Age-related Macular Degeneration
Excess lid skin / Saggy Eyelids (Dermatochalasis)
Lid lumps and bumps – Lid lesions
Inside your eye, there is a natural lens that can gradually become yellow and cloudy. This loss of clarity is called a cataract.
Cataracts can occur as early as your 40s or 50s; by the age of 65 they will have developed in more than 90% of people. Some conditions such as diabetes can speed up their development.
Cataracts develop gradually over time and at first may not cause any problems with your vision. As they progress, you may notice your eyesight becomes misty or hazy, or you may experience glare.
When your clouded lens is removed during cataract surgery, it is replaced by an intraocular lens — or “IOL”. These are about the size of a finger nail, but are small and soft. Your surgeon will choose the type of IOL that is right for you and fits in with your visual needs and goals.
Glaucoma is a disease affecting the optic nerve that lead to cause painless, progressive loss of peripheral vision. If left untreated and undiagnosed, it can lead to “tunnel vision” and eventually permanent loss of vision and complete blindness. It is one of the leading causes of irreversible blindness worldwide.
Family history is significant, first degree relatives of patients diagnosed with glaucoma are ten times more likely to develop the disease. The risk of a glaucoma diagnosis also increases with age, with approximately one in eight Australians over the age of 80 developing the disease.
There are a number of different types of glaucoma, requiring different treatments ranging from eye drops to laser to surgery.
Your doctor will explain the type of glaucoma you have and the treatment best suited for your needs.
The Glaucoma Australia website has more information: www.glaucoma.org.au
Age-related Macular Degeneration
Macular degeneration, also known as age-related macular degeneration (AMD) is the name given to a group of chronic, degenerative retinal eye diseases that cause progressive loss of central vision, leaving the peripheral or side vision intact. It affects the ability to read, drive, recognise faces and perform activities that require detailed vision. Macular degeneration is the leading cause of legal blindness and severe vision loss in older Australians.
Macular degeneration is progressive and painless and although it can lead to legal blindness, it does not result in total or 'black' blindness.
The earlier that macular degeneration is detected the earlier that steps can be undertaken to help slow its progression and save sight through treatment and/or lifestyle modifications.
Early and intermediate stage AMD
Caused by the progressive build-up of waste material (drusen) under the retina. These stages typically have little or no impact on vision, however some people with the intermediate stage may notice changes to their central vision.
Late stage AMD
This is the vision impairing stage, which can be further divided into dry (atrophic) macular degeneration or wet (neovascular) macular degeneration.
- Dry (atrophic): caused by the gradual atrophy (loss) of retinal cells. It may lead to a gradual loss of central vision. Currently there is no treatment available for the dry form. Research is being conducted to develop treatments.
- Wet (neovascular): caused by the formation of fragile blood vessels which leak fluid and blood within and under the retina. It often leads to a rapid loss of central vision. Loss of vision in one eye may go unnoticed if vision in a fellow eye is good.
This type of AMD requires urgent treatment.
Intravitreal injections are the most successful treatment for wet AMD. It turns off the leakage of fluid into the retina, and works in more than 95 % of people with macular degeneration.
For more information see the RANZCO website: https://ranzco.edu/find-out-more-about/age-related-macular-degeneration
A pterygium is a wing-shaped fleshy overgrowth on the surface of your eye. This can eventually extend onto the surface of your cornea, which is the clear front window of your eye. A pterygium can cause ocular irritation, particularly in hot and windy conditions, and it can also cause a change in your vision. In most cases, a pterygium grows from the inner corner of the eye closest to your nose, although it can also grow from the outer corner as well. It can affect one or both eyes.
Pterygium surgery is a day procedure, and is commonly performed under local anaesthesia. The pterygium is removed and sent to the pathology laboratory (to check there is no risk of transformation to a cancerous process) and a conjunctival graft (similar to a thin clear membrane) is harvested from the outer surface of your eye and sutured into place to decrease the potential recurrence of the pterygium.
After the surgery you will be given anti inflammatory antibiotic eye drops to use. It tends to be a little gritty and sore in the first few days after surgery but this should soon settle.
A retinal detachment is when the thin layer containing the eyes light receptors peels away from the wall of the eye – like the wallpaper peeling away.
The retina is held in position partially by a suction force. If a hole develops in the retina, then the suction force is lost and the fluid that normally fills the inside of the eye passes through the hole and enters the space underneath the retina. As more fluid passes under the retina, the retina gradually detaches from the inner wall of the eye. When the retina is detached the cells do not receive enough oxygen and glucose and it is not able to function properly. If the retina remains detached, it will slowly deteriorate and lose function permanently. If the retina can be reattached with surgery quickly enough, it is possible to recover some function.
The retina is a layer of special light-sensitive tissue at the back of the eye that sends nerve impulses up the optic nerve to the brain. The centre of the retina is called the macular and this areas is responsible for your central vision, required for reading, driving etc. A macular hole is a retinal problem whereby a hole develops in the macular region. A macular hole therefore causes distortion in the central vision and sometimes a dark spot is noticed in the centre of the vision. The underlying cause is thought to be due to a fine membrane around the macula which undergoes outwards traction which pulls the hole open. This is something that just happens to some people with age – there are no well established risk factors.
Macular hole requires surgical treatment. The success rate for such surgery is 99%.
The retina is a layer of special light-sensitive tissue at the back of the eye that sends nerve impulses up the optic nerve to the brain. The centre of the retina is called the macular and this areas is responsible for your central vision, required for reading, driving etc.
Epiretinal membrane – also known as macular pucker, premacular fibrosis or cellophane maculopathy – is a thin sheet of fibrous tissue that can grow over the surface of the retina. In some cases the epiretinal membrane remains mild and does not significantly alter the vision; this type requires no treatment. If an epiretinal membrane grows it may damage the macula and cause the vision to become distorted and blurred. If the membrane continues to progress, permanent damage to the central vision may occur. In these cases surgical treatment is required to remove the membrane.
Once the membrane is removed, the distortion and the vision improves in 90% of cases, taking up to a year to settle down. How much vision is restored depends on your general health, the health of your eye and the length of time that the membrane has been present. In general, most people regain around 50 % of the vision they have lost, however some will gain more and some less.
The retina is a layer of special light-sensitive tissue at the back of the eye that sends nerve impulses up the optic nerve to the brain. In people with diabetes, tiny blood vessels in the retina may become diseased and damaged. This process is called diabetic retinopathy. It usually affects the retina slowly, over months or years.
The longer a person has diabetes, the greater the risk of diabetic retinopathy. All people with diabetes are at risk, whether or not they are insulin dependent.
Diabetes can cause the blood vessels to swell and leak blood or fluid around the retina. The healing process forms scar tissue. These problems can damage the retina so badly that the retina functions less effectively and vision is impaired.
The area of the retina that provides the sharpest vision is called the macula. Leaking blood or fluid can cause the macular to swell (macular oedema). This causes blurred vision and is a common result of diabetic retinopathy.
Good control of your blood sugars significantly reduces your risk of developing or progressing retinopathy.
Macular oedema can be treated with intravitreal injections.
Retinopathy can be treated with laser, intravitreal injections and surgery as required.
For more information see the website: https://ranzco.edu/find-out-more-about/diabetic-retinopathy
Excess lid skin/Saggy Eyelids (Dermatochalasis)
Dermatochalasis is a condition in which the skin above the upper eyelid is sagging and interfering with function of the upper eyelid. It is very common and usually occurs with aging. If the skin is sagging enough to interfere with vision, surgery may be required. The surgical procedure to repair this condition is called Blepharoplasty.
Ectropion refers to the lower eyelid turning outward abnormally, and Entropion refers to the lower eyelid turning inward abnormally. These abnormal eyelid positions can be caused by several different conditions and usually lead to abnormal tearing, redness and discomfort. The surgical repair depends on the cause.
Lid lumps and bumps – Lid lesions
Lid lesions are common. Many are benign and require no treatment. However skin cancer in light-skinned people living in Australia is relatively common. Surgery is required to remove the cancer and repair the resulting missing tissue (“defect”).
If the defect is small, it may be done under simple local anesthesia. However, if the defect is large, it may require general anesthesia. Two basic techniques are used: Flaps and Grafts. A skin graft is done by removing skin in a normal spot and stitching it to fill in the missing tissue from the skin cancer removal surgery. A flap is done by incising (cutting) and stretching the skin around the defect to fill in the hole. Your doctor will choose the type of closure best for your skin defect.
A chalazion is a localised inflammatory response involving sebaceous glands of the eyelid that occurs when the gland duct is obstructed. A chalazion may resolve spontaneously or with warm compresses, lid scrubs, and lid massage. Sometimes local steroid injections are helpful. When there is no improvement, the chalazion may be incised and drained. This can be done in a procedural room or operating theatre, depending on the age of the patient and type of anaesthesia required.
A chalazion instrument is put in place and an incision is made in the inner aspect of the eyelid. The contents of the chalazion are then carefully drained with a curette followed by gentle pressure or heat to control any bleeding.
If you suffer from floaters then you are familiar with the frustrating visual disturbance caused by these cobweb and cloud-like shadows.
Floaters are small pieces of debris that float in the eye’s vitreous humor (the jelly-like substance in the main chamber of the eye). This debris casts shadows onto the retina (the light-sensitive tissue layer at the back of the eye). If you have floaters, it is these shadows that you see floating across your field of vision.
There is a new treatment for floaters called Laser Floater Treatment or LFT.
Laser Floater Treatment is a minimally invasive, in-office procedure that can provide much-needed relief from floaters. It can also delay or obviate the need for invasive surgery. The goal of LFT is to achieve a “functional improvement”. That is, to allow you to resume eye normal day-to-day activities without the hindrance of floaters.
It is performed as an outpatient procedure in your ophthalmologist’s office; you do not need to stay overnight in a hospital. The procedure typically takes from 10-45 minutes to perform and you may require more than one treatment session in order to achieve a satisfactory result.
Most patients will experience an almost immediate improvement in visual function. As an added benefit, you will be able to return to normal day-to-day activities directly following treatment: there is no need for patches or anti-inflammatory drops.
Vision with floaters, before treatment
Vision without floaters, following Laser Floater Treatment