Children do suffer from undetected vision problems, these may require diagnosis, ongoing monitoring or correction.  Your local optometrist can diagnose risks or problems in a 30 minute consultation, most consultations are bulk billed to Medicare. We recommend children have a full eye examination as they begin school (Age 5).

To allow our children the best chance to achieve their potential, as parents, we should be aware of some of the signs to look for;

* one or both eyes turning inwards towards the nose or outwards towards the ears
* pronounced tilting or turning of the head when your child is focusing on something
* continuous blinking of their eyes
* regular rubbing of their eyes
* red or blood shot eyes
* difficulty reading - common symptoms include skipping of words or lines, holding the book or technology close to their eyes
* complaints of head aches
* complaints about blurry vision or double vision
* squinting to enable clear focus off in the distance

Below are some hints to assist in keeping a healthy eye environment in your home;

* when reading always read with a light on and take regular breaks
* encourage children to take a break, spend some time outdoors, remember to wear your sunglasses when outdoors
* when in the car or outdoors wear sunglasses
* set a fixed duration for computer, smart phone or tablet use. if extended periods of use are present, encourage breaks
* promote healthy eating habits. Fruit, vegetables, nuts and fish are not only good for the human body, but great for our eyes. Antioxidants, Vitamin A and Omega 3 are all needed to keep or vision in best condition.

Do you know what Glaucoma is? Scenic Rim Optometrists have the knowledge and equipment to advise you if you are at risk of Glaucoma.

About 2% of Australians will develop glaucoma at some time in their life and there are usually no symptoms in the early stages.  Most glaucoma is inherited (genetic) and as a result direct family, parents, siblings and children. have up to ten times higher risk than others of developing glaucoma.  This works out to about a 1 in 4 chance of being affected in their lifetime.  There are an estimated 300,000 Australians with glaucoma but half are unaware.

As early detection and treatment protects against glaucoma blindness we think you should tell your family you have glaucoma and alert them to their own risk. Encourage each of your direct family to undergo a full eye examination, including an optic nerve check. Having a two-yearly review is also recommended.

Diabetes is the fastest growing chronic disease in Australia. Over 1.7 million Australians are living with diabetes and a further 280 Australians develop diabetes every day. Types of diabetes include, Type 1, an autoimmune condition that destroys insulin producing cells in the pancreas. Type 2, a metabolic condition where the pancreas is unable to produce enough insulin. Gestational, a metabolic condition which occurs during pregnancy in part due to pregnancy hormones, and in most cases disappears shortly after giving birth

Too much glucose, blood sugar, can cause problems all over your body, eyes included. In particular, there are four parts of the eye that are vulnerable to high blood sugar: the retina, the lens, the vitreous gel, and the optic nerve. The retina stretches over the back of the eye, kind of like a screen for the light that enters your eye. Images projected onto your retina are converted into signals your brain can interpret and transmitted through your optic nerve. Diabetics may develop a condition called diabetic retinopathy in which the blood vessels in your retina become damaged. The blood vessels could begin to leak, or new blood vessels can grow and obscure the retina. Either way, dark patches will begin to obscure vision, and even lead to blindness.

Diabetic Retinopathy

Non-proliferative (background) – The longer you have diabetes, the greater the risk of small blood vessels at the back of the eye being damaged by high blood glucose and high blood pressure. This can result in leakage and often progresses to blockage of the vessels that supply the retina with nutrients. This stage is called non-proliferative or background retinopathy and there may be no noticeable change in your vision.

Proliferative – Non-proliferative diabetic retinopathy can progress and the retina may grow new blood vessels. This advanced stage is called proliferative retinopathy. The new blood vessels are weaker and can bleed onto the retina or the vitreous, the jelly-like centre inside your eye. Vision can be affected, sometimes seriously and suddenly.

Diabetes is a chronic (long term) condition that affects the whole body including the eyes.  Diabetes interferes with the body’s ability to use and store sugar and can be classified as type one or type two.  Type 1 Diabetes is of an earlier onset and requires treatment with insulin immediately as the body cannot produce insulin itself.  Type 2 Diabetes is now more prevalent and generally comes on during adulthood.  Type 2 Diabetes requires lifestyle modification initially, often needs medication but may require insulin as the disease progresses.

Ocular Complications

Small blood vessels throughout the body, including the eye, are affected by diabetes.  The blood vessels can either be damaged or obstructed. 

When ocular blood vessels are damaged, blood and fluid leak into the surrounding retina (i.e. retinal haemorrhage).  Depending on the location and severity of the haemorrhage floaters may appear, vision may reduce dramatically or there may be no symptoms.

Blood vessel obstruction can lead to a number of complications.  The area/s usually supplied by the blocked vessels undergoes reduced blood flow and if this occurs at the macular, central vision is affected.  More issues can occur in response to blood vessel closure if it is widespread as oxygen supply to the retina is reduced overall.  To compensate for this lack of oxygen the eye “grows” new blood vessels (called neovascularisation).  The new vessels are fragile and leaky meaning they bleed into surrounding tissue.  If this goes untreated a cascade of events occurs.  Unchecked bleeding is followed by retinal scarring which can pull the retina away from the back of the eye, a “tractional retinal detachment”.  Another complication can be growth of new fragile blood vessels in the drainage channels of the eye.  This blocks fluid outflow from the eye leading to increased pressure in the eye.  This process is called neovascular glaucoma.

Risk Factors

·         How long you have had diabetes
·         How well the diabetes is controlled
·         Systemic hypertension (high blood pressure)
·         Systemic hyperlipidaemia (high cholesterol, triglycerides)

In decades past it wasn’t uncommon for people to go blind after a lifetime of having diabetes.  Due to major advances in treatment and earlier diagnosis, visual prognosis is much better today. 

Management and Treatment

Good diabetes control, maintaining normal blood pressure, keeping low blood cholesterol and triglyceride levels are extremely important measures to be taking to avoid sight threatening diabetic retinopathy (DR).

At an eye examination you can expect a number of tests to be performed including measurement of vision, prescription and intra-ocular pressure.  Assessment of the anterior (front) of the eye as well as the retina will also be performed.  To get a better view of the health of your eyes your optometrist / ophthalmologist will probably put drops in your eyes to dilate your pupils.  Other tests including retinal photography, OCT (scan of layers in retina), fluorescein angiography (imaging of blood flow through retinal vessels) can be needed. 

The aim of treatment can be to improve vision or stabilize disease progression and prevent further loss of vision.  The three main methods of treating diabetic retinopathy (DR) are laser, intra-vitreal injection and surgery. 

If your optometrist detects any significant diabetic retinopathy they will refer you to an ophthalmologist for further investigation and treatment, as required.

Regular eye exams are important – appropriate screening, follow up examinations and timely treatment can reduce the risk of severe vision loss or blindness by more than 90%.  Ensure you always attend appointments with your optometrist or ophthalmologist in the recommended timeframe.  If you ever experience a reduction in your vision or a sudden onset of floaters or spots in front of your vision see your ophthalmologist or optometrist immediately.

Where is the macula, what does it do?

The macula is in the middle of the retina which is a film lining the inside of the back of the eye.  The retina is sensitive to light and sends electrical signals to the brain when light reaches it.  The macula is essential for sharp, daytime vision including recognising faces, reading, using a computer and seeing colours clearly.

What is macular degeneration (AMD)?

Macular degeneration involves loss of structural integrity at the macula, this leads to deterioration in central vision but peripheral vision is not affected.  Depending on the nature of the changes at the macula it is classified as ‘wet’ or ‘dry’.  Dry AMD involves a build up of waste deposits (drusen), patches of abnormal pigmentation and areas of thinning at the macular.  Typically, dry maculopathy is associated with a gradual loss of central vision.  Wet AMD is the more aggressive form of macular degeneration and is related to fluid at the macula.  A process called “choroidal neovascularisation” is involved, what this means is new blood vessels growing inappropriately just below the retina.  This is a problem as the blood vessels can leak, in doing so they damage the macula and cause a rapid loss of central vision.

What are the risk factors?

The risk of having macular degeneration increases with age and a strong family history.  Another significant risk factor is smoking; in fact you are three to four times more likely to get macular degeneration if you smoke.  Cardio-vascular factors such as diabetes and high blood pressure can also increase risk of AMD.

Symptoms of macular degeneration may include...

o   Increasing difficulty reading
o   Distortion of straight lines i.e. they appear to be wavy
o   Trouble distinguishing faces
o   Black or missing patches in vision

What treatment is available for people with macular degeneration?

To date there is not a cure for macular degeneration but certain steps can be taken to limits it progression.  For prevention of macular degeneration certain lifestyle choices are important, these include not smoking, exercising and having a healthy diet (see ‘nutrition’ below). 

Your eye care specialist may recommend taking a supplement.  It has been shown by long term studies AREDS and AREDS2 (Age-Related Eye Disease Studies) that supplements can be beneficial in cases of early to intermediate AMD.  Supplements haven’t been shown to be useful in advanced macular degeneration or at the most early stages of AMD.   AREDS/2 showed that people who took a regular high dose of specific nutrients showed a reduced risk of disease progression and a 20 – 25% delay in vision loss.  The nutrients shown to be useful were Zinc, Vitamin C, Vitamin E, Omega-3, Selenium and Lutein/Zeaxanthin.  For the benefits these nutrients must be combined according to a certain formula. 

In the case of wet macular degeneration there is treatment available, again it is not a cure.  Wet AMD involves leakage from blood vessels growing under the macula which damages it and can cause rapid vision loss.  A drug that discourages growth of these new, leaky blood vessels is used to treat wet AMD.  Reduction of inappropriate blood vessel growth leads to reduced leakage at the macular and subsequently less damage and preservation of vision.  This medication is administered directly into the eye via injection.

Tips for a healthy macula

o   Get the health of your eyes checked regularly
o   Don’t smoke and avoid being around people smoking
o   Look after your general health including your weight, exercise frequently
o   Nutrition - Eat leafy green vegetables and fresh fruit daily, have fish two to three times a week and have a handful of nuts about once a week.  Avoid excessive fat and oil and choose complex (low GI) carbohydrates.
o   If recommended by  your doctor / optometrist take an appropriate supplement
o   Use an Amsler grid to self-monitor your macula
o   Be sun-smart to avoid getting UV damage to your eyes, especially important while young

Early detection is very important.  If you notice a reduction or any changes in your vision it is important you have your eyes examined.  Detecting macular degeneration early allows steps to be taken that may slow disease progression and prevent vision loss.

How well your child can see is very important to life at school, both academically and socially.  Vision has a crucial role in both learning and play.  Making sure your child can see well helps them to reach their full potential.

Parents and teachers are in an ideal position to detect signs that a child might not be seeing properly.  In many cases children with eye conditions don’t realise their vision is different to what it could be.  In these cases children try to adapt rather than expressing something is wrong.  Here are a few things to look out for:

What signs may indicate a vision problem?

·         One eye turns in/out while the other looking straight
·         Excessive blinking, red or watery eyes
·         Noticeable head tilting
·         Covering or closing one eye, especially while reading
·         Difficulty learning to read
·         Holding a book very close or sitting close to the TV
·         Squinting or straining to see board
·         Trouble recognising faces of friends or family in the distance
·         Headaches, blurred or double vision

When should children have their eyes tested?

·         Before starting school or during prep is ideal
·         At least every 2 years through school, more often in some cases
·         If a parent or teacher has any concerns

If you are worried about a child’s vision it is best to book them in with an optometrist for a comprehensive eye examination.  School screenings are important but don’t replace a thorough check up.  Even if you are not concerned about your child’s vision it is recommended you have their eyes checked regularly.  Consultation with an optometrist throughout childhood allows early detection of eye diseases or visual problems and is a good step towards maintaining good vision.

There are certain measures that can be taken in the home and classroom to maintain good vision and support developing eyes...

A healthy visual environment includes

·         Adequate (bright, even) lighting is important for reading and playing electronic games
·         Computer use limited to a maximum of 2 hrs at a time, may be less depending on child’s age and how their eyes are developing
·         A well lit classroom
·         Encourage outdoor activities (rather than reading) during school lunch break
·         A broad-brimmed hat to reduce amount of UV rays reaching your child’s eyes

UV rays from the sun pose a threat to our eyes all year around and in all weather conditions.  Just like our skin, our eyes can get burnt and develop serious complications in the long term from excessive exposure.  Damage to our eyes also occurs even if it’s not sunny and not the middle of the day.  Most of us are familiar with the dangers of spending too much time in the sun on hot, clear days.  Our eyes can sustain damage from ultra-violet light at other times too:  

How UV rays can reach our eyes

Direct exposure to sunlight
Reflected UV rays from
Water, snow (both significantly increases exposure)
Sand and concrete
Grass increase exposure to a certain extent
Clouds reflect and scatter light also

The angle of the sun to our eyes at the start and end of the day means more UV light can be absorbed by ocular tissue at these times than in the middle of the day.

Five steps to protect your eyes (tips from the optometry association)

1.       Make sure you protect your eyes from UV, even on days you don’t think the sun’s rays may be as damaging e.g. when it’s overcast.

2.       Limit exposure to UV as much as possible

3.       Wear a broad brimmed hat as it can reduce the amount of UV reaching your eyes by 50%

4.       For outdoor sports, sunglasses or UV blocking contact lenses should be considered.
 5.       Always use UV blocking lenses as well as another form of protection e.g. staying in shade or wearing a hat and sunscreen while outdoors.

Even relatively short bursts of exposure to UV can cause sore, red or irritated eyes.  Other conditions that can arise from UV damage include hypersensitivity to light, pterygium, cancer of the eye lids and front surface of the eye, cataracts and macular complications. Ocular damage accumulates over time and it still adds up even if individual episodes aren’t particularly long.

It’s important to be aware that we are all vulnerable to damage from the sun and to protect our eyes from the UV rays it emits.  Make UV protection part of your daily routine, all year round.

What is a cataract? Why do we get them?

Inside our eyes there is a natural lens, this sits just behind the iris, the coloured part of our eye.  When this biological lens of the eye goes hazy it is called a cataract.

 The lens of a young child is very thin and very clear, every day new lens fibres grow and the lens gets bigger.  As the lens increases in size, its flexibility reduces correspondingly.  This reduction in flexibility translates into less capability to change focus; hence, a child being able to see small objects within 10cm while most adults struggle to do this.  As more and more fibres are added to the lens its transparency is no longer maintained.  This is the most common way a cataract is formed.

Cataract is a general term referring to loss of transparency of the lens.  Usually this hazing occurs gradually over time, as outlined above.  Cataracts can be caused or develop earlier than they would naturally due to UV exposure, ocular trauma, disease or medication.   The fibres of the lens are arranged in a very particular way and trauma can upset this arrangement which leads to reduced transparency.  Conditions such as diabetes can cause cataracts to form earlier as can steroid use. 

How can I tell whether I have a cataract?

Cataracts cause a number of symptoms including reduced vision, increased sensitivity to glare, loss of contrast sensitivity and/or a frequently changing spectacle prescription.  An optometrist can diagnose and assess cataracts.  If your cataract/s requires treatment you will be referred to an ophthalmologist.

What can be done?

Often nothing is done when a cataract is first diagnosed, in some cases they are monitored over a number of years.  When vision is no longer adequate to comfortably perform day to day tasks such as reading or driving cataract surgery is considered. 

Cataract surgery includes removing the hazy lens and replacing it with a clear plastic lens.  Cataract surgery is a very safe procedure, in fact it is one of the most successful and commonly performed surgeries in first world countries.