At City Eyes an 18 point optical health check is carried out to detect any conditions that may be present.

Below are a few eye conditions that the optical health check aims to detect:

GLAUCOMA

Glaucoma is a disease caused by increased intraocular pressure (IOP) resulting either from a malformation or malfunction of the eye’s drainage structures. Left untreated, an elevated IOP causes irreversible damage the optic nerve and retinal fibers resulting in a progressive, permanent loss of vision. However, early detection and treatment can slow, or even halt the progression of the disease.

What causes glaucoma?

The eye constantly produces aqueous, the clear fluid that fills the anterior chamber (the space between the cornea and iris). The aqueous filters out of the anterior chamber through a complex drainage system. The delicate balance between the production and drainage of aqueous determines the eye’s intraocular pressure (IOP). Most people’s IOPs fall between 8 and 21. However, some eyes can tolerate higher pressures than others. That’s why it may be normal for one person to have a higher pressure than another.

Glaucoma Signs and Symptoms

Glaucoma is an insidious disease because it rarely causes symptoms. Detection and prevention are only possible with routine eye examinations. However, certain types, such as angle closure and congenital, do cause symptoms.

1.Angle Closure (emergency)
2.Sudden decrease of vision
3.Extreme eye pain
4.Headache
5.Nausea and vomiting
6.Glare and light sensitivity
7.Congenital
8.Tearing
9.Light sensitivity
10.Enlargement of the cornea

Glaucoma Detection and Diagnosis

Because glaucoma does not cause symptoms in most cases, those who are 40 or older should have an annual examination including a measurement of the intraocular pressure. Those who are glaucoma suspects may need additional testing.

The glaucoma evaluation has several components. In addition to measuring the intraocular pressure, the doctor will also evaluate the health of the optic nerve (ophthalmoscopy), test the peripheral vision (visual field test), and examine the structures in the front of the eye with a special lens (gonioscopy) before making a diagnosis.

The progression of glaucoma is monitored with a visual field test. This test maps the peripheral vision, allowing the doctor to determine the extent of vision loss from glaucoma and a measure of the effectiveness of the treatment. The visual field test is periodically repeated to verify that the intraocular pressure is being adequately controlled.

At City Eyes we also perofrm a new revolutionary test for Glaucoma using the Zeiss GDx nerve fibre analysis machine which can detect glaucoma in the earliest of its stages enabling treatment before loss of vision.

Glaucoma Treatment

Most patients with glaucoma require only medication to control the eye pressure. Sometimes, several medications that complement each other are necessary to reduce the pressure adequately.

Surgery is indicated when medical treatment fails to lower the pressure satisfactorily. There are several types of procedures, some involve laser and can be done in the clinic, others must be performed in the operating room. The objective of any glaucoma operation is to allow fluid to drain from the eye more efficiently.

Useful resources:

http://en.wikipedia.org/wiki/Glaucoma

http://www.bbc.co.uk/health/physical_health/conditions/glaucoma1.shtml

CONJUNCTIVITIS

Conjunctivitis, commonly known as pink eye, is an infection of the conjunctiva (the outer-most layer of the eye that covers the sclera). The three most common types of conjunctivitis are: viral, allergic, and bacterial. Each requires different treatments. With the exception of the allergic type, conjunctivitis is typically contagious.

The viral type is often associated with an upper respiratory tract infection, cold, or sore throat. The allergic type occurs more frequently among those with allergic conditions. When related to allergies, the symptoms are often seasonal. Allergic conjunctivitis may also be caused by intolerance to substances such as cosmetics, perfume, or drugs. Bacterial conjunctivitis is often caused by bacteria such as staphylococcus and streptococcus. The severity of the infection depends on the type of bacteria involved.

Conjunctivitis Signs and Symptoms

Viral conjunctivitis
· Watery discharge
· Irritation
· Red eye
· Infection usually begins with one eye, but may spread easily to the fellow eye

Allergic conjunctivitis
· Usually affects both eyes
· Itching
· Tearing
· Swollen eyelids

Bacterial conjunctivitis
· Stringy discharge that may cause the lids to stick together, especially after sleeping
· Swelling of the conjunctiva
· Redness
· Tearing
· Irritation and/or a gritty feeling
· Usually affects only one eye, but may spread easily to the fellow eye

Conjuncivitis Detection and Diagnosis

Conjunctivitis is diagnosed during a routine eye exam using a slit lamp microscope. In some cases, cultures are taken to determine the type of bacteria causing the infection.

Conjunctivitis Treatment

Conjunctivitis requires medical attention. The appropriate treatment depends on the cause of the problem.

For the allergic type, cool compresses and artificial tears sometimes relieve discomfort in mild cases. In more severe cases, non-steroidal anti-inflammatory medications and antihistamines may be prescribed. Some patients with persistent allergic conjunctivitis may also require topical steroid drops.

Bacterial conjunctivitis is usually treated with antibiotic eye drops or ointments that cover a broad range of bacteria.

Like the common cold, there is no cure for viral conjunctivitis; however, the symptoms can be relieved with cool compresses and artificial tears (found in most pharmacies). For the worst cases, topical steroid drops may be prescribed to reduce the discomfort from inflammation. Viral conjunctivitis usually resolves within 3 weeks.

To avoid spreading infection, take these simple steps:

1- Disinfect surfaces such as doorknobs and counters with diluted bleach solution
2- Don’t swim (some bacteria can be spread in the water)
3- Avoid touching the face
4- Wash hands frequently
5- Don’t share towels or washcloths
6- Do not reuse handkerchiefs (using a tissue is best)
7- Avoid shaking hands

AMBLYOPIA

Amblyopia is a term used to describe an uncorrectable loss of vision in an eye that appears to be normal. It’s commonly referred to as “lazy eye” and can occur for a variety of reasons.

A child’s visual system is fully developed between approximately the ages of 9-11. Until then, children readily adapt to visual problems by suppressing or blocking out the image. If caught early, the problem can often be corrected and the vision preserved. However, after about age 11, it is difficult if not impossible to train the brain to use the eye normally.

Some causes of amblyopia include: strabismus (crossed or turned eye), congenital cataracts, cloudy cornea, droopy eyelid, unequal vision and uncorrected nearsightedness, farsightedness or astigmatism. Amblyopia may occur in various degrees depending on the severity of the underlying problem. Some patients just experience a partial loss; others are only able to recognize motion.

Patients with amblyopia lack binocular vision, or stereopsis – the ability to blend the images of both eyes together. Stereopsis is what allows us to appreciate depth. Without it, the ability to judge distance is impaired.

Amblyopia Signs and Symptoms

1- Poor vision in one or both eyes

2- Squinting or closing one eye while reading or watching television

3- Crossed or turned eye

4- Turning or tilting the head when looking at an object

Note: Children rarely complain of poor vision. They are able to adapt very easily to most visual impairments. Parents must be very observant of young children and should have a routine eye exam performed by the age of 2-3 to detect potential problems.

Amblyopia Detection and Diagnosis

When amblyopia is suspected, the consultant will evaluate the following: vision, eye alignment, eye movements, and fusion (the brain’s ability to blend two images into a single image).

Treatment

The treatment for amblyopia depends on the underlying problem. In some cases, the strong eye is temporarily patched so the child is forced to use the weaker eye. For children with problems relating to a refractive error, glasses may be necessary to correct vision. Problems that impair vision such as cataracts or droopy eyelids often require surgery. Regardless of the treatment required, it is of utmost importance that intervention is implemented as early as possible before the child’s brain learns to permanently suppress or ignore the eye.

MYOPIA

Nearsightedness or myopia, occurs when light entering the eye focuses in front of the retina instead of directly on it. This is caused by a cornea that is steeper, or an eye that is longer, than a normal eye. Nearsighted people typically see well up close, but have difficulty seeing far away.

This problem is often discovered in school-age children who report having trouble seeing the chalkboard. Near-sightedness usually becomes progressively worse through adolescence and stabilizes in early adulthood. It is an inherited problem.

Myopia Signs and Symptoms

- Blurry distance vision
- Vision seems clearer when squinting

Myopia Detection and Diagnosis

Nearsightedness is detected with a vision test and refraction.

Treatment

The treatment for nearsightedness depends on several factors such as the patient’s age, activities, and occupation. Vision can corrected with glasses, contacts, or surgery. Refractive procedures such as LASIK can be considered for adults when the prescription has remained stable for at least one year.

HYPEROPIA

Farsightedness or Hyperopia, occurs when light entering the eye focuses behind the retina, instead of directly on it. This is caused by a cornea that is flatter, or an eye that is shorter, than a normal eye. Farsighted people usually have trouble seeing up close, but may also have difficulty seeing far away as well.

Young people with mild to moderate hyperopia are often able to see clearly because their natural lens can adjust, or accommodate to increase the eye’s focusing ability. However, as the eye gradually loses the ability to accommodate (beginning at about 40 years of age), blurred vision from hyperopia often becomes more apparent.

Hyperopia Signs and Symptoms

Difficulty seeing up close
Blurred distance vision (occurs with higher amounts of hyperopia)
Eye fatigue when reading
Eye strain (headaches, pulling sensation, burning)
Crossed eyes in children 

Hyperopia Detection and Diagnosis

Hyperopia is detected with a vision test called a refraction. Young patients’ eyes are dilated for this test so they are unable to mask their farsightedness with accommodation. This is called a wet refraction.

Treatment

The treatment for hyperopia depends on several factors such as the patient’s age, activities, and occupation. Young patients may or may not require glasses or contact lenses, depending on their ability to compensate for their farsightedness with accommodation. Glasses or contact lenses are required for older patients.

Refractive surgery is an option for adults who wish to see clearly without glasses. LASIK, Clear Lens Extraction And Replacement, LTK and intraocular contact lenses are all procedures that can be performed to correct hyperopia.

PRESBYOPIA

Presbyopia, also known as the “short arm syndrome,” is a term used to describe an eye in which the natural lens can no longer accommodate. Accommodation is the eye’s way of changing its focusing distance: the lens thickens, increasing its ability to focus close-up. At about the age of 40, the lens becomes less flexible and accommodation is gradually lost. It’s a normal process that everyone eventually experiences.

Most people first notice difficulty reading very fine print such as the phone book, a medicine bottle, or the stock market page. Print seems to have less contrast and the eyes become easily fatigued when reading a book or computer screen. Early on, holding reading material further away helps for many patients. But eventually, reading correction in the form of reading glasses, bifocals, or contact lenses is needed for close work. However, nearsighted people can simply take their glasses off because they see best close-up.

Presbyopia Signs and Symptoms

· Difficulty seeing clearly for close work
· Print seems to have less contrast
· Brighter, more direct light required for reading
· Reading material must be held further away to see (for some)
· Fatigue and eyestrain when reading

Presbyopia Detection and Diagnosis

Presbyopia is detected with vision testing and a refraction.

Treatment

The treatment for presbyopia is very simple, but is entirely dependent on the individual’s age, lifestyle, occupation, and hobbies. If the patient has good distance vision and only has difficulty seeing up close, reading glasses are usually the easiest solution. For others, bifocals (glasses with reading and distance correction) or separate pairs of reading and distance glasses are necessary. Another option is monovision: adjusting one eye for distance vision, and the fellow eye for reading vision. This can be done with contact lenses or permanently with refractive surgery.

ASTIGMATISM

Astigmatism means that the cornea is oval like a football instead of spherical like a basketball. Most astigmatic corneas have two curves – a steeper curve and a flatter curve. This causes light to focus on more than one point in the eye, resulting in blurred vision at distance or near. Astigmatism often occurs along with nearsightedness or farsightedness.

Signs and Symptoms of Astigmatism

Blurred vision (near and distance)

Astigmatism Detection and Diagnosis

Astigmatism can be detected and measured with corneal topography, keratometry, vision testing and refraction.

Treatment for Astigmatism

Astigmatism can be corrected with glasses, contacts, or surgically. The most common surgeries used to correct astigmatism are astigmatic keratotomy (procedures that involve placing a microscopic incision on the eye) and LASIK. The objective of these procedures is to reshape the cornea so it becomes more spherical or uniformly curved.

CATARACT

A cataract does not form on the eye, but rather within the eye.

A cataract is a clouding of the natural lens, the part of the eye responsible for focusing light and producing clear, sharp images. The lens is contained in a sealed bag or capsule. As old cells die they become trapped within the capsule. Over time, the cells accumulate causing the lens to cloud, making images look blurred or fuzzy.

For most people, cataracts are a natural result of aging. In fact, they are the leading cause of visual loss among adults 55 and older.



KERATOCONUS

Often appearing in the teens or early twenties, keratoconus is a progressive disease in which the normally round cornea thins and begins to bulge into a cone-like shape. This cone shape deflects light as it enters the eye on its way to the light-sensitive retina, causing distorted vision. Keratoconus can occur in one or both eyes.

New research has demonstrated a relationship between malfunction of beneficial enzymes found within the eye's surface and an accompanying chemical imbalance that leads to toxic damage and thinning of eye tissue. Because keratoconus can be found in extended families, this improper functioning of beneficial enzymes appears to have genetic causes about 5% of the time. Eye damage from keratoconus also can be linked to factors such as overexposure to sunlight, improper fittings of contact lenses, excessive eye rubbing, and continual (chronic) eye irritation.

Signs & Symptoms of Karatoconus

Keratoconus can be difficult to detect, because it usually develops so slowly. However, in some cases, it may proceed rapidly. Nearsightedness and astigmatism also may accompany this disease, creating additional problems with distorted and blurred vision. Glare and light sensitivity also may be noticed. Keratoconic patients often have prescription changes each time they visit their eyecare practitioner. It's not unusual to have a delayed diagnosis of keratoconus, if the practitioner is not familiar with the early-stage symptoms of the disease. 

Keratoconus Treatment

In the mildest form of keratoconus, eyeglasses or soft contact lenses may help. But as the disease progresses and the cornea thins and changes shape even more, glasses or soft contacts will no longer correct your vision.

Other keratoconus treatments include:

Rigid gas permeable contact lenses: If eyeglasses or soft contact lenses cannot control keratoconus, then rigid gas permeable contact lenses are an option to consider. The firmer material of a rigid contact lens vaults over the irregular cornea better than a soft contact lens to improve vision. But rigid contact lenses can be more uncomfortable to wear than a soft lens. Fitting contact lenses on a keratoconic cornea is delicate and time-consuming. You can expect frequent return visits to fine-tune the fit and the prescription. The process will begin again when the cornea thins and distorts even more, altering the contact lens fit and prescription needed for clear, comfortable vision.

Read more about rigid gas permeable contact lenses

AGE-RELATED MACULAR DEGENERATION (ARMD)

Age-related macular degeneration (ARMD) is a degenerative condition of the macula (the central retina). It is one of the most common causes of vision loss in the United Kingdom in those 50 or older, and its prevalence increases with age. AMD is caused by hardening of the arteries that nourish the retina. This deprives the sensitive retinal tissue of oxygen and nutrients that it needs to function and thrive. As a result, the central vision deteriorates.

Macular degeneration varies widely in severity. In the worst cases, it causes a complete loss of central vision, making reading or driving impossible. For others, it may only cause slight distortion. Fortunately, macular degeneration does not cause total blindness since it does not affect the peripheral vision.

AMD is classified as either wet (neovascular) or dry (non-neovascular). About 10% of patients who suffer from macular degeneration have wet AMD. This type occurs when new vessels form to improve the blood supply to oxygen-deprived retinal tissue. However, the new vessels are very delicate and break easily, causing bleeding and damage to surrounding tissue.
Patients with wet macular degeneration develop new blood vessels under the retina. This causes hemorrhage, swelling, and scar tissue but it can be treated with laser in some cases.

Dry macular degeneration, although more common, typically results in a less severe, more gradual loss of vision. The dry type is much more common and is characterized by drusen and loss of pigment in the retina. Drusen are small, yellowish deposits that form within the layers of the retina.

Macular degeneration may be caused by variety of factors. Genetics, age, nutrition, smoking, and sunlight exposure may all play a role.

Signs and Symptoms ARMD

1- Loss of central vision. This may be gradual for those with the dry type. Patients with the wet type may experience a sudden decrease of the central vision.
2- Difficulty reading or performing tasks that require the ability to see detail
3- Distorted vision (Straight lines such as a doorway or the edge of a window may appear wavy or bent.)
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ARMD Detection and Diagnosis

Eye physicians usually diagnose AMD. Vision testing, Amsler grid test, ophthalmoscopy, fundus photography and fluorescein angiography are some common tests performed during a retinal exam.

Treatment

There is no proven medical therapy for dry macular degeneration. In selected cases of wet macular degeneration, laser photocoagulation is effective for sealing leaking or bleeding vessels. Unfortunately, laser photocoagulation usually does not restore lost vision, but it may prevent further loss.

Recently, photodynamic therapy has proven to be effective in stopping abnormal blood vessel growth in some patients with wet AMD. This new type of laser treatment is far less damaging than laser photocoagulation and is the treatment of choice in many cases.

Early diagnosis is critical for successful treatment of wet macular degeneration.

Studies have indicated a strong link between nutrition and the development of macular degeneration. It has been scientifically demonstrated that people with diets high in fruits and vegetables (especially leafy green vegetables) have a lower incidence of macular degeneration. More studies are needed to determine if nutritional supplements can prevent progression in patients with existing disease.

COMPUTER VISION SYNDROME (CVS)

Computer vision syndrome (CVS) is a term that describes eye-related problems and the other symptoms caused by prolonged computer use. As our dependence on computers continues to grow, an increasing number of people are seeking medical attention for eye strain and irritation, along with back, neck, shoulder, and wrist soreness.

These problems are more noticeable with computer tasks than other near work because letters on the screen are formed by tiny dots called pixels, rather than a solid image. This causes the eye to work a bit harder to keep the images in focus.

There is no scientific evidence that computer screens are harmful to the eyes. A common myth is that eye strain caused by reading and close work is damaging to the eyes. This is not true; however, those who work at computers often experience many frustrating symptoms.

DRY EYE SYNDROME

Dry eye syndrome, which is also known as keratoconjunctivitis sicca, is a condition where the eyes do not make enough tears, or the tears evaporate too quickly. This can lead to the eyes drying out and becoming inflamed (red and swollen).

Signs & Symptoms of Dry Eye Syndrome

• dry or sore eyes
• blurred vision
• watering eyes
• eyelids stuck together when you wake up

Treatment for Dry Eye Syndrome