Sunlight is the most significant source of UV radiation and can damage various ocular tissues. The surface of the eye (snow blindness), the lenses (cataracts, also known as opacity) and the retina (solar maculopathy, macular degeneration) are in particular danger.
UV light consists of UV-A light (leads to skin tanning, but also skin ageing), UV-B light (leads to sunburn and skin cancer) and UV-C light (these are the most dangerous rays, but are almost completely blocked by the ozone layer).
What almost no one knows: Eyes can also get sunburn. The cornea and the conjunctiva are most affected. The highest risk is always when the sunlight is heavily reflected, something that can occur in a snow-covered landscape or when spending time by or in the water.
With the right glasses, however, everyone can optimally protect their eyes from dangerous UV rays. What you should keep in mind when purchasing a pair of sunglasses:

• UV light protection: Sunglasses that absorb at least 99% of UV rays or light rays up to 400 nm.
• Yellow filter: Also called blue blockers because they block all blue light. As a result, the eye perceives the surroundings in a yellowish tint. Benefit: Better contrast for very distant objects, especially on a cloudy or snowy day. Best suited for skiers, hunters, sailors and pilots.
• Polarisation filters: They block diffused light. For example, light reflected off water surfaces or cobble-stone pavement. Particularly useful for driving and fishing.
• Mirror lenses: They reduce the quantity of light reaching the eye, but do not offer any safe protection from UV radiation.
• Side protection: Sunglasses with this function protect the eyes from light entering from the sides.
• Gradient tint lenses: They are dark-coloured in the upper part of the spectacles, light-coloured in the bottom. They thus block the glare from above, but permit normal downward vision for the eyes. They are useful for drivers, but are not recommended for the beach or in snow because a strong glare can come from below.
• Photochromatic lenses: They darken automatically when it is bright and lighten when it is dark. Depending on the UV radiation and the temperature, these processes often take much less than five minutes thanks to new technologies.

Eye protection is also often recommended for medical reasons. This primarily applies to people with increased UV radiation risk. These include:

• Patients with macular and retinal degeneration. They should always wear glasses with a good UV filter when spending time outside.
• Patients after a cataract operation. These patients’ eyes are particularly sensitive to UV light because the natural lens has been removed and has been replaced by a plastic lens (intraocular lens). Sunglasses with 100% UV protection are necessary with older models because they absorb very little UV light. New intraocular lenses now have UV protection.
• Patients who are taking certain medication. Medication for psoriasis and active pharmaceutical ingredients such as tetracycline, doxycycline, allopurinol and phenothiazin are all so-called “photosensitive medications.” They increase the eye’s sensitivity to UV light. Your doctor will advise you about appropriate eye protection.
  

If your glasses are not optimally fitted, then there's no way you can benefit from your full visual potential. This can significantly impair your quality of life. Think about it: reading the menu in a restaurant becomes a nightmare or you feel insecure when driving. This raises several questions: can you damage your eyes if your glasses are too strong (overcorrection) or too weak (undercorrection)? What are the effects if your fields of vision are not ideally corrected? And does eye fatigue or 'poor' light – be it too bright or insufficient – pose a risk to your eyes?

Do you damage your eyes if your glasses are not optimally fitted?

No! Poorly fitted glasses don't have any long-term effect on the health of your eyes. However, we should distinguish between the eyes of an adult and the eyes of a child, the latter of which are still developing. If a pair of glasses is poorly fitted, then this can definitely impair the vision of children and young adults. Children are not emmetropic, meaning their vision is not ideal. A child's vision develops progressively: starting in its immediate vicinity, such as when looking at its mother, through the close-up range required later for painting or reading right up to 3D distance vision. In other words: this slight hyperopia is actually advantageous at first and is something which children ultimately gets used to with age. A pair of glasses can help children develop optimum vision. Visual defects don't damage adults' eyes – no matter if they're short-sighted, long-sighted, or if they wear the wrong glasses. Instead, your eyes 'learn' to correctly focus on different distances and to modify their visual performance, as well as possible, to accommodate the particular situation. If this happens over a longer period of time and requires greater effort from your eyes, then noticeable symptoms occur.

What are the negative consequences if glasses are not optimally fitted?

Glasses which are not optimally fitted to the wearer's eyes can lead to different symptoms. Here's a typical problem: you notice that your glasses don't provide you with unimpaired vision. This leads to a subjective deterioration of your vision. This doesn't cause damage, but it certainly strains your eyes. And it means that your eyes have to work harder. The possible consequences are numerous and include everything from headaches and neck pain, all the way to dizziness or double images. Burning or itchy eyes are another symptom. These aren't just a consequence of wearing the wrong pair of glasses. Dry air can also be the reason. However, an incorrectly fitted pair of glasses can contribute significantly to the problem.

Can you damage your eyes by wearing an incorrectly fitted pair of glasses for a longer period of time?

No, absolutely not. There are also no drawbacks if your visual performance deteriorates over time and your glasses, which had been optimally fitted, no longer provide ideal correction. You may not always realise that you're not benefiting from your full visual potential – you simply get used to this situation. Thus impaired visual performance is often only discovered by an objective source, i.e. when you're applying for a driving licence.

Carrots are good for the eyes – or have you ever seen a rabbit wearing glasses to prove otherwise? Not only is this comparison not very funny, it hasn't got a leg to stand on. And yet this health myth has been around for generations. The following is true, however: carrots contain a lot of beta-carotene. This is a precursor of the essential vitamin A. If this vitamin is lacking in your diet, it can have a negative impact on growth and the condition of your skin and hair. In extreme cases, it can even provoke night blindness. Most visual impairments, however, are usually the result of completely different causes.

There is an endless amount of popular wisdom that infiltrates our subconscious during childhood. Nowadays, most of these myths can be scientifically and unequivocally refuted. Some, however, do at least contain an element of truth. And what better example is there than the popular health myth "carrots are good for your eyes". But what is the reasoning behind this myth? The tasty vegetable contains a lot of beta-carotene. This substance is what gives carrots their orange colour, but it is also the precursor of the essential vitamin A, which really is good for the eyes. Nevertheless, this piece of wisdom only contains a grain of truth.

Nutritionists also refer to vitamin A as retinol. In fact, this name portends directly to the function it performs in the eye. The eye's retina contains cells that can produce a black and white image from even the slightest glimmer of light. Without retinol, no-one would be able to distinguish between the contrast of light and dark, and people requiring medical treatment for a critical vitamin A deficiency are even at risk of developing night blindness.

Luckily for us, this type of health complaint is very rare in our part of the world. What's more, there are plenty of foods which are even richer in vitamin A than carrots – such as spinach, cabbage or salad. Animal products, like liver for example, are even better, for they do not merely contain the precursor of vitamin A, they contain the vitamin itself.

So what is our conclusion? Munching regularly on carrots does indeed benefit your eyes, but it will not give you the improved vision you're hoping for. Now, like before, whether you're short-sighted or long-sighted, the only thing that can really help with the majority of visual impairments is a good pair of glasses.

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.