ARMD – Age related macular degeneration.
Age Related Macula Degeneration or sometimes known as ARMD is a disease of the eye which comes with age. If we all live long enough it will affect us in some form or other.
The macula is a part of the eye on the retina – which the layer on the inside of the eye (the red part you see in photos). The macula is very important and is responsible for what we see straight in front of us, allowing us to see fine detail for activities such as reading and writing, as well as our ability to see colour.
- Age – AMD is an age related condition so growing older makes the condition more likely.
- Gender– Women seem more likely to develop macular degeneration than men.
- Genetics – There appear to be a number of genes which can be passed through families which may have an impact on whether someone develops AMD or not.
- Smoking – Smoking has been linked by a number of studies to the development of AMD. It has also been shown that stopping smoking can reduce the risk of AMD developing.
- Sunlight – Some research suggests that lifetime exposure to sunlight may affect the retina. It is a good idea to wear sunglasses to protect the eyes. Especially here on the rock!!!!
- Nutrition – Research suggests some vitamins and minerals can help protect against AMD. Anti oxidants which are in tomatoes and yellow peppere, spinaich …. Supplements can also be taken as a form of prevention.
Although nothing can be done about age, gender and the genes we inherit, it is possible to control the other more environmental factors that seem to be linked to AMD. Protecting your eyes from the sun, eating a well balanced diet with plenty of fresh fruits and vegetables and stopping smoking may all help to delay the progress of AMD.
Because AMD affects the centre of the retina, people with the advanced condition will often notice a blank patch or dark spot in the centre of their sight. This makes reading, writing and recognising small objects or faces very difficult.
Can macular degeneration be treated?
If you have the wet type then this would be something that an Ophthalmologist – an Eye doctor – would advise you about as their is various injections and photodynamic therapy that can be carried out.
What can be done to help with “dry” AMD?
At the moment there aren’t any medical treatments for “dry” AMD. There is some research which suggests that vitamin supplements can help slow down the progression of “dry” AMD. They do not restore sight, but they may have a preventative role to play.
Ask your optometrist for details on this.
What is a cataract?
A cataract is a clouding of part of your eye called the lens. Your vision becomes blurred because the cataract is like a frosted glass, interfering with your sight. It is not a layer of skin that grows over your eye, despite what you may have heard.
If your doctor or optometrist/optician has told you that you have a cataract, don’t be alarmed. Many people over 60 have some cataract and the vast majority can be treated successfully. Early cataracts may not affect your sight and do not need treatment.
The function of the lens
The lens is a clear tissue found behind the iris, the coloured part of the eye. The lens helps to focus light on the retina at the back of the eye to form an image. To help produce a sharp image, the lens must be clear.
- Blurry sight
This is very common. You may notice that your sight has become blurred or misty or that your glasses seem dirty or appear scratched.
- Dazzled by light
You may be dazzled by lights, such as car headlamps, and sunlight.
- Change of colour vision
Your colour vision may become washed out or faded.
These eye problems may be a sign of other eye conditions. If you suffer from any of these symptoms, please see your optometrist/optician. Regular eye tests with your optometrist/optician can catch an eye condition in the very early stages.
Although researchers are learning more about cataracts, no one knows for sure what causes them. There may be several causes and some studies have linked smoking, excessive exposure to sunlight and poor diet with cataract development. Sometimes cataracts are caused by other health problems such as diabetes..
In the past the eye specialists often waited until the cataract was mature enough to be removed but now once it begins to interfere with your everyday activities then it is removed.
If you are a driver you must reach the visual standard required by the drivers and vehicle licensing authority and it may be necessary to have the cataract removed in order to keep your license.
Cataract is something that is going to come to all of us – some people do get it younger than others. The procedure to remove cataract is one of the most successful operations. Fewer than two percent of patients have serious, unforeseen complications.
What is diabetes?
Estimates suggest that nearly one person in twenty-five in the UK is affected by diabetes mellitus, a condition which means that, due to a lack of insulin, the body cannot cope normally with sugar and other carbohydrates in the diet.
Diabetes can start in childhood, but more often begins in later life. It can cause complications which affect different parts of the body, the eye being one of them. There are two different types of diabetes mellitus:
- Type 1 diabetes, which can also be referred to as insulin dependent diabetes mellitus (IDDM). This type of diabetes commonly occurs before the age of 30 and is the result of the body producing little or no insulin.
- Type 1 is controlled by insulin injections.
Type 2 diabetes, which can also be referred to as non-insulin dependent diabetes mellitus (NIDDM). This type of diabetes commonly occurs after the age of 40. In this type of diabetes the body does produce some insulin, although the amount is either not sufficient or the body is not able to make proper use of it.
Type 2 diabetes is generally controlled by diet or tablets, although some people in this group will use insulin injections.
Most sight loss due to diabetes can be prevented, but it is vital that it is diagnosed early. This can only be detected by a detailed examination of the eye. Therefore, regular, annual eye examinations are extremely important, as you may not realise that there is anything wrong with your eyes until it is too late.
Although your vision may be good, changes can be taking place in your retina that need treatment. Because most sight loss due to diabetes is preventable, remember:
early diagnosis of diabetic retinopathy is vital
have an eye examination every year
do not wait until your vision has deteriorated to have an eye test
the importance of early treatment of diabetic retinopathy cannot be stressed enough
Your family doctor, diabetologist or optometrist can examine your eyes for diabetic retinopathy. In some cases photographs of the retina are used to detect abnormalities without any other form of test. If a problem is found you will be referred to a consultant ophthalmologist (eye specialist) at a hospital eye clinic.
Remember, however, that if your vision is getting worse, this does not necessarily mean you have diabetic retinopathy. It may simply be a problem that can be corrected with glasses.
Important points to remember
Early diagnosis of diabetic retinopathy is vital.
Have an eye examination every year.
Do not wait until your vision has deteriorated to have an eye test.
Most sight-threatening diabetic problems can be managed by laser treatment if it is given early enough.
Do not be afraid to ask questions or express fears about your treatment.
Good sugar, blood pressure and cholesterol control reduces the risk of diabetes related sight loss.
Attend your diabetic clinic or GP surgery for regular diabetes health checks, including blood pressure and cholesterol monitoring.
Smoking increases your risk of diabetes related sight loss. Your GP can tell you about NHS stop smoking services in your area
But what exactly is dry eye?
Dry eye known medically as keratoconjunctivitis sicca or keratitis sicca, is a condition where there is a problem with the production of tears.
What are the symptoms of Dry Eye?
Usually eyes feel irritated, scratchy, dry and uncomfortable. Eyes may be red and there may be a burning sensation, or it may feel as if there is something in the eye like grit or an eyelash. Sometimes there may be periods of blurred vision but these normally go away after a short while or on blinking.
Sometimes eyes may even water too much which confuses a lot of people when we tell them they have dry eye as they see their eyes watering a lot.
Often eyes won’t actually feel dry but you may notice that there are no tears when you are upset or when peeling onions.
The layer closest to the eye is called the mucin layer. It coats the cornea which is the clear window at the front of the eye; it forms a foundation for the other layers of the tear film.
The middle layer is called the aqueous layer. This is the watery layer that most people think of when they think of tears. This layer is produced by the lacrimal gland which is underneath the upper eyelid. This layer provides moisture and supplies oxygen and other important nutrients to the cornea. This layer is mainly water.
The outer layer is called the lipid layer. This is an oily film which seals the tear film to the eye and helps to prevent any evaporation. Evaporation is the technical name for the watery layer being lost into the air.
The mucin and lipid layers are produced by small glands around the eye. Each time we blink the tears are spread onto the front of the eye. Excess tears are drained away by tiny drainage holes on the inside of the eyelids, these holes channel the excess tears into the nose. This is why crying sometimes makes your nose run
What about the tears when I cry or peel onions?
As well as being produced all the time to keep the eye moist, tears are also produced by a reflex – a reflex is the body’s automatic response to certain situations. Emotion, peeling onions or an injury, for example poking your eye, will produce excess tears. However these tears drain away quickly and do little to soothe a dry eye.
Sometimes dry eye is also a symptom of other conditions affecting other parts of the body particularly arthritis or a condition called Sjogrens syndrome. Sjogrens syndrome is a condition where, as well as dry eyes, people can also have a dry mouth and a dry vagina. This condition can also involve a type of arthritis
There are three main tests:
Tear film break-up time
This test finds out how long after blinking the eye starts to dry out.
The optometrist uses eye-drops with a special dye in them.
The optometrist instils the drops (puts the drops into your eye), will then ask you to blink a number of times, and then to stop and keep your eyes open without blinking.
The optometrist then uses a coloured light so that they can see the dye and time the period between your last blink and the formation of dry patches.
The dry patches are shown up by the dye.
If your eyes start to show these patches of dryness before ten seconds then it usually means that there is some evidence of a dry eye.
The dye does not change the colour of your eye and only stays in your eye for a short while.
What can be done once I have a diagnosis?
There are three main ways to help with dry eye:
Preserving the existing tear flow
Using artificial tears
Reducing the draining away of the tears
You can lower the temperature in rooms, since high temperatures make the tears evaporate more quickly. Central heating can make the air quite dry and sitting directly in front of a heating source like the fire can also be a problem. Obviously this needs to be balanced with the need for keeping warm especially for older people. Sometimes humidifiers can help by moistening the air.
Many people find that dry eye is worse during tasks such as reading or computer work. This is usually because we unconsciously blink less when we are doing anything that needs lots of visual attention. It may help you to make an effort to blink more when doing these tasks.
What about artificial tears?
Artificial tears in the form of eye drops are usually the mainstay of treatment for people with dry eye. The aim of the treatment is to supplement the tears and therefore make the eye more comfortable. They also stop any damage to the front of the eye from prolonged dryness.
There are three main types of tear substitutes that you may be prescribed:
Drops, gels and ointments – speak to your Optometrist about what is best for you.
What is glaucoma?
Glaucoma is the name for a group of eye conditions in which the optic nerve is damaged at the point where it leaves the eye. This nerve carries information from the light sensitive layer in your eye, the retina, to the brain where it is perceived as a picture.
Your eye needs a certain amount of pressure to keep the eyeball in shape so that it can work properly. In some people, the glaucoma damage is caused by raised eye pressure. Others may have an eye pressure within normal limits but damage occurs because there is a weakness in the optic nerve. In most cases, both factors of high pressure and weakness in the optic nerve are involved, but to a varying extent.
Eye pressure is largely independent of blood pressure.
The most common is chronic glaucoma (chronic = slow) in which the aqueous fluid can get to the drainage channels (open angle) but they slowly become blocked over many years (see Figure 1). The eye pressure rises very slowly and there is no pain to show there is a problem, but the field of vision gradually becomes impaired.
Acute glaucoma (acute = sudden) is much less common in western countries. This happens when there is a sudden and more complete blockage to the flow of aqueous fluid to the eye. This is because a narrow “angle” closes to prevent fluid ever getting to the drainage channels (see Figure 2). This can be quite painful and will cause permanent damage to your sight if not treated promptly.
Secondary and developmental glaucoma
There are two other main types of glaucoma. When a rise in eye pressure is caused by another eye condition this is called secondary glaucoma. There is also a rare but potentially serious condition in babies called developmental or congenital glaucoma which is caused by malformation in the eye. This document is about chronic and acute glaucoma.
Are some people more at risk of chronic glaucoma?
Yes. There are several factors which increase the risk.
Chronic glaucoma becomes much more common with increasing age. It is uncommon below the age of 40 but affects one per cent of people over this age and five per cent over 65.
If you are of African origin you are more at risk of chronic glaucoma and it may come on somewhat earlier and be more severe. So make sure that you have regular tests.
If you have a close relative who has chronic glaucoma then you should have an eye test at regular intervals. You should advise other members of your family to do the same. This is especially important if you are aged over 40 when tests should be done every year.
People with a high degree of short sight are more prone to chronic glaucoma.
Diabetes is believed to increase the risk of developing this condition.
Please note: People over the age of 40 years with an immediate family member diagnosed with glaucoma – parents, children or siblings – are entitled to a free sight test every year under the NHS.
viewing your optic nerve. This is mainly done now with our OCT machine that takes a 3D scan of that part of the eye and compares your results to hundreds of other people of your age to compare I’d it is within normal range.
measuring the pressure in the eye using a special instrument
being shown a sequence of spots of light on a screen and asked to say which ones you can see – visual fields test.
All these tests are very straightforward, don’t hurt and can be done by most high street optometrists (opticians).
Most people can still drive if the loss of visual field is not advanced. To assess possible damage to your peripheral vision you will need a special test to see whether your sight meets the standards of the Driver and Vehicle Licensing Authority. Ask your specialist about this. The International Glaucoma Association (IGA) leaflet about driving may also be helpful.
What if my sight cannot be fully restored?
Early detection and treatment will usually prevent or slow down further damage by glaucoma. If you do experience some sight loss much can be done to help you use your remaining vision as fully as possible.
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