Cataracts are a very common condition. As people age, everyone develops some amount of cataract, but not everyone requires surgery. If one thinks of the eye as a camera, then there is the film at the back of the camera, which is called the retina and inside the camera there is a lens for focusing. The eye has a lens and when it becomes cloudy with age, it is called a cataract. A cataract is a cloudy lens.
Surgery is required when the vision becomes impaired. Cataract surgery is one of the most common surgical procedures performed. The cataract is removed and replaced with an artificial intraocular lens. The operation is performed under local anaesthesia. This is not a painful procedure and is done in the day surgery. There are several follow up visits over two to three months, by which time most people’s vision will stabilize. Eye drops are used for four weeks post-operatively.
After surgery, glasses may be needed to read. Some patients may develop a clouding of the lens capsule at a later date causing blurring, which can be treated in the Doctors’ rooms with Yag laser. This is a painless five minute procedure.
There are risks associated with all operations and about 98% do well. 1% do poorly, 1% do very badly. About 1/1000 will develop an infection and/or haemorrhage where they may lose their vision completely, sometimes ever needing removal of the eye.
Glaucoma is an eye disease, which is one of the leading causes of blindness in Australia. Glaucoma is fairly common in adults over the age of 35. When diagnosed early, blindness from glaucoma is almost always preventable.
A clear, transparent liquid called the aqueous humour flows through the inner eye continuously. This inner flow can be compared to a sink with the tap turned on all the time. If the drainage gets clogged, water collects in the sink. If the drainage system of the eye gets similarly blocked, the fluid pressure within the inner eye is increased and can cause damage to the optic nerve.
Early diagnosis can be made by the Ophthalmologist in the course of a periodic eye examination. During the painless examination the doctor will determine the pressure of the eye. This is only part of the examination. If indicated, the fields of vision will be tested for shrinkage or blind spots. Using an ophthalmoscope to view the back of the eye, the doctor will examine the optic nerve to be sure no damage is occurring.
Glaucoma is usually controlled by eye drops or pills in various combinations. The purpose of these is to decrease the pressure by assisting outflow of fluid from the eye, or by decreasing the inflow of fluid.
If medications are poorly tolerated or ineffective in controlling pressure in chronic open angle glaucoma, surgery or laser treatment may become necessary.
If you are over the age of 35, you should have your eyes checked for glaucoma every 2 or 3 years. Your family doctor should be consulted whenever there is any decrease in vision.
This is one of the most common causes of decreased vision and blindness in Australia. MD can be diagnosed early with an examination of the retina by Dr George, and may also involve a fluorescein angiography. Diet, family history and lifestyle measures (smoking) are very important. Drusen is an early sign, which may show evidence of early macular degeneration. Symptoms may include; distortion of vision, difficulty recognising faces, central vision appears blurred or fuzzy. Dry AMD and the late stage geographic atrophy, currently have no treatment available. Wet AMD presents with leaking fluid and maybe blood under the retina, which can cause rapid changes to the retina. Currently there is effective treatment with anti-VEGF drugs such as Lucentis and Avastin injections to reduce the new blood vessel formation in the macula.
Blepharoplasty can be performed to treat dermatochalasis (which is drooping of the eyelids affecting vision); this can be performed in our rooms or in the hospital. Entropion correction can treat an inward turning of either eyelid if the margin rests and rubs on the eyeball. Ectropion is the outward turning of the eyelids, where the margin does not sit normally. It may fall or pull away and cause excessive drying, tearing and irritation. This could be repaired with a myocutaneous flap as part of the procedure. Dr George is qualified to perform Botox injections for blepharospasm. Epiphora is excessive tearing of the eyes and may call for insertion of punctal plugs or nasolacrimal probing to open the tear duct and clear any obstruction. Excision of lesions including basal cell carcinomas is common.
A pterygium is a common condition where changes occur on the white of the eye just separate from the coloured area, or iris. A pingueculum is often seen as a yellow, fatty looking, slightly raised are that may or may not be slightly blood shot. A pingueculum is very common and nearly everyone who spends time outside will have some pingueculae formation.
If the pterygium continues to grow, it will cover the pupil and lead to blindness; however not all pterygia need removal. They need to be removed if they are actively growing, causing marked discomfort, distortion of vision or perhaps for cosmetic reasons.
Surgery is usually undertaken in the clinic or in hospital. The pterygium is removed with microscopic instruments and cautery is used to stop the bleeding. To try and prevent recurrence, a flap of normal conjunctiva is brought from below and possibly also from above to try and build a barrier of normal tissue in front of the pterygium remnants, and this is sutured in place with microscopic nylon sutures so small that they cannot usually be felt.
Treatment with different types of laser can be performed in our Taree rooms: laser iridotomy for closed angle glaucoma, laser trabeculoplasty for open angle glaucoma, laser capsulotomy for opacification of the shell that holds the lens following cataract surgery and photocoagulation of the retina for diabetic retinopathy. Your eye is initially numbed with drops and then you place your chin on a stand similar to the one the doctor examines you with. This treatment only takes a few minutes. Your vision may return to normal after a few hours. Ingrowing eyelashes that cause considerable irritation and possible scarring to the cornea can also be lasered to inhibit their further growth.
Dr George may treat many urgent cases including: foreign bodies, chemical burns, trauma or lacerations to the eye, chronic infections and inflammation. He can assess the patient for possible retinal detachment, posterior vitreous detachment, temporal arteritis or a retinal hole and arrange an urgent referral for surgery if required. Premature babies with a suspicion of retinopathy of prematurity are examined early if suspected.
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