• Laser Vision Correction

    Find out more information about our consulting suites and cutting edge practices

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  • Cataract

    What is a cataract?

    A cataract is a clouding of the natural lens within the eye. It is not a growth, film or tumour and does not cause any pain or discomfort of the eye.

    Once a cataract starts to form, it will progressively continue to cloud over causing gradual loss of vision in the affected eye. The rate of progression varies from person to person.

    What are the symptoms of cataract?

    The most common symptom is gradual blurring of vision. Other symptoms may include: glare, change in colour perception, double vision (in the affected eye) and difficulty driving at night.

    When should a cataract be treated?

    Cataracts seldom require an emergency procedure. The most common reason to consider surgery is when the distance vision becomes hazy with your best distance spectacles. If your best corrected vision is insufficient for driving purposes, then cataract surgery is encouraged if it is likely that the vision will improve with surgery.

    What is cataract surgery?

    The aim of cataract surgery is to improve your vision. The surgery involves removing the hazy natural lens and replacing it with a small plastic lens. The procedure is usually performed under local anaesthetic and can take between 10-30 minutes surgical time.

    Is the procedure done with a laser?

    Traditionally, cataract surgery is done with a fine ultrasound probe which emulsifies the lens which is then aspirated. New laser technology is available which “pre-treats” the eye prior to proceeding with surgery. This makes the procedure slightly more precise and slightly safer. The visual results are the same as traditional cataract surgery. The eye surgeons at Armadale Eye Clinic have access to and use the laser during cataract surgery if requested.

    Will I need to wear glasses after the surgery?

    Prior to surgery, we measure the eye to see what would be the best lens to insert in your eye in order to provide you with perfect distance vision. This is achieved in the majority of cases. Most people require reading glasses after bilateral cataract surgery for fine print. New technology is available where the inserted lens allows you to see in the distance and near without glasses, however, these can result in haloes post surgery but are a good option to consider if you would lie to be “glasses free” after the surgery.

    What are he risks associated with cataract surgery?

    Like all invasive procedures, cataract surgery has risks. Any complication can have an affect on the final visual outcome. These complications include:

    Infection in the eye or endophthalmitis (Risk 1:1000 per operation)
    Loss of lens material into the back of the eye (would require a second procedure)
    Failure to achieve the desired refractive outcome (you may require spectacles to see perfectly in the distance)
    Retinal detachment.

    What does the procedure involve?

    After admission to the day surgery centre, you will be introduced to your anaesthetist who may give you some “calming medication”. Eye drops will be inserted in the eye to be treated. You will then have the laser pre-treatment if you have elected to o so. Then you will be escorted into the main theatre for the actual procedure.

    The eye will have a patch on after the procedure and you will have to leave the eye pad on until you are assessed by your surgeon the following day.

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  • Glaucoma

    Find out more information about Glaucoma and treatment options

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  • Macular Degeneration

    Find out more information about Macula Degeneration

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  • Retinal Conditions

    WHAT IS A CRVO? A vein occlusion is a blockage of one of the blood vessels that drain the blood away from the retina at the back of the eye. Blockage in a retinal vein causes a build-up of pressure in the vein, and this results in leakage of fluid into the retina causing swelling Continue Reading

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Retinal Conditions

WHAT IS A CRVO?
A vein occlusion is a blockage of one of the blood vessels that drain the blood away from the retina at the back of the eye. Blockage in a retinal vein causes a build-up of pressure in the vein, and this results in leakage of fluid into the retina causing swelling (oedema), as well as bleeding into the retina. If the vein blockage is severe enough, or if the swelling is not treated, permanent damage to the retina can occur.
There are two types of vein blockages:
1. CRVO: In CRVO, the blockage is in the CENTRAL vein, which drains the blood from the entire retina. The swelling and bleeding affects the whole retina, thus all of the field of vision is affected, including the macula, which is the central part of the retina that is responsible for reading vision.

2. BRVO: In BRVO, the central vein is still flowing, but there is a blockage of one of the branches of the central vein. Thus only the segment of the retina drained by that vein is affected. The result is a distortion or blur in a patch of the vision, while the rest of the field of vision is not affected. If the swelling and bleeding caused by the blockage extends into the central reading part of the retina (the macula), reading vision is also affected.
WHY DOES IT HAPPEN?
In some people, there is a reason why the vein blockage occurred. The most common reasons are:
– HIGH BLOOD PRESSURE (HYPERTENSION): this can cause damage to the arteries in the eye (hardening of the arteries, technically known as atherosclerosis), which causes pressure on the veins, and can eventually result in a vein blockage.
– DIABETES: this can also cause the vessels to harden.
– OTHER CONDITIONS CAUSING HARDENING OF THE ARTERIES (ATHEROSCLEROSIS)
– CLOTTING PROBLEMS: Rarely, a problem with the body’s clotting system can lead to the blood flow becoming ‘sluggish’ through the veins.
– GLAUCOMA / HIGH EYE PRESSURE
– INFLAMMATION WITHIN THE EYE
In many people, no specific cause can be found.
Your Eye Specialist will discuss with you whether you should have further testing for conditions that could have contributed to your vein blockage. Generally, a review of your general health by your local Doctor is recommended as well. Treatment of any risk factors is important in preventing further vein blockages in either eye, as well as preventing problems with blood vessels elsewhere in the body.
HOW IS IT DIAGNOSED?
Your Eye Specialist can tell if you have a vein occlusion by looking at the retina in the back of your eye while your pupil is dilated with eye drops. The following tests may also be needed:
1. OCT SCAN: this scan shows your Eye Specialist how much swelling is present in the retina, which helps determine which treatment to recommend. Having an OCT is a simple test to have – it feels just like having a photograph of the eye taken.

2. FLUORESCEIN ANGIOGRAM (FFA): In this test, a fluorescent dye is injected into the circulation through a small drip in the arm, while you are sitting in front of a special camera. The camera takes photos of the retinal circulation as the dye passes through it. This helps your Eye Specialist determine which areas of the circulation have been affected.
WHAT IS THE OUTCOME WITHOUT TREATMENT?
In people with CRVO, the vision rarely improves without treatment. Before treatments were available for CRVO, large studies were done to investigate the natural history of the condition. These studies showed that the outcome did vary, but the most important factor was how bad the vision was when a person was first seen by their Eye Specialist. For example:
IF NO LETTERS CAN BE READ ON THE EYE CHART:
– Chance of eventually achieving driving vision: 1 in 100
– Chance of reading something on the eye chart: 1 in 5
– Chance of staying the same or worse: 4 in 5
IF SOME LETTERS CAN BE READ, BUT NOT TO THE LEGAL DRIVING LEVEL:
– Chance of eventually achieving driving vision: 1 in 5
– Chance of being unable to read the eye chart: 1 in 3
IF THE LEGAL DRIVING LEVEL OR BETTER CAN BE READ:
– Chance of keeping the current level of vision: 2 in 3
– Chance of getting worse: 1 in 3
– Chance of being unable to read the eye chart: 1 in 10
In addition to its effect on your quality of vision, CRVO can also result in a condition known as RUBEOSIS. In this condition, the retina, which is starving for more oxygen and nutrients, sends a chemical signal into the eye that results in fine blood vessels forming on the IRIS at the front of the eye. These vessels can stop the drainage of any fluid from the eye, causing the eye pressure to rise. This results in a painful, red and blind eye (RUBEOTIC GLAUCOMA). The condition is difficult to treat, and it is critical that the development of any iris rubeosis is detected early. For that reason, it is likely your Eye Specialist will recommend frequent reviews in the months after your CRVO.
TREATMENT OPTIONS
If there is any underlying reason that your vein occlusion occurred, such as uncontrolled high blood pressure or glaucoma, it is extremely important that it is treated, both to improve the chance of successful treatment in your affected eye, and to protect your other eye.
Specific treatments your Eye Specialist may discuss with you include EYE INJECTIONS and LASER.
1. EYE INJECTIONS (ANTI-VEGF TREATMENT):

This is the newest and currently the best treatment for CRVO. This treatment is now regularly used in Australia and many countries overseas for people with CRVO. Three types of injection treatments are currently available – AVASTIN, LUCENTIS and EYLEA. The commonest treatment currently used in Australia is AVASTIN.

These injections are exactly the same types of medications used to treat people with wet macular degeneration, and the injections are given in the same way. Local anaesthetic is applied to the surface of the eye for comfort, and the injection can be given at the Clinic.

Occasionally, only one or two injections are adequate to treat CRVO, but in most people a series of eye injections are required. Treatment is often commenced on a monthly basis, depending on how quickly your eye improves. The aim of the injections is to resolve the swelling in the retina, and thus improve the vision, while giving the minimum possible number of treatments.

However, as the effect of the injection wears off, the swelling often tends to recur, along with the blurred vision. If this happens, ongoing ‘maintenance’ injections may be appropriate. Experience has shown us that everyone’s eye is different, and it can be very difficult to predict exactly who will respond to the treatment, and how often treatment will be required. Thus, a trial of treatment is often recommended, in order to determine what is the best vision that can be achieved, and how often treatment might be needed.

However, anti-VEGF eye injections do NOT work for everyone. In some people, the CRVO has already caused permanent retinal damage, and if that is the case, the vision will not improve significantly even if the retinal swelling resolves completely. In other people, the swelling of the retina persists in spite of regular injection treatment. If the injections do not seem to be improving your vision, your Eye Specialist may suggest that you stop the treatment, or recommend a trial of one of the alternative injection agents.

2. LASER:
This is RARELY USED in CRVO as it DOES NOT IMPROVE THE VISION. However, if iris rubeosis is occurring, your Eye Specialist may recommend PRP LASER, usually in combination with Avastin. While this will not improve your vision significantly, it is very effective in preventing the problems associated with rubeosis.
THE FUTURE
While at present, anti-VEGF injections are the best treatment for CRVO, we are hoping there will be more convenient treatments available in the future, such as eye drops or longer-acting injections. In the meantime, the aim is to keep your vision as good as possible, with the minimum number of treatments required to achieve that outcome.
VEIN OCCLUSIONS – BRVO
WHAT IS A BRVO?
A vein occlusion is a blockage of one of the blood vessels that drain the blood away from the retina at the back of the eye. Blockage in a retinal vein causes a build-up of pressure in the vein, and this results in leakage of fluid into the retina causing swelling (oedema), as well as bleeding into the retina. If the vein blockage is severe enough, or if the swelling is not treated, permanent damage to the retina can occur.
There are two types of vein blockages:
1. CRVO: In CRVO, the blockage is in the CENTRAL vein, which drains the blood from the entire retina. The swelling and bleeding affects the whole retina, thus all of the field of vision is affected, including the macula, which is the central part of the retina that is responsible for reading vision.

2. BRVO: In BRVO, the central vein is still flowing, but there is a blockage of one of its branches. Only the segment of retina drained by that vein is affected. The result is a distortion or blur in a patch of the vision, while the rest of the field of vision is not affected. If the swelling caused by the BRVO extends into the central part of the retina (the macula), the reading vision is also affected.
WHY DOES IT HAPPEN?
In some people, there is a reason why the vein blockage occurred. The most common reasons are:
– HIGH BLOOD PRESSURE (HYPERTENSION): this can cause damage to the arteries in the eye (hardening of the arteries, technically known as atherosclerosis), which causes pressure on the veins, and can eventually result in a vein blockage.
– DIABETES: this can also cause the vessels to harden.
– OTHER CONDITIONS CAUSING HARDENING OF THE ARTERIES (ATHEROSCLEROSIS)
– CLOTTING PROBLEMS: Rarely, a problem with the body’s clotting system can lead to the blood flow becoming ‘sluggish’ through the veins.
– GLAUCOMA / HIGH EYE PRESSURE
– INFLAMMATION IN THE EYE
In many people, no specific cause can be found at all.
Your Eye Specialist will discuss with you whether you should have further testing for conditions that could have contributed to your vein blockage. Generally, a review of your general health by your local Doctor is recommended as well. Treatment of any risk factors is important in preventing further vein blockages in either eye, as well as preventing problems with blood vessels elsewhere in the body.
HOW IS IT DIAGNOSED?
Your Eye Specialist can tell if you have a vein occlusion by looking at the retina in the back of your eye while your pupil is dilated with eye drops. The following tests may also be needed:
1. OCT SCAN: this scan shows your Eye Specialist how much swelling is present in the retina, which helps determine which treatment to recommend. Having an OCT is a simple test to have – it feels just like having a photograph of the eye taken.

2. FLUORESCEIN ANGIOGRAM (FFA): In this test, a fluorescent dye is injected into the circulation through a small drip in the arm, while you are sitting in front of a special camera. The camera takes photos of the retinal circulation as the dye passes through it. This helps your Eye Specialist determine which areas of the circulation have been affected.
WHAT IS THE OUTCOME WITHOUT TREATMENT
Whether your vision will improve after a BRVO depends on whether any permanent damage has already occurred to the retina, and on the amount of retinal swelling and bleeding. Generally, the outlook is better in BRVO than in CRVO. In the days before any treatment existed for BRVO, large studies were done to investigate the outcome in the condition. These showed that if the central retina (macula) was NOT swollen and the vision on the eye chart was still normal, the outcome was good without any treatment. However, if the central retina (macula) was swollen enough to blur the vision on the eye chart;
– The chance of gaining significant vision (>=2 lines on the eye chart) was 1 in 3
– The chance of losing significant vision (>=2 lines on the eye chart) was 1 in 5
– The most likely outcome was that the vision would stay the same level as it was when the condition was diagnosed.
Overall, about 1 in 3 people with blurred vision from BRVO would recover enough vision to reach the legal driving level with the affected eye, and about 1 in 5 would be unable to read any letters on the eye chart.
The outlook for vision was much worse in people who had uncontrolled high blood pressure. Thus, it is extremely important to see your local Doctor for review of your blood pressure control.
TREATMENT OPTIONS
If there is any underlying reason that your vein occlusion occurred, such as uncontrolled high blood pressure or glaucoma, it is extremely important that it is treated, both to improve the outlook for your affected eye, and to protect your other eye.
Specific treatments your Eye Specialist may discuss with you include EYE INJECTIONS and LASER.
1. EYE INJECTIONS (ANTI-VEGF TREATMENT):

This is the newest and currently the best treatment for BRVO. This treatment is now regularly used in Australia and many countries overseas for people who have a BRVO that is causing blurred vision due to swelling in the macula. Three types of injection treatments are currently available – AVASTIN, LUCENTIS and EYLEA. The commonest treatment currently used in Australia is AVASTIN.

These injections are exactly the same types of medications used to treat people with wet macular degeneration, and the injections are given in the same way. Local anaesthetic is applied to the surface of the eye for comfort, and the injection can be given at the Clinic.

Occasionally, only one or two injections are required to treat BRVO, but in many people a series of eye injections are needed. Treatment is often commenced on a monthly basis, depending on how quickly your eye improves. The aim of the injections is to resolve the swelling in the retina, and thus improve the vision, and to use the minimum number of treatment required to achieve that aim.

However, as the effect of the injection wears off, the swelling often tends to recur, along with the blurred vision. If this happens, ongoing ‘maintenance’ injections may be appropriate. Experience has shown us that everyone’s eye is different, and it can be very difficult to predict exactly who will respond to the treatment, and how often treatment will be required. Thus, a trial of treatment is often recommended, in order to determine what is the best vision that can be achieved, and how often treatment might be needed.

However, anti-VEGF eye injections do NOT work for everyone. In some people, the BRVO has already caused permanent retinal damage, and if that is the case, the vision will not improve significantly even if the retinal swelling resolves completely. In other people, the swelling of the retina persists in spite of regular injection treatment. If the injections do not seem to be improving your vision, your Eye Specialist may suggest that you stop the treatment, or recommend a trial of one of the alternative injection agents.

2. LASER:
While anti-VEGF eye injections are now the preferred treatment for most people with BRVO, laser to the involved area of retina can also help improve the vision in people with retinal swelling from BRVO, and in some people, this can avoid the need for ongoing injection treatments. This laser can be done at Armadale Eye Clinic if required. It is NOT the same type of laser that is used to ‘throw away your glasses’ or for cataract surgery. Your Eye Specialist will discuss laser further with you if this is an option in your particular condition.
THE FUTURE
While at present, anti-VEGF injections are the best treatment for CRVO, we are hoping there will be more convenient treatments available in the future, such as eye drops or longer-acting injections. In the meantime, the aim is to keep your vision as good as possible, with the minimum number of treatments required to achieve that outcome.