Age-related Macular Degeneration (ARMD)
- Retinal Detachment
- Retinal Tear
- Macular Hole
- Epiretinal Membrane
- Central Serous Retinopathy
- Diabetic Retinopathy
- Flashes and Floaters
- Retinal Vein Occlusion
- Dry Eyes
What is CATARACT?
Cataracts are one of the leading causes of reduced vision, glare and sometimes distortion in vision. Surgery involves the use of phacoemulsification which is an ultrasound probe. This removes the cataract through a very small incision in the front of the eye.
Once the lens has been removed, an artificial lens is inserted through the small incision. This lens unfolds inside the eye into the correct position. The small incision then seals itself or is closed with one or two sutures which are usually removed in the post-operative phase.
Following surgery, the eye will be padded overnight. You will be reviewed the following day and the pad will be removed. The vision will initially be blurry but it should clear over the following days and continue to improve over the next month to two months. New spectacles are usually prescribed at two months following the surgery.
Once the pad has been removed, the eye may be left opened and sunglasses or other spectacles may be worn to protect the eye. A plastic eye shield should be worn at night for the first two weeks following surgery to prevent any trauma to the eye.
The eye may feel irritated for the first week following surgery due to the small stitches and the surgery. Severe pain may indicate that the pressure in the eye is elevated or that an infection may be developing. A reduction in vision may suggest an infection or inflammation or development of retinal problems such as retinal detachment. These complications are however rare. Should any complications such as severe pain or loss of vision occur, it is advisable to contact Dr Lee as soon as possible.
You will be required to use eye drops and, in some cases, tablets to control the intraocular pressure following surgery. The eye drops are usually required for one to two months following surgery.
Following surgery, you should keep the eye clean and dry and take care while showering to avoid getting water in the eye for the first two weeks. You should also avoid prolonged coughing, straining, bending, or heavy lifting for one month following surgery. Swimming should be avoided for at least two months following surgery. You may walk about and perform your usual daily activities after a few days as long as care and hygiene is maintained.
What is MACULAR DEGENERATION?
There are two types of macular degeneration:
Dry type: This type does not leak and generally is the better type to have. The vision may decline at a slow rate causing loss of reading vision and central vision. There is no specific treatment apart from antioxidant vitamins.
Wet type: This type is due to abnormal blood vessels (called choroidal new vessels) growing at the macula (central part of the retina used for detailed vision such as reading). This causes leakage and bleeding under the retina, which can occur quite rapidly. This may lead to rapid loss of vision and blindness.
In both these types of macular degeneration the central vision is damaged but the peripheral vision is usually not affected.
Latest ANTI-VEGF Therapy
Eylea (aflibercept), Lucentis (ranibizumab) or Avastin (bebacizumab) are anti-vascular endothelial growth factor (VEGF) drugs, which have shown significant success in treating age related macular degeneration. These drugs are useful in the wet form of macular degeneration and they act by inhibiting the growth of abnormal blood vessels and help prevent leakage of these blood vessels.
Current research has found these drugs to be well tolerated as an intravitreal injection. Research so far has shown up to 70% of patients show improvement with this treatment.
Injection of these drugs is performed as an outpatient procedure. Topical and local anaesthetic is used and therefore the injection should have minimal pain. Patients are discharged on the same day and may go home with a patch on their eye. This is removed after approximately three hours and antibiotic eye drops such as Chlorsig are administered four times a day for three days to help prevent infection.
Patients need to be aware that in the first one or two days they may have some ocular irritation from the injection, as well as tearing and redness in the eye. They should notify City Eye Centre if they notice any persistent pain, signs of infection or severe loss of vision. Generally the side affects of these drugs are rare but they may include intraocular infection, which can cause loss of vision and requires urgent treatment. Other rare complications include lens damage, retinal detachment and very rarely blood pressure rise, and cardiovascular problems.
Up to 70% of patients notice some improvement after their first injection. Most patients require injection performed monthly for the first three months, often requiring OCT scans to monitor the progression and response to treatment. Following this the interval between treatments may gradually be increased up to two months. Treatment will be tapered by your Doctor according to the response that is obtained. Some patients have responded very well and only require one or two injections, whereas others have required repeated injections before they are stabilized.
Use of antioxidant vitamins, such as Macuvision, Lutein-Vision, Multivision, or Macutec has been reported to be useful in reducing the progression of macular degeneration by reducing oxidation damage to the retinal cells. Patients may take one or two Macuvision daily and some combine this with one or two tablets of Lutein-Vision daily. Multivision combines the active ingredients of both Macuvision and Lutein-Vision. A diet including fish, green vegetables and nuts is beneficial. Use of margarine, cooking oils (except olive oil) and processed food should be avoided. Smoking has also shown increased risk of macular degeneration progression and should be ceased.
What is RETINAL DETACHMENT?
A retinal detachment is where the retinal lining detaches from the back wall of the eye. This is due to a tear or a break in the lining, allowing fluid from the vitreous jelly to leak under the retinal lining, causing the retina to lift off. The retinal tear may occur due to trauma, or more commonly, due to vitreous traction from the vitreous jelly causing a rip in the retinal lining. In some cases, there may be a family history of retinal detachment. Also, high myopia (short-sightedness) may increase the risk of tears in the retina as the retina is thinner. Some patients are born with an inherited weakness in the retina causing lattice degeneration that may also pre-dispose them to a retinal detachment.
Approximately one in ten thousand people will suffer from a retinal detachment. Prior eye surgery or trauma may increase the risk.
Symptoms of a retinal detachment
The patient may notice symptoms of a retinal tear or detachment, such as a sudden onset of flashes and floaters, followed by loss of vision, with the impression that there is a curtain moving up and down or sideways. They may note that vision on one side of their field has decreased. The patient may also notice that their vision is blurred.
Treatment of a retinal detachment
Treatment of a retinal detachment involves an operation. There are two methods that can be used to treat a retinal detachment.
1. Vitrectomy surgery
Vitrectomy surgery involves the removal of the vitreous jelly which can harbour factors that cause scarring of the retina. The surgery also relieves traction in the vitreous jelly that may have caused the retinal detachment. Vitrectomy surgery uses microsurgical instruments inside the eye, enabling laser treatment to seal the retinal tear or break. Special gas is injected inside the eye to close the retinal break. This is usually absorbed over a period of six to eight weeks. Vitrectomy surgery is usually performed in conjunction with scleral buckling.
Scleral buckling surgery is usually reserved for smaller retinal detachments; usually for patients who have had no previous intraocular surgery.
Vitrectomy surgery, combined with scleral buckling surgery is usually performed in larger or more complex retinal detachments or in patients who have had former intraocular surgery.
In very severe cases of retinal detachment, where there is scarring of the detached retina, the scar is required to be removed with microsurgical instruments and long acting gas or special high grade silicone oil is required to be injected inside the eye to flatten the retinal detachment.
The length of time for surgery varies from approximately one hour for a scleral buckling operation to one and a half to three hours for a complicated case involving vitrectomy surgery and scleral buckling.
2. Scleral buckling
A scleral buckling operation is where a reinforcing silicone band is placed on the outer wall of the eye to close the retinal tear. This is used in conjunction with cryotherapy which seals the retinal tear or break. Air or gas may be injected into the eye which also helps to close the tear or break. The scleral buckle remains in place permanently and becomes part of the eye wall. In very rare circumstances, it may need to be removed at a later date.
In most cases, vitrectomy surgery and scleral buckling can be performed under local anaesthetic with sedation. If required, general anaesthesia can be provided.
The success rate for retinal detachment surgery is approximately 90%. Approximately 10% may require further surgery if the retina is not attached after the first procedure. In some cases the retina may be attached initially, but the retina may scar after about 6 to 8 weeks and re-detach. Once the patient’s retina remains attached for 3 months following the surgery, the incidence of further retinal detachment is much less.
The improvement in vision will depend on the amount of retinal detachment and the length of duration of a retinal detachment prior to the surgery. Following a retinal detachment procedure, normal vision may not be fully regained. This is due to damage to the photoreceptor cells in the retinal lining.
The vision following retinal detachment surgery may continue to improve for up to a year following the surgery.
What is RETINAL TEAR?
A retinal tear is a tear in the retinal lining. It occurs when the vitreous jelly traction on the retina causes a rip, such as a tear in wallpaper. This requires URGENT treatment as the tear may enlarge in size and the retinal lining may detach. This is caused by the fluid from the vitreous jelly leaking under the retina, causing it to lift off. This is like wallpaper falling off a wall due to inadequate adhesion. This may be associated with some haemorrhage into the vitreous jelly.
Treatment for a retinal tear usually involves laser treatment. This is usually done in the consulting rooms. You will be directed to look in a certain position, then the laser beam is used to treat the retinal tear. The laser causes a seal around the retinal tear. This is like welding.
You may feel some mild discomfort. It is important to look where directed and not look directly at the laser beam as this powerful beam of light can burn the central vision if you look directly at the laser beam.
It is also important to stop any medication (such as Aspirin or Warfarin) that may thin the blood, as this may cause further bleeding around the retinal tear. It is important to check with your doctor before stopping these medications.
Cryotherapy may also be performed in conjunction with laser if the tear is too large for laser treatment alone. This is usually performed in an operating theatre and is often done as a day procedure. The cryotherapy probe allows more powerful treatment to cause a reaction around the retinal tear to seal it.
Success of the Treatment
The treatment has a success rate of approximately 90 to 95%. Most retinal tears are effectively treated and usually do not require re-treatment. There are some patients in whom the retinal tear may enlarge despite treatment and these may require further laser or cryotherapy treatment. If a retinal detachment develops, then surgery will be required.
The patient should rest for approximately three days after the treatment, avoiding any heavy lifting or anything that may increase the blood pressure. If you do suffer from hypertension, then it is important to get this checked by your General Practitioner.
Following the laser treatment, your eye may ache and the vision will be blurry, due to the bright lights. This usually settles over a few hours. You may take analgesics such as Panadol or Panadeine, but it is important to avoid aspirin.
You may still see flashes of light and floaters after the laser treatment. This should settle with time, but may take some weeks to months. In some cases, an occasional flash of light of floater may persist, which usually does not cause any problem.
What to watch out for
You should watch out for a sudden onset of new flashes, or new floaters. Also watch out for loss of vision or the impression that a curtain is coming down or going up in your line of vision. These symptoms may mean progression of the retinal tear, or the development of a retinal detachment. Dr Lee’s consulting rooms should be contacted (on 3831 6888) as soon as possible and another appointment made.
Are drops required?
How much time should I take off work?
Most patients take one to three days off work. If your work involves heavy lifting and straining, then a longer period of up to a week may be required.
You will be required to attend for a follow-up appointment about a week after the treatment, or sooner as directed by Dr Lee. Following that, you will usually be required to re-attend a few weeks later.
If there is an associated vitreous haemorrhage with a retinal tear, you may require closer monitoring. Once the retinal tear is treated, the vitreous haemorrhage should clear, though may still take up to several weeks to some months to fully clear. The blood in the vitreous jelly usually gravitates to the bottom of the eye and is reabsorbed. If you shake your head, the vitreous haemorrhage may circulate again into the centre of the visual axis and you may notice a floater again.
Any increase in the floaters should be reported as this may mean that the retinal tear is bleeding further.
What is MACULAR HOLE?
A macular hole is a retinal problem whereby a hole develops in the macular region. This region is where the central vision is seen by the eye. Therefore this hole causes distortion in the central vision, and sometimes a dark spot is noticed in the centre of the vision. It is more common in the elderly and in women, though it can occur in both sexes. Trauma may also cause development of a macular hole. The underlying cause is thought to be due to a fine membrane around the macular region which undergoes centrifugal traction which pulls the hole open.
A cross-sectional (OCT) scan of the retina showing a hole developing in the macular (central) region of the eye.
Surgery is very successful in closing the macular hole and improving vision. Surgery involves vitreoretinal microsurgery where very fine microsurgical instruments are inserted inside the eye and the vitreous jelly removed. The fine inner retinal membrane which causes the macular hole is also removed. A special dye called ICG helps to remove this layer of traction. A special long acting gas is left in the eye which is absorbed over six to eight weeks and replaced with the eyes own fluid. The success rate of closure of a macular hole is greater than 95%. Some holes may require further surgery if the initial surgery is not successful in closing the hole. Very rarely, some holes, particularly those holes which have been present for a long period of time, may not be able to be closed.
Once the hole is closed, the distortion in vision should improve and the level of vision should also improve (in approximately 70 – 80% of cases). The degree to which this occurs, depends on the length of time that the hole has been present and the success of the surgery.
If the hole is not treated, then it may cause further deterioration in vision and enlarge with time leaving a larger size dark spot in the centre of vision.
In some small early macular holes, these may improve without treatment and are therefore observed. These however require regular follow-up. Once the macular hole begins to enlarge and your vision decreases, surgery may be considered to close the hole.
Following surgery, the vision will be blurred for approximately six to eight weeks, due to the gas bubble and the dilating eye drops.
For the first two weeks following surgery the patient needs to keep their face down for forty-five minutes in the hour, the other fifteen minutes may be used to perform normal duties. They need to sleep with their head face down as much as possible. The face down position can be maintained whilst sitting in a chair and keeping the head down.
Following the two weeks of positioning, the face down positioning need only be maintained for half an hour at a time, as directed by Dr Lee.
Eye drops need to be used for approximately two months following surgery. These will be advised accordingly when required.
New spectacles may need to be obtained two to three months following surgery.
Though macular hole surgery is successful in closing most macular holes, one should be aware that occasionally there are problems which can arise following surgery. A cataract may develop earlier than would be expected during the normal aging process. Sometimes cataract surgery is combined with macular hole surgery if a cataract is already present at the time the macular hole is diagnosed. Cataract surgery is a very quick and successful surgery. Occasionally, the eye may develop increased pressure (glaucoma) and medication may be required to control this.
Retinal tears or detachment of the retinal lining may develop during surgery, or following surgery, and may require further surgery to correct these.
Infection and haemorrhage are very rare risks which may occur with any surgery and if you notice pain or reduced vision following surgery, Dr Lee’s consulting rooms should be contacted on 38316888 or 33457111 as soon as possible.
When considering surgery, one should be aware of an approximate 10% risk of the other eye developing the same problem. Because of this, one would be severely impaired if both eyes should develop a macular hole. Surgery is usually successful in closing the hole, stabilising further deterioration in vision and improving the vision.
What is EPIRETINAL MEMBRANE?
An epiretinal membrane (or pre-macular fibrosis) is a scar which develops at the back of the eye on the retinal lining causing distortion in the vision. The scar may be due to the normal aging of the eye, or it may be due to previous retinal trauma or retinal tear. Surgery may be successful in removing the membrane and improving the distortion in vision. The eye though requires a detailed initial examination and fluorescein angiography to determine the possible cause and the state of the underlying retina underneath the scar.
If there is a chance that surgery may improve vision, then vitrectomy microsurgery with removal of the epiretinal membrane is indicated. Sometimes, this may be combined with cataract surgery if a cataract is present also.
In some cases, a long acting gas bubble is used to tamponade any retinal holes or tears which are identified at the time of surgery. The patient may therefore be required to keep their head face down or in a certain position following surgery for one to two weeks. This is not always necessary and patients will be advised following the surgery.
The vision will slowly improve over one to two months time. Initially, the vision will be blurred due to the dilating drops.
Surgery has an approximate 70 to 80% chance of improving the distortion in vision, though some residual distortion may remain. It is rare though, that the epiretinal membrane may recur and require further surgery.
While epiretinal membrane surgery has a high success rate, one should be aware that occasionally there are problems which can arise following surgery. A cataract may develop earlier than would be expected during the normal aging process. Sometimes cataract surgery is combined with epiretinal membrane surgery if a cataract is already present at the time the epiretinal membrane is diagnosed. Cataract surgery is a very quick and successful surgery. Occasionally, the eye may develop increased intraocular pressure (glaucoma) and medication may be required to control this.
Retinal tears or detachment of the retinal lining may develop during surgery, or following surgery, and would require further surgery to correct these. Infection and haemorrhage are very rare risks which may occur with any surgery.
Surgery is usually successful in removing the epiretinal membrane, stabilising further deterioration in vision and improving the vision and distortion.
What is CENTRAL SEROUS RETINOPATHY?
Central serous retinopathy (CSR) is a condition where fluid accumulates under the retina and symptoms generally include blurred, distorted vision or micropsia (objects appearing smaller). It is more common in males, typically in the young or middled-aged (20-50 years). The specific cause of CSR is unknown but it is thought to be associated with stress, fatigue and steroid use.
Patients with suspected CSR are required to have investigations such as a fluorescein angiogram and an OCT scan to determine the site of fluid leakage and confirm the diagnosis. The OCT test is very important as it provides information on fluid accumulation inside the retina. It is also useful in following the progression of the condition as it gives an indication of how much fluid remains under the retina with each follow-up.
Treatment usually involves a period of initial observation (for approximately 3-6 months) as some cases of CSR tend to resolve without any treatment. If the condition does not improve, photodynamic laser therapy or focal laser can be very effective in resolving the fluid and improving vision.
What is DIABETIC RETINOPATHY?
Diabetic retinopathy is a condition caused by diabetes mellitus where blood vessels of the retina are damaged due to the high blood glucose level. Such damage to the blood vessels of the retina can result in abnormal bleeding, swelling of the retina (macular oedema), poor blood flow to the retina, and/or scarring of the retina. It can occur for both Type I and Type II diabetes. The longer you have had diabetes, the more likely you are to develop diabetic retinopathy. The less well-controlled the diabetes, the more likely it is also to develop diabetic retinopathy.
There are two types of diabetic retinopathy: non-proliferative diabetic retinopathy (NPDR) and a more severe form, proliferative diabetic retinopathy (PDR). In NPDR the damaged retinal blood vessels develop tiny weak areas called microaneurysms. Over time, these microaneurysms can rupture and leak and resulting in retinal haemorrhages (bleeding). Fluid, fats and protein from the blood stream can also leak into the retina and cause swelling (oedema) and hard exduates. Over time, poor blood circulation of the retina can also result in death of nerve cells (ischemia). The combination of these processes can lead to a permanent visual loss.
In proliferative diabetic retinopathy (PDR), the retina can produce substances that promote the growth of new, abnormal blood vessels (neovascularization) in response to the ischaemia. These new blood vessels are however fragile and tend to bleed into the vitreous or result in scar tissues that pull on the retina and cause a very serious condition called tractional retinal detachment.
When diabetic retinopathy is diagnosed, you may need to undergo further investigations such as fluorescein angiography or an OCT scan to evaluate the severity of the condition. The purpose of these further investigations is to identify areas of macular edema, ischaemia and neovascularisation so appropriate treatments can be applied. A B-scan ultrasound may need to be performed when the vitreous haemorrhage is very dense and the retina can not be examined properly.
The most important aspect in the treatment of diabetic retinopathy is adequate long-term control of blood glucose level. Patients should monitor their glucose daily and have their hemoglobin A1c level checked with a GP. Regular eye examinations are important as symptoms of blurred vision or floaters only appear long after diabetic retinopathy has developed. Therefore, early detection and treatment before the retina is severely damaged is the most successful in minimizing the visual loss from diabetic retinopathy. It is also a good idea to keep blood pressure and cholesterol levels in check.
PANRETINAL PHOTOCOAGULATION (PRP)
Panretinal photocoagulation laser surgery is performed in proliferative diabetic retinopathy patients to prevent severe vitreous haemorrhages and blindness. The laser causes regression of abnormal blood vessels which grow at the back of the eye on the retina in diabetic patients.
Each session takes approximately fifteen to twenty minutes and multiple sessions are required. Usually three to four sessions per eye is required to treat the proliferative diabetic retinopathy.
There is some discomfort during the laser, and analgesics such as Panadol or Panadeine may be taken before the laser session.
The eye may be irritated and blurred for a few days following the laser surgery.
With time, one may notice some decrease in night vision and peripheral vision. This occurs due to the laser treatment, but is necessary in order to control the proliferative diabetic retinopathy.
In some cases of severe diabetic retinopathy where laser surgery is unsuccessful, vitreoretinal microsurgery might be indicated.
Vitreoretinal microsurgery in severe proliferative diabetic retinopathy involves the use of microsurgical instruments inside the eye to remove severe scar tissue and haemorrhage in the vitreous jelly. Laser treatment is also able to be performed inside the eye under direct vision. Following this, a special gas bubble is placed inside the eye which absorbs naturally over a few weeks. Following this, the vision may improve, depending upon the state of the eye prior to the surgery. The visual improvement though may take several months.
Whilst every care is made to improve the eye’s vision, the extent of improvement depends on the state of the retina at the time of surgery and how the eye improves following the surgery.
Risks include further haemorrhages into the eye, retinal detachment and cataract formation which may occur after surgery. Any of these complications may necessitate further surgery.
Intravitreal therapy such as Eylea, Avastin, Lucentis, and Triamcinolone may be necessary to treat macular oedema as well as new vessels in diabetic retinopathy. These drugs are currently used on an off-label basis to patients. Treatment may need to be repeated at regular intervals to continue long-term benefits. In some cases, these drugs may be combined with vitrectomy surgery.
What are FLASHES AND FLOATERS?
Floaters are due to debris in the vitreous jelly that may float across the visual axis and cause the patient to see an image such as a fine line, a “blob”, or a ‘cobweb” which may move.
What are the consequences of flashes and floaters?
They are usually benign, but one in ten patients with these symptoms may have a retinal tear, which requires treatment.
Flashes and floaters may often persist for months or even years.
What to watch out for
The following symptoms should be watched out for as they may indicate progression of the problems and development of a “retinal tear” or “retinal detachment”, they are:
- Sudden increase in the flashes
- They become persistent such as being present all day
- Floaters which become much larger
- Loss of vision
- The impression of a curtain coming down, coming up or moving sideways
If these occur, you should contact City Eye Centre on 3831 6888 as soon as possible to make another appointment. Please let the secretary know of your condition.
Follow-up for flashes and floaters
You may be required to attend for a follow-up, usually within a few weeks. This is important as your symptoms may progress and you may develop a tear in the retina over the subsequent weeks.
Are any drops required? No.
What is RETINAL VEIN OCCULSION?
Retinal vein occlusion is a condition where veins of the retina become blocked, resulting in leakage of blood and plasma (fluid from the bloodstream) into the retinal tissue. The bleeding (haemorrhage) and swelling (oedema) in the retina can cause symptoms such as blurred, distorted or loss of central vision. Disruption of the blood supply to the retinal tissues can result in a lack of oxygen and nutrition and cause permanent damage, such as loss of retinal circulation (ischaemia) or development of abnormal new blood vessels (neovascularisation). These abnormal new blood vessels unfortunately are fragile and have a tendency to bleed, which can result in vitreous haemorrhage, scarring of the retinal tissues, tractional retinal detachment and greater visual loss. In addition, if the vessels develop in the drainage angle of the eye, a severe form of glaucoma can also occur (rubeotic or neovascular glaucoma).
Retinal vein occlusion typically occurs in individuals greater than 50 years of age and is more common in patients with high blood pressure, diabetes, glaucoma, cardiovascular diseases, blood clotting disorders, or other inflammatory conditions.
There are two types of retinal vein occlusion:
- Central retinal vein occlusion (CRVO) if the blockage occurs in the main vein leaving the optic nerve of the eye.
- Branch retinal vein occlusion (BRVO) if the blockage occurs at one of the branches before reaching the main vein at the optic nerve.
When retinal vein occlusion is suspected, patients would need to undergo investigations such as a fluorescein angiogram and an OCT scan to determine the site and severity of the blockage as well as identifying the area of ischaemia (poor circulation). As retinal vein occlusion is often associated with macular oedema (swelling), an OCT scan is very valuable in evaluating the degree of fluid accumulation and monitoring treatment efficacy.
Retinal vein occlusion can be treated using a number of modalities:
- Laser can be applied to areas of ischaemia and oedema. When macular oedema is present, focal or grid laser photocoagulation is effective in reducing the amount of swelling.
- Intravitreal injections have been found effective in treating the macular oedema and improving vision in many cases. However, several treatment sessions may be required. a. Avastin/Lucentis (anti-VEGF drugs) b. Triamcinolone (steroid)
- Optic neurotomy (in CRVO) is used to decompress the optic nerve.
Recovery time may be variable from a few weeks to months. Any risk factors such as hypertension, hyperlipidaemia should also be treated.
What is GLAUCOMA?
Glaucoma is a progressive degeneration of the optic nerve. It is often the result of raised eye pressure. The most common type of glaucoma is termed “primary” as there is no specific cause. There are also secondary causes of glaucoma including trauma and cataract, as well as other eye disease.
What are the symptoms of glaucoma?
The main challenge of glaucoma is that there are often no symptoms early in the disease. The peripheral vision is first affected and it may not be until in advanced disease that this loss is noticed. Unfortunately, once the vision has been lost it is not reversible. If left untreated, only the central vision remains and eventually this can also lead to blindness. Occasionally patients may notice non-specific symptom such as headaches, eye tiredness, haloes around lights at night and/or patchy vision.
How is glaucoma diagnosed?
When you are reviewed by your eye specialist, your vision will be tested along with intraocular pressures, field testing and optic nerve assessment. Your optic nerve will also be scanned using technology such as the OCT (ocular coherence tomography). This is a sophisticated scanner that can quantitate the degree of optic nerve damage.
What are the treatments available?
Most patients are treated using eyedrops to lower the intraocular pressure. Sufficient lowering of the intraocular pressure is indicated by slowing of the progression of vision loss. If reasonable intraocular pressures are not achieved by medication alone, then laser or ultimately trabeculectomy surgery will be required. The surgery involves forming a new drainage to allow fluid to escape from the eye, thereby lowering the intraocular pressure. The aim is to preserve functional vision for the lifetime of the patient.
What is BLEPHARITIS?
Blepharitis is inflammation of the eyelids. Symptoms include redness, irritation, tiredness and dryness. It can cause discomfort of the eyes, however it is not generally sight threatening.
The cause of blepharitis is build-up of excess oils in the eyelid glands. There are 25 glands in the upper lid and 20 in the lower lid. The glands run vertically and open just behind the eyelashes*.
Blepharitis is a lifelong problem, however can be managed with a lid hygiene routine.
Treatment of blepharitis usually involves 3 steps:
- Hot compresses
- Lid massage
- Lid cleaning
1. Hot compress
- Heat face-towel with hot tap water – as warm as tolerated but don’t burn eye
- Place on closed eyelids for 5 minutes
2. Lid massage
- Use fingers or cotton bud to massage oil from glands
- Stroke downwards towards the lashes for the top lid
- Stroke upwards towards the lashes for the lower lid
- Massage for 3 minutes
3. Lid cleaning
- Wipe away excess oil with moist face-towel or proprietary products eg Lidcare, Sterilid
- Initially perform twice per day, morning and night
- For first 2 weeks may get slight worsening due to accumulated oils coming out
- After 2 – 3 weeks of cleaning, if symptoms settling, can perform once per day eg in the shower)
- Lubricants in addition can also relieve symptoms
- Steroid drops twice per day for 2 – 3 weeks
- Omega-3 capsules (eg fish oil, flaxseed oil) 2 per day
- Chloramphenicol ointment on eyelashes twice per day following lid cleaning for first month
- Doxycycline one tablet per day for 3 months
What is DRY EYE?
Dry eye is a disorder of inadequate tear film. It is due to reduced tear production by the lacrimal gland and/or excessive evaporation from the eye surface.
What causes dry eye?
Dry eye is a very common phenomenon and is also dependent on the surrounding environment. It is more common in women especially after menopause.
What are the symptoms?
Patients notice discomfort, irritation, photophobia, redness and blurring of the vision. In very severe cases the eye surface can become permanently scarred. Symptoms are worse in dry, windy conditions as well as indoors such as prolonged computer work, air-conditioning and fluorescent lights.
What are the treatments available?
Initially lubricants in the form of drops, gels or ointments can be used. They can be taken as required or on a regular basis throughout the day. If lubrication is not adequate, then occlusion of the tear drainage can be undertaken with small plugs or cautery. More extreme dry eye management includes use of serum drops and/or cyclosporin ointment.
What is KERATOCONUS?
Keratoconus is when the front part of the eye or cornea becomes irregular in shape due to thinning. There is no known cause but in some cases other family members may also have keratoconus.
What are the symptoms?
Patients notice progressive distortion of their vision over many years, usually starting in their teens and may progress into their 30’s. One eye is often affected more than the other. Other symptoms include irritation, glare and/or photophobia.
What are the treatments available?
Initially glasses or contact lenses can be prescribed to correct the distortion. Certain types of contact lenses can be specially designed for the individual patient. If lens correction is not suitable then corneal transplantation is possible to correct the abnormal corneal shape. Modern techniques greatly reduce the risks of complications such as rejection. Other options such as collagen cross-linking and intra-corneal inlays are available, but require more research to further define their place in management.
What is OCULAR SURFACE SQUAMOUS NEOPLASIA (OSSN)?
Ocular surface squamous neoplasia or OSSN is a malignant growth on the surface of the eye. It is mainly due to increased sun exposure over a long period.
Why does it need to be treated?
OSSN is similar to sunspots and squamous cell carcinoma of the skin. It needs to be treated otherwise it has the potential to grow and involve other parts of the eye and other tissues. These growths tend to be slow-developing, but it is better to treat them at an earlier stage.
What are the symptoms?
Patients present either as an incidental finding of routine eye examination or may present as a growth or irritation. Uncommonly patients present with reduced vision.
What are the treatments available?
Currently OSSN can be treated with eye drops or surgical excision. The treatment required depends on the individual patient. The medical treatments currently include topical Mitomycin-C and Interferon Alpha 2b. These medications have the advantage of treating the whole ocular surface for all abnormal cells and often does not require further surgical intervention. They do need to be taken over a period of weeks to months and thus compliance is important. In terms of surgical excision, this involves cutting the OSSN from the surface of the eye, leaving a healthy margin of tissue. The lesion can then be sent for pathology testing. Follow up visits are required to observe for any signs of recurrence.
What is PTERYGIUM?
A pterygium is a winged-shaped growth on the surface of the eye. It consists of blood vessels and fibrous tissue. It is related to excessive sunlight exposure over a long period.
What are the symptoms?
Patients notice redness and sometimes irritation in the area of the pterygium and if large can extend closer to the centre of the pupil resulting in reduced vision.
Does my pterygium need to be treated?
Generally pterygia are only treated if they are causing the above symptoms. Occasionally a pterygium may also be removed for cosmetic purposes.
What are the treatments available?
Initially topical lubricants and vasoconstrictors can be used to reduce symptoms. The only real treatment option is surgical excision and this is often accompanied by an autoconjunctival graft. This technique reduces the risk of recurrence of the pterygium to less than 5%. The resulting cosmetic appearance is also improved.