Blepharitis

What are the symptoms of eyelid infection?

Blepharitis is a term describing inflammation of the eyelids and is very common. It is often a chronic condition a bit like having dandruff, which is difficult to cure but can easily be managed with care.

It can have many causes, and is classified according to the location of the inflammation. Anterior blepharitis is inflammation of the part of the eyelid nearest to the lashes and outer edge of the lid margin, and the most common type of posterior blepharitis (in the part of the eyelid closest to the eye) is Meibomian Gland Dysfunction or MGD.

What are the symptoms of blepharitis?

The most common cause of dry eyes is blepharitis so many symptoms are similar. 

They can include:

• Eyes can look red-rimmed and sore, like you have been crying
• Swollen eyelids
• Lashes may be missing or misdirected
• Crusty debris around base of the lashes in anterior blepharitis 
• Irritation
• Itchy sensation
• Dry eyes

How do you manage blepharitis?

A regular regime of eyelid care and eyelid hygiene is essential. Your optometrist or doctor may also recommend the addition of regular eyelid warming if you have MGD.

Our senior optometrist recommends Blepharitis treatment by:

blephaclean     blephagel     blephasol     blephasol duo

Blephex - NEW BLEPHARITIS TREATMENT

Until now treatment for blepharitis has revolved around cleaning and massaging the eyelids with at home treatments. Unfortunately, these treatments can take months to work and have to be repeated very frequently to see any significant improvement. But a new treatment for blepharitis is set to change that.

Blephex is a painless deep clean treatment to the eyelids and meibomian glands that we perform for you in the practice that gives instant and lasting improvement to blepharitis symptoms. Repeated every 6-12 months, Blephex cleans debris, opens and unblocks the meibomian glands and can considerably improve blepharitis symptoms.  Blephex is ideal for persistent cases or where time is an issue and cleaning's hard to comply with.

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Cataract

This information should not replace advice that your optometrist or other relevant health professional would give you.

 

Overview

Cataracts are formed when the clear lens inside your eye becomes cloudy or misty. This is a gradual process that usually happens as we get older. It does not hurt.

The early stages of a cataract do not necessarily affect your sight.

The only proven treatment for a cataract is surgery. If the cataract gets to the stage where it affects your sight, your optometrist will refer you to a hospital to have this done. The surgery is carried out under a local anaesthetic and has a very high success rate.

 

Why do cataracts occur?

The main cause is age and most people will eventually develop a cataract in both eyes, although one eye may be affected before the other. However, smoking and exposure to sunlight have been linked to the formation of cataracts. Cataracts affect men and women equally.

Younger people can develop cataracts if they have an injury to the eye. Some medical conditions including diabetes or taking some sorts of medication may also cause cataracts. A very small number of babies are born with a cataract.

 

Will cataracts affect my vision?

Many people with a cataract notice that they need to change the prescription for their glasses. If you are long-sighted, you may even notice that you need your glasses less than you did before you had the cataract! You may notice that your vision is less clear and distinct. Car headlights and streetlights can become dazzling, and you may experience difficulties moving from shade to sunlit areas. Colours may look different too, and become faded or yellowed.

If you experience any of these symptoms, make an appointment to see you optometrist.

 

Can I prevent cataracts?

There are various supplements on the market which claim to help slow the progression of cataracts and some eye drops have been marketed as a treatment for them. There is no scientific evidence to suggest that any of these can prevent or treat cataracts. Stopping smoking and wearing good quality sunglasses may provide some protection in relation to cataracts, as well as other eye conditions. You cannot make cataracts worse by using your eyes too much.

 

Can I drive if I have cataracts?

If you have cataracts, you may continue to drive providing you still meet the vision standards for driving. Your optometrist will be able to advise you about this. If you are a car driver, you do not need to tell the DVLA about your cataract unless you cannot meet the vision standards for driving.

 

Treating cataracts

If your cataract is affecting your day-to-day life (for example; driving, reading or cooking), and your optometrist cannot improve this enough by changing your glasses, you can ask them to refer you to an ophthalmologist (eye specialist) for surgery. This involved removing the cloudy lens (the cataract) and replacing it with a clear plastic one. If you have cataracts in both eyes, surgery will normally be carried out on one eye at a time.

 

What does surgery involve?

You will have an initial appointment where the ophthalmologist will ask you about your general health to help make sure that the operation is suitable for you. In some parts of the country the NHS arranges for optometrists to discuss the operation with you rather than having all this done at hospital.

The ophthalmologist may also be able to correct short- or long-sightedness so that you may not need to wear your glasses as much after the operation as you did before. The ophthalmologist will assess and measure your eyes to decide what strength lens to put in your eye during the cataract operation.

Contact lenses may affect the accuracy of these measurements so if you wear contact lenses you must leave them out for a week before you have these measurements taken.

Most cataract operations are done using a local anaesthetic. You will be awake, but the ophthalmologist will make sure you do not feel the area around your eye. You will hear the ophthalmologist explaining what they are doing, and you may see some vague movements around your eye. The ophthalmologist will make a tiny cut in your eye to remove the cataract, and will normally insert a plastic replacement lens so that you can see clearly. This will usually take around 15-45 minutes.

You will not normally need stitches, but your eye will be covered to protect it from knocks after the operation. You will be allowed to go home the same day, but should have someone to go with you and to look after you for 24 hours after surgery. Do not drive.

 

What are the risks of cataract surgery?

Most people find that cataract surgery is successful and are happy with the results. However, as with all surgery, there are risks involved and you should not have the operation unless you feel it is right for you. Before you have surgery the risks will be discussed with you, and how they apply to you individual case. The time to have surgery may vary from person to person.

 

Can I choose not to have the surgery?

If it is not interfering with your daily life it is safe to leave a cataract in your eye. It does not become more difficult to remove if you wait before having surgery, although you will not be able to see as well as the cataract worsens. The cataract does not have to become 'ripe' for you to have the operation. Surgery can be done as soon as the cataract is interfering with your daily life.

 

After the operation

You will be given eye drops to use for the first few weeks after your operation. You should avoid heavy lifting and strenuous exercise immediately after the operation, but you can carry on with most activities around the home as normal. Nearly all of your vision will return within two days of surgery and many people are able to return to their usual daily routine 24 hours after the operation. You should avoid eye make-up, swimming, and getting soapy water in your eyes when you wash your hair for two weeks after the operation. If you go out on a windy day, you may feel safer with sunglasses to prevent grit getting in your eye. Ask you ophthalmologist about when you can go back to work.

If you have any concerns, give the eye clinic a call for advice.

 

Will I need new spectacles after my cataract operation?

Your eyesight will settle down in a few days of weeks. After cataract surgery most people need to wear glasses for either distance, near vision or both. If you wore glasses before the operation you will probably find that they will need changing after the operation, so you will need to see you optometrist again for an eye examination a few weeks after the surgery.

Your ophthalmologist or optometrist will be able to advise you as to when you can start driving again. You may find that it takes a few weeks to adapt to your vision with new glasses after cataract surgery. This is normal, and is due to your brain adapting to a different prescription.

 

Will the cataract come back?

After some months or years, some people notice that their vision becomes cloudy or misty again in the eye where the cataract has been removed. This is not the cataract returning, but is due to the sac which contains the replacement lens clouding up. This cloudiness can be removed by painless laser treatment in a matter of minutes. Contact your optometrist if you are worried that this is happening to you.

 

Do cataracts only occur in one eye?

If you have had a cataract removed from one eye, it is likely that you need the same treatment for the other eye at some point in the future.

 

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Children's Eye Health

This information should not replace advice that your optometrist or other relevant health professional would give you.

 

Overview

Most children have excellent sight and do not need to wear glasses.

Some children may have vision screening done and school (between the ages of four and five). However, the earlier any problems are picked up the better the outcome. If there are problems and they are not picked up at an early age, the child may have permanently reduced vision in one or both eyes. If you have concerns about your child's eyes, or if there is a history of squint or lazy eye in the family, do not wait for the vision screening at school. Take your child to a local optometrist for a sight test. This is free under the NHS for children under 16.

Your child does not have to be able to read or talk to have a sight test.

 

Babies

Babies can see when they are born, but their eyes don't always focus accurately. A baby's eyes may squint sometimes (they may not always line up with each other), but if their eyes always seem to squint, this should be investigated. Their eyes develop gradually, and after about six weeks they should be able to follow something colourful or interesting with their eyes.

An easy test you can do at home when a baby is over six weeks old is to see if your baby's eyes follow you around a room. If they don't seem to be able to focus on you properly - for example, if they can't follow you and recognise your facial gestures, or if their eyes wander when they are looking at you - it could suggest a problem. You can also try covering each of the baby's eyes in turn. If they object to having one eye covered more than the other, they may have problems seeing out of one eye. As they get older, you can start to point out objects both close up and far away. If they struggle to see the objects, contact an optometrist for advice.

 

Long- and short-sightedness

The light coming into the eye needs to be focused on the back of the eye (the retina) for you to see clearly. Some people have eyes that are too short, which means the light focuses behind the retina (they are long-sighted). This means that they have to focus more than they should do, particularly on things that are close up. Other people have eyes which are too long, so the light focuses in front of the retina (they are short-sighted). This means that they cannot see things clearly if they are far away from them (such as the TV or board at school). Both conditions can run in families and both are easily treated with glasses.

 

Astigmatism

If your eye is shaped more like a rugby ball than a football, light rays are focused on more than one place in the eye, so you don't have one clear image. This may make it hard to tell 'N' from 'H', for instance. Glasses which correct this may make a child feel strange at first, although their vision with the glasses will be clear. Astigmatism often occurs together with either long- or short-sight and glasses are used to make the focus clear.

Don't expect your child to tell you if there is a problem.

 

Lazy eye and squint

About 2-3% of all children have a lazy eye, clinically known as 'amblyopia'. This may be because they have one eye that is much more short- or long-sighted than the other, or they may have a squint (where the eyes are not looking in the same direction). If you notice your child appears to have a squint after they are six weeks old, you should have their eyes tested by an optometrist as soon as possible,

The sooner the child is treated, the more likely they are to have good vision. It is more difficult to treat a lazy eye if the eyesight has finished developing (usually around the age of seven), although it may still be possible to significantly improve the vision in the weaker eye.

The NHS recommends that all children should have vision screening during their first year at school. This is not a full eye examination but is an important way to identify reduced vision at an early age. The screening test is done in school, usually by a school nurse, and is important because many children will not realise they have a lazy eye, and parents may not be able to see it. If your child misses the school screening for any reason, you should take them to your local optometrist for a sight test (paid by the NHS).

Don't expect your child to tell you there is a problem. Children assume that the way they see is normal - they will not have known anything different.

The treatment will depend on what is causing the lazy eye.

  • If it is simply because the child needs glasses, the optometrist will prescribe these to correct sight problems
  • If the child has a squint, this may be fully or partially corrected with glasses. However, some children may need an operation to straighten the eyes, which can take place as early as a few months of age
  • If the child has a lazy eye, eye drops or patching the other eye can help to encourage them to use the lazy eye to make it see better

Whether a child needs glasses or not is because of the shape and size of their eyes. Wearing glasses will not change their eye shape, and will not make your child's eyes worse. If your child has a lazy eye, wearing glasses may make their sight permanently improve. Your optometrist will tell you how often and when your child should wear their glasses.

 

Which children should be tested?

You should make sure your child has a full eye examination if:

  • your child has special needs - children with special needs often have eye problems
  • there is a history of a squint or lazy eye in your child's family
  • people in the family needed to wear glasses when they were young children

Signs to look out for

  • one eye turns in or out - this may be easier to spot when the child is tired
  • they rub their eyes a lot (except when they are tired, which is normal)
  • they have watery eyes
  • they are clumsy or have poor hand and eye co-ordination
  • your child avoids reading, writing or drawing
  • they screw up their eyes or frown when they read or watch TV
  • they sit very close to the TV, or hold books or objects close to their face
  • they have behaviour or concentration problems at school
  • they don't do as well as they should at school
  • they complain about blurred or double vision, or they have unexplained headaches

Simple treatments like wearing glasses or wearing a patch for a while could be all that you child needs. The earlier that eye problems are picked up, the better the outcome will be.

If flash photographs of your child show a white colour in their pupil, or red eye in only one eye, not both, when they are looking straight at the camera, you should ask your optometrist for more information. These could be signs of a very rare but serious condition.

 

Colour blindness

Around one in 12 men and one in 200 women has some sort of problem with their colour vision. If you suspect that your child has colour-vision problems, or if there is a family history of colour-vision problems, ask your optometrist about it. There is no cure, but you can tell you child's teachers, so that they use colours appropriately.

 

Protect your child's eyes from the sun

Some studies suggest that exposure to high levels of sunlight throughout you life may increase your risk of developing cataracts and AMD (age-related macular degeneration), although this has not been proven for AMD. Because children tend to spend a lot of time outside, it's important to protect your child's eyes in the sun. Make sure your child's sunglasses have UV protection and carry the British Standard (BS EN ISO 12312-1:2013) or CE mark. You can also protect your child's eyes by making sure they wear a hat with a brim or a sun visor in bright sunlight.

However, scientific studies have shown that children who spend time outdoors are less likely to be short-sighted, so don't stop your child exercising outdoors - just make sure their eyes are properly protected.

Diabetes

If you are diagnosed with diabetes (type 1 or 2), you may be aware that the condition can lead to changes in your eyes.

How does looking inside the eye help see diabetic changes?

The retina inside the eye is the only part of your body where we can see your blood vessels without peeling back skin to have a look. By checking the health of these vessels, it gives us a good idea of the health of the vessels elsewhere in the body that we can’t see so easily. Diabetes can cause changes to the blood vessel walls which makes them weaker and more likely to leak. These changes are called diabetic retinopathy and are graded depending on the severity of the condition. 

What happens if I get diabetic retinopathy?

Detecting diabetic changes in your eyes early on means that any problems can be treated sooner. Improving diabetic control and blood pressure can often make a significant improvement to diabetic retinopathy. In some cases, you may require laser treatment to your retina to seal the leaking blood vessels and prevent further damage. Occasionally injections into the eye are needed to help stop leaking blood vessels. Without treatment diabetic retinopathy can lead to sight loss. Therefore, if you notice any changes in your vision, you must book an appointment immediately. Even if you are not due for a check up or have been seen recently, it doesn’t mean that problems can’t develop quickly so always book an examination if you are concerned.

How common is diabetic retinopathy?

Only between 5 and 10 percent of all people with diabetes develop proliferative retinopathy; much more develop earlier stages of retinopathy. It is more common in people with type 1 diabetes than type 2. Sixty Percent of type 1 diabetics show some signs of proliferative disease after having diabetes for 30 years.

How can I prevent diabetic retinopathy?

Direct links between diabetic control, smoking, blood pressure and diabetic retinopathy are well known. If you are diabetic you should:

  • Maintain a healthy diet and weight
  • Keep a healthy blood sugar level. Poor diabetic control increases the risk of diabetic retinopathy as well as other systemic problems.
  • Keep up with you regular GP and diabetic nurse tests to keep a check on your diabetic control and blood pressure.
  • Take any medications as prescribed
  • Give up smoking

 

What are the symptoms of diabetic retinopathy?

During the early stages, diabetic retinopathy does not cause any noticeable symptoms until the later stages, when your vision becomes affected.

In later-stage retinopathy you may notice:

  • Floaters (debris floating around in your vision)
  • Blurred vision 
  • Sudden loss of vision

If you notice any of these symptoms, you must see your optometrist or GP immediately.

Does diabetes put me at greater risk of other eye conditions?

Yes, being diabetic increases your risk of other conditions such as glaucoma, and cataracts. Earlier detection leads to earlier treatment, a better prognosis and in some cases prevention of conditions developing at all.

Detailed examination of retinal blood vessels can often show up the signs of other systemic diseases.  High blood pressure can cause the blood vessels to become more tortuous over time – a little like a hose pipe that wiggles when you increase the pressure of the water. We can also identify hardening of the blood vessels by changes in their structure and colour. Sometimes we can also see blockages or thrombosis forming which can be an important sign of potential health problems such as stroke in the future. 

Dry Eye

This information should not replace advice that your optometrist or other relevant health professional would give you.

 

Overview

Dry eye is a common condition that may be caused because your eyes do not produce enough tears, or because the tears that you have evaporate too quickly or do not spread evenly across the front of your eye. The symptoms are usually in both eyes.

Dry eye can make your eye feel scratchy or irritated. In severe cases it may temporarily make your vision blurry. It can be uncomfortable, but rarely causes serious eye damage.

This page aims to help you understand the causes of dry eye and what you can do to help yourself.

 

What is dry eye?

Dry eye is a chronic (long-term) condition. This means that once you've had it, it can come back even after it has cleared up. If often affects both eyes, but one may be worse than the other. There are several treatments for dry eye, and you can do some of these at home.

Dry eye does not normally cause permanent problems with your sight, but in severe cases it can become very painful and cause permanent damage to the front of your eye.

 

Who is at risk of dry eye?

Dry eye is more common in women and in people aged over 65. It is often just a symptom of getting older. This is because as you get older, your eyelids are not as effective at spreading your tears across your eyes when you blink. Also, the glands in your eyelids that produce the oily part of your tears become less effective as you get older. In some people these glands, which are called meibomian glands, can become blocked and the lids may become red and uncomfortable. This is a condition called blepharitis.

Some drugs or health problems may affect your tear film. In women, changes in hormone levels, for example during the menopause, pregnancy or while using the contraceptive pill, can increase the risk of dry eye. Your doctor or optometrist will be able to give you advice on this.

 

Why do my eyes feel dry, but they still water?

The tear film is made of three layers. The layer closest to your eye is called the mucin layer, and helps to stick the other tear layers to your eye. The middle layer is the watery layer, which provides moisture to the eye and helps to wash away anything that gets into the eye. It is the watery layer that increases when you cry. The outer layer of your tears is an oily layer which stops the tears from evaporating too quickly. This is produced by the maibomian glands in your eyelids.

The normal time for your tear film to last between blinks is over 12 seconds. If the tear film breaks up too soon, the sensitive corneal nerves on the surface of your eye may be exposed and then you will cry. This is common in the cold, the wind or if you forget to blink when you are concentrating on the computer, TV or when driving. Crying will dilute the oily layer that reduces evaporation of the tears and make your eyes feel dry again. If your eyes water a lot you may find it helps to use a product that increases the oily layer of your tears to reduce this evaporation. Your optometrist will be able to advise you on this.

 

What can I do about dry eye?

Once your optometrist knows what is causing your dry eye, they can give you advice on how to manage it. There are four main ways to help you dry eye.

1. Avoid using make-up and keep your eyelids clean

Eyeliner, particularly when put on the rim of your eyelid, may block the maibomian glands that produce the oily part of your tear film. This may cause the area around your eyes to be inflamed. It is also important to make sure you keep your eyelids clean, particularly if you have blepharitis.

2. Be aware of your environment

There are some environments that may make your eyes feel more dry. High temperatures and central heating may increase the evaporation of your tears and make your eyes feel more dry, as can draughts and air conditioning.

You may find it helpful to reduce the temperature of your central heating at home and try to avoid draughts near your face, for example by directing car air vents away from your face. Some people find that using a humidifier to put more water into the air may help to slow down the evaporation of their tears.

If you are out on a windy day you may find it useful to wear glasses or sunglasses (ideally the wraparound type) to protect your eyes from the wind. Try to avoid smoky atmospheres as these may irritate your eyes.

3. Use eye lubricants

There are several types of eye lubricants available. Most of these aim to lubricate your eyes by giving you extra moisture. They are available as drops, gels or ointment, and most are available without a prescription. If you find the drops wash out of your eye too quickly you may find the gel-type better as they are thicker and so stay in your eye for longer.

Ointment is generally used for people whose eyes dry out at night because they do not fully close their eyes. Ointments are usually used only at night because they are sticky and cause blurry vision.

Eye lubricants do not contain any drugs and so you can use them as often as you like. However, some contain preservatives which may make your eyes sore. If you are using them more than six times a day you should use preservative-free drops.

If your dry eye is caused by your tears evaporating to quickly, you may find it helpful to use a spray rather than artificial tear drops. These sprays aim to replenish the oily layer of your tears and stop them evaporating as quickly. There are available without prescription and are sprayed onto the edges of your eyelids when your eyes are closed. When you open your eyes the solution spreads across the surface of your eye, creating a new oily film.

4. Have treatment to stop the tears from draining away

Your tears drain away into your nose through four small drainage channels in your eyelids (one in each of the upper and lower lids). Small plugs, called punctum plugs, can be put into the holes in your lower eyelids to stop the tears from draining away and help the tears to stay in your eye for longer. Your optometrist will be able to give you advice on this. The plugs can easily be removed if necessary.

 

Using a computer

Some people find that their eyes feel dry while they are looking at a computer screen (or afterwards). There is no evidence that looking at a computer screen does your eyes any harm, but it may make you blink less often. We recommend that when you use a computer you make sure you blink often and try to look away from the screen regularly, just for a few seconds, to give your eyes a rest.

 

What if I wear contact lenses?

Some people find that if they wear contact lenses their eyes may feel dry. This may be worse with some types of lenses than others. If you notice this, you may find that changing to a different type of contact lens or reducing the amount of time you wear your lenses will help you. Make sure you mention this when you go for your contact lens check-up so that your optometrist can suggest what to do about it.

 

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Eye Examination

We take our time with you in all aspects of your visit, not just trying on frames. Your test will usually last around 30 minutes, but if we need to take longer, we will.

Your eye examination will start with a short questionnaire performed by our friendly reception team. Don't worry; we will complete the form for you. This questionnaire helps us to gain important information from you in terms of what you use your glasses for. It's just a nice casual chat and if you want a coffee while we do this, then we can also provide this. You can also take this time to browse our selection of beautiful frames.

Following this brief questionnaire, our experienced optometrist will come and collect you from the waiting area and take you through to our exam room where your eye exam will be conducted. We do this in a relaxed, comfortable environment. We employ friendly optometrists who will explain your eye exam to you so you know as much as you need to. This will usually take around 30 minutes. Once complete, you will be brought back downstairs to speak to one of our dispensing opticians.

We now take the time to help you pick out a frame that suits you. We are very open and honest, and if we think that a shape or colour of a frame is not right for you, we will tell you and explain why, but at the end of the day it's still your choice. Our dispensing optician will also talk to you about your ophthalmic lens options and what we would recommend. This ophthalmic recommendation is based on the answers from your initial questionnaire along with the results from your eye exam. As we are an independent optician, we are not tied down to one brand of lens and therefore have a lot more options for you to ensure you are getting the best lens for your requirements.

This is all done in a friendly, no pressure environment. Click here to request an eye examination appointment. 

Your sight is important, so you should look after it with the best eye test possible. An Ophthalmic Examination is the best way to care for your eyes. This ophthalmic examination provides early detection of many eye conditions including glaucoma, macular degeneration, cataracts and visual field problems. We will measure your corneal thicknesses as well as hospital standard visual field testing and pressure measurements. We assess for binocular vision and muscle problems, dry eye and lid problems. The examinations last for approximately 30 minutes. Following the tests we will discuss the results with you so as you can leave knowing your eyes have had the very best examination possible, allowing detection and prevention of sight-threatening problems.

Zeiss Humphrey Threshold Visual Field Analysis

Your field of vision is every area that you can see with your eyes pointing straight ahead. It is important to have a wide field of vision to help us navigate around, especially when walking or driving. You can lose part or all of your visual field through many different ways including cataracts, glaucoma, strokes, circulatory disorders, neurological conditions, certain brain tumours and even smoking. It is essential to have your visual field regularly assessed as many conditions, if caught early, can be treated.

We use the Zeiss Humphrey Visual Fields 720i - the very same as the one used at the QMC eye clinic.

Our Humphrey Visual Field Analyser is considered the gold standard in advanced visual field testing. It accurately assesses how wide and sensitive your visual field is. Unlike basic visual field screening which concentrates on evaluating large chunks of your vision at a time, the Humphrey Visual Field Analyser can pick up even very subtle defects in your visual field by analysing each nerve pathway in detail. This allows for detection of problems. However, even a perfect visual field should regularly be measured as this provides an accurate individual baseline to monitor future changes from again allowing earlier diagnosis of problems.

Slit Lamp Biomicroscopy

To accurately view the interior and exterior of the eye in 3D we use slit lamp indirect biomicroscopy - a technique which involves specialist skills and an advanced piece of equipment to view all the hard to reach corners of the eye. This method can help us identify retinal bleeds, holes, tears and detachments far more accurately than traditional methods of looking in your eyes. Biomicroscopy also aids detection of diabetic eye disease, glaucoma, Papilloedema (pressure behind the eye), Truemacular degeneration, hypertension and many other conditions.

Colour Vision

We check colour vision firstly in childhood to establish if there is an inherited problem and gain a baseline for future reference. Some colour deficiencies that occur later in life can be caused by illness, accident or poisoning. Colour vision is easy to check. The test is performed under daylight lighting conditions in the consulting room. There are several variations of colour vision testing, some requested for particular occupations.

Colour vision deficiency is commonly known as colour blindness. Real colour blindness when people see things only in greyscale is very rare. Most people with colour vision problems have an inherited red-green colour deficiency which leads to confusion of colours in that spectrum. Due to its inheritance pattern it is most common in men. Approximately 8% of men and 1% of women are colour deficient.  There are other types of colour deficiency that can affect other colour groups as well. Red, green and blue cone cells at the back of our eyes detect colour variations. In colour deficient eyes one or more type of the cones may be absent or deficient therefore affecting the ability to perceive certain colours.

Binocular vision

Is the ability of the two eyes to work as a pair. Binocular vision allows us to perceive depth and maintain a single image i.e. avoiding double vision. Binocular vision problems can often be subtle and lead to signs of visual stress such as:

  • Print jumping as you read
  • Difficulty focusing on individual words or letters.
  • Diplopia (double vision)
  • Tired eyes when performing visual tasks
  • Strabismus (squint)

At every eye examination your binocular visual balance will be assessed, to ensure you are getting the most comfortable vision possible, eliminating signs of visual stress. If a binocular vision problem is identified there are many methods we can use to help alleviate symptoms including using prismatic correction in spectacle lenses and eye exercises.

Binocular vision problems may be present from childhood or develop later in life. Certain conditions may lead to sudden binocular vision problems, these include diabetes, hypertension and nerve palsies.

Flashes and Floaters

This information should not replace advice that your optometrist or other relevant health professional would give you.

 

Overview

Floaters look like small, dark spots or strands that appear to float in front of your eyes. Floaters are very common and are normally harmless. They are more common if you are short-sighted or as you get older. Some people notice they see flashes of light. These can be due to movement of the gel inside the eye. Very occasionally, flashes or an increase in floaters can be a sign of retinal detachment, which needs treating as soon as possible. This is more common as you get older, or in people who are short-sighted or have had eye surgery.

If you get any of the following symptoms and you cannot contact your optometrist, you should seek urgent attention ideally from an eye casualty department at the hospital. It is important that you seek advice promptly if you have:

  • a sudden increase in floaters, particularly if you also notice flashing lights
  • a new, large, floater
  • a change in floaters or flashing lights after you have had a direct blow to your eye
  • a shadow spreading across the vision of one of your eyes

 

What are floaters?

Floaters appear as black spots or something that looks like a hair or small pieces of cobweb. These can be semi-transparent or dark and appear to float in front of your vision. If you have had these for years, your eye and your brain learn to ignore them. Sometimes the number of floaters increases as you get older. Occasionally an increase in floaters can be a sign of problems inside the eye.

Because they 'float' in the jelly of your eye, you will find that if you move your eye to look at a floater it will move away in the direction you moved your eye. You might only see the floater if you are staring at a light coloured surface or at the sky during the day.

Some people find that floaters can be a nuisance, but most people become used to them. They rarely cause problems with your vision.

 

Why do floaters occur?

Some people are born with floaters. Other floaters occur as you get older when the gel in your eye, the vitreous humour, naturally shrinks. The gel separates into a watery fluid and wavy collagen fibrils. The fibrils are seen as line-shaped floaters. Sometime the gel shrinks enough to collapse away from the light sensitive lining at the back of your eye, which is called the retina. One the gel has collapsed, some people see a large ring-shaped floater.

The collapse of the vitreous gel can pull on your retina. If this happens you would see flashes of light - see 'flashes'.

Floaters can also be caused by some eye diseases that cause inflammation. This is not very common.

 

Who is at risk of floaters?

Floaters are more common in people who are short-sighted. They may increase if you have had an eye operation such as cataract surgery, or laser treatment after cataract surgery.

 

What might happen if I have floaters?

Most of the time floaters are harmless. Sometimes they may be annoying, but treatment is not advised.

Occasionally a sudden increase in floaters - either one or more large ones or a shower of tiny ones - may be a sign of a more serious eye disease such as a retinal detachment. This is when your retina pulls away from the back of your eye: it may lead to a sudden increase in floaters and possibly a blank spot or shadow in your vision which does not go away. This needs immediate attention.

If you notice these symptoms you should contact your optometrist straight away. If you cannot do this you should seek urgent attention from an eye casualty department nearby, you can go to your usual hospital casualty department, but it is best to go to an eye casualty department if you can. An ophthalmologist, a specialist eye doctor, will need to use eye drops and a special light to look inside your eyes to check if your retina is damaged.

 

What are flashes?

Some people may see flashes of light in front of one of their eyes, like small sparkles, lightning or fireworks. These tend to be in extreme corners of your vision, come and go, and don't obscure any part of your vision. The flashes don't last for a defined length of time, and you may notice them more if you go from a light to a dark environment. They may continue for several months. These are different to the shimmering or zig-zag lines that may be part of a migraine. Migraine shimmers are a flickering of light, often on only one side of your vision, which then expands to the outside of your vision with a sort of jagged pattern. This will often obscure at least part of your vision (the left or right side). The shimmers usually go away after 10-20 minutes and may be followed by a headache, although some people may get migraine shimmers even if they do not have a headache afterwards.

Flashes occur when there is a pull on your retina. This might happen as the vitreous get inside your eye becomes more liquid and collapses. You may experience flashes occasionally, on and off over weeks or months. Flashes can also occur if you are hit in your eye.

Flashes related to a collapse of the gel inside your eye are more likely to happen as you get older.

Sometimes flashes just indicate a tug on your retina and nothing more. However constant flashes may be a sign of retinal detachment.

A retinal tear or retinal detachment may lead to a sudden increase in floaters as well as flashes. You might notice a shadow at the edge of your vision too. This needs immediate attention. If you notice these symptoms you should contact your optometrist straight away. If you cannot do this you should seek urgent attention from an eye casualty department at the hospital. If there is no eye casualty department nearby you can go to your usual casualty department, but it is best to go to an eye casualty department if you can. An ophthalmologist, a specialist eye doctor, will need to use eye drops and a special light to look inside your eyes to check if your retina is damaged.

 

Who is at risk of retinal detachment?

Some people are more at risk of a retinal detachment. These are people who:

  • have had eye surgery, such as a cataract operation or laser surgery after a cataract operation
  • are moderately short-sighted (over -3.00D)
  • had had a previous eye injury
  • have a family history of retinal detachment
  • have had a previous retinal detachment in that eye or the other eye
  • are over the age of 50
  • have certain retinal diseases such as lattice or other retinal degeneration
  • have certain systemic diseases such as Marfan syndrome

Glaucoma

This information should not replace advice that your optometrist or other relevant health professional would give you.

 

Overview

Glaucoma is a group of eye diseases in which the optic nerve, which connects your eye to your brain, is damaged by the pressure of the fluid inside your eye.

This may be because the pressure is higher than normal, or because the nerve is more susceptible to damage from pressure. This may affect one or both of your eyes. There are two main types of glaucoma: chronic glaucoma, which happens slowly; and acute glaucoma which happens quickly. Chronic glaucoma is much more common than acute glaucoma.

 

Who is at risk of chronic glaucoma?

Anyone can develop chronic glaucoma. This risk of developing chronic glaucoma increases if you:

  • are aged over 40
  • are very short sighted
  • are of African or Caribbean origin
  • are closely related to someone with chronic glaucoma
  • have raised pressure within your eye. This is called ocular hypertension (OHT)

If one of your parents or children, or a brother or sister, has glaucoma, and you are over 40, the NHS will pay for your eye examination.

 

How is chronic glaucoma detected?

Because the early stages of chronic glaucoma do not cause symptoms, the best way to catch it early is to have regular eye examinations.

There are three main tests to see if you have chronic glaucoma. The first one is where you optometrist looks at the nerve at the back of your eye using an ophthalmoscope, or a slit lamp to shine a light into your eye. They may also take a photograph or a scan of the nerve. This can be useful for future visits, to help them see if things have changed.

The second test is where the optometrist measures the pressure inside your eye. This is done by using a machine which gently blows a puff of air at your eye, or by numbing your eye with drops and then gently pressing an instrument called a tonometer against it. The tests do not hurt, although the puff of air may make you jump a bit.

The third test is where the optometrist tests how wide your visual field is - how far you can see around you when you are looking straight ahead.

Sometimes you can have chronic glaucoma even if you have normal eye pressure, which is why you will usually have at least two of these three tests. If the results are not clear, you may be asked to do one or more of the tests again on a different day.

 

I have been told that the pressure inside my eye is high, but I do not have glaucoma

Some people naturally have pressure that is above the normal range, but this pressure does not cause any damage to their eyes. This means they do not have glaucoma. However, they are more likely to develop chronic glaucoma, so your optometrist or ophthalmologist (a specialist eye doctor) will tell you how often you should have this checked.

 

What will happen if I have chronic glaucoma?

If your optometrist suspects that you may have glaucoma, he or she will refer you to an ophthalmologist. If you have chronic glaucoma, you will be given eye drops to use every day. They will reduce the pressure and help control the build-up of fluid. They will not hurt.

Because you will not feel different in any way, you will not be able to tell that the treatment is working. This is why it is very important that you:

  • go to your follow-up appointments; and
  • keep on using the drops. If you find it hard to use the eye drops, you can get special bottles or holders to make it easier.

In a small number of cases, an ophthalmologist may recommend that you have an operation to help drain the fluid away.

There is no cure for chronic glaucoma but it can b e treated, normally with eye drops. Any existing damage will probably be permanent, but your sight could get much worse if you stop using the treatment. It is very important that you use the eye drops every day, even if you cannot tell that they are helping.

 

I have glaucoma. Can I drive?

If you are a car driver and have been diagnosed with glaucoma in both eyes, this will affect the amount you can see, and the law says that you must tell the DVLA (Driver and Vehicle Licensing Authority). You may have to take some extra tests, but most people are still allowed to carry on driving, You can find out more at www.direct.gov.uk/driverhealth.

 

Acute glaucoma

This is a type of glaucoma where the drainage channels inside your eye are blocked or damaged in some way. This causes the pressure inside your eye to increase rapidly.

Sometimes the increase pressure can come and go, and some people get short burst of pain and/or discomfort and blurred vision. This can happen when your pupils get bigger, so it may be at night or when you are in a dark area (like the cinema) or when you are reading.

Other symptoms are an ache in the eye which comes and goes, red eyes, or seeing coloured rings around white lights, or it can be a bit like looking through a haze or mist.

If you get these symptoms it is important to act quickly, even if the symptoms appear to go away, as your vision may be damaged each time the symptoms occur.

If you have these symptoms but they have gone away you should see you optometrist as soon as possible and mention that you have had these symptoms. If you have had the symptoms and they have not gone away you should go to the Accident and Emergency department immediately so that the pain and the pressure in the eye can be relieved.

People who are more likely to get acute glaucoma are:

  • people over the age of 40
  • women
  • people of East Asian or South Asian origin
  • people with a family history of close-angle glaucoma
  • people who are long sighted

For more information, look up glaucoma on the NHS Choices website www.nhs.uk, or phone SightLine, an information, support and advice service provided by the International Glaucoma Association, on 01233 648170, or visit www.glaucoma-association.com.

International Glaucoma Association

Macular Degeneration

This information should not replace advice that your optometrist or other relevant health professional would give you.

 

Overview

The macula is an area at the back of your eye that you use for seeing fine detail such as reading a book.

Macular degeneration (MD) covers a number of conditions which affect the macula. The conditions affect your ability to do certain tasks such as reading and watching television, but does not affect your ability to walk around as your side vision is not affected.

One of the most common symptoms of MD is noticing that straight lines appear wavy or that there are patches missing from your vision. You may not notice this if it happens in one eye as your other eye will compensate, so it is important to regularly check your vision in each eye separately. You can do this by looking with each eye separately at the straight lines on a door frame or Venetian blind. If you notice the lines are distorted or there are missing patches, you should see your optometrist straight away.

 

What is macular degeneration?

Macular degeneration (MD) happens when the macula at the back of your eye becomes damaged. This can make it harder to see fine detail, such as recognising faces, or to read or watch television. However, this does not normally affect your ability to walk around as the edge of your vision should not be affected.

 

Does it cause blindness?

MD is the leading cause of blindness in the UK. However, most people with MD still have their peripheral (side) vision and so can see well enough to get around. However, they may not be able to see well enough to read without strong magnification.

 

Does it happen more as you get older?

The most common forms of MD happen more as you get older and are known as age-related macular degeneration (AMD). Around one in 10 people aged 65 or over show some signs of AMD. Some younger people may have MD caused by a genetic condition but this is less common than AMD.

 

What are the symptoms of AMD?

Some people simply notice that things appear blurry or they have difficulty reading, even with their normal reading glasses. Other people may notice that they have a smudge in their central vision which does not go away, or they may notice that straight lines are distorted or wavy.

Some people with AMD may notice that they become sensitive to bright light, or that they find it difficult to adapt when going from a dark to a light environment. Some people notice that colours can fade.

These symptoms are more noticeable if you look for them with each eye separately, because if you have both eyes open then the better eye may compensate for the other one. We recommend you check your vision on a regular basis by looking at some detail, such as a book or magazine and covering each eye in turn. This will help you notice any changes in your vision early.

 

Can I do anything to protect myself from getting AMD?

Smoking is known as a major risk factor for developing AMD so if you smoke, try to stop. It is also believed that having a diet that is rich in coloured fruit and vegetables (for example, kale, spinach, celery and broccoli) may reduce your risk of developing AMD. A link has been found between obesity and AMD so you should try to maintain a healthy weight.

Other factors that increase your risk of developing AMD include having a family history of the condition. It is slightly more common in women than men. It is possible that exposure to ultraviolet light may be linked to AMD so we recommend you wear UV-absorbing glasses when you are going to be outside for long periods.

There are lots of dietary supplements on the market which claim to be beneficial for eye health. They may be helpful for some people. Discuss whether or not that may be helpful for you with your optometrist.

You should note that if you smoke or have been exposed to asbestos you should not take beta carotene.

 

I have heard that AMD can be 'wet' or 'dry' - is this right?

AMD can be classified as early or late. Early AMD is always dray AMD. This is when yellow deposits, known as drusen, build up behind the macula. Most people with early AMD have near normal vision. There is no treatment for early AMD.

A minority of people with early AMD can progress to late AMD. Late AMD may be 'wet' or 'dry'.

The commonest form of late AMD is the wet form. This happens when abnormal blood vessels begin to grow behind the macula and leak fluid. This pushes the macula away from its blood supply at the back of your eye and causes a rapid loss of vision (straight lines become wavy, or you have a blank spot or smudge in the centre of your vision).

You can check this yourself by looking at straight lines such as door and window frames or Venetian blinds. Or, you can look at a grid of squares printed on paper, called an Amsler grid.

Your optometrist will be able to advise you on this. It is important to do this with each eye separately and while wearing your glasses, if you need them. Wet AMD can be treated, so if you notice these symptoms, you need to see your optometrist straight away.

Late dry AMD is called geographic atrophy and is rarer than late wet AMD. This is where you loose vision because the retina at your macula thins but there are no leaking blood vessels.

Find out more about the Valeda Light Delivery System for the treatment of Dry AMD by following this link.

 

The Amsler test

  • Wear the glasses you usually wear to read
  • Hold the chart about 30cm (12 inches) away from your face
  • Cover each eye in turn. With the other eye look at the black dot in the middle of the chart. Are all the lines straight? Do you see any distortion, or any broken or wavy lines? Do you see any missing patches?
  • If you see anything unusual, you should contact your local optometrist straight away.

 Please click this link for more information and a larger, printable version of this grid

amsler grid

 

Is there any treatment for AMD?

There is currently no treatment for dry AMD. Lighting is very important and you may find it easier to read if you have good light at home, or sit near a window to read. If the dry AMD is interfering with you ability to see fine details, your optometrist can advise you on special magnifiers which can help you. Organisations link the RNIB or local services can provide you with equipment that can help you manage your day-to-day tasks. Your optometrist or GP will give you advice on contacting these services.

Wet AMD can often be treated if it is caught early enough and this is normally done by injecting a drug into the gel inside your eye. This shrinks the new blood vessels that are pushing the macula away from the back of your eye. You may need to have this repeated every four weeks for a few months. This will be provided on the NHS. It is important to spot any changes early by checking the vision in each eye separately and contacting your optometrist immediately if your vision suddenly becomes distorted or you have a blank spot in your vision.

If you have wet AMD, your optometrist will refer you to a specialist eye doctor, known as an ophthalmologist. The ophthalmologist will decide if you need treatment by taking some scans of the back of your eye to show the thickness of the retina. They may also inject you in your arm with some special dye to see how this travels through the back of your eye, while taking a series of flash photographs of the inside of your eye.

 

After treatment

If you find you are struggling to see things because of poor vision, ask your doctor or optometrist for details of your local low vision service. RNIB can also give you advice on the help that is available. Contact the RNIB on 0303 123 9999.

Email: helpline@rnib.org.uk

Website: www.rnib.org.uk

For support in your local area, and more information about AMD contact the Macular Society.

Website: www.macularsociety.org

Tel: 0300 3030 111

 

Macular Society

MacuShield

Valeda Treatment for Dry AMD

A Brighter Horizon for Dry Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is an eye disease that leads to vision loss and can cause blindness. The dry form affects 80% of individuals with AMD.

It tends to progress more slowly than the wet type but leads to a subsequent loss of visual acuity. In dry AMD, drusen can form below the macula over time, causing a progressive loss of central vision.

Until recently, apart from nutritional advice, there was no suitable intervention before the patient developed the wet form of AMD.

Several studies have recently shown encouraging results treating eye disease, such as AMD with a technique known as photobiomodulation (PBM).

The process is not a heat therapy but is more akin to photosynthesis in plants or 'Physiotherapy for the eye'.

Light, in the far red and near-infrared spectral range, can stimulate the cells, which lead to a cascade of photochemical reactions. This may facilitate the repair of damaged tissue in the retina and promote function.

The original study (LightSite 1) was undertaken in Canada with patients given 9 treatments over a 3 to 4 week period. The patients were tested before treatment and the 1 month after treatment and the majority had intermediate to advanced AMD.

Results, 50% of PBM treated patients showed an improvement of 5 or more letters, with 92% of patients with no Geographical Atrophy at the start responding. At the same time contrast sensitivity improved and in a group of patients, drusen volumes were seen to fall.

A second study (LightSite 2) was set up in Europe, with the UK, France, Germany, Italy, and Spain taking part using a similar regime of 9 treatments in 3 to 4 weeks. While interrupted by Covid which reduced the recruitment of patients, the interim results have been similarly striking.

These patients were at an earlier stage in the disease and had better vision to begin with however 35% of PBM treated patients had 5 or more letters of improvement. At the same time the growth rate of Geographical Atrophy was decreased by 44% at 10 months.

Another study from America (The ElectroLight Study) assessed the patients for visual acuity, contrast sensitivity and Electroretinography (ERG) of the visual function.

Interim analysis showed a 47.8% improvement in Acuity of 10 to 14 letters and an improvement in contrast sensitivity. At the same time the patients showed an improvement in function over time with the ERG parameters.

The Valeda Light Delivery System is the first approved treatment for Dry Age-Related Macular Degeneration (Dry AMD) using Photobiomodulation. Dry AMD is the leading cause of central vision loss in the elderly. Without treatment, Dry AMD can progress as you age, leading to vision loss.

Dry AMD gradually impacts your vision through the following:

  • Loss of vision: As AMD progresses, your central focus may become smudged, distorted or lost. This impacts driving, recognizing faces, reading, watching TV, and other aspects of your life.
  • Loss of contrast: It becomes more difficult to see textures and contrasts. This can cause difficulty with navigation uneven walkways and stairs leading to an increased risk of falling.
  • Impaired depth perception: Difficulty with properly judging distances can lead to accidents and falls.
  • Poor tolerance for changing light levels: Difficulty with adjusting to changing light levels and worsening glare.
  • Need for brighter light levels: More light may be needed for daily activities such as reading, cooking and other everyday tasks.

 

How can the Valeda Light Delivery System help?

Valeda uses Photobiomodulation (PBM) to apply specific wavelengths of light to the eye. Clinical studies have shown that Valeda can improve visual outcomes.

In the aging eye, cells may become sick, leading to loss of function and cell death. PBM works by stimulating energy production within the cells of the eye and improves their ability to perform their roles. Healthy cells are essential for good eye health.

Although PBM is currently used as a therapy in other diseases and conditions, Valeda is the first device designed specifically for dry AMD treatment.

The earlier Dry AMD is diagnosed and monitored by an eye care professional, the better the results will be in treating the disease and preserving your vision. An eyecare professional can determine how frequently you need to be seen for check-ups and treatments based on your unique vision history.

Who is suitable for the Valeda Treatment?

Valeda is indicated for use in the treatment of dry age-related macular degeneration (AMD) patients with vision impairment. Those individuals receiving treatment should have a doctor diagnosis of Dry AMD. The stage of Dry AMD may impact the benefits of the treatment. Your doctor will discuss your diagnosis and treatment plan with you.

Who is NOT suitable for the Valeda treatment?

As a precaution, patients have not been tested and should not be treated with Valeda if they have any known reactions to light exposure, or if they have a history of light-activated central nervous system disorders (e.g. epilepsy, migraine). In addition, patients should not receive treatment within 30 days of using any photosensitizing medications (e.g. topicals, injectables) before consulting with their physician.

What's involved with the Valeda treatment? Do I need any special preparation?

If you wear glasses or contact lenses, you will be asked to remove them prior to receiving treatment. Your eyes will not be dilated for the Valeda treatment. You will be seated comfortably at the Valeda Light Delivery System. The person administering the treatment will guide you through each step of the treatment which takes less than 5 minutes. Treatment for both eyes will take less than 10 minutes.

Clinical trials have shown benefits in visual function following treatment 3 times a week for 3-4 weeks. This is the recommended treatment protocol with Dry AMD. In a recent clinical study, patients received no more than 3 treatments a week and no more than one treatment in a 24 hour period. If you miss a treatment, it is recommended to make up the session within the 3-4 week treatment series period.

What are the clinical benefits of the Valeda treatment?

Treatment with Valeda improves benefits in overall visual function including improvement in vison when scored on the eyechart and improved detailed vision. Photographic imaging also shows improvement in scans of the eye when assessed for drusen (protein deposits that are observed in the diseased eye).

What are the potential side effects of the Valeda treatment?

Photobiomodulation (PBM) is a low level light based therapy that helps cells improve their function. PBM has been used in many different diseases and disorders for decades with a positive safety profile. In clinical trials in dry AMD patients, the use of light therapy has also shown to be safe. Valeda is designed to be eye safe. There have been no treatment-related side effects noted in previous studies with the Valeda.

What can I expect during and after the Valeda treatment?

It is well known that looking at bright light can produce an afterimage. Another name for this is photobleaching, where the cells the "see" that specific colour become fatigued. For example, if you look at red light, those colours may fade after treatment and you will see more of the opposite colour (i.e. green). This phenomenon may be seen immediately following treatment and will recover in a couple of minutes. You will be able to partake in normal activities following the treatment.

What if I have cataracts?

Patients can receive the Valeda treatment if they have cataracts.

The Valeda Light Delivery System is available at John Flynn Opticians. Call us on 0115 9255051 to book or to discuss further.

OCT

Spectralis logo

4D HD Optical Coherence Tomography (OCT)

It is important that you have your eyes examined regularly to check your eyesight and the health of your eyes, in particular checking for diseases such as Age-Related Macular Degeneration (AMD) and Glaucoma that could have consequences if left undiagnosed.

 

With our new 4D HD Optical Coherence Tomography (OCT) imaging technology, we are now able to identify and monitor the smallest change, and that changes everything. The SPECTRALIS 4D HD OCT Advanced Eye Examination uses a patented eye-tracking system that produces a 3 dimensional image of the eye, allowing us to more easily identify if you are at risk of or suffering from the eye diseases mentioned above and much more. The tracking system allows the scan to be placed in exactly the same place (to 1 micron) on every visit, giving a true 4D view of change over time.

Please contact us to schedule your HEIDELBERG SPECTRALIS 4D HD OCT Advanced Eye Examination by ringing 0115 925 5051 or 0115 939 2421

Presbyopia

This information should not replace advice that your optometrist or other relevant health professional would give you.

 

Overview

There are two main parts of your eye which are responsible for focusing light onto your retina so that you can see clearly.

These are your cornea, which is the transparent dome-shaped part at the front of your eye which covers your iris, and the lens inside your eye. The lens inside your eye changes shape to allow you to see things that are close to you.

As you get older the flexibility of the lens inside your eye reduces. This means that you are less able to focus on things that are close to you, so you may need to have reading glasses. This page explains why this happens and what the various options are for correcting it.

 

What is presbyopia?

When you look at something that is far away, you eye - if you are perfect sighted - is shaped so that the object is clearly focused on your retina. This means that the image is clear.

When you look at something close up, for example to read a book, the muscles in your eye that surround the lens contract to make the lens change shape. This focuses the light from the book onto your retina. The lens inside a child's eyes is elastic, and so can change shape easily to enable them to change focus from looking at something far away to looking at something close up. As we get older, however, the lens naturally stiffens and so it changes shape less easily. This means that the distance up to which we are able to focus gets further away and we are no longer able to focus on things that are close to us, having to hold them further away to see them clearly. This is more noticeable when we want to look at something very close to us, such as threading a needle. It may also mean that it may take longer for us to focus from looking at something close up to looking at something far away (or vice versa).

This change in focusing tends to become more noticeable when we reach out late thirties or forties as we then find it difficult to focus on things that are at the normal reading distance. It is quite common to see people who are presbyopic holding things away from them in an attempt to see them clearly.

As this affects things that are close to you first, your vision of things that are further away - such as the computer - is not affected until later, when your lens has lost almost all of its elasticity.

Because the lens has lost its elasticity, when you are presbyopic you will need glasses to focus on the different distances you need to see. This may mean having separate pairs for distance and reading and maybe for middle distance such as looking at the computer or reading sheet music.

 

What is the treatment for presbyopia?

Presbyopia is a natural part of ageing and there is no cure for it. The solution is generally to wear glasses for reading. Because reading glasses focus light that comes from objects that are close to you, you will find that is you wear them and look at something far away, it will appear blurred. This is quite normal, and you will often notice people peering over their reading glasses to see clearly in the distance. If you do not want to do this, or prefer not to have a separate pair of reading glasses, the alternatives are bifocal or varifocal lenses.

Bifocal glasses have two separate areas of the lens which are separated by a line: the top part of the lens focuses light from distant objects, and the bottom part of the lens focuses light from near objects. Varifocal lenses work in a simmilar way to bifocal lenses, but they have no line as the lens gradually changes its focus from top to bottom. This allows you to see objects at any distance clearly, simply by looking at the object and moving you head up and down so that your eyes look through the correct part of the lens.

 

Are there exercises I can do to stop needing reading glasses?

Presbyopia is not caused by muscle weakness but by the lens stiffening as we age. There are no exercises that can help this.

 

Will presbyopia affect my distance vision?

If you are emmetropic (perfect-sighted), presbyopia will only affect your ability to see close up (reading, for example) and middle vision (using a computer, for example). It does not affect your distance vision, so you will still be able to drive without glasses.

If you are hyperopic (long-sighted), as you get older and the lens stiffens, both your distance vision without glasses and your near vision will become worse. You will then need to wear separate glasses for both distance and near vision, or have bifocals or varifocals, to see clearly. Your optometrist will tell you which applies to you.

 

Will presbyopia affect my near vision?

If you are myopic (short-sighted), you will find that you can read more easily by taking your (distance) glasses off, although if you are very short-sighted you may have to hold things very close to see them clearly without your glasses. This is because your natural focus is close up, so you can see things clearly at this distance without your glasses. You may prefer to have bifocals or varifocals to stop having to take your glasses off when you want to read.

 

I notice I mainly need my reading glasses at night - why is this?

It is very common to find that, if you need glasses, things are more blurry without them in dim light. This is because your pupils get bigger in poor light and you have less depth of focus. This means that you notice the blurriness more. The opposite effect is that you will often see better in bright light, for example outdoors in the sunshine when your pupils become smaller. This increases your depth of focus so that you don't notice the blurriness as much. You may also find that you are more tired at night, so your muscles find it more difficult to contract to change the shape of your lens.

 

Will I make my eyes worse by wearing glasses?

No. As presbyopia is caused by the lens stiffening, and not the muscles weakening, wearing glasses will not make your eyes worse. However, you may notice that when you take your glasses off, things appear to be worse without them than they were before you had them. This is simply because you are noticing how clear and comfortable vision should be. Before you had the glasses, you were unaware how blurry your vision really was because it changed slowly over the years.

Presbyopia will get worse as you age until you reach your late fifties, when you will have no natural focusing ability left. Unfortunately there is nothing you can do to stop it.

 

Can I use off-the-shelf reading glasses?

Ready-made reading glasses to correct presbyopia are available from optometrists. They are also available from many shops. They are designed for reading only and are not suitable for driving. They are only correct for you if both of your eyes have the same prescription and you have no astigmatism. Research has shown that they are often not made to the same standards as prescription glasses*, so we would recommend you have a prescription pair for your 'main' pair of reading glasses, although it is ok to have ready-made readers as spares.

Even if you use ready-made reading glasses it is very important that you see your optometrist for regular eye examinations as people over 40 years of age are more at risk of eye diseases such as glaucoma and age-related macular degeneration.

*Elliott DB, Green A. Many Ready-Made Reading Spectacles Fail the Required Standards. Optom Vis Sci 2012;89:E446-E451

 

I don't want to wear glasses - can I have contact lenses instead?

Correcting presbyopia with contact lenses is more complicated than correcting it with glasses. This is because you can look through different parts of a varifocal lens simply by moving your head or eyes. As contact lenses move with your eye, it is more difficult to do this and correct the focus both for distance and near vision, although bifocal and varifocal contact lenses are available. An alternative which works very well for some people, is to correct one eye for distance and the other eye for reading. This is called monovision. We suggest you discuss the various options of contact lenses with your optometrist.

Sports Vision

The correct eyewear will not only protect your eyes from UV or accidental damage but can also enhance your performance. Gaining the sharpest most balanced vision will not only improve the clarity of what you see but also reduce fatigue, improve hand eye co-ordination and accuracy giving you the sporting edge over your competitors. At John Flynn Opticians we are proud to look after the eyes of sports men, women and children from a wide variety of sports and offer a range of frame and lens choices to suit your individual needs, whether that be for competitive sport or leisure.

Recent high profile eye injuries have highlighted the need for eye protection in various sports. We stock both non-prescription and prescription protection for various sports including squash, football and cricket.

We can also order bespoke prescription swimming goggles!

Our senior optometrist has a Diploma in Sports Vision (DipSv).

If you’d like to see clearly without spectacles, why not try contact lenses which offer superior peripheral vision and everyday UV protection. Contact lenses can enhance vision and sporting performance as well as safety by seeing hazards more clearly. Daily contact lenses can be perfect for every day wear or a cost efficient choice for wearing for sports or days out as frequently or infrequently as required. optics that cut glare and keep your eyes comfortable when you’re driving.