Note: The material in this article is not intended as an alternative to personal, professional medical advice. Written material can only offer information and advice. And, however well intended, all advice is, by definition, subjective. Readers should immediately consult a trained and properly qualified health professional whom they trust and respect, for advice about any symptoms or health problem which requires diagnosis, treatment or any kind of medical attention. While the advice and information in this Report are believed to be accurate at the time of publication, neither the author nor the publisher can accept any legal responsibility for errors or omissions which may be made.

A Trio Of Common Eye Problems

Cataract, glaucoma and retinal detachment are three of the commonest, most worrying and most disabling of eye problems. If you’re over sixty then the chances are high that at least one person you know well has had at least one of these problems. If you’re over seventy and you haven’t had to face any of these three then you probably owe someone up there a little prayer of thanks.
The notes that follow aren’t intended to be comprehensive. But they will, I hope, provide you with a useful and comforting quick reference guide to this trio of common eye problems.

Cataract

Cataract (a loss of transparency of the lens of the eye) most commonly occurs in the elderly and occurs so often that it is often regarded as simply due to the natural degenerative process of ageing. Most people over the age of 65 have some degree of cataract – usually confined to the edge of the lens and, therefore, not interfering much, if at all, with vision. Most people over the age of 75 have some visual deterioration resulting from cataract formation.

It isn’t just the elderly who are susceptible to cataracts forming; people who suffer from diabetes mellitus are prone to them too. And it is possible for babies to develop ‘congenital cataracts’. Infants who have a variety of rare genetic disorders such as galactosaemia are prone to having cataracts at birth. And cataracts can sometimes occur in infants who have Down’s syndrome. Congenital cataracts may also be caused if the mother has an infection in early pregnancy, especially with the German measles virus.

If you’ve ever seen anyone with a cataract in its advanced stages, you might imagine that the sufferer must be totally blind in the affected eye. Not so. Light can still be transmitted by the densely opalescent (milky-white) lens. However, vision can still be impaired (sometimes quite badly so) causing an increasing loss of clarity.

Cataracts usually affect both eyes but it is quite common for one eye to be affected more than the other.

Those who may be at special risk of developing cataracts include patients who:

• Have been taking corticosteroid drugs for a long period of time.
• Have been exposed to infrared radiation, X-rays and/or microwaves.
  
• Have long-continued disorders of the eye/s such as uveitis and iritis.
  
• Have suffered an injury to the lens of the eye.
  
• Are over 60.
• Symptoms may include:
• Increased blurring of vision.
• Halos around lights.
• Colours may look different.
• As density of the lens increases, the person affected may become short-sighted. (One curious result of this phenomenon is that someone who was previously long-sighted may be able to read without using reading glasses for the first time in years.)
• Milky-white lens (advanced stages).
• There is no pain with a cataract.

Note: It is quite usual for cataract sufferers not to experience any of the above symptoms. The most common symptom that is often experienced is progressive deterioration of vision.

Treatment of cataract

Although a change in the spectacles used can improve the sight in its early stages, as the cataract progresses and vision deteriorates sufferers may need surgery.
Providing the eyes are otherwise healthy, the visual affects of surgery are often excellent. Surgery involves the refractive power of the eye being replaced by a special, implanted lens.

Glaucoma

Chronic (open-angle) glaucoma

There are different types of glaucoma but the most common form, which tends to run in families, is called chronic (open-angle) glaucoma.

Chronic glaucoma is due to a gradual obstruction of fluid that normally drains into and out of the eye. Over a period of time, this blockage can cause a rise in pressure inside the eye. This can result in damage and possible loss of vision because the slow rise in intraocular pressure compresses the blood vessels which feed the fibres of the optic nerve.

Chronic glaucoma mainly affects those over the age of 40 and is one of the most common major eye disorders in the UK, affecting an estimated 250,000 people. It is a major cause of blindness.

But try not to let this fact depress you too much because glaucoma does not impair vision if treated early. It’s important, therefore, to visit your doctor or your optician at the slightest change in your vision.

Because there are usually no symptoms with chronic glaucoma in its early stages (unlike acute glaucoma there is usually no pain) you would be wise to have a routine eye-examination at least once a year (do make sure that the eye examination includes a glaucoma test), especially if you have a family history of the disease.

Symptoms may include:

• Blurred vision, particularly on one side toward the nose.
• In small areas there is loss of peripheral vision.
• Halos around lights.
• Vision does not adjust well from light to dark.
• Headaches.
• Aching eye/s, pain.
• Blind spots.
• The eyeball may feel hard.

Usually there are no symptoms with chronic glaucoma until quite late on in the development of the disease.

Risk factors for chronic glaucoma may include:

• Age (glaucoma is commoner over the age of 40).
• Family history of acute or chronic glaucoma.
• Smoking.
• Tiredness.
• Overwork.
• Emotional stress.

Acute (closed-angle) glaucoma

Acute (closed-angle) glaucoma is caused by a sudden obstruction of the outflow of fluid in the eye.

Symptoms may include:

• Severe, throbbing eye pain and headache.
  
• Redness of the eye.
  
• Blurred vision.
  
• Halos around lights.
  
• Nausea and vomiting can sometimes occur.
  
• Dull but severe pain in and above the eye.
  
• Swollen upper eyelid.
• Fixed, dilated pupil.

Note: Sufferers may experience only a few of the above symptoms. It is important that you see your doctor immediately if you experience any changes in your vision or any symptoms in or around your eyes. Acute glaucoma requires urgent medical treatment. If left untreated, acute glaucoma can cause blindness.

Risk factors for acute glaucoma may include:

• Age.
  
• Smoking.
  
• A family history of the disease (or of farsightedness).
  
• Fatigue and emotional stress.

Treatment

It is important to treat glaucoma effectively. If untreated it can cause blindness. But the increased rise of pressure in the eye that occurs in glaucoma can normally be treated effectively. Treatment for glaucoma is usually life-long.

Eye-drops that help to reduce the pressure in the eye are normally prescribed by a doctor. The doctor may also prescribe diuretic drugs to help reduce the pressure. If the eyes refuse to respond to this kind of treatment then surgery may be needed.
Acute glaucoma requires urgent medical treatment. Eye-drops or pills are normally given to help control the pressure in the eye and surgery may be necessary later on to help prevent another attack.

It’s vital that anyone being treated for glaucoma should keep taking the treatment that has been prescribed otherwise the pressure inside the eye will just continue to rise. And this may result in permanent loss or impairment of vision. If the treatment produces unpleasant side effects you should see your doctor as soon as possible. You should also see your doctor promptly if you have an eye infection, pain in the eye, redness or any sudden changes in vision.

Retinal Detachment

Retinal detachment is a separation of the retina (the light-sensitive layer of tissue that lines the interior of the eye) from the tissue beneath it.
Retinal detachment can affect all ages and both sexes, but it tends to be more common in men. It is commoner among people with myopia (extreme short-sightedness) and among patients who have had cataract surgery.

Symptoms of retinal detachment may include:

• Blurred vision.
  
• Gradual loss of vision which may be so gradual that it is not noticed for some time.
  
• Flashes of light.
  
• Floaters (caused by spots of blood being released into the eye).
  
• There is no pain with a retinal detachment.

These symptoms can affect one or both eyes. Sometimes none of these symptoms may be present. The sufferer will eventually know that he or she has a detached retina when what appears to be a ‘black curtain’ covers his or her field of vision in the affected eye.

Some of the causes of retinal detachment may include:

• Injury to the eye.
  
• Eye surgery – can sometimes cause the retina to detach itself, especially if there were complications.
  
• Retinal detachment can occur spontaneously without any underlying disease.

Risk of retinal detachment may increase with:

• Age.
  
• Vascular disease.
  
• Diabetes mellitus.
  
• A family history of retinal detachment.
  
• A previous retinal detachment.

To prevent retinal detachment:

• Have any underlying disease (such as vascular disease or diabetes mellitus) kept under control.
  
• Wear a protective eye shield when playing sports which may cause eye injuries. (Eye injuries seem to be particularly common among squash players – possibly because the ball is just the right size to fit into the eye.)
  
• See your doctor straight away if you experience any visual disturbances.

Treatment

Treatment for retinal detachment usually involves surgery.

Copyright Vernon Coleman 2001

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