VISUAL EYE PROBLEMS

A LOOK THROUGH THE MOST COMMON VISUAL EYE PROBLEMS

Cataracts

What are cataracts?

Cataracts are not as many people think, a skin which grows over the front of the eye. They are caused when the lens inside the eye which is responsible for focusing the light becomes cloudy and opaque, often giving the patient the feeling of looking through a dirty window.

How do you get cataracts?

The most common type of cataracts are related to increasing age, typically affecting 50% of people over the age of 75. Cataracts can also be secondary to inflammation in the eye, diabetes or injury. Rarely cataracts are congenital or run in families.

What problems would I notice with my eyes?

As the cataract develops the lens in the eye becomes more cloudy and the vision becomes increasingly blurred. A cataract also scatters light inside the eye so patients with cataracts often complain of glare and light sensitivity. A hat with a brim of tinted spectacles can often help. Cataracts all develop at different rates, some can take years to develop fully. Usually both eyes are affected although the cataract is often worse in one eye.

How is cataract detected?

Cataracts can be seen by the examiner looking into the eye with an instrument called an ophthalmoscope. The eye can also be seen with s slit-lamp microscope where a light beam is shone through the pupil to look at the lens in the eye.

How are cataracts treated?

Initially the blurred vision can be treated with spectacles, most cataracts cause more frequent changes in spectacle prescription. When spectatcles can no longer improve the vision sufficiently the patient would be referred to an eye clinic to be assessed for surgery. Surgical treatment consisits of removing the cloudty lens from the eye and replacing it with an artificial implant lens. Surgery can in most cases be conducted with a local anaesthetic.

Conjunctivitis

Conjunctivitis is an infection or inflammation of the tissue which covers the white section (sclera) of the eye. It is usually caused by bacteria, but may also be due to virus, fungi and allergic causes. Symptoms can include hot gritty eyes, discharge, watery eyes, sensitivity to light and swelling of the eyelids.

Most bouts of conjunctivitis get better without treatment, but sometimes drops or eye ointment may be necessary. If your doctor provides any treatment it is important to complete the course. Ointments will make vision slightly blurred and drops can sting. This is normal and treatment should be continued.

Conjunctivitis is very contagious, so the use of separate towels and soap at home is sensible. Rubbing the eyes can make things worse and could lead to infecting the other eye, so it is best to try not to touch the eyes with your hands.

Untreated conjunctivitis should not persist for more than 10 to 14 days. If it does, or if vision difficulties are noticed, advice should be sought.

Diabetes

What is diabetes?

Diabetes is caused when the pancreas either fails to produce or produces insufficient insulin into the blood stream. Insulin is responsible for the absorption of sugar into the body which is needed for energy, if the sugar is not absorbed then the level within the blood becomes too high. If sugar can not be stored the patient will experience weight loss, hunger and fatigue.

How do you get diabetes?

Diabetes tends to run in families. Diabetes which occurs in later life and is controlled with tablets or diet tends to be more hereditary. Whereas diabetes which occurs in a younger person and is controlled with insulin injections tends to be less hereditary.

What problems will I notice with my eyes?

When diabetes first occurs blurred vision may be noticed depending on the blood sugar level. When the diabetes is controlled the variation in vision should be minimal. If the diabetes started to affect the back of your eyes you would probably not be aware that anything was wrong. The changes occur in the blood vessels in the retina, which is the membrane at the back of the eye which focuses light.

Diabetes damages the small blood vessels which makes them leak fluid and blood, then new blood vessels may form which are very prone to bleeding and scarring of the retina. All of these problems lead to blurred vision which can not always be improved unless treatment is performed early. Regular check-ups on your eyes are essential. The NHS will pay for you to be tested by an Optometrist regularly, it is important that this is done so that an changes can be treated straight away.

How can diabetes be treated?

Diabetic eye disease can be treated with a laser which is used to seal up the leaky blood vessels in the retina. The treatment is much more effective if performed in the very early stages of diabetic eye disease. Problems with the eyes are much more likely in diabetics that are poorly controlled but they can occur even if there has been good control.

Floaters

“Floaters” are dark, translucent, spidery shapes, which appear to be floating within the field of vision. It often appears they can be “brushed away”, but this proves impossible. If an attempt is make to look directly at them they appear to move away.

They are generally more obvious when viewed against a plain, brightly lit background, such as a blank wall of a piece of paper. They have often been present for a long period of time before they are noticed, but generally once noticed they seem to become more of a nuisance. However, they are rarely a cause for concern.

Floaters are generally tiny particles which become detached from the “vitreous”, the jelly-like substance which fills the inside of the eye. These particles float about and cause a shadow to be cast on to the retina, at the back of the eye.

Most floaters are unlikely to disappear but they can reduce as the years pass.

The only time they need to be taken seriously is if they suddenly increase in number, if they occur in conjunction with a blank patch in the field of vision. If this happens you need to be seen for an eye examination as quickly as possible, or present to the nearest eye casualty department, as a small section of the retina may have also detached. If this has occurred then eye surgery or laser treatment is necessary to re-attach the retina, which will prevent the retina totally detaching and the eye losing its sight completely.

Glaucoma

What is Glaucoma?

Glaucoma is a name given to a group of eye disorders which are characterized by a raised eye pressure. The most common type is Chronic Open Angle Glaucoma’ and affects approximately 5% of people over the age of 65.

What is pressure in the eye?

There is a current circulation of fluid within the eye, the fluid is responsible for providing nourishment to certain tissues in the eye through drainage channels situated towards the front of the eye. Normal pressure is created if the amount of fluid produced is equal to the amount of the fluid leaving the eye. If the fluid cannot escape or too much is produced then the pressure rises. The eye pressure has nothing to do with blood pressure.

How do you get Glaucoma?

Glaucoma can not be caught. It is a defect of the eye which only becomes apparent in adult life. Glaucoma can only be an inherited condition, the incidence rises considerably in people who have a close relative with Glaucoma. Glaucoma is also more common in those people who are short-sighted and those with diabetes.

What symptoms does a patient experience?

In chronic open angle glaucoma the pressure in the eye increases very gradually over a period of months or even years. There is no pain or blurred vision associated initially with raised pressure and therefore the patient is unaware that a problem exists. If the pressure continues to increase, small blood vessels which feed the optic nerve are attacked and in turn the nerves which conduct the sight to the brain are destroyed and loss of peripheral vision occurs. The result of untreated Glaucoma is tunnel vision. In another type of Glaucoma called ‘Acute Glaucoma’ the pressure increases dramatically over a period of hours, causing severe pain, a red eye and blurred vision.

How is Glaucoma detected?

It is important that Glaucoma is detected as early as possible as any loss in the field of vision can not be restored. The examiner will look into the eye to see if the optic nerve is damaged. The pressure of the eye is measured using an instrument which blows a gentle puff of air towards the eye, or by numbing the eye with drops and placing a small instrument against the eye. A field test is also conducted to test for gaps in the field of vision. All the tests are extremely straightforward and painless.

How is Glaucoma treated?

The treatment aims to reduce the pressure in the eye. This is usually done with drops, which either reduce the amount of fluid produced into the eye, or help fluid drain from the eye. Occasionally surgery is necessary to reduce the pressure.

How can I avoid Glaucoma?

Regular eye examinations are extremely important so that small changes in eye pressure can be investigated and treated as early as possible to prevent any damage to the eye occurring. If you are over 40 and have a close relative with Glaucoma, the NHS will pay for you to be tested annually or more frequently if necessary, to screen for Glaucoma.