Eye Health

The role of an optometrist is not only to prescribe sunglasses and contact lenses but to ensure that the eye is healthy. The importance of a regular eye health check is the early detection of ocular diseases such as glaucoma, age related macular degeneration (ARMD) and cataracts.

Glaucoma

What is glaucoma?

Glaucoma is an eye disease that is caused by damage to the optic nerve. The optic nerve is responsible for transmitting messages to the brain. There are several risk factors involved in glaucoma including intra-ocular pressure (IOP). It is known that high IOP can damage the nerves at the back of the eye causing irreversible nerve damage leading to loss of vision. However, it has also been found that normal IOP can cause nerve damage. This is the reason why regular eye examinations are so important.

Normal optic nerve and cupping Glaucomatous optic nerve and cupping

What are the risk factors?

Intra-ocular pressure
Family history of glaucoma
High Myopia (Short-sightedness)
Migraines
Diabetes
Present and past use of cortisone drugs
Age

How is glaucoma detected?

A glaucoma test involves:

1. Assessment of the optic nerve with an ophthalmoscope
2. Intra ocular pressure measurement using a tonometer
3. Visual Field screening

Can glaucoma be treated?

There is no cure for glaucoma. Glaucoma can go undetected for a long time because it is the peripheral vision that is first affected. Unfortunately the longer it is left undetected, the more damage is done and hence greater loss of vision. The earlier the detection, treatment can be started and progression of the disease slowed down. Treatment does not recover vision that has already been lost.

Treatment options include:

Eye drops to reduce the pressure
Laser (trabeculoplasty)
Surgery (trabeculotomy)

(Check out www.glaucoma.org.au to read more about the different types of glaucoma).

Age-Related Macular Degeneration

What is Age related Macular Degeneration (ARMD)?

ARMD is a degenerative disease of the macular (the region used for central vision). Genetics, age, nutrition, smoking, and sunlight exposure may all play a role in its etiology. ARMD varies greatly in its severity from total loss of central vision to slight distortion. There are two types of ARMD: wet and dry. Wet ARMD affects about 10% of people with macular degeneration and can cause a sudden loss of central vision. Dry ARMD can take longer to affect the central vision, however, both types can make driving, recognising faces, difficulty reading and doing any tasks that require details hard. People with mild ARMD may notice that straight lines may appear distorted.

Early ARMD

How can ARMD be detected?

An optometrist can detect ARMD by doing a vision test, using an Amsler Grid test, examination of the macular, monitoring the macular through fundus photography and referring to an ophthalmologist for fluorescein angiography.

What is the treatment for ARMD?

There is little that can be done for dry macular degeneration. Wet ARMD in some cases can benefit from laser photocoagulation which is effective in sealing leaking or bleeding blood vessels. This does not restore lost vision but can prevent further loss.

Photodynamic therapy also a type of laser treatment has proven to be far less damaging than laser photocoagulation and is effective in stopping abnormal blood vessel growth in some patients with ARMD. This has become the treatment of choice in many cases.

Early diagnosis is critical for successful treatment of wet macular degeneration. Patients can monitor changes at home with an Amsler grid, which can help in the early detection of progression.

Can vitamin and mineral supplements help with ARMD?

Recent studies have shown that nutrition is strongly related to prevention of macular degeneration. It is recommended that patients incorporate dark leafy green vegetables into their diet. Taking a supplement which includes zinc, vitamin C, E and beta carotene can aid in the preservation of eye health and vision especially in ARMD. Smokers, however may be at higher risk of lung conditions by taking beta carotene supplements. Check with your health care provider before commencing any supplements.

Patients who have been diagnosed with ARMD can make a few lifestyle changes which will aid in preservation of eye health.

• Monitor your vision with an Amsler Grid – this will help in the early detection of change.
• Ensure that your multi-vitamin and zinc intake is adequate in your diet. Antioxidants, along with zinc and lutein are essential nutrients, all found in the retina. (Consult your GP before commencing any supplements).
• Ensure that you have enough dark leafy green vegetables in your diet.
• Always protect your eyes with sunglasses. Ultraviolet rays are believed to cause damage to the pigment cells in the retina.
• Quit smoking. Smoking impairs the body’s circulation, decreasing the efficiency of the retinal blood vessels.
• Exercise. Cardiovascular exercise improves the body’s overall health and increases the efficiency of the circulatory system.

Cataract

What is a cataract?

A cataract is the clouding of the eye’s crystalline lens. The lens works like a camera to focus light onto the retina and also it changes focus so that we can see both far away and close. The lens is made of mainly protein and water. As we age, the protein clumps together forming a cloudy media. We call this a cataract.

What causes a cataract?

Research has suggested that exposure to ultraviolet (UV) light can cause cataracts. There has also been research to show that diabetics are at greater risk at developing cataracts. Some drugs such as steroids, diuretics and tranquillizers have an effect on the crystalline lens leading to cataract formation.

How will I know if I have a cataract?

A cataract will start out small and you may not notice any change to your vision. As it progresses, you may notice deterioration of your vision. The quality of your vision may appear cloudy and you may experience more glare than you have noticed before. At night, the car headlights may appear brighter and glarier and colours may not appear duller than you may remember.

Can cataracts be treated?

When symptoms first appear, a change to your glasses prescription may be all that is needed. As the cataract progresses and starts to interfere with your lifestyle, surgery may be an option. Cataract surgery these days is simple, painless and effective. The cloudy crystalline lens is removed and a new intra ocular lens (IOL) is replaced in the eye. Technology is constantly improving allowing IOLs to be easier to insert and surgery to be less complicated.

Dry Eyes

What causes dry eyes?

One of the eye’s defense mechanisms is the corneal tear film. The tear film is made up of water, mucin and oil. If there is an imbalance in these components, the eye will develop some dryness.
Dry eyes can also be caused by several other factors including age, especially through menopause due to hormonal fluctuations; as a side effect on many medications such as anti-histamines and birth control pills; the environment that you live/work in especially with air conditioning and heating. Insufficient blinking can also lead to dry eyes typically with staring at the computer.

Systemic diseases such as rheumatoid arthritis and lupus, rosacea or Sjogren’s syndrome have an effect on the lubrication of the eye.
Incomplete eyelid closure or tear duct problems can result in dry eyes also.

What are the symptoms of dry eyes?

The symptoms of dry eyes include foreign body sensation, irritation and redness. This can be confirmed by an optometrist examining the cornea.

How can I treat dry eyes?

Dry eyes may be a condition that stays around for life. It can not usually be cured (depending on the cause). The basic treatment of dry eyes is with the use of ocular lubricants. There are many lubricants available on the market, so which one do you use?

* Suitable for use with contact lenses

The best way to know which product will be most suitable to your eye needs is to consult the optometrist for an examination and advice.

Dry eye treatment and management due to other causes may require referral to an ophthalmologist (eye specialist) for assessment.

Recent research suggests that smoking and taking multivitamins can increase your risk of dry eye syndrome, and that eating a lot of omega-3 fatty acids (found in fish) may decrease your risk.

The eye health and vision is very important to maintain lifestyle and livelihood. It is important that you have regular eye examinations as suggested by the optometrist to ensure that there are no signs of disease or change. An eye health check can sometimes identify general health diseases such as diabetes, hypertension and hypercholesterolemia. Referral to the GP will verify the findings.

REMEMBER: The earlier the detection, the better the prognosis and visual outcome