Topic: Eye Health & Conditions

What is Diabetic Retinopathy?

Diabetic retinopathy is commonly known as a complication of diabetes.

Anyone who has type 1 or type 2 diabetes has the potential for developing the disease. 

On average, one in three people with diabetes will develop some form of diabetic eye disease.

Diabetes is referred to as a ‘systemic disease,’ which means that it affects the entire body, rather than a single organ or body part. One of the long-term effects of diabetes is damage to large and small blood vessels. The smallest and most delicate blood vessels in your body are in your eyes, supplying the retina with oxygen and nutrients. When these blood vessels are damaged, the cells around them can start to die. This is what is referred to as diabetic retinopathy.

Diabetic retinopathy is a ‘progressive disease,’ meaning that it gets worse over time. Although some effects, such as blurriness and distortions, may be mild or subtle at the start, without treatment, diabetic retinopathy can cause loss of vision and blindness. 

 

What are the types of diabetic retinopathy?

Diabetic retinopathy is classified into two types. Not everyone will experience diabetic retinopathy in the same way, and the type you have may change as the disease progresses.

At first, there may be no symptoms and no pain, possibly just mild vision problems. This type is called ‘non-proliferative diabetic retinopathy’ (NPDR). In this early stage of the disease, the blood vessels in your retina develop small swollen spots called ‘blebs’.

As the disease progresses, it may evolve into ‘proliferative diabetic retinopathy’ (PDR). At this stage, circulation problems deprive the retina of oxygen. Then, new, fragile blood vessels begin to grow in the retina and into the vitreous – the gel-like fluid that fills the back of the eye. The new blood vessels are abnormal, weak and may leak blood into the vitreous, clouding vision.

 

What are the symptoms of diabetic retinopathy?

Because diabetic retinopathy seldom causes pain and symptoms are not always apparent in the earliest stages, retina damage can occur long before there are noticeable signs. As the condition progresses, you might develop:

• Floaters (spots or dark strings floating in your vision)
• Blurred vision
• Fluctuating vision
• Dark or empty areas in your vision
• Vision loss

 

When should you see your eye doctor?

Despite the fact that the duration of diabetes is considered one of the strongest predictors of diabetic retinopathy, studies show that nearly half of all Australians with diabetes are not having regular diabetes eye checks.

If you have diabetes, you should visit an eye doctor (optometrist) – even if you don’t have any symptoms of eye disease or vision impairment. 

Having diabetes doesn’t automatically mean you will have vision loss. Taking an active role in diabetes management can go a long way toward preventing complications. Consulting an optometrist should be an established part of any sensible diabetes management plan.

 

What will your eye doctor do?

An eye doctor (optometrist) will want to review your medical history and may request your diabetes care plan from your general practitioner.

To detect diabetic retinopathy, your optometrist will perform a dilated eye exam. During this examination, drops are placed in your eyes to dilate your pupils, which will help your optometrist see inside your eyes for any signs of retinopathy. 

Your optometrist can pick up early signs of the condition by taking photos of your retina and can establish a schedule for future eye examinations. All of these procedures are painless and simple.

 

What are your treatment options?

While modern eye surgery has come a long way, there is, unfortunately, no cure for diabetic retinopathy. However, it can be diagnosed and slowed down if caught in the early stages. The treatments concentrate on stopping the progression of the disease and preserving vision. Typically, the earlier the detection, the less invasive the treatment. As these treatments require surgery, your optometrist may need to refer you to an ophthalmologist.

For more information

Your local Eyecare Plus optometrist will provide you with all the eye health information you need about diabetic retinopathy.

Diabetes Australia is the national body for people affected by all types of diabetes, and a respected and valued source of information and advice.

What is Colour Blindness?

There are some misconceptions about ‘colour blindness’. For a start, it is not true that ‘colour blind’ people can only see black and white. 

Almost all colour blind people can see colour combinations, they just have trouble differentiating between them.

There are different types of colour blindness, but the inability to see any colour at all – a condition called ‘monochromacy’ – is extremely rare.

Colour Blind Awareness

There are approximately 350 million people in the world who do not have normal colour vision and are considered ‘colour blind.’ 

The condition mainly affects males. The condition is found in 8% of men and 0.5% of all women.  About 549,000 Australians (2.2% of the population) are colour blind – or have a colour vision deficiency.

Being ‘colour blind’ has nothing to do with the quality of our vision or how much light we see. It is not a form of blindness, but a deficiency in the way most colours are perceived.

Types of colour vision deficiency

Although there are a number of different types of colour vision deficiencies, they can be separated into three different categories: red-green, blue-yellow and monochromacy colour vision deficiency.

• Red-green

The most common form of colour blindness is red-green colour blindness. People with red-green colour blindness have a hard time telling the difference between the colours red and green. Red-green colour blind people know that a red traffic light is usually at the top and the green lights at the bottom of the traffic lights but they are unable to differentiate between a red light or a green light. 

• Blue-yellow

This type of colour blindness is less common, and more severe. People with this condition can not tell the difference between blue and green or the difference between yellow and red.

• Monochromacy

People with this condition see no colour at all. They have no colour perception. This is total colour blindness. This is the most severe form of colour blindness and is extremely rare.

Causes

Colour vision is made possible by cone cells in the retina, which is a thin wall of tissue at the back of our eyes. The cone cells are sensitive to red, green or blue light, which they combine to give us the wide range of colours we normally see. If one or more of these cone cells is faulty, a person is colour blind.

Colour blindness is usually inherited. If you are born with it, it won’t get any better, or worse. Some people become colour blind as a result of diseases such as diabetes or multiple sclerosis, or they develop the condition over time as they age.

Symptoms

Almost half of all colour blind people are unaware of their condition. This can create a number of problems, especially for children. Many daily activities, such as choosing food, playing sports or reading involve colour.

It’s important to remember that ‘Colour-blind’ people still see colours, but certain colours appear washed out or are confused with other colours. 

If you have difficulty distinguishing between blue and yellow, or red and green, have difficulty seeing light colours, or if you are frequently told by others that the colour you think you are seeing is wrong, it is important to book an appointment with your optometrist to ask whether you could be colour blind.

Treatment

Currently, there is no cure for colour blindness. However, there is help available in special lenses that can enhance colour vision and minimise colour vision deficiency. They are available as contact lenses or glasses. Results vary, depending on the person. While some colour blind people consider these lenses life-changing, others have been disappointed in the results, and claim they don’t work at all.

Colour Blind Adaptation

If you or a loved one is concerned that they don’t have normal vision or has a colour vision deficiency, contact the eye care professionals at Eyecare Plus. They will perform a thorough eye examination and determine if you have normal colour vision or a colour deficiency.

Having a vision deficiency such as colour blindness can be frustrating, but in most cases, it is not a serious threat to vision. 

With patience and practice, people who are colour blind can make lifestyle adjustments that can be made that can help them adapt to the condition.

There are also a number of apps and learning aids available for people who are colour blind. Consult with your local Eyecare Plus optometrist who will provide the best options available to help you make the most of your vision.

At Eyecare Plus Optometrists colour vision testing is a routine part of the eye examinations of every new patient and child.

What is Cataract?

A cataract is a clouding of the lens of the eye.

It is a cloudy or opaque area in the normally clear lens of the eye. For people who are developing cataracts, looking through the cataract is like looking out a frosty or foggy window. 

Cataracts can make it more difficult to read or drive a car, especially at night.

Developing cataracts

Cataracts usually develop in people over age 55, but they can also occur in infants and young children or as a result of trauma or medications. Usually, cataracts develop in both eyes, but one may be worse than the other.
Cataracts will not go away on their own. Without proper intervention, they can worsen and may lead to total vision loss.

Clouding of the lenses

Lenses are the nearly transparent structures that sit right behind the pupils in your eyes. Their main purpose is to focus and direct light rays onto the retina at the back of the eye. 

In order for us to see clearly, our lenses need to be clear. As we age, however, protein can build onto them, and turn them cloudy.

Cataract symptoms

Cataracts generally form very slowly. At first, they don’t disturb eyesight. Gradually, however, the clouded areas on the lenses become larger and denser causing sight to worsen. Signs and symptoms of a cataract may include:

• blurred vision
• sensitivity to light (seeing a glare or ‘halos’ around lights)
• reduced night vision
• fading or ‘yellowing’ of colours
• Frequent changes in eyeglass prescription

When the cataracts impair your vision or interfere with your usual activities, cataract surgery is usually recommended. Fortunately, cataract surgery is generally a safe, effective procedure.

Types of cataract

There are three main types of cataract, named for their location in the lens:

1. Nuclear Cataracts

Nuclear sclerotic cataracts is the most common type of cataract. ‘Nuclear’ refers to the clouding of the central portion of the lens (nucleus) and ‘sclerotic’ means ‘hardening’ of the lens.

2. Cortical Cataracts

These cataracts start on the outside edge of the lens and form lines that then move towards the centre, like the spokes of a wheel.

3. Posterior Subcapsular Cataracts

The posterior subcapsular cataract is the clouding of the back of the lens, beneath the membrane that holds the lens in place.

Causes of cataracts

In Australia, over 700,000 people are affected by cataracts. Most cataracts are due to age-related changes in the lens of the eye, other factors can contribute to the development of cataracts, including:

• Eye trauma
• Family history
• Diabetes
• Excessive sun and UV ray exposure
• Smoking
• Heavy alcohol use

Congenital and infantile cataracts

Cataracts can present at birth or develop in early infancy. It is very rare. Researchers estimate it occurs in approximately two out of every 10,000 births. 

When a baby is born with a cataract it is called a ‘congenital cataract.’  If a cataract develops in the first six months of life, it is known as an ‘infantile cataract.’ A common cause of congenital cataracts in babies is heredity. Sometimes, the cataracts in the baby can be traced to an infection of measles or rubella in the mother in the first trimester of pregnancy. 

How to reduce the risk of cataracts

Things you can do to reduce your risk of cataracts:

• Stop smoking
• Reduce your alcohol use
• Wear sunglasses and a hat whenever you are outside for eye protection from the sun
• Eat a well-balanced diet
• Have a regular eye examination, particularly if you are over 60

What to expect at the optometrist

Cataracts are most commonly diagnosed by an eye doctor (optometrist). Your Eyecare Plus optometrist will be able to perform an eye exam to check for cataracts. 

Your eye doctor will look at the appearance of your eye during the eye exam.

During your eye exam your eye doctor may examine your eye with a slit lamp, which will show the location and pattern of the cataract.

Based on that information, your optometrist will discuss treatment options and possibly refer you to an ophthalmologist for cataract surgery.

Cataract surgery

Cataract surgery, also called ‘lens replacement surgery,’ is one of the most frequently performed eye surgery procedures performed by an ophthalmologist, in the world. It is simple and low-risk. During the eye surgery, the patient’s cloudy lens is replaced with a clear intraocular lens (IOL). Most IOLs are made of silicone or acrylic. The entire procedure takes about thirty minutes and is performed in a day surgery or a hospital.

Once the cataract has been completely removed with surgery, it does not return.

Are cataracts inevitable?

Cataracts are a natural part of the aging process. Although they are not inevitable, most of the figures suggest that, if you live long enough, the risk of developing cataracts is high. About 30% of people in Australia over the age of 50 have age-related cataracts. For people over the age of 80, the prevalence of cataracts is about 80%. The prevalence of cataracts in Indigenous Austraians is five to six times higher than non-Indigenous Australians in those aged over 60.

What is Amblyopia?

The medical name for lazy eye is ‘amblyopia’ (am-blee-OH-pee-uh). It starts from reduced vision, generally in only one eye. 

The condition is the leading cause of decreased vision among children. It generally develops from birth up to age seven years.

Amblyopia develops from a miscommunication between the eyes and the brain. If one eye is stronger than the other, the brain slowly begins to prefer it and ‘tunes out’ the weaker eye. Over time, the brain relies so much on the stronger eye that vision in the weaker one gets worse.

Early detection is vital

Amblyopia does not go away on its own.

If amblyopia is left untreated, it can have long term consequences for a child’s vision, and lead to permanent vision problems. 

The key to helping your child’s vision and preventing long-term problems with amblyopia is early diagnosis and treatment by your eye doctor (optometrist). 

The earlier the diagnosis, the better the chance of a complete recovery.

What causes amblyopia?

If vision in one eye is worse than in the other, the two ‘views’ provided by the eyes can not be combined into one clear image by the brain. Instead, the brain responds by dulling or ignoring the image sent by one of the eyes (usually the weaker one).  

Over time, the brain gets used to working with the strong eye, and it ‘turns off’ the other one. Unfortunately, the eye ignored by the brain will not develop normal vision.

There are three different causes to lazy eye amblyopia, but fundamentally, the condition stems from one eye being stronger than the other.

Strabismic amblyopia 

Strabismic is the most common cause of lazy eye amblyopia.

Strabismus is the condition of misalignment, when both eyes don’t look in the same place at the same time. When this happens, the brain begins to ignore the visual input from the misaligned eye.

Refractive amblyopia 

Refractive amblyopia is when the eyes are aligned, but one eye has significant far-sightedness or near-sightedness. 

The brain then chooses to go with the information coming in from the less-affected eye and tunes out the impaired one.

Deprivation amblyopia 

Deprivation amblyopia is the most severe form of lazy eye. 

It happens when there is a cloudy area in the lens (cataract) that prohibits clear vision in that eye. Urgent treatment is required to prevent vision loss.

Symptoms of amblyopia

Often, children with amblyopia have no obvious symptoms and the condition goes undetected until they have their first comprehensive eye exam.   

Noticeable symptoms include…

• One eye is fully or partially shut
• The child’s head is always turned or tilted to one side
• The child bumps into things frequently

Is lazy eye the same as crossed eyes?

Contrary to popular opinion, lazy eye and crossed eyes are not the same thing. 

The medical term for crossed eyes is ‘strabismus,’ which is a problem with eye-alignment. That is: both eyes do not look at the same place at the same time.

Lazy eye, on the other hand, is a lack of development of clear vision (acuity) in one of the eyes.

Frequently, crossed eyes cause your eye to become lazy. Often, to avoid double vision caused by crossed eyes, the brain ignores the input from one of the eyes. This leads to laziness in the eye. Although they appear similar they are two distinctly different conditions.

Crossed eyes (‘strabismus’) is a condition of misaligned eyes. When the eyes point in two different directions. Lazy eye (‘amblyopia’) is when visual input from one eye is ignored by the brain. 

Lazy eye treatment

Early treatment of amblyopia lazy eye is crucial. Amblyopia treatment is as follows:

Glasses

If a vision problem is causing amblyopia, your optometrist will be able to treat it first. They may recommend glasses or contacts (for children who are near-sighted or far-sighted) or surgery (for kids with cataracts).

Eye Patches

The next step is to retrain the brain and force it to use the weaker eye. The more the brain uses it, the stronger it gets. Training involves putting an eye patch over the good eye so that the lazy eye has to work. Eye patching is an effective idea. Since the brain is only getting information from the eye that doesn’t have the eye patch on, it can’t ignore it. The eye patch is worn a few hours each day by the child.

Eye drops

Another option is putting special eye drops in called atropine eye drops, which are less conspicuous than patches. Atropine works on the same principle as patching, but is less conspicuous. Atropine eye drops temporarily blur out the stronger eye and force the brain to take signals from the ‘lazy eye.’ The drops will cause blurry vision for a short while in the good eye, resulting in the lazy eye having to work harder and as a result, will get stronger.

Effective treatment of lazy eye is highly successful when it is started early – the sooner your child starts having a regular eye exam in order to commence treatment, the better.

Eyecare Plus encourages all parents to schedule routine eye exams for their young children before they start school.

What is Glaucoma?

Glaucoma is a complex disease that is usually caused by a gradual increase in intraocular pressure (IOP) on the optic nerve. It is rare in people under 40 and the risk of developing glaucoma increases slightly with each year of age.

Glaucoma is the leading cause of blindness in people over the age of 60.

It is the gradual nature of the disease that makes glaucoma so insidious. As eye pressure builds up progressively, parts of the optic nerve become damaged irreversibly. Over time, if untreated, the progression of glaucoma results in vision loss.

The optic nerve is the bundle of nerve fibres that run like a communication cable from the back of your eyes to your brain.

Although glaucoma cannot be prevented, if it is diagnosed and treated early, glaucoma can usually be controlled.

 

What are the types of Glaucoma?

There are several types of glaucoma. The two most common types are Primary Open-Angle Glaucoma (POAG) and Primary Angle-Closure Glaucoma (PACG).

Primary Open-Angle Glaucoma is the most common form of glaucoma in Australia. It is characterised by high intraocular pressure (IOP) in the eye, which damages the optic nerve and leads to loss of peripheral vision.

Primary Angle-Closure Glaucoma is more common in long-sighted eyes, older people, women and in Asian populations. It is caused by an inherited narrowness of the drainage angle of the eye.

 

What are the Glaucoma risk factors?

Age. The risk of developing glaucoma increases slightly with each year of age, particularly for people over the age of 60.

Family history. As many as 40 to 60 percent of all patients with glaucoma have a family history of glaucoma. First degree relatives (parents, siblings and children) are at greater risk – they have an almost one in four chance of developing glaucoma in their own lifetime, and that risk doubles if the relative has advanced glaucoma.

Ethnicity. Asia accounts for almost 60 percent of the world’s total glaucoma cases. People of Asian descent are at higher risk of angle-closure glaucoma. People of Japanese descent are more likely to develop low-tension glaucoma.

 

When should you see your eye doctor?

Glaucoma is sometimes called the ‘sneak thief of sight’ because it slowly damages the eyes before there is any vision loss. 

Glaucoma Australia estimates that over 300,000 people in Australia have glaucoma, however, only 50 percent know they are living with the disease. There are no warning signs for most types of glaucoma and self-diagnosis is not possible.

All Australians 50 years or older should visit their eye doctor (optometrist) at least every two years for a comprehensive eye exam, which would include a glaucoma check.

Those who have a family history of glaucoma or are of Asian or African descent, are encouraged to get their eyes checked at least every two years from the age of 40.

 

What sort of eye examination will you have?

There is no one single diagnostic eye examination for glaucoma. Your optometrist will perform a variety of tests, using a variety of devices to look for glaucoma symptoms and will then analyse the clinical findings. The glaucoma tests are completely painless.

 

What are the treatment options?

Glaucoma does not go away and there is no cure. Glaucoma treatment is aimed at reducing pressure in the eye. Regular use of prescription eye drops is the most common treatment and often the first treatment. Sometimes cases may require systemic medications, laser treatment, or eye surgery.

 

How can you live with Glaucoma?

As long as a glaucoma diagnosis is provided early and managed well, most patients with glaucoma continue to enjoy a full life. Lifestyle changes would need to be made and adherence to the recommended course of treatment has to become part of a normal routine.

To learn more about glaucoma, speak with an eye doctor (optometrist). 

Your local Eyecare Plus optometrist will provide you with all the eye health information you need about glaucoma.

 

What about marijuana treatment for Glaucoma?

In the early 1970s, hopes were, well, ‘high’ when studies showed that smoking marijuana lowers intraocular pressure (IOP). Gradually, however, the clinical consensus on the use of marijuana for the treatment of glaucoma has changed. Today, medical opinion is nearly unanimous in asserting that the beneficial effects of marijuana have been overstated. How did marijuana lose its status as a miracle drug for glaucoma?

The short answer is that further studies revealed serious limitations to its actual use in glaucoma. First, there are doubts about its effectiveness in lowering chronic eye pressure because the human body develops a tolerance that limits its usefulness.

Second, the lowering of the pressure in your eye is notoriously brief (three to four hours), and would require constant dosing – some reports estimate that it would require eight to 10 marijuana cigarettes a day to maintain 24 hour IOP control.

The side effects are even more substantial when you consider that, because glaucoma is a chronic condition, a patient would be required to inhale or ingest substantial doses of cannabis every day, possibly for the remainder of adult life.

Leaving aside the concerns about the serious cardio-pulmonary and psychoactive side effects, this treatment would be expensive – much more expensive than established glaucoma treatments currently in use.

In the final analysis, current glaucoma medications more consistently lower IOP with fewer side effects and with a longer duration of action. Eyecare professionals and the Australian Department of Health maintain that marijuana should not be used in the management of glaucoma. The best way to treat glaucoma is with the prescribed therapies combined with long-term monitoring of the disease.