Month: November 2019

The timing of a cataract operation should be tailored to the individual’s visual requirements. Some will need and want their cataract removed sooner than others. For example if the person wishes to continue to drive then a cataract will need to be removed when it is still relatively mild. Early surgery may also be appropriate if the cataract is affecting the individual’s ability to perform their job safely and effectively, or if it is spoiling the enjoyment of their hobbies and past times. However if the person has less demanding visual requirements then it may be appropriate to leave the cataract until it is more advanced. The decision to operate or not should be based on the particular circumstances and wishes of each patient. There are not fixed rules about the timing of surgery.

Each individual should consider how much difficulty their cataract is causing them. Their optometrist or doctor may have spotted some cataract but if the patient is having no vision problems then surgery is probably not needed. Cataract on it own is rarely harmful to the eye. Sometimes the patient may be aware of impaired sight but can cope safely with all their needs of daily living and may not wish to undergo surgery. This is quite acceptable. On the other hand if the individual is bothered by even mild cataract it may be entirely appropriate to remove it. In such circumstances there is no need to wait until it gets worse or becomes “ripe” or “mature”. The days of that approach are long gone.

There are though sometimes special factors that may influence the timing of cataract surgery. If there is some other disease or abnormality within the eye then surgery may need to be delayed, or performed as soon as possible, or may not be worthwhile at all. Which of these applies will depend on the exact nature of the other condition. If the cataract is in an only eye, then the small risks of surgery must be considered very carefully. The chance of an only eye suffering serious surgical complications is remote but the consequence could be devastating. Again each case must be considered on it own merits setting the risks of surgery against the likely benefits. Generally speaking though one would hesitate a little more before removing a cataract from an only eye, but if the visual impairement is significant then surgery may still be the right thing to do.

Very rarely a cataract may be directly harmful to the eye or vision. This can occur if the cataract is particularly advanced (“hyper-mature”), or physically large. In these circumstances it should usually be removed quickly.

Having been given the necessary information by their eye specialist in the end the decision to opt for surgery, or not, rests with the patient. It is often helpful and reassuring to discuss the issues with family and friends. No one should be arm twisted into having cataract surgery. Keep in mind though that most cataracts develop slowly and there is a creeping compromise to vision. If this occurs simultaneously in both eyes there is a faded memory of what vision used to be like. The affected individual may not fully appreciate what they are missing. It is often with amazement and surprise that they realize, after the cataract has been removed, how bright and colourful the world really still is. So if your vision isn’t what it used to be because of cataract and there is no particularly good reason not to have it fixed why go on waiting.

Let’s not try to portray too negative an image of laser eye surgery. Undoubtedly, you will be going in with eyes wide open and aware of the risks involved and by the time you are in the operating chair, you will have weighed up all the pros and cons and will be happy with your decision. Here are some of the associated risks which could occur:

• vision loss
• visual symptoms
• regular follow ups as a result of under or over treatment
• dry eyes
• diminishing results

Let’s examine the risks in a little more detail. Always keep in mind the success of this procedure is very high but the following can occur in some instances.

Under or over treatment is an interesting side effect and this is usually a frequent occurrence. What this means is perfect vision without the aid of visual aids only occurs in a small percentage of patients. Further post operative treatment may be required while if a patient wore glasses before the surgery, there is a strong chance they will still be required to wear them after the procedure.

Visual problems such as loss of vision and symptoms such double vision and halo effects are serious side effects which are not too common. However, they still can occur. Vision loss of some description is a real blow as it usually cannot be reversed with further surgery.

Many patients will go in with high expectations given the feedback they received and the excellent success record of laser eye surgery but this in itself is a risk. Keep your expectations at a realistic level and discuss with your surgeon exactly what you could reasonably expect from the surgery.

Dry eyes and diminished results are two more risks to consider. Dry eye syndrome is a result of the eye being unable to produce moistness and this can be an extremely uncomfortable time for the patient. Results diminishing over time is a factor particularly for those with far sighted vision.

There may come a time when laser eye surgery risk is non existent given the rapid rate in which technology is advancing. Right now though, the risk is always there and longer term side effects are still a little unclear. However, the benefits most patients have experienced through this type of procedure during the past ten years has been remarkable and remember, if you are deemed an eligible candidate for eye surgery, the final decision is always in your lap to make.

By becoming more educated about the harmful effects of UV rays on the eyes, you will be better able to choose quality sunglasses that are capable of providing lasting protection to you from the irreversible damage to your vision that can result from prolonged exposure to the sun.

Prescription sunglasses are specially designed for people who need vision correction to see clearly while also providing protection from the sun’s rays. Many sunglass companies now make stylist, fashion-conscious sunglasses that also require a prescription.

Prescription sunglasses are designed to protect the user from the harmful ultraviolet rays of the sun. However, polarized lens can provide added protection for the eyes from glare that occurs when light is reflected off flat surfaces such as water or snow. Another great choice is photo-chromatic sunglasses because they have the ability to darken in the sun yet lighten automatically when you go indoors.

Until recently prescription sunglasses were not available in a wrap-around style. The curvature of the lens would cause vision distortion. Now with new technology, prescription sunglasses are available with wrap-around making them very fashionably.

If you require custom-made prescription sunglasses, be aware that they will cost you more and usually no refund is available from the manufacturer. Make sure you work with a reputable company that offers quality prescription sunglasses and first class service.

Anyone with reduced vision is visually impaired, and can have problems functioning, ranging from minor to severe difficulty. There are two general classifications of low vision in use today:

• partially sighted – visual acuity that with conventional prescription lenses is still between 20/70 and 20/200 (a person with 20/70 eyesight must be 20 feet away to see clearly an object that a person with 20/20 eyesight can see clearly from 70 feet away);
• legal blindness – visual acuity that cannot be corrected to better than 20/200 with conventional lenses and/or the patient has a restricted field of vision less that 20 degrees wide. (Note that some definitions of “partially sighted” include the legally blind.)

Low vision impairments take many forms and exist in varying degrees. It is important to understand that the visual acuity alone is not a good predictor of the degree of the problem a person is having. Someone with relatively good acuity (e.g., 20/40) can be having a very hard time functioning, while someone with worse acuity (e.g., 20/200) might not be having any real problems doing the things that they want to do.

The common types of low vision are:

Loss of Central Vision – the center of the person’s view is blurred or blocked, but side (peripheral) vision remains intact. This makes it difficult to read or recognize faces and most details in the distance. Mobility, however, is usually unaffected because side vision remains intact.

Loss of Side Vision – typified by an inability to distinguish anything to one side or both sides, or anything directly above and/or below eye level. Central vision remains, however, making it possible to see what is directly ahead. Typically, loss of side vision affects mobility and slows reading speed because the person sees only a few words at a time. Sometimes referred to as “tunnel vision.”

Blurred Vision – objects both near and far appear out of focus, even with the best conventional spectacle correction possible and even when the target is very large.

Generalized Haze – the sensation of a film or glare that may extend over the entire viewing field and may produce various patterns or areas of relatively severe vision loss.

Extreme Light Sensitivity – exists when standard levels of illumination overwhelm the visual system, producing a washed out image and glare disability. People with extreme light sensitivity may actually suffer pain or discomfort from relatively normal levels of illumination.

Night Blindness – inability to see outside at night under starlight or moonlight, or in dimly lighted interior areas such as movie theaters or restaurants.

Doctors of Optometry who specialize in low vision care are skilled in the examination, treatment and management of patients with visual impairments not fully treatable by medical, surgical or conventional eyewear or contact lenses. Each type of low vision problem requires a different therapeutic approach. A thorough examination by an optometrist, which will also include tests to determine the patient’s current vision status, may also include a vision rehabilitation program to enhance remaining vision skills.

The low vision specialist will ask for a complete personal and family general health and eye health history. In addition, the optometrist will discuss the functional problems with the patient, including such things as reading, functioning in the kitchen, glare problems, travel vision, the workplace, television viewing, school requirements, and hobbies and interests.

Preliminary tests may include assessment of ocular functions such as depth perception, color vision, contrast sensitivity, and curvature of the front of the eye. Measurements will be taken of the person’s visual acuity using special low vision test charts, which include a larger range of letters to more accurately determine a starting point for gauging low vision. Visual fields are usually evaluated, and each eye will be examined.
The optometrist may prescribe various treatment options, including low vision devices, as well as assist the person with identifying other resources for vision and lifestyle rehabilitation.

There is a wide variety of optical devices and adaptive products available to help people with low vision live and/or work more productively and safely. Most people can be helped with one or more of them. Unfortunately, only about 20-25 percent of those who could benefit have been seen by a low vision specialist and had treatment options, including low vision devices, prescribed specifically for them. The more commonly prescribed devices are:

• Spectacle-mounted magnifiers – A magnifying lens is mounted in the individual’s spectacles or on a special headband. This allows use of both hands to complete the close-up task, such as reading.
• Spectacle-mounted telescopes – These miniature telescopes are useful for seeing longer distances, such as across the room to watch television, and can also be modified for near (reading) tasks.
• Hand-held and stand magnifiers – Serve as supplementary aids. They are convenient for reading such things as price tags, labels, and instrument dials. Both types can be equipped with lights.
• Electro-optical aids – Closed-circuit television (also called CCTVs) enlarge reading material on a video screen. Some are portable, while some can be connected to a computer. The user can adjust the image brightness, size, contrast and background illumination.

In addition, there are numerous other products to assist those with low vision, such as large-type books, magazines, and newspapers, books-on-tape, talking wristwatches, self-threading needles, and more.

If you, or someone you love, suffers from low vision, your optometric low vision specialist can provide the help and resources needed to gain back the independence and freedom that once seemed lost. People with low vision can be taught a variety of techniques to perform daily activities with what vision remains. There are government and private programs that offer educational and vocational counseling, occupational therapy, rehabilitation training, and more.