The Eye Practice

Glaucoma was once thought to be a raised eye pressure, which slowly compressed the optic nerve until it stopped functioning.  The optic nerve is the cable at the back of the eye that provides the connection to the visual cortex of the brain.  If the nerve is not functioning properly this in turn interferes with the vision.

At one point because it was thought that excess eye pressure was solely responsible for glaucoma, it was a simple treatment.  Drop the pressure to some point and then the glaucoma is managed.

Unfortunately it was discovered to not be so simple. Over the years various risk factors were discovered to be associated with glaucoma disease progression.  Currently a full glaucoma test involves:

1. Ask for a full family and medical history.
2. Measure the pressure (sometimes at different times of the day).
3. Measure the central cornea thickness. The thinner the cornea the more likely that a given eye pressure will cause damage.
4. Do a peripheral vision test. Glaucoma tends to affect the peripheral vision before the central vision.
5. Careful observe the optic nerve looking for characteristic changes, which can represent glaucoma.
6. The observation is best done by taking a photograph of the optic nerve.
7. Taking a Optical Coherence Tomography of the optic nerve (OCT).  This can be compared to an MRI. An OCT is able to monitor an optic nerve over time looking for change that can represent glaucoma.

At The Eye Practice you can be guaranteed of a comprehensive glaucoma evaluation on every visit.  We have the most advanced technology available, while our resident optometrist Dr Jim Kokkinakis is endorsed to treat it.

The Eye Practice was one of the first optometrical practices in Australia to invest in OCT technology.  This was done in 2005.  Since then there have been multiple upgrades with statistical analysis software that allows early and more accurate detection.

What is scary is that at any given time, of all the people that have glaucoma, only about half of them have a diagnosis and are being treated.  The other half either have not been tested comprehensively and been missed or have not been tested at all.

It is tragic that this occurs in this day and age.  Make sure that you are screened for glaucoma, especially if you are over 40 years of age.

Call us on 9290 1899 and make an appointment or make  an online booking HERE.

In a future post we will discuss what happens if you are diagnosed with glaucoma.

Keratoconus is documented in the medical literature as affecting 1/2000 of the population. Even though this might sound rare, it isn't really.  There are many diseases that have a far lower prevalence.

There is plenty of evidence to show that keratoconus is transmitted genetically even though many people with keratoconus will tell you they do not know anyone else in their family with the eye condition - they have somehow drawn the short-straw!

The reality is if a patient has clinically diagnosed keratoconus there is about an 8% chance that they will have another member in their family with the condition.  On these statistics alone one must conclude that  keratoconus has some sort of genetic basis, as it is significantly more prevalent than the 1/2000 that occurs in the general population.

Some of the best studies in genetics related to keratoconus have been done by an American ophthalmologist called Dr Yaron Rabinowitz.  In one of his studies he examined the family members of a number of his keratoconic patients.  Amazingly he discovered that up to 50% of the family members had at least a very low level of keratoconus, which had not been clinically diagnosed previously.

A very low level of keratoconus is called Forme Fruste Keratoconus and typically is so mild that if there is any vision problem, the vision can be corrected easily with normal glasses.

Forme Fruste Keratoconus really only can be diagnosed using sophisticated equipment called corneal topography and global pachymetry.  The Eye Practice is only one of a few optometry practices in the country that has invested in this advanced technology.  This is to make sure that no patient can be missed with keratoconus.

A very common question that we are asked at The Eye Practice is:

"I have keratoconus and I am scared of having children, just in case they get it.  What should I do?"

The reality is that having keratoconus is not something that should stop you from having children, in case they develop it.  Chances are that they will be one of the 92% that do not develop it anyway.

Today we are in a position to diagnose keratoconus very early and in doing so can choose to have a procedure called collagen cross-linking.  This procedure when done early enough is likely to significantly suppress the progression of keratoconus.  CLICK HERE for further information about Collagen Cross Linking for keratoconus.

In future posts about Keratoconus we will discuss; things that seem to be associated with keratoconus and things that a person with keratoconus can do to not contribute to further progression of the condition.

Myopia, near-sightedness or short-sightedness are all the same thing.  There seems to be anecdotal evidence that not only do your genes play a role, but also the environment you are exposed to.

To date there are many twin studies to show that genetics plays some role in the development of myopia.  To prove though that the environment has some role has proven more elusive.

A study published in the American Academy of Optometry's journal in 2009, showed that in a similar genetic pool from China, urban children had significantly more myopia than a group from rural areas.

"The fact that people exhibit different patterns or rates of myopia in urban and rural settings appears to suggest an impact of environmental effects, given that the genetic backgrounds are very similar among people living in the urban and rural areas of the same country.

However, the urban-rural difference may be a surrogate for other myopigenic environmental risk factors because the education, socioeconomic, and nutrition status of the people should also tend to be different in urban and rural environments.

The study in Xiamen found that children in the city spend more time on near-work activities and less time on outdoor activities outside school than children in the countryside: the average time was 2.2 h of near-work per day in the city vs. 1.6 h/d in the countryside, 5.6 h of outdoor activity per week in the city vs. 15 h/week in the countryside."

Without going into more studies Dr Jim Kokkinakis of The Eye Practice is convinced that environmental influences do contribute to the development of myopia or short-sightedness.  Over the years he has examined the eyes of many trade people.  This group of workers tends not to read excessively and is doing manual labour - few of them are myopic.  Office workers on the other hand that are in offices all day staring at computer screens tend to be myopic. 

Is this a good study - of course not but sometimes your gut feel can be correct.

The ideal study to prove this concept once and for all is a large identical twin study of siblings that have been separated at birth and brought up in different environments.  If myopia was purely genetic, we would expect the separated twins to have the same level of myopia. 

On the other hand if the environment played a role we would expect to find a significant difference of myopia incidence between the identical twin siblings that were separated.  Until this study is done and published we think there is more than enough evidence to suggest that lack of outdoor activity combined with excessive reading and computer work plays a role in the development of myopia.

Contact Lenses in Australia represent around 8% of the eye (or vision) correction population.  This is relatively low when compared to other countries like the USA, which is over 20%.

This is a real shame because contact lenses are a great vision correction option, which are under utilised in Australia due to many reasons.  We will discuss these reasons a little later in this post.

Did you know that if someone is introduced to contact lenses at some point for the first time, there is up to a 50% chance that they will have failed or discontinued their use within the first 12 months.  Basically this means that due to the high dropout rate the proportion of people that use contact lenses has not really risen for 20 years world-wide.

At The Eye Practice we specialise in contact lenses; from the most simple to the most complex.  Over 30% of our patients that need a vision correcting option wear contact lenses.  As we have said before on average it is only 8%, so why does our success rate far exceed the norm?  

With many years of experience dealing with all types of prescriptions and needs, we have identified the main vital issues in contact lens wear that can lead to contact lens failure or significant reduction in comfortable wearing time.

When you understand and apply these important principles you will be ahead of at least 95% of contact lens wearers.  You certainly will be ahead of the many people that are currently struggling with their contact lenses and feel that they have no options.

In the next post we will discuss one of the issues that causes contact lenses to fail:

• Compliance in contact lens wearing and cleaning schedules.
  

Cataracts have many causes.  It has always been an issue throughout history.  In a later post we will go through the history of cataract surgery - it is fascinating.

The most common causes of cataract are:

• Age
• Trauma/injury to the eye
• Congenital cataracts that develop in infants
• Developmental cataracts that occur in children
• Other eye diseases or eye surgery
• Diabetes and diabetic related eye disease
• Medications such as steroids
• Prolonged exposure to ultraviolet light
• Smoking or previous smoking

Age is the predominant risk factor for cataracts.  At The Eye Practice we are advising about cataracts every day of the week, as ultimately everyone will develop one.  That's as long as you live long enough.  So here is the moral to the story; make sure you develop cataract otherwise you have not lived long enough!

These days the technology to operate on cataracts and rehabilitate vision is so advanced that it is probably one of the most successful procedures done on the human body.

Laser Eye Surgery is one of the most asked about vision options at The Eye Practice.

As mentioned in a previous post Dr Jim Kokkinakis has consulted for the leading laser centre in the country for a period of 6 years between 1996 and 2002.  He has seen all the complications that can occur, while at the same time seen the overwhelming positive results that usually occur.

It is estimated that around 1/1000 people that have laser eye surgery will have a significant complication that they perceive as devastating.  This does not mean blindness but means that the patient is significantly worse off than they were before the procedure.  We will leave the in depth details of the various complications for another post, but for now just profile, who we think is a good laser surgery candidate:

1. Up to -8.00 Diopters of myopia - it seems that once you try and do more than this the shape of the eye is changed to the point where the vision can be distorted and the patient ultimately not happy.
2. Up to -4.00 Diopters of astigmatism - again beyond this accuracy and final visual quality is less than ideal.
3. Up to +4.00 Diopters of hyperopia.
4. A corneal thickness of greater than 500 microns.
5. Older than 25 years of age and younger than 35 years of age - doing laser eye surgery during this age one can expect roughly 20 years of total independence from any optical aids like glasses or contact lenses.
6. Minimal dry eye problems - dry eye syndrome is a common side effect of laser eye surgery, therefore if there is any pre-existing condition it is likely that after the surgery there can be significant irritation and fluctuating vision, which could be difficult to treat.

What we find fascinating is that the ideal age bracket is not the most common done.  The most common person that has laser eye surgery is in fact a male between the ages of 38 and 42.  We believe that this type patient is quite likely going through a mid-life crisis, which along with the Harley Davidson purchase and getting rid of the glasses, is all about feeling younger.

Another interesting statistic is that laser vision eye surgery (in Australia) tends to be more popular from the beginning of spring through till the beginning of autumn.  It has something to do with better weather, getting outdoors and enjoying the lifestyle.  Glasses and contact lenses can be perceived as a nuisance.  Laser eye surgery gets prioritised more often during these seasons.  Human psychology  is an amazing thing!

If you think you are a good candidate for laser eye surgery call us at The Eye Practice on 9290 1899 or CLICK HERE to make an online appointment so we can check you for suitability.  Successful laser eye surgery patients will tell you, it was one of the best decisions they made in their life.

Eye Strain is such an issue in the world, that a global pharmaceutical company called Bausch & Lomb decided in early 2010 to host a Symposium on the topic.  They invited around 10 practitioners from around the world to contribute and we are proud that Dr Jim Kokkinakis (of the Eye Practice) represented the Asia-Pacific region.

The group has been called the Asthenopia Advisory Board (Asthenopia being the medical name for Eye Strain).

Some very interesting information was shared amongst the group.  The data that was collected after a global study by Bausch & Lomb can be summarised as follows:

• 3800 patients were surveyed from around the world
• Eye Strain was experienced by many patients - overall 78% complained.
• Symptoms were described as: Pain in eye, Headache related to Near work, Tired eyes and Eye Strain
• Of the patients complaining of Eye Strain around 90% reported it to be bothersome
• Over 50% of patient felt that they had NO solution for this problem!

What an amazing study.  Eye Strain potentially has the potential to greatly affect  most peoples quality of life and it seems that we just take it as a given.

Visit The Eye Practice's dedicated Eye Strain website where we have all sorts of tips.  Ultimately a comprehensive eye test by an Eye Strain specialist like Dr Jim Kokkinakis could make you more comfortable and more productive.  Eye Strain can be solved! Call 9290 1899 or CLICK HERE for an online appointment.

Conjunctivitis also known as Pink Eye or just simple Red Eyes is a common consultation for the local General Medical Practitioner (GP).  As we discussed in a previous post, most Conjunctivitis or Pink Eye will resolve by themselves over the course of a number of days.  Does that mean we need to be complacent?  NOT AT ALL!  There are umpteen reasons why eyes get red, inflamed and irritable.

Getting an accurate diagnosis and therefore accurate treatment is not that straight forward.  A Therapeutically Trained Optometrist has both the education, the experience and importantly the equipment to get to the bottom of the problem. 

Your local GP is certainly educated but does not have the appropriate equipment to magnify the eyes to the level required for accurate diagnosis.  Optometrists in general have magnifying equipment called a Slit Lamp Biomicroscope that allows detailed viewing of the delicate structures of the eyes.

The image on the left is of an optometrist examining a patient, whilst the image on the right is the type of detail that can be observed. 

It is not possible to get this with the naked eye plus a pen torch that the GP in most cases would use. 

What we need to make clear here is that the GP just does not have the volume of eye issues coming in on a daily basis that would need him or her to invest in equipment like a SLIT LAMP BIOMICROSCOPE.

So what does the GP normally do with a red eye?  Depending on perceived severity in most cases they will prescribe a broad spectrum antibiotic called Chlorsig.  This comes in both a drop form and an ointment form.

Similar statistics exist for Chlorsig as do Bleph-10 mentioned in a previous post.  Millions of prescriptions per year are written for Chlorsig, which until very recently was available by prescription only from a pharmacy.  It is not possible that in a population the size of Australia that one in 5 people every year have a red eye that is caused by a bacterial infection.  GP's will default to Chlorsig just in case it is a bacterial infection (which in most cases it is not). 

If you think you have some form of Conjunctivitis call The Eye Practice now on 9290 1899 and make an appointment for an evaluation and a treatment plan. 

So what is the most common cause of Conjunctivitis, Pink Eye or Red Eyes?

We will answer this question and a whole host of other things to know about Conjunctivitis in upcoming posts.

Glasses or Spectacles as we know them today date from the 12th century, when Venetian glass blowers started making lenses that could fit into a wooden or horn frame, which would sit on the nose. In 1718, Edward Scarlett, a London optician, put arms on eyeglasses to hold them on the ears.

When you understand and apply these important principles you can be at ease with wearing glasses AND MOST IMPORTANTLY: choose the ones that are appropriate to your needs and lifestyle.

Stay tuned for the next Glasses and Spectacles post. We will start with a very important issue:

Do glasses or spectacles weaken your eyes and make them lazy?

Macular Degeneration has been talked about extensively in the media.  And for good reason.  As we have mentioned before it is the leading cause of legal blindness in a population over 50.  With an aging population, which is living longer, the numbers of legal blindness from Macular Degeneration will escalate dramatically over the next 20 years, if nothing is done to stem the wave.

Eye Nutrition seems to be very important to possibly protect us from Macular Degeneration. 

There are two important ingredients that we need in our diet to protect our eyes.  They are:

1. Omega-3 (commonly known as Fish Oil or Flaxseed Oil for the vegetarians) is an essential building block of the cells that make up our whole body.  The eyes also are many up of cells.  It is thought that the average person needs to consume around 3 to 4 servings of lightly grilled fish per week to load the body with enough Omega-3 to sustain our cells at a healthy level.  I am not sure about you, but I would be lucky to have a serving a month! Supplementation then is a must for the majority of us.  At the Eye Practice we commonly prescribe Thera Tears Nutrition Gel capsules, which not only gives you the necessary dosage of Omega-3 for Macula protection but also treats the very annoying dry eye syndrome.
   
2. Lutein and Zeaxanthin are two less well known antioxidants that are highly concentrated in the macula area and are thought to protect the macula from damage.  The best food source for these two very important antioxidants is from lightly cooked spinach.  Add some garlic and lightly stir fry a serving at least 3 times per week and you have the basis for very healthy eyes.

Lutein and Zeaxanthin also can be obtained from supplements such as Blackmores Lutein-Vision.

There is even a cookbook that has been written on behalf of the Macular Degeneration Foundation.  This is for people that really want to stay on top of their eye-health - especially if you have significant signs of macular degeneration.  CLICK HERE FOR MORE INFO.

And now that we have our diet correct, stay tuned for the next Macular Degeneration fact.  It will also be an important one.