Common Eye Problems

Some of the more common eye problems include:

 Some people’s eyes have difficulty focusing at certain distances. These optical problems are called refractive errors and are usually easily corrected with glasses or contact lenses.

The typical conditions are Myopia, Hyperopia, Astigmatism or Presbyopia.

Myopia (Shortsightedness)

People with Myopia have eyes that are more naturally focussed for close vision but do not see distant objects clearly as they are unable to re-focus for longer distances. It is usually quite simple for the Optometrist to correct Myopia with glasses or contact lenses and it can also be reduced by orthokeratology or refractive surgery. The actual cause of Myopia is not known but it is likely to be a combination of genetic and environmental factors such as excessive reading or computer use.  About 15% of the population is shortsighted. The exact causes of myopia are unknown, although it appears to be a combination of genetic and environmental factors.

Hyperopia (Longsightedness)

Hyperopic people are the opposite of Myopic and do not see objects up close clearly but focus more easily at longer distance. The cause of this condition is probably genetic and the hyperopic eyeball may be smaller then average. Hyperopia can also be corrected with glasses or contact lenses.  Low degrees of hyperopia sometimes do not require any correction in children and young adults. It seems that younger people can often compensate for their hyperopia by changing the focusing power of the lens inside the eye (accommodation), although this may cause symptoms of eye strain.

Astigmatism

Astigmatism is a focusing error that causes asymmetric blur with some directions in an image being more out of focus than others. Unlike both myopia and hyperopia where all directions in an image are blurred uniformly . Astigmatism is generally due to a misshapen cornea on the front surface of the eye. Normally the cornea’s curvature is completely spherical in all directions but with an astigmatism the curve is non-spherical or steeper in one direction than another.  In some cases, astigmatism may be due to irregularities in other components – such as the lens and the retina – of the eye. People with astigmatism usually have difficulty in seeing fine detail – and often suffer from eyestrain and headaches if the degree of astigmatism is high. Unlike Myopia or Hyperopia the blur is at all distances. Astigmatism may also be combined with either of these conditions as well. The cause of astigmatism is thought to be genetic or merely natural variation.
Astigmatism can be corrected with glasses and some may be helped by contact lenses.

Presbyopia

As people age the eye lenses and the muscles that control them become less flexible and gradually loses the ability to focus at a near or normal reading distance.  It becomes noticeable for just about everyone from about the age of 45  when they can no longer focus comfortably on objects within an arm’s length.  Presbyopia is not a disease but a situation that affects everyone. Presbyopic people need vision correction with a spectacle prescription that is designed for close distances to enable them to see up close. This is why most people have glasses for reading when they are older. It is thought that the most likely cause of presbyopia is a loss of elasticity of the crystalline lens inside the eye. It is possible to have myopia and astigmatism with presbyopia but this can be corrected with multi-focal glasses.  A range of options are available to correct presbyopia  including single vision reading glasses (which will make near objects clear but distant objects blurry) and multifocal glasses (which incorporate progressive lenses that provide clear vision at both distance and near). Less commonly used spectacle forms include ‘look-overs’ or half-glasses, and bifocal or trifocal glasses. Presbyopia can also be managed by prescription of special multi-focal contact lenses.

Keratoconus

Keratoconus is a thinning of the central zone of the cornea, the front surface of the eye, which results in the normally round shape of the cornea becoming distorted into a cone-like bulge. Considerable visual impairment can result which is not generally improved with glasses. Keratoconus is thought to be genetic in origin & is estimated to occur in 1 out of every 2000 persons in the general population. It becomes apparent between the ages of 16 and 30 years with the initial symptoms  usually a blurring and distortion of vision that may be corrected with spectacles in the early stages of the condition. Frequent changes to the spectacle correction may be required as the cornea becomes progressively thinner. It is nearly always bilateral, although it is often asymmetrical.  Vision can be markedly improved if rigid contact lenses (or similar) are fitted and which is often the only adequate means of alleviating this condition. Keratoconus does not cause blindness.

Strabismus (Heterotropia)

Strabismus is a condition which involves a lack of coordination between the extraocular muscles which means that the eyes are not properly aligned with each other – and not working together – when focusing. With strabismus, the affected eye may be turned in (convergent squint) or turned out (divergent squint). As a result, the eyes look in different directions and do not generally focus on the same point. A person with strabismus won’t have proper binocular vision (therefore affecting depth perception) and they may also have amblyopia (‘lazy eye’) in the affected eye.  Strabismus may be treated with spectacles, special eye exercises, occlusion (patching of one eye) and surgery. Strabismus is present in about 4% of children. Treatment should be started as soon as possible to ensure the development of the best possible visual acuity and stereopsis.

Eye Co-ordination Disorders

Some people never develop the ability to aim their eyes in a co-ordinated way at the object they are looking at. The result may be headaches, eyestrain, double vision or the eyes turn in or out. One eye may even look away in different direction while the dominant eye focuses on the subject. The optometrist can measure eye alignment and detect if there is any strain. Eye exercises or glasses can be prescribed to assist with co-ordination disorders.

Eye co-ordination disorders other than Strabismus include:

Esophoria where there is a tendency of the eyes to want to turn more inward than necessary when an individual is viewing an object at near or at distance which tends to cause the individual to experience eyestrain, headaches, blurred or double vision, difficulty concentrating on and comprehending reading material and other symptoms. Sometimes esophoria is caused by a refractive error such as hyperopia (farsightedness), and glasses or contacts can correct the problem alone. However, sometimes vision therapy is needed to help re-train the eyes to function more appropriately.

Exophoria is where there is a tendency of the eyes to want to turn more outward than necessary when an individual is viewing an object at near or at distance, which tends to cause the individual to experience eyestrain,  headaches, blurred or double vision, apparent movement of print, and difficulty concentrating on and comprehending reading material.  Vision therapy is an effective treatment option.

Fusional Vergence Dysfunction is the inability to efficiently utilize and/or sustain binocular vision. Symptoms tend to include eyestrain, headaches, decreased comprehension, inability to concentrate while reading, excessive tearing, and blurred vision. A patient will have difficulty with both base-in and base-out prisms. Vision therapy is an effective treatment option.

Cataracts

Long term exposure to ultraviolet light from the sun can cause the lenses in our eyes to become cloudy or opaque, which affects the vision. This is known as cataracts and is a change in the lens material rather than a growth. This is generally the result of ageing but can also result from exposure to radiation or toxic substances or even trauma to the eye and in rare cases cataracts can be present at birth. Wearing dark sunglasses and a hat outside may help prevent this condition. Surgery to replace the clouded lenses with synthetic ones is quite common and usually straightforward. The optometrist will refer the patient to an eye specialist for examination and surgery if they detect cataracts. Cataract surgery is now a relatively minor and straight forward procedure – usually performed on an out-patient basis – and most patients will have an intraocular lens inserted at the time of surgery to replace their own cloudy lens. Cataracts are very common in people over the age of 65 and a family history of cataracts can increase the likelihood of developing the condition. Over time cataracts will generally get worse, with increased cloudiness of the lens causing the patient’s sight to become worse and affect their quality of life.

Glaucoma

Glaucoma is a degenerative disease of the optic nerve that transmits information from the eyes to the brain. Glaucoma is usually associated with an increase in pressure inside the eye (intraocular pressure  or IOP)  which can then lead to irreversible blindness particularly for peripheral or side vision. Glaucoma is a particularly dangerous eye disease because most patients are unaware of a problem as there are usually no symptoms until permanent vision loss has occurred. Checking for glaucoma is an important reason why regular eye examinations are required. Glaucoma often runs in families so let the optometrist know of any family history of the disease. Your eyes will be examined through special instruments and simple tests will determine if there is any sign of glaucoma. Glaucoma is usually prevented or controlled with eye drops. If topical medications cannot reduce IOP enough to prevent optic nerve damage, the Optometrist will refer you to an eye specialist for further diagnosis and treatment.  The IOP can be decreased further by surgery that increases the drainage of fluid from the eye.

Age Related Macular Degeneration (ARMD)

Age-related macular degeneration (ARMD) is the leading cause of blindness in older people in Australia. The macula is the central part of the retina and it is responsible for our ability to read, recognise faces, drive a car, see colours, and any other activity which requires fine vision. ARMD is a result of age-related changes in the function of the macula that cause progressive loss of central vision, leaving only peripheral or side vision intact. About 85% of cases of ARMD are classed as “dry” ARMD. This is a slower form of the disease causing gradual loss of vision and it is due to cell death in the retina and the retinal pigment epithelium. The other 15% of cases are classed as the “wet” ARMD. This is a more severe form of the disease (usually associated with rapid vision loss) and is caused by the growth of fragile new blood vessels into the retina that then leak and bleed, leading to scarring and loss of vision. There is no treatment for dry ARMD. There are currently three possible treatments for wet ARMD – photodynamic therapy, laser photocoagulation and anti-VEGF drugs.

Diabetic Retinopathy

About 7% of Australians have diabetes which may vary a diabetic person’s vision from day to day, depending on their blood sugar levels.  Approximately 2% of people who have had diabetes for 15 years or longer will become blind and 10% will develop severe visual impairment. Optometrists can help by examining diabetic patient’s eyes for damage to the retina and this is assisted by the use of digital retinal photography. Sophisticated photographic equipment produces a high-resolution photograph of your retina, optic nerve and blood vessels and enables us to screen for abnormalities which can help with early detection of diseases including glaucoma, macular degeneration and retinal changes that may be associated with diabetes.Any  abnormalities detected can then be monitored and treated to better protect the quality of your sight and overall eye health. These images are stored by Anthony Smith Optometry to regularly track your visual health.

Diabetic retinopathy is an eye disease caused by the complications of diabetes and it is the most common way in which diabetes causes vision loss and potential blindness. A diabetic person should see their optometrist at least once a year (or more as advised by the optometrist) for ongoing management and vision loss can be prevented if diabetic retinopathy is detected and treated early. If required a referral to an eye specialist for further evaluation and possible laser treatment of the retina will be arranged.

Colour Vision Problems

Some people are born with colour vision defects and this condition, commonly known as colour blindness, predominantly effects males. It is rare for someone to be totally unable to recognise colours. The more typical defect is to confuse particular colours, such as shades of red and green. Optometrists have special colour plates to test colour vision, however most people adapt to their deficiency and there is normally no correction aid available.  The most relevant reason for testing a person’s colour vision is when it may be important for a person’s intended occupation.

Eye Infections and Injuries

If your eyes have pain, redness, irritation, inflammation or other physical symptoms you may have an eye infection or injury. If this is the case the optometrist will propose treatment to relieve the symptoms and treat the problem. If the condition is more serious the optometrist will refer you to an appropriate eye specialist or clinic. It is best to seek advice quickly as it is usually easier to treat the problem sooner rather than later.

If it is after hours the best course of action may be to go to the Eye and Ear Hospital (32 Gisborne Street, East Melbourne) where there is 24 hour emergency department.

Dry Eyes

Tears lubricate the eye and stop the surface from drying out. A thin film of tears is swept over the eye surface every time you blink. When there aren’t enough tears on the front of the eyes people will feel dryness, irritation, grittiness, soreness, burning or redness. The reasons may be environmental or physical. Over time, the resulting dryness can damage the surface of the eyeball. The optometrist has tests to determine if a patient has this problem and can recommend or supply eye drops to provide relief & alleviate the symptoms but there is no cure for dry eye. If the underlying cause is more serious the patient will be referred to an eye specialist for treatment. Dry eye is more common as we get older because we produce a smaller volume of tears. Some medications can trigger dry eye, as can some general health conditions. Dry eye is particularly common in postmenopausal women and people with arthritis.