All Posts Tagged Tag: ‘Glaucoma’

Optic Nerve Haemorrhage At 4 OClock

Glaucoma Suspects and Continuity of Care

Optic Nerve Haemorrhage at 4 to 5 O'Clock position

Optic Nerve Haemorrhage at 4 to 5 O’Clock position

I recently had a lady in who was last tested by us 7 years ago, but returned to us having visited an optician’s chain, twice apparently. Her last eye test was two years ago. She complained that her glasses were “never right”. Though they were not “not right enough” to complain, or have another eye test, until they broke.

She admitted that she was supposed to return to that optician’s after six months for a check up, but did not bother, and claimed to not remember why she should return.

One of her eyes showed classic signs of Glaucoma- she had a loss of optic nerve tissue in a specific area of the optic disc, and a flame shaped haemorrhage at the same place. Visual field testing was full- there seems to be no loss of vision in the eye which I suspect has a problem- this means that (IMHO) it has been detected early enough – flame shaped haemorrhages are incredibly suspect for glaucoma damage, and we will refer her on via the GP to see a specialist.

The Ophthalmologist specialist perhaps will not agree with me, but an optic nerve haemorrhage at an area of disc loss is very, very suggestive of Glaucomatous damage to the optic nerve. There were also other changes which were evident from the previous records, which also showed an increase in the cupping of the optic nerves – indicative of progressive (damaging) changes.

The Optic Nerve connects your eye to your brain, and is therefore rather important for your normal vision!

This elderly lady should have understood why returning in six months was required, it should have been explained in a way she understood, though perhaps it was and she just does not remember…..

Being a Glaucoma suspect is not the end of the world – it is an easily controllable eye problem. But first you must be diagnosed, and then controlled – slowly go blind, or put drops in the eyes at bed-time, maybe twice a day?

Hmmm – SLOWLY (AND PAINLESSLY) GO BLIND, or put drops in my eyes – I would rather not have to put drops in my eyes every day, but it is I think better that SLOWLY GOING BLIND!?!

My first suggestion, to most of my clients would be pick an optician, and stick with that optician – otherwise no-one will get to know your eyes!

This post is not “touting for business” – it is a suggestion that you should stick with the same Optometrist, the one who know your eyes and sight the best – the one who has your previous records!

My number two suggestion, which perhaps should be number one, is to regularly compare the vision from each eye individually, and call an Optometrist if there is any distortion or anomaly in either of the eyes.

Can you see to drive? National Glaucoma Awareness Week 2015

In the UK it is national glaucoma awareness week.

The focus for National Glaucoma Awareness Week, 8-14 June 2015 is on driving and encouraging people to have regular eye health checks to ensure that they are safe to drive. It is only with regular eye health checks through a local optometrist (optician), that people will know if their driving vision is affected. This is particularly important with glaucoma, as it has no symptoms in the early stages. But, with early detection and continued treatment people will often retain useful sight for life and be safe to drive for many years

Driving and our ability and safety to do so, is something that many people take for granted. Yet, how many people have a regular eye health check to ensure that their vision is accurate? Even if a person can see a number plate at 20 metres, how many have been tested for glaucoma which affects vision?

There is an estimated 600,000 people with glaucoma in the UK, but 300,000 are undiagnosed. As there are no early symptoms it is vital that people over the age of 40 have regular eye health checks every one or two years. Advanced glaucoma leads to serious loss of sight. Comments Russell Young, CEO of the International Glaucoma Association “the majority of us wouldn’t take our cars on the road without an annual service and MOT yet, we are happy to put ourselves behind the wheel without knowing if we can see safely to drive. A visit to the optometrist will quickly check our safety and detect if there is any risk of glaucoma. Glaucoma is a complex condition, in that the brain fills in what the eyes cannot see. Many people will insist their vision is perfectly normal even when there is significant loss of vision”.
“Around 10 per cent of the calls we receive to our helpline are from people worried about whether their glaucoma is going to affect their ability to drive. Yet the majority of those that report to the DVLA will not need further tests, and of those that do most will be found safe to drive”, Young continues.

Glaucoma causes misty, patchy or blurred vision in places. It can cause people to miss the unexpected such as a person crossing the road, a cyclist passing, or a vehicle merging into traffic. The only way to know for sure about your vision and your safety on the roads is to have regular eye health checks every one to two years, particularly if you are over the age of 40.

“It is important people know if they do have glaucoma that has caused damage to vision in both eyes, they are required by law to report their condition to the DVLA. If they fail to do so they can face a criminal conviction, a fine up to £1000 and may be uninsured to drive. The good news about glaucoma is with ongoing treatment people can protect their vision and most people will retain useful sight for life”, Young concludes.

Further information about Glaucoma and driving with Glaucoma can be found on the IGA website, or via the Sightline (helpline) on 01233 64 81 70.

Source: Can you see to drive? National Glaucoma Awareness Week 2015 / News

Glaucomatous Disc

Is your Sight worth 33cent per week???

Glaucoma is called the thief of sight, because it painlessly damages vision, and can become fairly advanced before the sufferer even notices they have a problem.

Two recent clients highlight the importance of regular eye checkups.

The first was a lady who suddenly noticed that she could not see out of one eye- she was aware of being able to see finger movement to the extreme periphery in the eye, but was unable to see her hand straight in front of her face. She felt this had been a sudden onset, and because of that we squeezed her in – sudden losses of vision require urgent investigation. Unfortunately, on examination I was able to say that while she may have suddenly noticed the problem, it had been coming on for a number of years – Glaucoma is a fairly slowly advancing condition.

Because her other eye is unaffected (though both eyes are now being treated – eye drops once per day – to lower the pressure inside them), with proper care from the doctors and regular checks, she should have normal vision throughout life, so long as nothing else happens to the good eye. It is always better to have two good eyes than one, just in case.

Another recent example was a gent, not an old man, who had failed a driving sight test at the GP, so booked in to have one done by me. He had not had his eyes tested for at least ten years, and mentioned that he had been aware of a “greyness” in the right eye for the past year or so. His vision on the test chart was significantly worse in the right eye, and not improvable with a spectacle correction. As part of the driving sight test we always check the field of vision to ensure it is normal, and even with a fairly crude (but effective) check, it was obvious that he was unable to see very much in the poorer right eye, but even the other eye showed a significant defect- he was struggling to see to his right hand side with either eye. So his straight ahead vision was down in one eye, but his “around about” vision was affected in both. His eyes showed the characteristic damage of glaucoma – where the nerve connecting the eye to the brain withers slowly away.

I was unable to sign his form for driving- we cannot sign a form for someone with an undiagnosed and untreated eye disease. We referred him onward through his GP for an Ophthalmologist to have a look at his eyes, but even when this is treated and under control, he may no longer be able to drive. Glaucoma treatment is aimed at preventing further damage, but his peripheral vision is already quite badly affected and it is unlikely to improve, yet he was completely unaware of having a problem.

Regular eye tests are important – to lose the right to drive for something so easily prevented…..

Most adults are entitled to an eye test free of charge due to either Medical Card or PRSI entitlement, though certain civil servants on reduced PRSI rates, and the self employed (as ever) get no help. Even so, €35 for an eye test, recommended usually every 2 years -34 cent per week that works out.

You spend more than that on hair appointments, even men spend a lot more than that on haircuts. What price your sight?

To book an eye test give us a call in either Kingscourt or Bailieborough – the numbers are on this page.


A still from a video simulating driving with Glaucoma

Driving Vision and Glaucoma

Yesterday was the annual AGM of the Association of Optometrists, and also a study day- all Optometrists have to undertake a certain amount of Continuous Education and Training. At the moment this is voluntary, but will probably become compulsory in due course.

One of the lectures at the study day was about driving and vision, a subject that has become very topical of late. Particularly interesting I thought were a couple of videos which tracked the eye movements of Glaucoma patients when tested in a Hazard Perception Test. It had always been assumed that people who have a visual field deficiency will scan around, and move their head more to compensate for their problem, but as is mentioned here, the issue is that they may not even realise that they have a problem, and even if they are aware of an issue, they do not see the problem. If you don’t see something, you don’t think “I didn’t see that” – you just don’t see it.

The Hazard Perception test used eye tracking to follow the “Point of Regard” of normals and Glaucoma patients, also measured were reaction times – when would they hit the brakes?  The study found that people with Glaucoma do not scan around more than normals – indeed one of the videos below show that they remain fixed almost exclusively on the car ahead, failing to notice the hazard of a car pulling out ahead, until the car they are following reacts to the threat.

Video Number 2 shows the Glaucoma patient’s Point of Regard in Blue, the normals are shown in red, it is quite noticeable how little the Glaucoma patient looks at other aspects of the driving scene – they completley fail to look at the pedestrian with the buggy, something all the normals are obviously worried about.

Video number 3 has superimposed onto it a representation of the patients field of vision-  the more dense the areas of field loss, the darker the overlay. (It moves around because its position is relative to the fixation point, the blue dot. Remember that a Glaucoma patient will not see this blackness, they will just have blank areas, their brain will fill in the details as best it can.




The Glaucoma losses featured in Video 2 and 3 are mild to moderate – according to UK standards (where this study was done), this patient would still be legal to drive.

This shows that even if you do not feel that you have a problem, you should have your eyes regularly checked!


The full articles are available to read at these two links;

Obstacle Avoidance, Visual Detection Performance, and Eye-Scanning Behavior of Glaucoma Patients in a Driving Simulator: A Preliminary Study

Exploring Eye Movements in Patients with Glaucoma When Viewing a Driving Scene


Sleep Apnoea

Sleep Apnoea, (or Apnea if you use American English) has recently been linked to poor outcomes for people with Wet AMD- researchers have found that many people who do not respond to IntraVitreal injections of Lucentis (bevacizumab) did have undiagnosed and therefore untreated Sleep Apnoea.

Sleep Apnoea is a potentially serious condition where the individuals throat narrows when sleeping. In some individuals the throat can become completely closed, causing them to be unable to breath. They will struggle to breath when asleep, but the brain then wakens the person, and while it may take a few seconds, they do start to breath again, though there may be a choking sensation until they do start. This can cause a seriously disrupted night for the sufferer and perhaps partner, and sleep apnoea sufferers are often chronically tired, some can fall asleep in the middle of a sentence, or even while driving.

People with sleep apnoea are usually constantly tired, and the reduced Blood Oxygen levels during an episode can cause problems with many body organs, including the brain and the eye. Another recent finding is that people with this condition are 1.67 times more likely to develop Glaucoma than non sufferers.

There are different types of Sleep Apnoea, the most common type is Obstructive, and can be managed by weight loss- if applicable, restricting alcohol intake and stopping using sleeping tablets if used. Sometimes just raising the head more, a different sleeping position, and nasal decongestants can help. Other sufferers can use a special mask which feeds higher than normal pressure air to them- this extra pressure helps keep the airway open. Apnoea can affect both sexes, but is more likely in men, and may tend to run in families, possibly indicating a genetic link.

The link to poorer outcomes in AMD is here, and the link to the increased risk of Glaucoma is here – you may need to register (free) to see the articles.

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