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Eye conditions

imageCataracts occur when the clear lens inside your eye becomes cloudy or misty. This is a gradual process that usually happens as we get older. It does not hurt. The early stages of a cataract do not necessarily affect your sight.

If the cataract gets to the stage where it affects your vision your optometrist will refer you to hospital. Cataract removal surgery is carried out under local anaesthetic and is very safe. Once you have had the cataract removed it will not return, although you may need laser treatment at a later stage.

Why does cataract occur?

The main cause is age. However, smoking, poor diet and exposure to sunlight have been linked to cataracts.
Younger people can develop cataracts if they have an injury to the eye. Some medical conditions including diabetes or certain medication may also cause cataracts. A very small number of babies are born with a cataract.

What is glaucoma?

Glaucoma is the name for a group of eye conditions in which the optic nerve is damaged at the point where it leaves the eye. This nerve carries information from the light sensitive layer in your eye, the retina, to the brain where it is perceived as a picture.

Your eye needs a certain amount of pressure to work properly. In some people glaucoma damage is caused by an increase in eye pressure, others may have an eye pressure within normal limits but damage occurs because there is a weakness in the optic nerve. In most cases, both factors of high pressure and weakness in the optic nerve are involved to varying degrees.

Eye pressure is largely independent of blood pressure.

How common is glaucoma?

In the UK some form of glaucoma affects about two in 100 people over the age of 40.

Are there different types of glaucoma?

Yes. There are four main types.

  • Chronic glaucoma
    The most common is chronic open angle glaucoma in which the part of the eye where the aqueous fluid drains away (called the "angle") isn't blocked, but the fluid doesn't drain properly. This causes the eye pressure to rise very slowly over many years and doesn't cause any noticeable symptoms at first. There is no pain but the field of vision gradually becomes impaired.

    Are some people more at risk of chronic glaucoma? Yes. There are several factors which increase the risk:

    • Age - Chronic glaucoma becomes more common with increasing age. It is uncommon below the age of 40 but affects one per cent of people over this age and five per cent over 65.
    • Race - If you are of African origin you are more at risk of chronic glaucoma, it may develop earlier and be more severe. It is strongly advised that you have regular eye examinations.
    • Family - If you have a close relative who has chronic glaucoma then you should have an eye test at regular intervals. You should advise other members of your family to do the same. This is especially important if you are aged over 40 when tests should be done every year.

      *Please note: People over the age of 40 years with an immediate family member diagnosed with glaucoma – parents, children or siblings – are entitled to a free sight test every year under the NHS.

    • Short sight - People with a high degree of short sight are more prone to chronic glaucoma

  • Acute glaucoma
    Acute (sudden) glaucoma is much less common in western countries. The fluid pressure rises quickly due to a complete blockage of the drainage canals. This will result in permanent damage to your sight if not treated promptly.

    What are the symptoms of acute glaucoma?
    The sudden increase in eye pressure can be very painful. The affected eye becomes red, the sight deteriorates and may even black out. There may also be nausea and vomiting. In the early stages you may see misty rainbow coloured rings around white lights.

    Prevention of Acute Glaucoma: Using the OCT, a scan of the front structures of the eye can assess the risk of an acute attack.

  • Secondary and developmental glaucoma
    There are two other main types of glaucoma. When a rise in eye pressure is caused by another eye condition this is called secondary glaucoma. There is also a rare but potentially serious condition in babies called developmental or congenital glaucoma which is caused by malformation in the eye. This document is about chronic and acute glaucoma.


imageWhat is macular degeneration?
Sometimes the delicate cells of the macula become damaged and stop working, there are many different conditions which can cause this. If it occurs later in life, it is called “age-related macular degeneration”, also often known as AMD.
There are two types of macular degeneration or AMD, usually referred to as “wet” and “dry”. This is not a description of what the eye feels like but what the ophthalmologist (eye specialist) can see when looking at the macula.

“Dry” AMD is the most common form of the condition. It develops very slowly causing gradual loss of central vision. Many people find that the vision cells simply stop working like the colours fading in an old photograph. There is no medical treatment for this type. However, aids such as magnifiers can be helpful with reading and other small detailed tasks.
“Wet” AMD results in new blood vessels growing behind the retina, this causes bleeding and scarring, which can lead to sight loss. “Wet” AMD can develop quickly and sometimes responds to treatment in the early stages. It accounts for about 10 per cent of all people with AMD.

Both “wet” and “dry” AMD usually involve both eyes, although one may be affected long before the other. This sometimes makes the condition difficult to notice at first because the sight in the “good” eye is compensating for the loss of sight in the affected eye. You cannot wear out your sight, so do not be afraid to continue to use the “good” eye as normal.

The good news is that AMD is not painful, and almost never leads to total blindness. It is the most common cause of poor sight in people over 60 but very rarely leads to complete sight loss because only the central vision is affected. This means that almost everyone with AMD will have enough side (or peripheral) vision to get around and keep his or her independence.

What causes AMD?
At the moment the exact cause for AMD is not known. However there are a number of risk factors which have been identified.

Age – AMD is an age related condition so growing older makes the condition more likely.

– Women seem more likely to develop macular degeneration than men.

– There appear to be a number of genes which can be passed through families which may have an impact on whether someone develops AMD or not.

– Smoking has been linked by a number of studies to the development of AMD. It has also been shown that stopping smoking can reduce the risk of AMD developing.

– Some research suggests that lifetime exposure to sunlight may affect the retina. It is a good idea to wear sunglasses to protect the eyes.

– Research suggests some vitamins and minerals can help protect against AMD.
Although nothing can be done about age, gender and the genes we inherit it is however possible to control the environmental factors that seem to be linked with AMD. Protecting your eyes from the sun, eating a well-balanced diet with plenty of fresh fruit and vegetables and stopping smoking may all help to delay the progress of AMD.

What are the symptoms of AMD?

In the early stages your central vision may be blurred or distorted, with objects looking an unusual size or shape and straight lines appearing wavy or fuzzy. This may happen quickly or develop over several months. You may be very sensitive to light or actually see lights, shapes and colours that are not there. This may cause occasional discomfort. AMD is not painful.

Because AMD affects the centre of the retina, people with the advanced condition will often notice a blank patch or dark spot in the centre of their sight. This makes reading, writing and recognising small objects or faces very difficult.

What should I do if I think I have macular degeneration?

If you suspect that you may have AMD but there are no sudden symptoms, you should see us or your family doctor who will refer you to an eye specialist. If there is a rapid change in vision, you should consult your doctor or hospital’s Accident and Emergency department immediately.

If you have AMD in one eye, and you start getting sudden symptoms in your other eye, then you should go to your hospital or ask your GP to arrange an emergency appointment, as soon as possible. This will ensure that you get treatment within a few days.

What is blepharitis?

Blepharitis is an inflammation of your eyelids. It can make eyelids and eyelashes red and crusty and make your eyes feel irritated or itchy. It can also lead to burning, soreness or stinging in your eyes. In severe cases, your lashes may fall out, and you can develop small ulcers or styes. You may find your eyelids become puffy. The symptoms tend to be worse in the morning and when you wake up you may find your lids are stuck together.

Blepharitis can be uncomfortable, but rarely causes serious eye damage.

Blepharitis is a chronic (long-term) condition. This means that once you have had it, it can come back even after it has cleared up. It normally affects both eyes. You can usually treat it by just taking care with your hygiene, but you may need treatment for several months.

imageFloaters look like small dark spots or strands that appear to float in front of your eyes. Floaters are very common and are normally harmless. They are more common if you are short sighted or as you get older.

Some people also notice they see flashes of light. These can be due to movement of the gel inside the eye.

Very occasionally, flashes or an increase in floaters can be a sign of a retinal detachment, which needs treating as soon as possible. This is more common as you get older or in people who are short sighted or have had eye surgery.

If you get the following symptoms, you should come and see us or your GP:

  • A sudden increase in floaters, particularly if you also notice flashing lights.
  • A new, large, floater.
  • A change in floaters or flashing lights after you have had a direct blow to your eye.
  • A shadow spreading across the vision of one of your eyes.

If you notice any of the above symptoms, you should come to see us for a health examination, covered under the Welsh Assembly’s WECS scheme.