recurrent corneal erosion syndrome melbourne vic

Recurrent Corneal Erosion Syndrome – Causes, Symptoms & Treatment

The cornea is a delicate structure and the most sensitive part of the eye. That transparent dome of tissue at the front surface of your eye, the cornea is responsible for bending, or refracting, light to provide clear vision. There is a myriad of conditions that can affect the cornea, with effects ranging from no noticeable symptoms to significantly debilitating pain and permanent loss of vision. Recurrent corneal erosion syndrome is a disease that can cause real distress for some patients, leading to corneal surgery, while for others is only a mild irritation that can be easily managed with over-the-counter lubricant eye drops. 

 

The Cornea 

As mentioned earlier, the cornea is a very sensitive part of the eye. The lightest touch from a speck of dust can cause irritation and reflexive tearing, an important reflex response designed to protect the eye. It’s no wonder that a more significant injury, such as the severely-named “recurrent corneal erosion”, can have a real impact on quality of life. 

The cornea is made up of five layers:

  • The epithelium at the front surface of the eye; the epithelial cells are adhered to a basement membrane
  • Bowman’s membrane underneath the epithelial basement membrane
  • The corneal stroma, which makes up the bulk of the cornea 
  • Descemet’s membrane, immediately behind the stroma
  • And the corneal endothelium, which is comprised of cells responsible for controlling the water content of the cornea 

 

Recurrent Corneal Erosion Syndrome

Recurrent corneal erosion syndrome is a corneal condition that involves the epithelium and its basement membrane. In this disease, the epithelial cells are poorly adhered to the basement membrane in certain patches across the cornea, resulting in these cells separating from each other in what is known as a recurrent corneal erosion. A recurrent corneal erosion is basically a defect at the level of the corneal epithelium. They are most common in people in their 30s and 40s, with a slight bias towards females. 

about recurrent corneal erosion syndrome melbourne vicA recurrent corneal erosion is typically characterised by a sudden sharp pain in the eye upon waking in the morning. The theory behind this presentation is that overnight, the corneal epithelial cells stick to the inside of the upper eyelid as the eye’s surface dries. Combined with mild superficial swelling of the epithelium due to the lids being closed during sleep which leads to weakened anchoring of the epithelium to its basement membrane, as the eyelids open in the morning this can mechanically erode, or pull, the epithelium from the basement membrane. Other symptoms associated with this condition include tearing, redness, and light sensitivity in the affected eye. There may also be some disturbance to the vision, whether from the corneal defect itself or from the excessive tearing. As the name suggests, recurrent corneal erosion tends to happen again and again, often in the same area of the cornea. 

It is not always understood why a patient may have a weakened epithelial adhesion to the corneal basement membrane. However, in up to about 65% of cases, a history of previous corneal trauma can be identified, such as a scratch from a tree branch, fingernail, or piece of paper. Another predisposing factor for recurrent corneal erosion syndrome is the presence of an epithelial basement membrane dystrophy, which is a genetic corneal condition. Epithelial basement membrane dystrophies account for up to 29% of cases of recurrent corneal erosions. Patients who have dry eye syndrome, diabetes, ocular rosacea, or blepharitis also tend to be at a higher risk of experiencing a recurrent corneal erosion

 

Recurrent Corneal Erosion Treatment

Recurrent corneal erosion syndrome can be difficult to treat, leading some patients to get quite frustrated at the lack of relief. Many eyecare practitioners will begin with conservative therapy before escalating to corneal surgery in very severe, stubborn cases. 

First line therapy is generally lubricant eye drops or eye ointment. Typically, this involves frequent use of preservative-free artificial tears during the day plus a thicker, more viscous eye ointment at night before bed to discourage the corneal epithelium from sticking to the underside of the eyelid. This should be considered as a preventative measure to avoid an attack from occurring. During an active episode of a corneal erosion, the optometrist or ophthalmologist may prescribe a preventative antibiotic to avoid a bacterial infection from taking advantage of the epithelial defect, as well as pain relief tablets as needed. Large corneal defects may benefit from having a contact lens inserted on the eye to provide some protection from the environment. If these treatments are ineffective, you may be referred for corneal surgery with an anterior eye specialist. 

Corneal surgery options for recurrent corneal erosion syndrome include:

  • Anterior stromal micropuncture – this involves using a fine needle to prick through the superficial layers of the cornea. The basis of this treatment is that the micro punctures stimulate the cornea to fortify the basement membrane
  • Debridement and superficial keratectomy – using a burr or scalpel, loose epithelium is removed from the eye, allowing new, healthy epithelium to regrow
  • Phototherapeutic keratectomy – this may be considered the last option for corneal surgery where other treatments have failed. After removing loose epithelium with debridement, a laser is used to vaporise several micrometres of Bowman’s membrane, allowing re-epithelisation with healthy cells. 

If you think you may be experiencing recurrent corneal erosions, it is important to be examined by an experienced optometrist or ophthalmologist. Call us today at (03) 9070 5753 for a consultation.

 

 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

 

chalazion vs stye melbourne vic

Chalazion vs Stye – Understanding the Differences of 2 Eyelid Bumps

Our eyelids are delicate structures but are also a lot more intricate and functional than we give them credit for. Most of us will experience a little lump or bump on an eyelid at some point in our lives – some of these eyelid bumps are harmless while others need the attention of a specialist in oculoplastic surgery. Out of all the garden variety eyelid bumps, the most commonly confused are a chalazion vs stye

 

The Eyelid

Understanding a little of the anatomy of the human eyelid will help us to have a better grasp of the difference between a chalazion vs stye

Our eyelids serve several purposes, including physically protecting the sensitive surface of the eye as well as providing lubrication via several different glands. The eyelid is made up of layers of smooth muscle, connective tissue, fibrous tissue, a mucous membrane known as conjunctiva, and various secretory glands. Lining the upper and lower eyelid margins are a particularly important set of glands known as the meibomian glands, which open their orifices just behind the eyelash line. The oily secretion produced by these glands is called meibum, which has the purpose of lubricating the surface of the eye, keeping these tissues healthy and contributing to clear vision. 

Each eyelash follicle is paired with two additional types of glands known as the glands of Zeis and Moll. The glands of Zeis are sebaceous glands while the glands of Moll are modified sweat glands. Both of these glands support the health of our eyelashes, with their secretions keeping the lashes from becoming brittle.

While the glands of our eyelids are certainly useful, they can also be subject to infection and blockages, much like other glands throughout our bodies. It’s then that you may experience one of those inconvenient little eyelid bumps

 

Chalazion vs Stye 

about chalazion vs stye melbourne vicChalazia and styes are among the most common lumps and bumps found on the eyelid. Although both are considered benign, both types of eyelid bumps can be a cause of concern for many people, particularly if the lump is large, sore, or red, leading them to enquire about oculoplastic surgery. The underlying cause is what differentiates a chalazion vs stye, although many people will use the term “stye” to cover both types of bumps. 

A chalazion (plural, chalazia), is a blockage of a meibomian gland in the eyelid without an active infection. Initially a chalazion may begin as a stye but then eventually the infection resolves, leaving behind a painless bump that we then call a chalazion. A chalazion is made up of blocked meibum accumulating in the surrounding soft tissues of the eyelid as its usual drainage route through the duct is obstructed. The main concern for someone with a chalazion is not pain or redness, even when the chalazion is touched, but more of a cosmetic issue. A chalazion can vary in size, with some being large enough to put some pressure on the cornea and causing temporarily blurred vision. Unfortunately, chalazia are known to take some time to clear, from weeks to months.  

On the other hand, a stye, also known as a hordeolum, involves an active infection. An external stye is due to an infection of one the glands of Zeis or Moll, and typically appears as a yellowish-whitish pimple around the base of the affected eyelash follicle. Conversely, an internal stye or hordeolum involves an infection of a meibomian gland inside the eyelid. It’s an internal stye that is most likely to be confused with a chalazion as they both appear as bumps under the skin of the eyelid. Because there is an active infection, styes are typically sore and associated with redness and inflammation. 

 

Treatment

Most styes and chalazia will self-resolve without needing intervention from an oculoplastic surgery doctor. To hasten the healing process, you may consider using a gentle warm compress over the affected eyelid in order to encourage blood flow to the area, or your optometrist and GP may pluck the eyelash associated with an external stye to help drainage of the blocked glands. As tempting as it may be, however, you should never try to pop a chalazion or stye as this will potentially exacerbate the lesion. Some eyecare practitioners may prescribe a topical antibiotic ointment for an external stye but these should be avoided in the case of chalazia as there is no infection. 

Large chalazia and styes that are taking a long time to self-resolve with home remedies such as a warm compress can be referred to an ophthalmologist experienced in oculoplastic surgery. For very stubborn chalazia, the eye specialist can perform a surgical procedure to remove the contents of the chalazion, known as an incision and curettage. There is also the option of steroid injections into the eyelid to help the chalazion to resolve more quickly. 

Styes and chalazia are known to recur, whether in the same area of the eyelid or elsewhere. Several risk factors have been identified in the likelihood of developing recurrent styes and chalazia, such as having acne rosacea or meibomian gland dysfunction. A chalazion that frequently pops up in the same area may require examination by an ophthalmologist to rule out any other conditions that may mimic a chalazion, such as an eyelid carcinoma. 

Call us today at (03) 9070 5753 for more info.

 

 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. 

corneal infection melbourne

Corneal Infection – Underlying Causes That Will Affect Your Eye Health

While some corneal infections result in only a mildly irritated eye, depending on the underlying cause and its location on the cornea, a corneal infection has the potential to severely impact eye health, causing permanent damage to your sight. A corneal infection can be caused by bacterial or viral infections, or be due to a fungus or microscopic parasite. In some unfortunate cases, an eye may be infected by more than one pathogen simultaneously. 

The cornea is the front surface of the eye and must remain clear and transparent in order for light to pass through to reach the retina at the back of the eye and provide vision. Any disruption to this tissue, such as damage and scarring from corneal infections, can physically impede the passage of light into the eye, resulting in blurred vision. The cornea is also the most sensitive part of the eye, with a speck of dust being able to cause a great deal of discomfort. 

 

Causes of Corneal Infection 

A corneal infection is often referred to as keratitis, which translates to inflammation of the cornea. Although not all keratitis cases are necessarily active infections, all corneal infections involve inflammation at some point in their development. 

 

Bacterial Infections

Most corneal infections are caused by bacteria, usually staphylococcus aureus or pseudomonas aeruginosa. Bacterial keratitis, in particular pseudomonas infections, can be aggressive and a significant threat to eye health, and so should be addressed promptly by an eyecare practitioner endorsed to prescribe antibiotic medications.

causes corneal infection melbourneRisk factors for the development of a bacterial keratitis include contact lens wear, in particular when poor contact lens hygiene is practised, such as overnight wear or wearing a lens for longer than the recommended disposal schedule. Other underlying causes of compromised eye health can also predispose a person to bacterial keratitis, such as being immunocompromised or an eye injury. 

Symptoms of bacterial corneal infections include mild pain, redness, and a mucous or pus discharge from the eye. You may also be able to see a round whitish opacity on the cornea, which is an ulcer caused by the infection. If this ulcer is large and central, or if there is significant discharge, you will also experience some effect to your vision.  

 

Viral Infections

You may have heard of the herpes virus and adenoviruses in a context outside of eye health. However, these two viruses are in fact most commonly responsible for viral infections of the eye. Herpes simplex keratitis is caused by the type 1 herpes simplex strain of virus, the same strain responsible for causing cold sores around the mouth. It is also possible to get shingles in the eye in a condition known as herpes zoster ophthalmicus, caused by the varicella zoster virus of the herpes family. Once infected by a herpes virus, the virus remains in the body for life, typically lying dormant unless reactivated. Reactivation of the virus causes recurrent infection and inflammation, which can cause significant damage to the corneal tissues if not adequately managed. 

Adenoviruses are a group of viruses often behind the common cold, causing characteristic symptoms such as fever, cough, and sore throat. Adenoviral infections of the eye are highly contagious and can be spread through droplets of bodily fluids left on surfaces, including tears. 

Viral infections of the cornea typically present as a red, sore, watery eye with blurry vision. Patients also often report light sensitivity and in the case of adenoviral infections, may feel a burning or itching sensation in the affected eye. Viral keratitis is usually only on one side, though due to the contagious nature of the adenovirus, may transfer to the other eye in a matter of days if proper hygiene isn’t observed. Cases of herpes keratitis often have a history of cold sores or may have an active shingles infection along the scalp and face. Patients with an adenoviral infection may report having had a recent cold or flu or having been in contact with someone else with a cold or eye infection. Both a herpes and adenoviral infection of the cornea have the potential to cause scarring of the cornea, especially if recurrent. 

 

Fungal Infections

Fungal keratitis is often more difficult to diagnose due to the slow nature of its development and the fact that symptoms typically present only days after the original infection. Many fungal eye infections also cause very little pain or irritation, which can further delay diagnosis and treatment, resulting in severe consequences for eye health and vision. 

Contact lens wear is again a risk factor for fungal keratitis, as is an immunocompromised state. It is not uncommon for a fungal corneal infection to be caused by some sort of vegetative trauma to the eye, such as a scratch to the cornea by a branch or a leaf or dirt flicking into the eye. 

 

Parasitic Infections

Parasitic keratitis is usually caused by a ubiquitous protozoan found in air, soil, and water, known as acanthamoeba. Acanthamoeba keratitis is uncommon, which is fortunate as the characteristic symptom of this infection is pain disproportionate to the appearance of the eye. Other symptoms include redness, watery discharge, and light sensitivity; however, these are typically mild in comparison to the pain reported. Acanthamoeba eye infections are an ocular emergency and must be treated promptly with potent antimicrobial eye drops to prevent permanent blindness. 

 

Any suspect corneal infection should be seen immediately by an eyecare practitioner for proper diagnosis and management. Call us at (03) 9070 5753 today.

eye cataract treatment melbourne

Eye Cataract Treatment – What To Expect?

“Cataract” can be a scary word for some. For many people the first thought that comes to mind is wondering whether they’re about to go blind. The next thought is typically wondering what happens next, and what they can expect during eye cataract treatment

 

What is a Cataract?

A cataract refers to an opacity in the crystalline lens of the eye. This lens is located just behind the coloured iris and is usually clear and transparent to allow light to pass through. However, with time and age this lens gradually loses its transparency, becoming hazy or developing a discrete opacity – this is then considered a cataract. While advancing age is the most common cause of cataracts, other conditions or factors can cause a cataract or increase your risk of developing one, including:

There are three types of age-related cataracts. Nuclear sclerosis appears as a yellowish-brownish haze in the centre of the lens, a section known as the nucleus. Cortical cataracts grow as spoke-like opacities in the cortex of the lens, which surrounds the nucleus. A posterior capsular cataract is an opacity at the back surface of the lens, further into the eye. Cataract symptoms will vary depending on the type and location of the opacity, though often there can be more than one type present in the eye simultaneously. Symptoms include glare sensitivity, blurred vision, altered colour perception, and increased difficulty with night vision. Nuclear sclerotic cataracts also have the potential to cause what’s known as a “myopic shift”, meaning that your contact lens or spectacle prescription becomes more short-sighted, or a higher minus script. Interestingly, this means that some patients find their reading vision improves without corrective lenses. 

expectation eye cataract treatment melbourneAs a cataract tends to form very slowly in the eye, cataract symptoms may not become noticeable for years. This also depends on a person’s visual demands and daily activities as to how bothersome their eye cataract symptoms become. For example, a painter who requires very fine colour vision discrimination will likely be more affected by a milder cataract compared to an accountant who works on a computer and can easily enlarge their screen. A person’s visual demands and health of their eye guides cataract treatment timing. This leads us to the next question – what is the best treatment for cataract?

 

Eye Cataract Treatment

The only definitive treatment of a cataract in current medicine is surgical removal of the cataract. Your local optometrist will usually be the first to detect a cataract in the eye; cataract treatment is generally only recommended if the symptoms bother you enough to warrant intervention. Many early cataracts, and even moderate opacities, can simply be monitored. In most cases it’s not harmful to defer cataract surgery. There will be some instances where you may be advised to undergo treatment even if you’re still content with your vision – this includes situations where your vision no longer meets the legal visual requirements for holding a driver’s licence or if the presence of the cataract is affecting the pressure in your eye by blocking the drainage of fluid from the eyeball. 

Once it’s decided that your cataracts are ready for surgery, your optometrist will refer you to an ophthalmologist for the operation. Cataract surgery is typically a quick and uncomplicated procedure with very high success rates in Australia. 

The procedure is conducted under local anaesthesia; very rarely is a general anaesthetic used though many surgeons will offer a sedative if you’re feeling anxious or restless. A small incision is made at the edge of your cornea, which is the clear bubble of tissue at the front of the eye, to allow the necessary instruments to access the cataract inside. The cataract is then broken into fragments small enough to be suctioned out, leaving behind the capsular bag that used to hold this cataract. Different ophthalmologists will have a preference on the method of fragmenting the cataract, either with a technique known as phacoemulsification or a combination of phacoemulsification and the use of a femtosecond laser. 

Once the cataract has been removed from the capsular bag, an artificial lens implant known as an intraocular lens (IOL) is then inserted in its place, which is designed to refract, or bend, the passage of light rays such that they focus clearly on the retina at the back of the eye. The power of this IOL is calculated before you undergo surgery and can reduce your dependency on glasses and contact lenses after the operation by accounting for your existing prescription, basically like having corrective lens implanted in the eye. Your surgeon will discuss your options of IOLs, which include:

  • Monofocal: correcting for one viewing distance, either near or far sight. Some patients may choose to have one monofocal IOL designed for long distance in one eye and a monofocal IOL for reading vision in the other, an arrangement known as monovision
  • Multifocal: these provide clear vision for multiple distances
  • Accommodative: designed to provide some degree of flexible focus to mimic your own eye’s ability to change focus
  • Toric: correct astigmatic prescriptions

 

If you’re concerned about cataracts, speak to Armadale Eye Clinic by calling us at (03) 9070 5753 for advice tailored to your situation.

 

 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. 

what is epiphora melbourne armadale eye clinic

What Is Epiphora and What Causes It?

Tears play an important role in the health of our eyes as well as aiding clear vision. A deficit of tears leads to dry eye, which can significantly impact quality of life by causing discomfort and variable, blurry vision. But what about the opposite end of the spectrum when someone suffers excessively watery eyes?

 

What is Epiphora?

Epiphora is the medical term for watery eyes and the excessive production of tears. Epiphora can occur in one eye (unilateral) or both (bilateral), and often is asymmetrical, being worse in one eye than the other.

Watery eyes can be a reflexive reaction to some sort of temporary irritation to the eye, such as exposure to chemical fumes or a speck of dust. The rapid production of tears aims to flush away the irritant and protect the delicate surface of the eye.

However, some people suffer from persistently watery eyes, which makes it more likely they may require the attention of an oculoplastic surgery specialist.

 

What is Epiphora Caused By?

Watery eyes can be caused by a number of factors, though not all will require referral for oculoplastic surgery.

Causes of epiphora can include:

  • Conjunctivitis: Conjunctivitis refers to an inflammatory condition of the conjunctiva, the translucent membrane that covers the whites of the eye. You may be familiar with infective conjunctivitis causes, such as a bacterial or viral conjunctivitis. Viral conjunctivitis often presents with watering and epiphora of the eye, accompanied by redness and itching or soreness. Allergic conjunctivitis is also commonly associated with epiphora, along with the hallmark itching and puffiness. You may also experience other symptoms of allergy, such as nasal symptoms.
  • Trauma: If you’ve ever accidentally been poked in the eye, you’ll know that in addition to some significant pain and discomfort, your eye is likely to water profusely. As the surface of the eye is highly sensitive, it doesn’t take much to cause this reflexive reaction – even just brushing a finger against the cornea can trigger a watery eye.treatment what is epiphora melbourne
  • Dry eye: When discussing what is epiphora, it may be unexpected to encounter dry eye disease as a possible underlying cause. However, because the eye’s surface requires constant moisture and lubrication for good health, it makes sense for the body to have a reflexive mechanism to produce more tears when the cornea becomes dry. This results in a release of more fluid from the lacrimal gland, which can then end up overflowing. Treating the watery eye is then – counterintuitively – a matter of actually treating dry eyes, such as with artificial tear lubricants or warm compresses.
  • Poor structure and/or function of the nasolacrimal system and eyelids: Epiphora due to changes to the tear duct (nasolacrimal) system and eyelids can be one of the more difficult causes to identify. If your optometrist or GP suspects issues along the nasolacrimal system as a contributing factor then you may be referred to a specialist in oculoplastic surgery.

 

Oculoplastic Surgery for Epiphora

The nasolacrimal system is involved in the production of tears as well as its drainage from the surface of the eye. There are multiple components of a healthy tear film, produced by various glands in different locations around the eyes. As all these components are secreted onto the surface of the eye, together they form the tear film, which aims to protect and lubricate the eye. Eventually, this tear film gathers along the lower eyelid due to gravity. From there, the blinking motion of our eyelids pushes what’s known as the tear prism, or tear lake, towards the inner corners of the eyes, where two tiny openings sit on the eyelid margins, known as puncta. Tears then drain through the puncta and, via a system of ducts and channels, through the nose and down the throat.

Issues with the nasolacrimal system and eyelids can contribute to epiphora, including:

  • Weak or incomplete blinking: If the eyelids do not blink well, whether due to a disease such as Bell’s palsy that causes weakness of the facial nerves, or simply from lazy blinking, the tear lake is less efficiently drained through the puncta, leading to overflow of tears from the eye.
  • Loose lower eyelids: With age, our skin loosens and can sag; the eyelids are no exception. If the lower eyelid does not sit well-positioned against the surface of the eye, it will have difficulty holding up the tear lake, resulting in these tears running down the cheek due to gravity. Additionally, a sagging lower eyelid, known as an ectropion, may result in the puncta also sitting away from the eye’s surface, making it difficult for tears to efficiently drain through it.
  • Narrowing of the puncta: This can often occur due to age-related changes to our skin, where the opening of the puncta becomes smaller with time, impeding the drainage of tears.
  • Narrowing or obstruction of the ducts: There are various locations where the nasolacrimal drainage channels may become narrowed or blocked, hindering the proper flow of tears through to the throat and resulting in a backlog and overflow of tears from the eye. These obstructions, whether full or partial, can be due to age, trauma, or even a growth or tumour.

An ophthalmologist experienced in oculoplastics is able to perform a thorough examination to determine what is your epiphora caused by and advise whether your condition is suitable for surgery.

Contact us today at (03) 9070 5753 to schedule your next appointment!

 

 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

retinal tear treatment melbourne

Symptoms of Retinal Tear & Treatment

The retina is the paper-thin tissue lining the inside of the back of the eye. It’s made up of several layers of cells that work together to sense light and images entering the eye before sending along neural impulses to the brain for the perception of vision. Disease or damage to the retina, such as a significant retinal tear or retinal detachment, can result in permanent vision loss.

A retinal tear occurs when the tissue of the retina forms a break or rip. This is different from a detachment when part of the retina lifts away completely from the rest of the eye, though a retinal tear may risk deteriorating into a detachment, which must be then referred for urgent retinal surgery.

Symptoms of a retinal tear include:

  • Floaters – appearing as tiny black specks, dots, or sometimes described as cobwebs, that float around the vision in the affected eye. These floaters can come in and out of view and persist for some time.
  • Flashing lights – also called photopsia, sudden flashes in the vision from a retinal tear occurring may appear like a lightning strike or glint out of the corner of your eye.

Occasionally, a retinal tear may also result in an area of blurred vision if the tear caused some damage and bleeding from the tiny capillaries of the retina. There is never any pain or discomfort from a tear, or even a detachment, as the retina contains no pain receptors.

Most retinal tears occur spontaneously with no cause, though there are several risk factors that are associated with the likelihood of developing a tear. These include a family history of retinal tears or detachments, certain eye operations such as cataract surgery, or conditions which cause a thinned retina, such as high myopia (short-sightedness) or the presence of a peripheral retinal abnormality known as lattice degeneration. Advancing age and trauma to the eye area can also put a person at higher risk of forming a retinal tear.

 

Retinal Tear Treatmentabout retinal tear treatment melbourne

Not all retinal tears need treatment. Some are safe to simply monitor with regular eye exams, and in fact, some will self-heal by naturally scarring and sealing themselves back against the eye.

When deciding if a retinal tear needs treatment, such as retinal surgery, the eye doctor will consider several factors based mainly around the risk of the tear deteriorating into a detachment. Any predisposing risk factors you have, such as the presence of high myopia or whether you’ve previously had a retinal tear or detachment in either eye, will be taken into account, as well as the location, size, and shape of the tear. Retinal tears that are small, peripheral (that is, far out to the edges of the retina, away from the central vision), and asymptomatic (not presenting with any flashes or floaters or disturbances to the vision), may be monitored by an experienced eyecare provider without needing referral for retinal surgery. The type of tear may also be taken into consideration as research has found that certain types of retinal tears and holes are more likely to deteriorate into a detachment.

If your eye doctor finds that your retinal tear is at a significant risk of becoming a sight-threatening retinal detachment, he or she will recommend retinal tear treatment as a preventative measure.

Depending on the facilities available to your local eye doctor, retinal surgery for tears is typically provided as an in-office treatment under local anaesthesia, meaning the ophthalmologist can perform it in the consulting room without needing to send you to an operating theatre or hospital. There are two types of retinal surgery procedures to treat a tear – laser photocoagulation or cryopexy.

Both photocoagulation and cryopexy aim to create controlled scarring around the edges of the retinal tear, thereby sealing the break and re-adhering the torn tissue back to the underlying structures of the eye. Photocoagulation utilises a laser device carefully aimed through the pupil of the eye to create this scarring while cryopexy is performed by placing a probe against the outside of the eye to essentially freeze the edges of the torn retina and induce scarring and reattachment. Depending on the experience and expertise of the ophthalmologist, both procedures take roughly 10 to 15 minutes to complete.

While there is minimal discomfort experienced during either procedure, the recovery time for photocoagulation tends to be much shorter than for cryopexy. Many patients are able to return to their normal routine immediately after a laser photocoagulation procedure with little to no disturbance to their vision post-treatment, though many surgeons will recommend avoiding any activities that risk traumatising the eye while the scarring forms for a couple of weeks. Conversely, an eye having undergone a cryopexy procedure may take up to 2 weeks to fully heal and settle, with the vision being temporarily blurred and the eye slightly red and swollen.

As with many medical procedures, there is a small chance of an adverse effect from either photocoagulation or cryopexy, such as permanent vision loss from the small areas of necessary scarring during treatment. However, because retinal tears tend to occur in the periphery away from the central vision and the treatment areas are quite small, it is very rare that the area of vision loss is significant enough to be noticeable or impact on normal activities.

It is important to remember to maintain regular eye examinations with your eyecare practitioner even after having successful retinal tear treatment as the tear may reoccur or a new tear may form in the same or opposite eye.

 

 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

signs of glaucoma melbourne

Signs of Glaucoma That You Need To Lookout For

Glaucoma is a category of eye disease known as optic neuropathies. The optic nerve of the eye is responsible for carrying signals received by the sensory retina at the back of the eyeball all the way to the visual processing centres of the brain for what we call sight.

Considering that 2 out of every 100 of Australians will develop glaucoma in their lifetime, it’s not unlikely that you perhaps already know someone who has been diagnosed with the disease, or at least you’ve heard of the term. But what is glaucoma and how is treated, and more importantly, are there any early signs of glaucoma that you could look out for? 

 

What Causes Glaucoma?

Glaucoma is diagnosed when the optic nerve suffers progressive damage due to an increase in the pressure of the eye, known as the intraocular pressure. In order to keep a healthy optic nerve, the normal intraocular pressure range is typically quoted as between 10-21mmHg (millimetres of mercury), however, it’s important to note that this does not mean that someone with intraocular pressures within this range will never develop glaucoma or someone with pressures slightly higher than this will definitely have glaucoma.

At a basic level, the intraocular pressure is determined by the balance of fluid production and drainage within the eye; this fluid is known as aqueous humour, and is different from the tears you secrete on the surface of the eye. If aqueous drainage is hindered for some reason, or if production is excessive, this will cause the intraocular pressures to rise. 

Glaucoma is an extremely complex disease and doctors do not fully understand all the factors that interact and contribute to its development. We know that age plays a big role, particularly past the age of 50. People who have a direct family member with glaucoma are ten times more likely to develop it themselves, suggesting a genetic factor. Through research we have also noted various other associations with the risk of glaucoma, including the presence of sleep apnoea, diabetes, and myopia (short-sightedness). 

 

The Signs of Glaucoma

Unfortunately, glaucoma has a nickname – the sneak thief of sight. This is because in the vast majority of cases, glaucoma, at least in the early to moderate stages, is actually asymptomatic.

causes treatment signs of glaucoma melbourneIn fact, half of people who have glaucoma are unaware they have the disease. There is a specific type of glaucoma called acute angle-closure glaucoma that can present with noticeable symptoms, such as severe pain, a red eye, and hazy vision, however, most people with glaucoma will have no warning until the more advanced stages of the disease when there is already marked vision loss. 

The reason for this is because the optic nerve itself feels no pain from any damage, and the loss of vision from glaucoma typically begins in the periphery. If you think about which areas of your vision you’re most aware of, it’s your central vision – when you want to pay attention to something or someone, you will tend to look directly at it.

Peripheral vision is still important, such as noticing the movement of something coming towards you out of the corner of your eye, but we are less likely to be aware of changes and deterioration to the extremities of our visual field, particularly if they occur as slowly over time as happens during glaucoma. By the time a person with glaucoma does become aware that their peripheral vision has deteriorated, the disease is already likely in its advanced stages. 

Because of this, regular eye exams with an eyecare practitioner, whether your local optometrist or, if you have strong risk factors for glaucoma, an ophthalmologist, is your best chance of diagnosing any glaucoma while the disease is still in its asymptomatic early stages. A thorough eye exam is able to detect the signs of glaucoma before you become aware of any issues and will involve tests such as:

  • Measuring your intraocular pressure
  • Examining the features of your optic nerves including its size and colour
  • Taking scans of your retinal nerve fibre layer to detect any areas of thinning and damage
  • Performing a visual field test to map the sensitivity of your peripheral vision

If glaucoma is detected, your eyecare clinician can commence appropriate glaucoma treatment immediately. 

 

Glaucoma Treatment

Luckily, the treatment of glaucoma is often quite effective. Although there is no currently existing cure that can reverse any vision loss that has already occurred or get rid of glaucoma altogether, timely glaucoma treatment aims to prevent or at least slow further vision loss. 

A great deal of research is going into treatment for glaucoma as we understand more about the disease. All therapies aim to improve the balance between aqueous outflow and production, thereby reducing the intraocular pressure. Currently, available treatment options include:

  • Eye drop medications – these are instilled at least once a day and will need to be taken long-term to keep the eye pressures under control
  • Laser treatment – known as laser trabeculoplasty, some patients only require this once-off while others may need a repeat application a few years later
  • Surgery – there are various effective surgical techniques to improve the drainage of aqueous humour from the eye, such as the insertion of a stent or shunt 

Each treatment has pros and cons and one may be more suitable for an individual compared to another. The most important thing to remember is undiagnosed glaucoma cannot be treated – regular eye tests are your best bet at catching it early.

 

 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

macular degeneration symptoms melbourne

Macular Degeneration – Symptoms, Risk Factors, and Treatment

Age-related macular degeneration is considered to be the leading cause of legal blindness in Australia, accounting for half of all cases of blindness. Unfortunately, the vision loss caused by macular degeneration is irreversible and there is currently no cure that can guarantee to halt the progression of any vision damage.

However, there are some steps that can be taken to reduce your risk of developing the disease or suffering further vision loss in the presence of existing macular degeneration

 

What is Macular Degeneration? 

The macula is the anatomical part of the eye responsible for your central vision. The retina is the sensory layer of tissue lining the inside of the eyeball; the macula is a part of this that contains the highest density of photoreceptors, the sensory cells that detect and respond to light before the signals are converted to neural impulses that are then sent onward to the brain for visual processing. 

Macular degeneration is a disease that results in damage to the retinal tissues that support the high-energy function of these photoreceptor cells, known as the retinal pigment epithelium. Although there is still much more to understand about exactly why and how the damage occurs, we know that during age-related macular degeneration, metabolic waste material known as drusen begins to accumulate beneath the retinal pigment epithelium, interfering with the health and function of these tissues.

The resultant effect is that the photoreceptor layer, dependent on a healthy retinal pigment epithelium, also becomes damaged, leading to the characteristic macular degeneration symptoms of central vision deterioration. In more advanced stages of macular degeneration, known as the neovascular form, new blood vessels form under the retina, which is fragile and can leak blood and fluid, causing severe retinal damage and vision loss. 

There are several risk factors associated with the development of age-related macular degeneration. Some of these are modifiable lifestyle choices while others are simply the luck of the draw. 

  • Age – the risk of macular degeneration increases with increasing age
  • Family history of the disease – those with an immediate family member with macular degeneration are 50% more likely to develop the condition themselves
  • Smoking – cigarette smoking has been linked with a 3 to 4 times increased risk of developing macular degeneration compared to a non-smoker, and smokers are also at risk of encountering the disease 5 to 10 years earlier than a non-smoker with all other things being equal 
  • Systemic conditions – certain diseases, such as obesity and hypertension, have been linked to an increased risk of macular degeneration  

 

factors macular degeneration symptoms melbourneMacular Degeneration Symptoms

In most cases, macular degeneration symptoms occur gradually, and an individual with the disease may not even be aware of any changes to their vision for years. Macular degeneration symptoms can also be non-specific, meaning that they are not unique to macular degeneration and may be dismissed by a patient thinking they simply need an updated spectacle prescription.

Typically, macular degeneration symptoms can include: 

  • Blurring of your central vision – this may not be immediately identifiable, but instead you may first begin to become aware of increasing difficulty with specific tasks that require detailed vision, such as reading text or recognising faces from a distance 
  • Distortion in your vision – because of the formation of drusen disrupts the uniform, smooth layers of retinal tissues, you may see straight lines as wavy or curved
  • Dark patches in your vision – significant areas of photoreceptor damage and death will result in complete loss of vision in that particular area of your retina, which you may perceive as a black hole in your field of view
  • Sudden loss of central vision – in the case of wet macular degeneration, the loss of sight can be quite dramatic if a large retinal bleed were to occur 

Your peripheral vision is likely to remain unaffected. Macular degeneration symptoms can differ in severity between the eyes, and in some cases may only present in one eye while the other eye experiences no issues at all. 

 

Treatment

Currently, there is no treatment for dry macular degeneration. Management is aimed at addressing modifiable factors such as cigarette smoking and cardiovascular disease in an effort to slow the rate of vision deterioration. There are also nutritional factors that have been shown to be beneficial for the health of the macula, such as increasing your dietary intake of the antioxidants zeaxanthin and lutein. 

For the wet form of macular degeneration, modern therapies are most commonly in the form of an injection of medication into the eye rather than retinal surgery. These medications are known as anti-vascular endothelial growth factor (anti-VEGF) drugs and are designed to block the proteins produced by the retina in wet macular degeneration that trigger the formation of new blood vessels.

Laser retinal surgery procedures such as photodynamic therapy are very rarely used in the modern management of macular degeneration nowadays; in specific cases it may be used as an adjunct treatment if the condition cannot be controlled entirely with anti-VEGF injections.

Another type of laser retinal surgery known as laser photocoagulation employs the use of a high-energy thermal laser that aims to destroy and seal leaking blood vessels. However, this treatment also results in damage to the surrounding retina and so is only used in the minority of cases where the formation of new blood vessels occurs in the retina some distance away from the crucial central vision. 

As early intervention can help to identify what steps can be taken to reduce your risk of progressive vision loss from macular degeneration, it’s important to maintain regular eye examinations with your eyecare provider. 

 

 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

diabetic retinopathy treatment sydney

Diabetic Retinopathy Treatment – Causes and Symptoms

An estimated 5% of the Australian population have some type of diabetes. However, this prevalence is considered to be an underestimation as many Australians live with undiagnosed diabetes; experts estimate this rate to be around 1 undiagnosed diabetic for every 4 adults with known diabetes. Diabetes, also known as diabetes mellitus, is a metabolic disease involving a deficiency in the production and/or function of the hormone insulin. This results in an elevated concentration of glucose (sugar) in the bloodstream, which damages the blood vessels throughout the body as well as the organs and other anatomical structures that are dependent on this blood supply. 

Diabetes-related complications include:

  • Increased risk of a heart attack
  • Increased risk of a stroke
  • Reduced blood flow to the feet and legs, resulting in peripheral arterial disease
  • Diabetic kidney disease
  • Dental problems
  • Damage to the nerves throughout the body
  • Increased risk of eye disease, including diabetic retinopathy

 

Diabetic Retinopathy

The retina is the sensory tissue lining the inside of the back of the eyeball and is responsible for detecting light and forwarding these signals onto the brain for the perception of vision. Throughout the retina and surrounding anatomical structures are many tiny blood vessels that help to support the high energy activities of this part of the eye. Elevated blood glucose levels have the potential to damage these retinal blood vessels, resulting in an eye disease known as diabetic retinopathy

There are two broad categories of diabetic retinopathy – non-proliferative and proliferative. During the non-proliferative stage of the disease, an ophthalmologist or optometrist examining your retina may detect signs such as:

  • Tiny haemorrhages or yellowish deposits called exudate throughout the retina due to leaking damaged retinal blood vessels
  • Areas of swelling known as oedema in the retina, also due to leakage of fluid from damaged vessels
  • Areas of whitening known as ischaemia, due to restriction of blood supply to that part of the retina
  • Other visible changes to the blood vessels throughout the retina

symptoms causes diabetic retinopathy treatment sydneyIf the case of advanced diabetic eye disease, proliferative diabetic retinopathy is diagnosed by observing the formation of new blood vessels in the retina. Because these new vessels are fragile and poorly formed, they are at risk of causing a large haemorrhage in the eye, which may fully or partially obscure your vision. Though vision loss directly from a haemorrhage may be temporary until the blood can be cleared, the presence of new blood vessels may also result in further complications such as retinal scarring and distortion, a retinal detachment, or glaucoma. Proliferative diabetic retinopathy always requires treatment, typically in the form of retinal surgery. 

 

Diabetic Retinopathy Treatment

In the milder stages of retinopathy, you may have few or no symptoms at all and diabetic retinopathy treatment is not warranted. Those early signs of diabetic eye disease can be managed by good overall diabetes control. However, if you develop fluid swelling around your macula, which can occur even in the non-proliferative stages, you will notice a blur or distortion to your central vision as we are most aware of this part of our field of view. Depending on the severity of the swelling, your eye doctor may recommend simply monitoring your retina and allowing time for the swelling to self-resolve, or may recommend diabetic retinopathy treatment in the form of laser retinal surgery or eye injections to protect the vision and prevent further retinal damage. 

Laser retinal surgery aims to seal off leaking blood vessels in a process known as photocoagulation. In a way it can be thought of as applying laser burns to select areas of the retina to weld closed the damaged blood vessels. Laser retinal surgery may also be used to reduce the trigger for new vessel growth during proliferative retinopathy by deliberately burning and scarring areas of retinal tissue, thereby reducing the oxygen demand of that part of the retina. Though there may be some loss of peripheral vision from this treatment, it helps to preserve the rest of your sight, particularly your crucial central vision.

Medical diabetic retinopathy treatment in the form of eye injections is also used in cases of macular swelling or proliferative retinopathy. The medications used are often a class of drug known as anti-VEGF (vascular endothelial growth factor), which work by blocking the chemicals released by the tissues of the eye that stimulate the growth of new blood vessels. 

In the case of a very large haemorrhage inside the eye as a result of proliferative retinopathy, your eye surgeon may recommend a procedure known as a vitrectomy, which involves the complete removal of the vitreous gel that usually takes up the space in the back half of the eyeball. By removing the vitreous, the blood obscuring the retina can also be cleared, restoring your vision. 

Other complications as a result of diabetic retinopathy need to be treated as they arise. In the case of a retinal detachment this requires retinal surgery; in the case of glaucoma your ophthalmologist may discuss with you a number of appropriate treatments, such as eye drops or glaucoma surgery. People with diabetes are also at a greater risk of developing cataracts, which are treated with surgical removal.

People with diabetes are encouraged to have regular eye tests with their optometrist or ophthalmologist, even if your vision seems normal. Even moderate non-proliferative diabetic retinopathy can occur in the absence of any noticeable symptoms, but to an eyecare professional this can help to signal that your overall diabetes control needs to be revised.

The best way to avoid needing any sort of diabetic retinopathy treatment is to manage your diabetes well from the beginning, whether that’s with diet or medications as advised by your GP, diabetes educator, or endocrinologist. 

 

 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

difference between long and short sightedness melbourne

The Difference Between Long and Short Sightedness Explained

Unfortunately, no, long sightedness is not exactly as simple as being the opposite of short sightedness. People with long sightedness can in fact often still see up close, and those with short sightedness are often quite content with their long-distance vision even without glasses or contact lenses. The terminology can be a little misleading as the difference between long and short sightedness is not quite as straightforward as it may sound.

Let’s differentiate first these two refractive errors and later discuss what’s the right eye treatment for them.

 

Refractive Error and Anatomy

Vision is dependent on multiple factors, some of these simply anatomical and others cognitive. From an anatomical point of view, the refractive components of the eye – that is, those parts of the eyeball involved in the bending (refraction) of light – include:

  • The tear film – the thin layer of fluid at the very front surface of the eye. In addition to providing protection and lubrication for the eye, it is also the first surface that light passes through to form vision.
  • The cornea – the clear dome of tissue that sits over the coloured iris. The cornea is designed to be optically transparent to allow full transmission of light; its curvature is also largely responsible for how light is refracted.
  • The crystalline lens – this sits just behind the coloured iris and is held in place by the ciliary muscle and zonular fibres. This arrangement allows the lens to flex its shape to adjust the focus of light in a process called accommodation. We accommodate when we want to bring the focal point of light forward within the eye, such as when we are looking at something up close.

The term “refractive error” covers both long sightedness, short sightedness, as well as astigmatism, and occurs when there is a mismatch between the refractive power based on the eyeball’s refractive components and the eyeball length, known as axial length.

 

The Difference Between Long and Short Sightedness

Long sightedness goes by a few other names – far-sightedness, hyperopia, or hypermetropia. Although it may seem most intuitive to simply think of long sightedness as the ability to see at long-distance but not at close, most younger patients are actually quite clear and comfortable at all viewing distances.

explained difference between long and short sightedness melbourne

Long sightedness is a situation where the axial length of the eyeball is too short for its refractive power; that is, when the eye is relaxed, light is refracted to focus at a point behind where we want it to be for clear vision, which is the retina at the back of the eye.

However, a patient with an active accommodation system and long sightedness is able to control the focus of their crystalline lens in order to bring forward the focal point of light entering the eye, landing this point right on the retina for clear vision. This does mean that even for long distance viewing, a long sighted patient is always exerting some accommodative effort to clear their vision; this effort is increased when viewing closer objects.

To add to the complexity, around the mid-40s a natural age-related phenomenon sets in – presbyopia. This refers to the progressive inflexibility of the lens inside the eye, and eventually accommodative ability is lost entirely. The combination of the age of the patient and the degree of the far-sighted prescription therefore is what really determines how clearly someone can see at a certain distance.

For example, a 20-year-old patient with a low long sighted script will be quite happy at both short and far viewing distances while a 20-year-old with moderate long sightedness may be fine for long-distance vision but struggle with eyestrain and headaches during reading; a young patient with very high hyperopia can have blur at both distance and near vision. Alternatively, a presbyopic 50-year-old patient with low hyperopia may see quite clearly for far-distance while still having difficulty reading up close.

Luckily, short sightedness is much easier to explain. Also known as near-sightedness or myopia, short sightedness occurs when the axial length of the eyeball is too long for its refractive power; that is, when the eye is gazing into the far distance, light will focus to a point in front of the retina. However, as an object approaches closer, the nature of optics means the image created by this object moves further back into the eye and may eventually focus onto the retina – this explains why people with short sightedness can often see well up close but require spectacles to clear their far vision.

Presbyopic patients with short sightedness will find at some point that they prefer to remove their distance spectacles in order to see clearly for reading up close; an alternative to this is the use of multifocal glasses that contain both distance and near vision sections within the lens. Depending on the degree of short sightedness, some patients may be happy without any vision correction, such as a young person with a low degree of short sightedness who may feel they see well enough at distance without correction, and are also able to accommodate to see clearly for reading.

Although understanding the difference between long and short sightedness may not have been as simple as you expected, both types of refractive error can be addressed with various strategies including glasses, contact lenses, or refractive surgery.

 

Call us now on (03) 9070 5753 for more info.