What is a cataract?
A cataract is the opacification of the natural crystalline lens in the eye. Most cataracts develop slowly and they will increasingly impair vision over time. There is no cure for cataracts. They can only be removed by surgery and at the same time a small lens implant replaces the natural lens of the eye.
What is it like to have a cataract?
Cataracts mostly develop slowly, and in both eyes, so you may not have been aware that you had them. You might have noticed increasing difficulty with visual tasks such as reading and driving, especially in more dimly lit environments. You may find that colours dull and your vision gradually become cloudy. New spectacles will not fix the cataract and you may not notice any improvement in vision with a new script.
Do I have to have cataract surgery?
Cataracts do not damage the eye in normal situations. It is quite safe to postpone cataract surgery if you are unsure about proceeding. With cataract, your vision will decline slowly over a period of 1-3 years. Some internet pages may claim that some medicine or natural remedy will remove or dissolve a cataract – this is simply not true.
What will happen to me before cataract surgery?
Firstly the Ophthalmologist takes some measurements on your eyes to determine what size lens to implant in your eye. They usually do measurements on both eyes at the same time.
You will be given more information by your Ophthalmologist about the timing of surgery. They never operate both eyes on the same day therefore most people have one eye operated on, followed by the second eye 2-4 weeks later.
What will happen to me on the day of surgery?
Cataract surgery is usually performed as a day surgery procedure. While there is no need to stay overnight, some patients who live alone may choose to spend one or two nights in Hospital. Usually you will be in the day hospital unit for about three hours in total. The surgery takes 20-30 minutes and is performed under local anaesthetic. You will be mildly sedated during the operation, but will feel no pain or discomfort. It is normal to feel a little anxious before and during the operation and we will make sure you are comfortable and relaxed when you come to have your surgery. The natural lens of the eye is broken up, removed, and replaced with an artificial lens. Most Ophthalmologists uses the new femtosecond laser to perform some of the important manual parts of surgery with great precision and accuracy.
After surgery you will go home with a clear plastic shield over the eye and you will have instructions regarding eye drops. It is expected that the eye will feel a little bit gritty or mildly uncomfortable for a day or so after surgery.
Complications of Cataract Surgery
Cataract surgery is well tolerated.
Most people will have a 99% chance of seeing better following surgery. This will not be the case if you have a pre-existing eye condition such as macular degeneration or glaucoma and your Ophthalmologist will alert you to this if it applies to you.
All operations carry risks and one in a thousand (1/1000) people will have a major complication such as infection, bleeding or a major intra-operative complication.
What is the macula?
The macula is the central part of the retina. It is located directly behind the pupil at the back of the eye. It is the most sensitive part of the retina as it providing detailed vision and colour vision. You read, recognize faces, thread a needle, drive a car and watch TV with your macula. Diseases of the macula can affect all of these functions.
What is macular degeneration?
Macular degeneration is a condition where the portion of the retina that is responsible for detailed vision such as reading or recognizing faces (called the macula) is damaged. There are two forms of macular degeneration – wet macular degeneration and dry macular degeneration.
How is macular degeneration detected?
Ask us to provide you with an Amsler grid that can be used for regular self-checks at home. Darling Downs Optometrist can further test with an extensive examination that includes looking at the back of the eye, taking retinal photos and a non-invasive OCT scan at $59.00 if required.
How is macular degeneration treated?
Currently there is no treatment for the dry form of macular degeneration. Wet macular degeneration can be treated with a regular schedule of intravitreal injections. Ultraviolet protection (with wrap-around sunglasses and a wide brimmed hat), a diet rich in anti-oxidants (leafy green and red/yellow vegetables, corn, eggs and fish) and not smoking all help to reduce the risk of AMD progressing.
What is glaucoma?
Glaucoma is the name given to a group of eye diseases in which the optic nerve at the back of the eye is slowly destroyed. In most people this damage is due to an increased pressure inside the eye - a result of blockage of the circulation of fluid in the eye or blocked drainage. In other patients the damage may be caused by poor blood supply to the vital optic nerve fibres, a weakness in the structure of the nerve, or a problem in the health of the nerve fibres themselves.
Over 300,000 Australians have glaucoma. While it is more common as people age, it can occur at any age. As our population becomes older, the proportion of glaucoma patients is increasing.
- Glaucoma is the leading cause of irreversible blindness worldwide.
- One in 10 Australians over 80 will develop glaucoma.
- First degree relatives of glaucoma patients have an 8-fold increased risk of developing the disease.
- At present, 50% of people with glaucoma in Australia are undiagnosed.
- Australian health care cost of glaucoma in 2005 was $342 million.
- The total annual cost of glaucoma in 2005 was $1.9 billion.
- The total cost is expected to increase to $4.3 billion by 2025.
- The dynamic model of the economic impact of glaucoma enables cost-effectiveness comparison of various interventions to inform policy development.
Source: Tunnel Vision. The economic impact of Open Angle Glaucoma, Centre for Eye Research Australia, 2008
What are the symptoms of glaucoma?
In the first instance, glaucoma is asymptomatic. The problem with this is that you can permanently lose part of your vision before the disease is diagnosed. This is why ophthalmologists and optometrists recommend regular testing – every two years once you turn 40.
Who is at risk?
Although anyone can get glaucoma, some people have a higher risk, those with a family history of glaucoma, diabetes, migraine, short and long sightedness, previous eye injuries and steroid eye drops used in the past or at present.
What is the usual management of glaucoma?
Glaucoma assessment will involve checking the vision, the intraocular pressures and looking at the optic disc. Other tests may be performed such as visual fields, OCT imaging of the optic disc and glaucoma parameters and fundus photography.
Treatment for Glaucoma
1. Eye drops
Eye drops are the usual first line management of glaucoma.
Laser surgery can be used to lower intraocular pressure in glaucoma. It is used when eye drop medications are not lowering the eye pressure enough or are causing significant side effects. It may sometimes be used as initial treatment in glaucoma.
A trabeculectomy is an operation to make the pressure lower inside the eye. It involves making a new channel in the sclera, through which fluid flows out into a space underneath the outer layer of the eye.
Glaucoma may get worse if the pressure inside the eye is not low enough. Trabeculectomy is recommended when eye drops are not controlling the pressure and there is a significant risk that glaucoma is going to cause further damage to your sight.
What is a Pterygium?
A pterygium is a small fleshy growth of tissue on the front surface of the eye. It is usually raised and red. It can increase in size over time, and spread across onto the cornea. It occurs in response to sunlight exposure, usually acquired during childhood and early adulthood.
What symptoms do pterygiums cause?
Because pterygia are raised, they can cause ocular irritation and symptoms of dryness or foreign body sensation.
They can result in blurry vision by destabilizing the tear film, or through induced astigmatism (by deforming the front of the eye).
They can also become very red and unsightly and cause sufferers distress through their appearance.
How can I treat my pterygium?
Regularly application of ocular lubricants are normally the first line of defence. This will help alleviate the irritation. Unfortunately your pterygium will not regress with eye-drops alone.
Reasons to have your pterygium removed include...
Surgical removal is recommended once the pterygium gets close to the pupil margin.
What will happen to me if I have pterygium surgery?
Pterygium removal is conducted under assisted local anaesthetic. The operation usually takes 45-60 minutes and you will feel no pain or discomfort during the procedure.
After your operation, your eye will feel very sore for 3-4 days. It will be watery, feel like gritty sand is inside your lids, and your eye will be very sensitive to light.
We recommend you take one week off from work/normal duties if possible.
Your eye will be red for 6-8 weeks after surgery.
Dry eyes are a very common but potentially debilitating condition. There are many causes of dry eye, but the most common is meibomian gland dysfunction, also called Blepharitis. This result in the important oil layer of our tears being unstable and thinner than it should normally be.
Healthy tears are vital to your eyes functioning correctly. Your tears are a very important part of your eyes, immunity, cleaning system and optical pathway. When your eyes are dry you may experience:
- Painful, sore gritty eyes
- Blurred vision
- Recurrent corneal infections or erosions
- Persistent eye “fatigue”
- A pressure feeling behind the eyes
- “Watering” eyes
Talk to our Optometrist about the best approaches to your specific dry eye problem.
Blood in the Eye
Sometimes small blood vessels in the whites of the eyes break and cause a red spot or speck. This is called a subconjunctival hemorrhage. The blood vessels may break because of sneezing, coughing, vomiting, straining, or bending over, but sometimes there is no clear cause. The blood may look alarming, especially if the spot is large. It is usually not a cause for concern and will clear up in 2 to 3 weeks. Subconjunctival hemorrhage is usually not a serious problem if your vision is normal, there is no eye pain, and the bleeding does not cover a large portion of the white of the eye and does not spread into the colored part of the eye (iris).
Bleeding that occurs between the colored part of the eye (iris) and the cornea is called a hyphema. This is more serious than bleeding that occurs in the white of the eye. You may have mild pain or no pain at all. After an eye injury, blood usually appears immediately. But if the injury is mild, blood may not appear until up to 5 days later. You may also have vision changes. A hyphema may be a more serious problem for a person who has sickle cell disease. If you have a hyphema, see an eye specialist (ophthalmologist).
Medicines that help prevent blood clots may increase the risk of bleeding in both the white or colored part of the eye. When there is bleeding into the eye, do not take aspirin, aspirin-related products, or nonsteroidal anti-inflammatory drugs (NSAIDs) for pain because they can increase bleeding. Use acetaminophen (such as Tylenol) instead.
Floaters in my Eye
Eye floaters are small moving spots that appear in your field of vision. They may be especially noticeable when you look at something bright, such as white paper or a blue sky.
Eye floaters can be annoying, but they generally don't interfere with your sight.
Occasionally a particularly large eye floater may cast a subtle shadow over your vision. But this tends to occur only in certain types of light.
Most of the time people learn to live with eye floaters and ignore them. And they often become less noticeable over months to years. Only rarely do benign eye floaters become bothersome enough to consider treatment.
But sometimes eye floaters are a sign of a more serious condition. You should seek immediate medical attention if you notice a sudden increase in the number of eye floaters.
Immediate medical attention is especially important if the floaters are accompanied by flashes of light or a loss of side vision. If you have these symptoms, see an eye doctor right away. If available, choose an ophthalmologist with retinal expertise. Without immediate treatment, you can have permanent vision loss. These symptoms may be caused by:
- Retinal detachment
- Retinal tear
- Bleeding within the eye
Symptoms of Eye Floaters
Eye floaters, when seen, usually appear to have some slight. They generally appear to dart away when you try to focus on them.
Eye floaters can appear in many different shapes, such as:
- Black or gray dots
- Squiggly lines
- Threadlike strands, which can be knobby and semi-transparent
- Ring shaped
Once you develop eye floaters they usually do not go away, though they tend to improve over time.
Causes of Eye Floaters
Most eye floaters are caused by small flecks of a protein called collagen.
The back compartment of the eye is filled with a gel-like substance called vitreous humor.
As you age, the vitreous and its millions of fine collagen fibers shrink and become shred-like. Shreds can accumulate in the vitreous. The clear vitreous gel which completely fills the back of the eye earlier in life decreases in size and no longer can fill this space…. it pulls away from the retina and it is often the areas of previous attachment to the retina which are seen as floaters as they now float freely in the vitreous gel.
Meibomian Gland Dysfunction and Treatment
What are Meibomian (Oil) Glands?
Meibomian glands are glands that are arranged vertically within the eyelid near the lashes. The force of an eyelid blink causes oil to be excreted onto the posterior lid margin. The oil is the “staying power” of the tears that helps prevent rapid tear evaporation. In a patient with Meibomian gland dysfunction (MGD), vision is affected because there is too much or too little oil in the tear film.
What is Meibomian Gland Dysfunction?
MGD, is the most common form of lid margin disease. In the early stages, patients are often asymptomatic, but if left unmanaged, MGD can cause or exacerbate dry eye symptoms and eyelid inflammation. The oil glands become blocked with thickened secretions. Chronically clogged glands eventually become unable to secrete oil which results in permanent changes in the tear film and dry eyes. Symptoms include:
- Light Sensitivity
- Red Eyes
- Foreign Body Sensation
- Intermittent Blurry Vision
What is the Treatment?
1. Warm Compresses
Heating the lids will increase oil production and melt the oil that has solidified in the glands. Use a warm washcloth to apply heat on the eyelids for two minutes. This warms the oil, allowing it to flow more freely, and helps soften lash debris.
Apply light pressure with your index finger or a Q-tip to the lid margin near the lash line. Roll the finger upward on the lower lid while looking up, then roll the finger downward on the upper lid while looking down. Excessive manipulation of the lids can cause additional irritation, so lid massage and scrubs should be performed only twice a day during the acute stage, and once daily during maintenance
3. Lid Scrubs
This helps to remove oil, bacteria and debris. It also stimulates the oil glands. Use a Q-tip or a warm washcloth on the tips of your fingers to rub along the lash line on the top and bottom lid.
4. Flax Seed Oil
In addition to the above, some people benefit by adding omega-3 fats to their diet which will help with the oil consistency. About 1tsp/day for toddlers or 1Tbsp/day for older children is enough. Mix with juice, smoothies, or hot cereal. Do not take with blood-thinning medication or blood-sugar lowering medication. If your child can take pills, there are tablets that can be taken instead (ex Thera Tears Nutrition).
5. Systane Balance Eye Drops
Used in conjunction with warm compresses and lid massage helps to health of Meibonian Glands so that it can produce the essential oils in the tear film.