Eye Health

Simple tips for healthy eyes

Your eyes are an important part of your health. There are many things you can do to keep them healthy and make sure you are seeing your best. Follow these simple steps for maintaining healthy eyes well into your golden years.

Have a comprehensive dilated eye exam.

You might think your vision is fine or that your eyes are healthy, but visiting your eye care professional for a comprehensive dilated eye exam is the only way to really be sure. When it comes to common vision problems, some people don’t realize they could see better with glasses or contact lenses. In addition, many common eye diseases such as glaucoma, diabetic eye disease and age-related macular degeneration often have no warning signs. A dilated eye exam is the only way to detect these diseases in their early stages.

During a comprehensive dilated eye exam, your eye care professional places drops in your eyes to dilate or widen the pupil to allow more light to enter the eye, the same way an open door lets more light into a dark room. This enables your eye care professional to get a good look at the back of the eyes and examine them for any signs of damage or disease. Your eye care professional is the only one who can determine if your eyes are healthy and if your vision is at its best.

Know your family’s eye health history.

Talk to your family members about their eye health history. It’s important to know if anyone has been diagnosed with a disease or condition, since many are hereditary. This will help to determine if you are at higher risk of developing an eye disease or condition.

Eat right to protect your sight.

You’ve heard carrots are good for your eyes. But eating a diet rich in fruits and vegetables, particularly dark leafy greens such as spinach, kale or collard greens is important for keeping your eyes healthy too. Research has also shown there are eye health benefits from eating fish high in omega-3 fatty acids, such as salmon, tuna and halibut.

Maintain a healthy weight.

Being overweight or obese increases your risk of developing diabetes and other systemic conditions, which can lead to vision loss, such as diabetic eye disease or glaucoma. If you are having trouble maintaining a healthy weight, talk to your doctor.

Wear protective eyewear.

Wear protective eyewear when playing sports or doing activities around the home. Protective eyewear includes safety glasses and goggles, safety shields, and eye guards specially designed to provide the correct protection for a certain activity. Most protective eyewear lenses are made of polycarbonate, which is 10 times stronger than other plastics. Many eye care providers sell protective eyewear, as do some sporting goods stores.

Quit smoking or never start.

Smoking is as bad for your eyes as it is for the rest of your body. Research has linked smoking to an increased risk of developing age-related macular degeneration, cataract, and optic nerve damage, all of which can lead to blindness.

Be cool and wear your shades.

Sunglasses are a great fashion accessory, but their most important job is to protect your eyes from the sun’s ultraviolet rays. When purchasing sunglasses, look for ones that block out 99 to 100 percent of both UV-A and UV-B radiation.

Give your eyes a rest.

If you spend a lot of time at the computer or focusing on any one thing, you sometimes forget to blink and your eyes can get fatigued. Try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds. This can help reduce eyestrain.

Clean your hands and your contact lenses properly.

To avoid the risk of infection, always wash your hands thoroughly before putting in or taking out your contact lenses. Make sure to disinfect contact lenses as instructed and replace them as appropriate.

Practice workplace eye safety.

Employers are required to provide a safe work environment. When protective eyewear is required as a part of your job, make a habit of wearing the appropriate type at all times and encourage your co-workers to do the same.

I can see fine, why do I need an eye examination?

Eye ExaminationStudies have repeatedly shown the sense people most fear losing is their sight and yet many people do not attend for regular eye tests. Although your vision may appear fine, many ocular diseases, such as glaucoma, will go unnoticed in the early stages and the later they are discovered the harder it can be to treat them. In normal circumstances you should have an eye test at least every two years unless advised otherwise by your optician. Annual tests may be needed depending on your age or medical history.

Newcastle Optician - Geoff Steven and Son
 

What happens during an eye test?
GDXOur standard eye test lasts about half an hour as we take our time performing all the tests we feel are necessary to ensure your ocular health, although it may take a little longer if the optician feels as though some extra tests are necessary. Your eyes will be examined by one of the Steven family with a combined total of over 55 years of optical experience. At Geoff Steven and Son no two eye tests will be exactly the same as each one is taylor made to suit your needs but during the test we will:

* Take your History and Symptoms
* Check your visions
* Perform ocular motor balance tests
* Perform basic field screening
* Check your intra-ocular pressures (important for detecting glaucoma), depending on your age/family history
* Examine the external and internal structures of your eye
* Humphreys Check your pupils react normally (pupil defects can give an indication of a range of different health problems, not just to do with the eye)
* Issue a spectacle prescription and offer advice on what we feel would be best for your eyes

This is the minimum we will do. There may be other tests that our opticians feel are necessary, using our state of the art equipment (see our “specialist equipment” section) but he will advise you at the time of your test.

Am I eligible for a NHS (free) test?
The following receive a free eye test at any one of our branches:
* Over 60
* Under 16
* 16 to 18 in full time education
* Registered blind/partially sighted
* Suffering from diabetes or glaucoma
* Over 40 and the parent, brother, sister of child of person with glaucoma
* Claiming: income support, pension credit, job seekers allowance, family tax credit


If in doubt ring one of our branches for confirmation.

What sort of things can be detected in an eye test?
Digital Retina CameraThe range of ocular diseases that can be detected at an eye test is never ending (for anyone interested the red atlas website www.redatlas.org shows ocular photos from hundreds of different ocular diseases). The most common conditions seen by our optometrists on a regular basis include:
* Glaucoma
* Diabetes
* Macular degeneration
* Cataract
* High blood pressure

Will I be obliged to buy glasses?
No, never! As mentioned earlier we are a small family business and all our optometrists are members of the Steven family. As such they have no “sales targets” to meet, as in some opticians. They are under no pressure to recommend glasses to you unless they feel as though they are clinically necessary.

How do I book an eye test? Ring whichever one of our branches you would like to test your eyes (see the “branches” section) and simply ask to book a test. It could not be easier.

Eye Health

In Myopia (short-sightedness), the eye is longer than normal, or the cornea is too steep so that light rays focus in front of the retina. Near objects are clear, but distant objects appear blurred. For the most part, this is an inconvenience, considering how frustrating it can be to be dependant on contact lenses or spectacles. In addition, eyes with a high degree of Myopia are at an increased risk of developing a serious condition like retinal detachment or glaucoma.

 

In Hypermetropia (long-sightedness), the eye is shorter than normal, or the cornea is too flat so that light rays focus behind the retina. Light rays from close objects such as pages of a book cannot be focused on clearly by the retina. Someone with hypermetropic eyes may find their vision blurred when looking at objects near them and for vision to be clearer when looking at faraway objects. Placing a plus powered (convex) lens in front of a hypermetropic eye allows the image to be moved forward, allowing for correct focus on the retina.

A degree of long-sightedness is common in many people. However, this only presents a problem when our ability to see is significantly affected or common headaches and eye strain.

When we are young, the lens in the eye can change its shape allowing us to focus on near objects. After the age of 40, the lens becomes noticeably more rigid and reading at close range becomes increasingly difficult. This condition is called presbyopia and is a normal part of ageing.

What are the symptoms of Presbyopia?

Presbyopia is usually first noticed by difficulties reading in low light. Often, you may find it will take longer for eyes to refocus from reading to distance and from distance to reading. Spectacles may be required to give additional focusing power to the eye as reading proves more problematic.

The distance of reading dictates which power you would require. For example, looking at a computer screen will require a different power for reading a book. We will ask you about your lifestyle and take this into account when prescribing your reading addition to ensure clarity of vision for the required visual task. 

What is glaucoma?

Glaucoma is the name for a group of eye conditions that damage the optic nerve. This nerve carries information from the light-sensitive layer in your eye, the retina, to the brain, where it is perceived as an image. The retina can be thought of as akin to the ‘film’ of a camera where light is focused. The information is then sent along the optic nerve.
All glaucomas have certain key features in common. These are increased pressure inside the eye, ‘cupping’ of the optic disc, and loss of the peripheral visual field. Any two of these 3 features is usually enough to have an extreme risk of glaucoma.


What controls pressure in the eye?

The eye is filled primarily with water-based substances and liquids. Think of there being a ‘tap’ inside the eye – constantly producing fresh liquid. This ‘tap’ is a layer of cells behind the iris (the coloured part of the eye). The fluid produced is called ‘aqueous’. This liquid is inside the eye and is not connected to the tears.
The eye also has a ‘drainage’ system. The drains are located at the front of the eye, between the edge of the cornea and the iris.
So, increased pressure in the eye is due to increased fluid production or decreased drainage of fluid from the eye (or a combination of both).

How does increased pressure damage the nerve?

The mechanism of damage is unclear. Certainly, when the pressure goes up very suddenly (as in acute glaucoma), there is clearly a lack of blood supply to the nerve head in the eye. There are various other theories as to how nerve damage actually occurs.
What is certainly known is that LOWERING this pressure delays the progression of glaucoma. In sudden acute glaucoma, lowering the pressure can save the sight in an eye that is otherwise destined to lose vision.

How common is glaucoma?

It is one of the commonest reasons for blindness in the Western world. There are several different types. These include chronic simple glaucoma (the commonest Type), acute glaucoma, congenital glaucoma and secondary glaucoma, which arise secondary to some other condition or influence.

Who gets chronic glaucoma?

There are several ‘risk factors for developing chronic glaucoma. These are:

  • Age – Chronic glaucoma is uncommon below 40 but affects 1% of people over this age and 5% over 65.
  • Race – People of Afro-Caribbean origin have an increased risk of developing glaucoma.
  • Family History – There is a ‘genetic’ element to glaucoma. If a close relative (parent/sibling) has Glaucoma, you should not worry, but ensure you have regular checkups to detect any changes as early as possible, should they ever occur.
  • Myopia – Very short-sighted people are more at risk of developing chronic glaucoma.

Why can untreated chronic glaucoma cause serious loss of sight?

The main reason is that chronic glaucoma usually has NO SYMPTOMS. There is no pain, and your eyesight will seem to be normal too, but silently, your vision is slowly deteriorating. Glaucoma tends to damage the peripheral field of view first, so it is not noticed by most. Only when the peripheral field has been significantly damaged, do some people start bumping into things or see oncoming vehicles at the last minute.

How is chronic glaucoma detected?

Few tests can help detect glaucoma. These are:
Measuring the pressure inside the eye – often a puff of air or a special contact ‘tonometer.’
Examination of your’ visual field’ – usually a machine where you press a button when you see lights in your peripheral vision.
Examination of your optic nerve by your optometrist.
All these tests are very straightforward, don’t hurt and are be done by our optometrists at the practice.

Can chronic glaucoma be treated?

YES. A simple regimen of daily drops to the eye can delay glaucoma progression in the vast majority of people. Sometimes, an operation called Trabeculectomy is required. Both of these treatments are very effective indeed.

Acute Glaucoma

What is acute glaucoma?

This is a form of glaucoma where the pressure inside the eye shoots up very suddenly. It happens because of a physical blockage of the drainage channels inside the eye at the ‘angle’ of the eye (where the cornea meets the iris). This is why it is often referred to as ‘Angle Closure Glaucoma’.

What are the symptoms of acute glaucoma?

Severe Pain – often, people wake up in the night with very severe pain in 1 eye (although it can happen in both eyes simultaneously – this is uncommon).
Redness of the eye.
Blurred Vision – sometimes ‘haloes’ can be seen around bright lights.
Nausea & Vomiting.

How is Acute Glaucoma treated?

Acute glaucoma is initially treated with powerful drugs to help bring down the pressure inside the eye very rapidly. Subsequently, depending on the nature of the cause of the attack drops, laser and surgery are the various options available to the surgeon.
A similar treatment, usually with laser only, is usually performed in the other eye to ensure the same acute attack cannot happen.

Approximately 3% of the population is affected by diabetes. Increases in blood glucose concentration (hyperglycaemia) occur when there is a lack of naturally produced insulin in the body. There are two main types of diabetes, Type 1 (Insulin Dependent), which affects those with damage to certain cells in their pancreas and usually occurs for individuals in their teens. Insulin injections must be administered regularly. Type 2 (Non-Insulin
Dependent) people with diabetes do not necessarily have to inject insulin and often has a later onset (50+ years). It can be controlled through a good diet and with the occasional use of tablets.

Any person with diabetes should have their internal eye health checked annually using pupil dilation in conjunction with retinal camera photography. These images will be archived for future comparison. The diabetic retina characteristically shows a progression of circumstances, including different types of “exudates”, “haemorrhages”, “cotton wool spots”, and ultimately end-stage retinal detachment. Although, with good blood glucose regulation, most diabetics can prevent significant eye damage.

While the partial treatment offered (photocoagulation) can be effective, the best means of prevention is accomplished solely through good diabetic respect and frequent eye assessment.

What is Macular Degeneration?

Age-related macular degeneration (ARMD) is the commonest cause of vision loss in people aged over 50 years old. The prevalence (the number of new cases each year) increases with age. It is caused by degeneration of the macula, the central and most sensitive part of the retina at the back of the eye.

What is the Macula?

The macula is the central part of the retina, responsible for enabling fine detail to be discerned. The remainder of the retina enables ‘peripheral vision’ only. Without using the macula, tasks like reading small print and recognising faces become difficult or impossible. The macula contains a yellow pigment (hence the term macula lutea).
The disease becomes increasingly more common amongst people in their 60s and 70s. By the age of 75, almost 15% of people have this condition to some extent. The biggest risk factor is thus age. Other risk factors are a family history of the condition, cigarette smoking, and being white caucasian.

What are the types of ARMD?

There are two main types of ARMD often termed ‘Dry ARMD’ and ‘Wet ARMD’. The pathological process is different between the two. In the wet form, there is a proliferation of abnormal blood vessels under the macula. In dry ARMD, small yellow deposits are collected within the retina called drusen and degeneration (atrophy) of the retinal tissue at the macula. The dry form is more common, but the wet form is usually more sudden and devastating to the vision.


The paler elevated area at the macula represents the area where the retina is elevated, under which there is an abnormal ‘membrane’ due to the abnormal proliferation of blood vessels.

What does ARMD do to the vision?

ARMD affects only the central area of the vision. The condition thus never causes complete blindness or loss of sight.

Is there any treatment for ARMD?

Currently, there is no cure for ARMD. The risk of developing ARMD can be reduced by not smoking. Studies have given us some evidence that a diet rich in antioxidants and certain pigments (found in dark green vegetables like broccoli and kale) may reduce the risk of progression of the disease process.
For a tiny percentage of ‘wet’ ARMD cases, a treatment called ‘Photo Dynamic Therapy (PDT) may be used to reduce the risk of further visual deterioration.

LUCENTIS Injections

A NICE (National Institute for Health and Care Excellence) approved treatment for wet ARMD called LUCENTIS. This is known as an ‘Anti-VEGF’ agent. VEGF is an acronym and stands for Vascular Endothelial Growth Factor. Lucentis can reduce the proliferation of the abnormal blood vessels that grow under the retina in wet ARMD. The drug is administered by injection into the eye. A minimum of 3 injections is required, with the average number of injections required being 7.
LUCENTIS has been shown to significantly improve the final visual outcomes for a large proportion of patients with wet ARMD. However, the treatment only works in the early stages of disease onset and is ineffective once the wet ARMD has caused chronic scarring of the retina.

Cataracts are prevalent. In fact, the majority of those over 65 have some cataract development. If you have been told you have cataracts, DO NOT be alarmed.
The word “cataract” comes from the Greek word “Cataract”, which means waterfall. The lens can appear to look a bit like a waterfall when the cataract is quite advanced.

What is a cataract?

A cataract refers to the ‘opacity of the lens inside the eye. Looking through a cataract can be thought of as a little bit like looking through an old stained piece of glass – instead of a clear new sheet.
There are many different types of cataracts. Not all cataracts cause symptoms. If a cataract causes no symptoms, it can usually be left alone. If symptoms such as blurred vision occur, then cataracts can be treated very successfully with surgery.

 What is the lens?

The eye lens is a transparent body located behind the iris (the coloured part of the eye). The lens can change shape, and in doing so, can accommodate to keep things focused on the retina at the back of the eye.

What are the causes of a cataract?

Cataracts are commonest in older people. However, they can occur at any age. Some children are born with cataracts (congenital cataracts).
Cataracts are associated with the sun – and so are far more common in areas of the world such as India & Africa. Other causes include injury, diabetes, certain drugs, and some ocular diseases.

What are the common symptoms of cataracts?

For most people, the main complaint is some deterioration in the quality of vision. Most people usually feel they need another sight test to get their glasses updated.
Sometimes, people can complain of a ‘shadow’ behind objects they are looking at.
Certain types of cataracts can cause glare in bright light conditions.
Because cataracts normally develop very slowly over many years, most people don’t notice the gradual deterioration in their vision until it starts to interfere with their daily activity or, indeed, their optometrist spots it.

How are Cataracts treated?

The most effective treatment for cataracts is removing the cataract and replacing the cloudy lens with a clear artificial lens implant.
The lens of each eye should be clear for your eyes to work properly. The clear lens allows light to reach the retina at the back of the eye, enabling you to see things. With a cataract, less light can reach the retina, so your vision is affected. A cataract can be present for a while before you notice you have one. If you have a cataract, it will continue to develop. When spectacles can no longer improve your vision, the only way to restore your vision is by having the cataract removed by surgery.

The cataract operation

Cataract surgery is one of the most common and quickest surgeries performed today. Modern cataract surgery (called phacoemulsification) is usually performed under local anaesthetic as a day case procedure. A tiny incision is made into the eye during the surgery, and the lens is removed with an ultra-sound probe. The lens capsule is left behind, which is used to house the new lens implant. The whole procedure takes between 15 and 20 minutes, and the visual recovery is rapid, with most patients noticing improved vision within a matter of days.

Lens implant types

Each patient and each eye is different. Measurements are taken before surgery (called biometry) to establish the correct lens power for the individual eye. Lens implants also come in different types. The two major categories of lens implant are: 

 

Monofocal lenses – (the vast majority of patients have this lens type put in). These provide good distance vision, but glasses are required for close work. 

Multifocal lenses – These lenses offer a high probability of achieving spectacle independence, i.e. providing patients with the ability to see far and read without glasses.

Multifocal lenses have been shown to offer a high chance of reducing dependence on glasses for near and middle distance vision. However, patients can experience a reduction in contrast sensitivity (especially in dim lighting) and halos and glare around lights at night. Some patients are prepared to accept these visual effects because they are very keen to reduce their reliance on glasses.
The pre-operative preparations for patients interested in multifocal lens implants are more involved than when monofocal lenses are being used. A wider range of issues needs to be discussed, and post-operative management is more intensive. These are the major reasons that these lenses are not offered on the NHS.

Retinitis Pigmentosa is a hereditary disease where a specific gene defect causes the cells to misfire in the retina of the eye.

There isn’t a defined cure or treatment. However, many find the onset to be quite slow. The symptoms begin with central vision losses, but cases where the outside of vision can deteriorate slowly, creating a tunnel vision effect.

Bad vision in environments with dim lighting at the later stages in life is considered an early RP symptom. These can be connected to other eye problems, which in some cases are called syndromes. The loss of hearing, along with RP, is called Usher’s Syndrome.

What is Nystagmus?

Nystagmus is a classified eye disease where the patient experiences an involuntary movement of the eyes. They oscillate from side to side, up and down or even in a circular motion.

People who have Nystagmus are usually either blind or have an inferior vision. Their vision can be considered a lot worse than what some would call short-sighted, and their vision is already hampered to a certain extent.

Nystagmus Patients

There is ‘Early Onset Nystagmus’, which starts in the first six months of a baby’s life, which can also be called infantile or ‘Congenital Nystagmus’. It can also affect people at a later stage in life, which is known as ‘Acquired Nystagmus.’

Causes of Nystagmus

The main cause of Nystagmus during the early stages is a defect in the visual connection between the eye and the brain or the eye itself. During childhood, Nystagmus can appear in many different eye diseases such as glaucoma, cataract or retina diseases among albinos. Children with Down’s syndrome are also prone to Nystagmus.

Most people worry about hereditary Nystagmus, which can be confirmed through making an appropriate and accurate diagnosis of the initial condition and then consulting a geneticist to find out more accurately the chances of you passing on Nystagmus to the oncoming generation. The geneticist can also help with further information and counselling.

Nystagmus is not contagious and cannot be passed on through contact. This means people who develop it at a later stage have other causes. These causes can range from a stroke to multiple sclerosis, or even a blow suffered to the head.

Nystagmus can be classified as a symptom of much worse eye disease. It is necessary to consult an Ophthalmologist (Eye Specialist) immediately at the earliest signs of it. This should be done whether the patient is a child or an adult.

Available treatments

There is no said cure available for Nystagmus at this time. However, there are several helpful treatments. Glasses and lenses rarely do anything to fix Nystagmus, but they should be worn strictly if other eye problems exist. Patients may be diagnosed with being ‘long’ or ‘short sighted’ along with having Nystagmus, which is not uncommon as ‘long’ and ‘short-sightedness is caused by the eyes’ inability to focus correctly due to its shape.

There are three types of retinal detachments. The most common form is a break in the retina’s sensory layer, causing fluid to seep underneath. This eventually causes a separation in the layers of the retina. Individuals who are particularly short-sighted, with historic eye injuries or who have undergone eye surgery are most susceptible to this type of detachment. This is due to the thinner and more fragile retina in short-sighted people. The second most common type is increased traction on the retina by strands of scar or vitreous tissue, which can ultimately pull the retina loose.

The third most common type occurs when small pockets of liquid form within a special gel (the vitreous), which usually lines the inside of the eye. Eventually, some of this fluid moves between the gel and the retina, causing the vitreous to peel away from the retina. The retina, which is like the film of a camera, can see the outer part of this gel floating inside the eye – which causes floaters. Sometimes, when the vitreous gel comes away from the retina, it can cause a hole or tear to appear in the retina. This is because the vitreous gel sometimes has areas where it is strongly attached to the retina. As the gel falls away from the retina (a bit like wallpaper falling from the wall), the gel can tear the retina (like the wallpaper may take a piece of paint or plaster from the wall).

If a hole or tear develops in the retina, there is an increased risk of retinal detachment. A detached retina can cause vision loss and requires a surgical operation to put the retina back in the right place. Thus, you must have your eye examined urgently on the onset of symptoms. There are other less common reasons for floaters – e.g. bleeding into the gel in the back of the eye from a blood vessel (usually in diabetic patients).

Floaters are extremely common and are sometimes associated with flashing lights in the eye, especially when they first appear. When they first appear, they normally affect one eye but may affect both eyes simultaneously.
In fact, they’re so common that approximately two-thirds of the population will have floaters by the time they are in their mid-sixties! However, they can occur at any age.

What do Floaters look like?

Most people describe floaters as little ‘blobs’ or ‘cobwebs’ or  ‘string like’ or ‘amoeba like’ features that move around in the eye and can be best seen when looking at a light plain surface. However, floaters can take any number of appearances and are different in everybody.

What causes these floaters?

The commonest cause of floaters is called ‘vitreous detachment’. The main section of the eyeball is filled with a special gel known as ‘the vitreous. Normally, the gel fills the back of the eye, so the gel’s outer part is in contact with the retina (which lines the inside of the eye).
As we get older, small pockets of fluid form within the gel. Eventually, some of this fluid moves between the gel and the retina, causing the vitreous to peel away from the retina. The retina, which is like the film of a camera, can see the outer part of this gel floating inside the eye – which causes floaters.
Sometimes, when the vitreous gel comes away from the retina, it can cause a hole or tear to appear in the retina. This is because the vitreous gel sometimes has areas where it is strongly attached to the retina. As the gel falls away from the retina ( a bit like wallpaper falling from the wall), the gel can tear the retina ( like the wallpaper may take a piece of paint or plaster from the wall).

What causes the Flashing Lights?

As the gel comes away from the retina, the tractional pull on the retinal tissue causes the flashing lights in the eye. Once the traction has ceased, the flashing lights normally subside.

Why do I need my eye examined if I have new onset Floaters and/or Flashing Lights?

The vitreous detachment may tear the retina. If a hole or tear develops in the retina, there is an increased risk of retinal detachment. A detached retina can cause vision loss and requires a surgical operation to put the retina back in the right place. Thus, it would help if you had your eye examined urgently on the onset of symptoms. There are other less common reasons for floaters – e.g. bleeding into the gel in the back of the eye from a blood vessel (usually in diabetic patients).

Should I be worried about Floaters?

Most floaters are innocuous, and there is no need to worry. However, if you have had a new onset of floaters, you need to have your eyes examined by an optometrist as a matter of urgency. THIS IS ESPECIALLY IMPORTANT IF YOU ARE SHORT-SIGHTED.
By seeing an optometrist early, it can be diagnosed and treated before it progresses into something more serious if there is a problem.

Introduction

Dry eyes occur when the eyes either don’t make enough tears or the quality of the tears produced is reduced, which means the tears can evaporate rapidly from the surface of the eye, allowing the eye to dry. Often, the reduced tear quality results from blockage or inflammation of the oil glands within the lid margin. When the surface of the eyes dries out, the eyes become inflamed. They appear red, and the whites of the eyes can appear to be pink and swollen. Normally, the eyes become very irritable. When seen on a microscope, using a fluorescent dye called fluorescein and a special cobalt blue light, the denuded surface areas can be seen as green specks on the surface of the eye.

Dry eyes can be divided into two broad categories.

If the main problem is a lack of tear production, the term ‘keratoconjunctivitis sicca’ or ‘aqueous deficiency’ is used. However, if the main problem is the poor quality of tears (but plenty of them) due to inflammation or blockage of the oil-secreting glands in the lid margin, the condition is called the ‘obstructive meibomian gland disease’, more commonly referred to as blepharitis.

Who gets Dry Eye Syndrome?

It is more common in women than men and is found most commonly in the over 60s age group. However, it can happen at any age.

What are the symptoms of Dry Eye Syndrome?

The symptoms can be extremely variable, causing anything from mild irritation to severe discomfort.

Symptoms include

  • Foreign body sensation/feels like something is in the eyes
  • Eyes feel ‘gritty’ – often worse in the mornings
  • Blurred vision
  • Burning sensation in eyes
  • Irritable eyelids
  • Light sensitivity
  • Redness of the whites of the eyes
  • Painful eyes
  • Excessive watering

 

In Dry Eyes, why do the eyes sometimes water excessively? How can the eyes be dry if they are watering all the time? This a paradox which is explained as follows:

Blinking spreads a tear film over the surface of the eye – the eyelids do the opposite to what a windscreen wiper does on a car. The eyelids spread a thin film of tears over the front of the eye. When there are not enough tears, or if the quality of tears is poor, the eye’s surface becomes dry, which causes inflammation.
Special receptors on the eye’s surface are then stimulated by this inflammation, which causes a ‘reflex tear production’. This leads to the main tear glands literally ‘switch the tap on’ to wet the dry surface. The result is often the production of excessive watery tears (as opposed to oily tears), which results in watering of the eyes.

What causes Dry Eye Syndrome?

  • Ageing over 60’s are the commonest group to suffer
  • Hot, dry or windy climates – causes evaporation of tears
  • Inflammatory diseases – e.g. Rheumatoid arthritis affecting joints, is associated with a higher risk of dry eyes.
  • Side effects from medications – e.g. The oral contraceptive pill


Does Dry Eye Syndrome cause loss of vision?

Normally dry eyes cause no visual deterioration. However, in severe cases where the eye is allowed to desiccate, the cornea may scar, and this could cause reduced vision.

How is Dry Eye Syndrome treated?

There is no absolute ‘cure’ for dry eye syndrome. However, most people can get significant relief from symptoms using a variety of treatments and measures.

Lid Margin Hygiene

If the underlying cause is blepharitis/lid margin disease, treating this can often improve the ocular surface and reduce symptoms.
This can be done by simply applying a hot compress using hot tap water and a clean flannel to the eye each day and cleaning the lid margin with the water and flannel. Some people recommend using chemicals such as baby shampoo and sodium bicarbonate. Still, more often than not, these can cause ocular surface irritation, and so at least initially, they are best avoided.

Lubricants

Regular lubrication in the form of gels or drops can help keep the surface of the eyes wet and thus reduce symptoms. Often, this is combined with lid margin hygiene.
There is a wide range of eye drops available – consult our optometrist for advice on which one to use.

Tear duct surgery

When there is a severe dry eye with a reduction in tear production, blocking the drainage of tears down the tear ducts can help keep the tears produced on the eye’s surface.
Temporary plugs are normally inserted first. In some cases, permanent closure with surgical cautery may be used.

Other measures

Diet omega-3 oils and flaxseed oil in the diet may help improve tear quality.

‘Think Blink’

When concentrating (e.g. using a computer or driving), we can blink up to 5 times less often, leading to increased tear evaporation. Remembering to blink more often can help keep the eye surface wet.

Humidifiers

Moist air leads to less evaporation of tears. Avoiding air-conditioned environments and direct heat (e.g. an open fire or heat from a cooker) can help for the same reason.

How is Blepharitis diagnosed?

Blepharitis refers to inflammation of the eyelid margins. There are two broad categories of the condition – Anterior Blepharitis and Posterior Blepharitis.

Anterior Blepharitis affects the front part of the eyelid margin, near the roots of the eyelashes. It is commonly caused by bacteria that normally live on our skin that produce an irritative toxin that causes inflammation. The lid margin often looks ‘crusty’, and when seen under a microscope, the appearance can be similar to dandruff. Anterior Blepharitis can cause the eyelids to become red, itchy and sometimes slightly swollen too.

 

Posterior Blepharitis is also referred to as Obstructive Meibomian Gland Disease. The meibomian glands are located within the eyelid, and the glands open onto the lid margin, behind the roots of the eyelashes. The glands normally produce a special oily secretion for the tears. The meibomian glands sometimes become inflamed and blocked, causing a reduction in amount and disturbance in the quality of the oily secretions. This can cause eyelid margin irritation and secondary dry eye effects on the ocular surface.

Who gets Blepharitis?

Blepharitis is very common indeed – 5% of eye problems in primary care are related to blepharitis. People of any age can be sufferers, but it is more common in older people over 50. It is not something ‘caught’ or inherited. The reason for some people developing blepharitis is poorly understood.

What are the symptoms of blepharitis?

People who have blepharitis may not suffer from any symptoms at all. However, for those that do report symptoms, one or any combination of the following symptoms are common:

  • Irritation of the eyelids and/or eyes
  • Redness of the eyes
  • Sore eyelids – sometimes red and swollen lid margins
  • Crusting of the eyelid margins
  • Eyelids may stick together on waking in the mornings
  • Burning and tearing of the eyes
  • Gritty sensation in eyes
  • Pain on looking at bright lights (photophobia)
  • Small eyelid margin cysts

 

How is Blepharitis diagnosed?

Blepharitis is normally diagnosed in primary care by GPs on the clinical history alone. When a slit lamp microscope is available, for example, at the optometrist’s or ophthalmologist’s clinic, the lid margin can be examined closely. Simple visualisation of the lid margin along with the history is how the diagnosis is normally made.

How is Blepharitis treated?

Unfortunately, there is not a definitive cure for blepharitis. There are many different ways clinicians have managed patients with blepharitis over the years. There is no definitive treatment that is an indicator that no single treatment works significantly better than all others.

Lid margin cleaning

Both types of blepharitis can be helped with what is commonly referred to as ‘lid margin hygiene. Put simply. This means regular cleaning of the lid margins. The use of the following regimen works for most people. The use of additives to water such as baby shampoo or sodium bicarbonate may actually increase the amount of irritation, and so at least initially, this is not recommended. Use clean hot tap water (boiled sterile water is not necessary).

  1. Take a clean flannel and soak in hot tap water (not too hot).
  2. Place the flannel onto the closed eye and apply gentle pressure for 30 seconds to 1 minute, or until the flannel cools.
  3. Then, take the flannel, and again wet with hot clean tap water.
  4. Use this flannel to scrub along the lid margin (top and bottom eyelids), being sure to scrub the area at the roots of the lashes. Do this for a good 30 seconds to 1 minute. Don’t use cotton wool, as it is too smooth and doesn’t remove debris and a simple, clean cloth.
  5. Repeat on the other side.

 

Carry out this cleaning regimen twice a day for at least a month. Most people will experience a reduction in symptoms. If not, seek expert help from your optometrist, who will be able to make further recommendations or refer you to an ophthalmologist, if required. Other management measures are briefly mentioned below.

Avoid irritants

Minimising chemical irritants that include certain eye drop preservatives and makeup can help reduce blepharitis symptoms.

Dietary Changes

Some evidence suggests that omega 3 oils such as those in Flax seed can improve the quality of meibomian gland secretions.

Antibiotics

Occasionally, if there is marked bacterial anterior inflammation or an associated skin condition such as seborrheic dermatitis or even Rosacea, your doctor may prescribe antibiotic eye ointment or oral tablets.

Keratoconus is the most common dystrophy of the cornea, affecting around one person in a thousand, although some reports indicate prevalence as high as 1 in 500 individuals. It is typically diagnosed in the mid to late teens and attains its most severe state in the twenties and thirties.

Keratoconus in detail

Keratoconus is a degenerative non-inflammatory disorder of the cornea (the front window of the eye) and generally affects both eyes. The underlying problem is a weakness of the supporting collagen fibres in the cornea. This makes the cornea structurally and biomechanically “weak”. As a result, the cornea assumes a more conical shape with resultant irregular astigmatism.
The progression of Keratoconus can be quite variable, with some patients remaining stable while others progress rapidly or experience occasional exacerbations over a long and otherwise steady course. A genetic predisposition to keratoconus has been observed, with the disease running within families in 10% of all cases.

How is Keratoconus diagnosed?

From the patient’s history, a detailed slit lamp examination and sophisticated corneal imagery can assess the profile of the cornea.

Symptoms of Keratoconus

Symptoms can include substantial distortion of vision (astigmatism), with multiple images, blurry (near and farsighted) vision and sensitivity to light (photophobia). Initially, most people can correct their vision with glasses. But as astigmatism worsens, most patients can be managed with specially fitted rigid gas permeable contact lenses to reduce the distortion and provide better vision. Symptoms may be unilateral initially and may later become bilateral. In 20% of patients, the condition is progressive and requires surgical intervention.

What are the surgical interventions?
Corneal INTACS

A recent surgical alternative to a corneal transplant is the insertion of intrastromal corneal ring segments. These are clear, thin prescription inserts placed in the corneal periphery during a brief procedure. The rings act as scaffolding to the cornea providing support, and push out against the cornea’s curvature, flattening the peak of the cone and returning it to a more natural shape. The procedure is carried out on an outpatient basis and offers the benefit of being reversible and even potentially exchangeable as it involves no removal of eye tissue.

Corneal Collagen Crosslinking

Corneal Collagen Crosslinking with Riboflavin (also known as C3R) is a new procedure that has been shown to strengthen the weak corneal structure. The cornea is made up of many layers of collagen arranged in a very regular pattern with cross links for strength. In conditions where the cornea is abnormally weak, such as keratoconus, there are fewer of these links, resulting in bulging of the cornea. C3R works by increasing collagen cross-linking, thereby strengthening the cornea.
The procedure involves applying riboflavin eye drops to the cornea and then using UV light to activate the riboflavin inducing cross-links in the cornea.
The development of this new technique is a big step in managing keratoconus as it addresses the underlying pathophysiology of the condition rather than just treating the symptoms. It is important to emphasise that this procedure slows the progression of the disease, and patients may still require corrective contact lenses post-operatively.

Corneal Transplantation

This is the last port of call for Keratoconus patients and is reserved for those patients with significant corneal scarring or where INTACS and Crosslinking have not been successful or are not suitable.
The procedure involves replacing the diseased cornea with a donor cornea which is secured with excellent stitches. The visual recovery is prolonged, but the vast majority of patients have a good outcome.
Newer techniques have also been developed, which involve replacing only the diseased anterior cornea rather than the full thickness of the cornea, which was commonplace in the past.

(Article reproduced with permission from Consultant Corneal Surgeon – Mr Ali Mearza FRCOphth)

Dyslexia, also known as alexia or developmental reading disorder, is characterized by difficulties in reading and differing comprehension of language despite normal or above-average intelligence. This includes phonological awareness, phonological decoding, processing speed, orthographic coding, auditory short-term memory, language skills and verbal comprehension.

Dyslexia is the most common learning difficulty. Some see dyslexia as distinct from reading difficulties resulting from other causes, such as a non-neurological deficiency with hearing or vision or poor reading instruction. There are three proposed cognitive subtypes of dyslexia (auditory, visual and attentional). However, individual cases of dyslexia are better explained by specific underlying neuropsychological deficits (e.g. attention deficit hyperactivity disorder, a visual processing disorder / visual stress) and co-occurring learning difficulties (e.g. dyscalculia and dysgraphia). Although it is considered a receptive (afferent) language-based learning disability, dyslexia also affects one’s expressive (efferent) language skills.