A cataract is a clouding of the part of the eye called the lens. Vision becomes blurred or dim because light cannot pass through the clouded lens to the back of the eye. Cataracts can form at any age, but most often are a natural consequence of getting older. They develop slowly and are painless. In younger people they can result from an injury, taking certain medication or illnesses such as diabetes.

Common symptoms may include the following complaints:

• Blurred vision
• Double vision
• Poor vision in bright light
• Colour change
• Increase in short sight

What can be done?

In the early stages tinted spectacles or wearing a hat to shield your eyes from the sun may help. Eventually, however, should the condition progress and the symptoms increase, the most effective treatment is a simple operation to remove the cloudy lens. We will refer you to your GP or hospital.

Cataract surgery is a common surgical procedure and in most cases can be carried out under local anaesthetic on a day-case basis, without an overnight stay in hospital.

The cloudy lens will be surgically removed from your eye and replaced by a plastic lens. The procedure takes about 20 minutes and is performed through a 3mm incision made to the eye, behind the upper eyelid. The incision is self healing and, in virtually all cases, no stitch is needed.

Your distance vision should return to normal but you will usually require spectacles for reading vision.

Flashes and Floaters

‘Flashes and Floaters’ are visual symptoms that require early investigation, especially if you see them for the first time.

The eye is filled with a gel made up mainly of water, but also containing soluble salts, proteins and collagen fibres. With the normal ageing process the collagen fibres degenerate, resulting in separation of the solid and liquid parts of the gel. This can occur earlier in short sighted eyes resulting in floaters.

The gel in the eye is only weakly attached to the retina, with firmer attachments at the edge and near the optic nerve. Changes in the eye can occur and the gel may shrink away from the retina.The space between the gel and retina fills with fluid.This is known as Posterior Vitreous Detachment (PVD).

When this occurs, patients often suddenly develop floaters that look like a ring or net curtain. 98% of PVD’s occur in people over the age of 45.

Flashes often occur following PVD. Flashes are normally in the peripheral visual field after eye movement and are more noticeable in the dark. On occasions excess movement of the gel inside the eye can lead to a retinal tear or hole.This allows fluid to seep behind the retina and can lead to retinal detachment.

Eye examination using drops for pupil dilation is necessary to eliminate the presence of retinal damage and should be carried out as soon as possible after noticing the symptoms.

Most cases of PVD will resolve spontaneously within six weeks. If the symptoms persist longer than this, or increase in severity within this time, then further eye examination is necessary.

These examinations are not covered by a routine NHS eye examination and private fees may apply.

Symptoms such as black shutters or curtains across the vision, and blurred vision would suggest retinal detachment and emergency advice should be sought immediately.

Age Related Macular Degeneration (AMD)

AMD occurs when there is a break down of cells in the macula which is the most sensitive area at the back of the eye. A loss of sight occurs in the central field of vision but leaves peripheral vision unaffected. AMD is in two forms. Dry AMD, the most common form of the disease, occurs when the build up of waste material and lack of proper nutrition causes a gradual deterioration of the macula, usually over many years. The second form,Wet AMD, is more aggressive in its development. It is caused by the growth of abnormal blood vessels in the retina which can leak and lead to scarring and loss of central vision.

Treatment for some patients with WetAMD is possible using a light sensitive drug, (Visudyne) combined with cool laser which is used to seal leaking blood vessels on the retina. The causes of AMD are not known although research indicates that genetic causes, dietary factors and lifestyle may all play a part. Once sight has been lost as a result of Macular Degeneration it can not be restored, but it is thought that the progress of the disease can be slowed by making lifestyle changes.

We believe it is safe to recommend the following to our patients:

• Cease smoking immediately.
• Limit saturated fats, cholesterol and alcohol.
• Use sunglasses and hats to reduce the amount of light entering the eye.
• Control of high blood pressure.
• Have an eye examination at least once every two years.
• Eat generous daily helpings of spinach, kale or broccolli which are rich in lutein and zeaxanthin (carotenoids).

Any patient concerned about AMD should also take a well-balanced antioxidant supplement containing 6mg lutein on a daily basis.

We stock two dietary supplements rich in lutein. Macushield and Nutrof Total both provide capsules of Lutein which is the recommended daily dose. The capsules also contain other vitamins essential for good ocular health.

Diabetic Eye Problems

Diabetes affects the eye in a number of ways.

Damage may occur when the fine network of blood vessels in the retina leak fluid. This is known as diabetic retinopathy. Cataracts can develop earlier and progress more rapidly in diabetics than in other people. Untreated diabetes may also cause frequent or noticeable changes to your eyesight.

Serious eye problems are less likely if diabetes is well controlled and most sight loss from the disease can be prevented if detected early and treated.

How can we help?

The Optometrist will check the appearance of the retina with specialist equipment. Photographs of the retina may be used to detect and monitor any abnormalities. If diabetes is suspected, the Optometrist will refer you to a GP or hospital for medical advice. If diabetes is diagnosed, your eyes will need to be examined regularly for signs of eye problems.

What can be done?

Most sight threatening diabetic problems can be prevented by laser treatment if it is carried out early enough. The laser can seal the blood vessels that are leaking fluid into the retina.

Glaucoma

Glaucoma is the name for a group of eye conditions in which the optic nerve is damaged and is often associated with raised pressure within the eye. This leads to a reduction in the field of vision and sight loss. In most cases glaucoma sufferers will experience no symptoms until significant damage has occurred.

Who is at risk?

• People over the age of 40.
• Patients with a family history of glaucoma in close relatives.
• People who are diabetic or very short-sighted.
• African-Caribbean people.

How do we check for glaucoma?

Our Optometrist will check the appearance of the optic disc at the back of the eye using specialist equipment. Visual field assessment will be conducted using our Zeiss field screener. Small points of light are used to check for defects in the visual field. Eye pressure measurement is conducted using an instrument that emits a small puff of air onto the surface of the eye.

What can be done?

If detected early enough, glaucoma can usually be treated. In most cases eye drops to reduce the pressure in the eye will be prescribed, although in some cases an operation is needed.To aid detection of glaucoma, we recommend an eye examination every two years, or more frequently if you are considered at risk. If glaucoma is suspected, we will advise you whether you need to be referred to a GP or hospital. Once treatment is underway, you may be referred back to us for monitoring.