COMMON DISORDERS OF THE EYE Presentation by Beverley Baily Clinical Nurse Specialist Central Coast Day Hospital 2012

OBJECTIVES AT THE END OF THE SESSION PARTICIPANTS WILL BE ABLE TO:  ATTAIN KNOWLEDGE ON THE BASIC ANATOMY OF THE EYE  UNDERSTAND SOME OF THE COMMON DISORDERS OF THE EYE

OBJECTIVES cont’d  DEVELOP AN INTEREST IN THE CURRENT TREATMENTS AVAILABLE FOR EYE DISORDERS  ACQUIRE KNOWLEDGE OF SERVICES AVAILABLE FOR THE VISUAL IMPAIRED

ANATOMY OF THE EYE

ENJOY HEALTHY EYES FOR LIFE Eye changes occur as we get older. Permanent vision loss need not be a part of ageing. The majority of eye conditions that affect older people are painless and progress slowly over many years. Most eye conditions affecting older people can be treated.

ENJOY HEALTHY EYES FOR LIFE Regular eye checks, early detection and medical intervention can help to restore vision or prevent further vision loss. People aged 35 and over are encouraged to have regular eye checks.

ENJOY HEALTHY EYES FOR LIFE Your eyesight is your most valuable sense. Protect your eyes. If you experience a gradual or sudden loss of vision, seek medical advice immediately.

CATARACT DEFINITION A cataract is a clouding of the normally clear lens inside the eye. When the lens becomes cloudy, light rays cannot pass easily through.

CATARACT SYMPTOMS Vision becomes blurred, both for near and distance objects. Sensitivity to glare in bright sunlight. Distortion or ghosting of images may also occur. Colour vision can be decreased.

CATARACTS

CATARACT CAUSE Age is the most common cause, but cataracts can also occur in babies and children. They may develop as a result of injury or eye disease. They may be associated with medical conditions such as diabetes.

CATARACT CAUSE Both smoking and exposure to sunlight increase the risk of cataracts. Cataracts are not a growth or film over the eye and are not caused as a result of overusing the eye or eyestrain. You generally can’t see your cataract in the mirror.

CATARACT TREATMENT In the early stages of cataract, glasses or contact lenses can help correct minor visual problems. When vision is seriously impaired, the most effective treatment is to surgically remove the affected lens and replace it with an artificial lens.

CATARACT Most surgery is performed on a day-only basis under local anaesthesia, with sedation. There are many variations in technique, the most common being phacoemulsification surgery. The cataract is removed through a very small, secure opening about 3mm in length, with implantation of an intra-ocular lens specifically chosen to match your eye.

CATARACT FOLLOW UP CARE Your eye may be covered or protected for one night. A plastic shield at night may be required for a few extra nights depending on the surgeon. You will have a follow up appointments for review by your surgeon, usually the next day and over the following weeks.

CATARACT You will be able to function normally from Day 1, but strenuous activities must be avoided for some weeks. You will have eye drops prescribed to use as instructed by your surgeon. Your new intra-ocular lens will restore your distance vision that you had before the cataract developed.

CATARACT Over the post-operative review period glasses will be prescribed for your new eye, particularly to help with reading vision.

AGE RELATED MACULAR DEGENERATION DEFINITION Age Related Macular Degeneration causes loss of central, detailed vision. People may notice that straight lines appear distorted or wavy or that reading becomes increasingly difficult.

AGE RELATED MACULAR DEGENERATION

SYMPTOMS Straight lines appear wavy or distorted. Reading and any activity that requires fine vision becomes increasingly difficult. Distinguishing faces becomes a problem. Dark patches or empty spaces appearing in the centre of vision.

AGE RELATED MACULAR DEGENERATION EARLY DETECTION IS IMPORTANT In its early stages it may go unnoticed. Symptoms should never be dismissed as part of “just getting older”. Detecting changes early allows you to take steps to slow down the progression.

AGE RELATED MACULAR DEGENERATION

TREATMENT Dry Macular Degeneration There are currently no treatments to reverse the macular degeneration. However, supplements, diet and lifestyle changes may be effective.

AGE RELATED MACULAR DEGENERATION TREATMENT Wet Macular Degeneration. There is no cure, however the following methods are providing a greater opportunity for many in saving sight and keeping as much vision for as long as possible.

AGE RELATED MACULAR DEGENERATION TREATMENT Anti-Vascular Endothelial Growth Factor (VEGF) intravitreal injections – eg. Lucentis and Avastin. Laser photocoagulation. Diet, supplements and lifestyle.

AGE RELATED MACULAR DEGENERATION Amsler Grid

DIABETIC RETINOPATHY DEFINITION Diabetes causes damage to blood vessels in the retina, which may lead to loss of vision.

DIABETIC RETINOPATHY RISK FACTORS People who have had diabetes for a long period. Diabetics with high blood pressure. People with high sugar levels. Poorly managed diabetes. Diabetics who become pregnant.

DIABETIC RETINOPATHY SYMPTOMS Blurred, distorted or patchy vision that can’t be corrected with glasses. Problems with balance, reading, watching television and recognizing people. Overly sensitive to glare. Difficulty seeing at night.

DIABETIC RETINOPATHY TREATMENT Annual eye checks to pick up early signs of damage. Control blood-glucose levels and make sure the diet is low in fat. Once vision has been affected, seek treatment to prevent progression.

GLAUCOMA DEFINITION Glaucoma is the name given to a group of eye diseases in which the optic nerve at the back of the eye is slowly destroyed. In most people this damage is due to increased pressure inside the eye.

GLAUCOMA Other damage may be caused by poor blood supply to the optic nerve, a weakness in the structure of the nerve and/or a problem in the health of the nerve.

GLAUCOMA

GLAUCOMA SYMPTOMS Chronic glaucoma (primary open-angle) Is known as the “sneak thief” of sight and can result in a slow and painless loss of vision, with side vision being affected first.

GLAUCOMA Acute glaucoma (angle-closure). Rapid increase of pressure inside the eye due to a blocked drainage system causing pain, nausea, blurred vision and redness of the eye.

GLAUCOMA Measuring intraocular pressure Measuring Intraocular Pressure

GLAUCOMA RISK FACTORS Family history of glaucoma Diabetes Migraine Short sightedness (myopia) Long sightedness (hyperopia) Eye injuries

GLAUCOMA RISK FACTORS Blood pressure Past or present use of cortisone drugs (steroids)

GLAUCOMA TREATMENT Regular eye checks from the age of 35 Medication Laser Drainage surgery

RETINAL DETACHMENT DEFINITION Retinal detachment is a separation of the retina from the back of the eye.

RETINAL DETACHMENT RISK FACTORS Severe myopia (short sighted). Retinal tears. Trauma. Family history. Complications from cataract surgery.

RETINAL DETACHMENT SYMPTOMS Decreased vision Feeling of looking through a veil or curtain Flashes and floaters

RETINAL DETACHMENT TREATMENT Photocoagulation (Laser). Surgery. Vitrectomy. Indirect Laser or Cryotherapy. Insertion of Gas, Silicone Oil or Heavy Liquids.

CENTRAL COAST DAY HOSPITAL NURSING AND ADMINISTRATION

REFERRAL AGENCIES Central Coast Day Hospital Telephone: Sydney Eye Hospital Telephone:

REFERRAL AGENCIES Glaucoma Australia Telephone: Guide Dogs NSW/ACT Telephone:

REFERRAL AGENCIES Macular Degeneration Foundation Telephone: Vision Australia Telephone:

QUESTIONS

REFERENCES Central Coast Day Hospital Diabetes Australia Glaucoma Australia International Journal of Ophthalmic Practice Macular Degeneration Foundation “Ophthalmic Care” Janet Marsden