The Eye Practice

Conjunctivitis in children is often of the contagious variety.

Children are typically social creatures, learning how to properly interact with one another through their daily actions. They are often in close contact through daycare, preschool, and in the classroom. Of course, they don't always know any better about what spreads conjunctivitis or pink eye, and they have to be taught properly.

There are many ways to teach children about the spread of pink eye and how to prevent it from getting worse. Here are some ideas that can help you and your kids from getting this condition, and how to avoid spreading it around.

 

What to Teach your Kids

The first thing to teach your kids is the concept of “hands off!” Teach them not to rub their eyes or touch their eyes without washing their hands first. Teach them how to properly use tissues and handkerchiefs, and not to share towels or personal hygiene items.

Other things to teach kids include:

·       Proper hand washing techniques. This can be made fun when they're young by using a song while they lather their hands. Make hand washing a fun, feel-good practice, and they'll actually start to do the activity on their own.

·       Teach and remind older children not to share eye drops, contact lenses, or cosmetics with each other. Sharing these items is a high-risk activity in spreading conjunctivitis. Discourage it as much as possible.

·       Teach and remind children to use tissues for coughs and sneezes, and to cover their noses and mouths appropriately.

What You can Do

There are several things you can do as a caregiver, whether you are a parent or guardian, or a teacher or daycare specialist.

·       Encourage the good habits listed above. Always have disposable tissues on hand for wiping eyes. It's a good idea to carry around hand sanitizer, too, as hand to eye contact is one of the easiest ways for conjunctivitis to set in to the eyes.

·       Don't share personal items. Demonstrating good behavior is the best way to impart it onto children.

·       Frequent hand washing is necessary during a pink eye outbreak. Encourage children to do the same by modeling that behavior in yourself.

·       Toys, counters, sinks, faucets, and other surfaces should be kept clean, especially so during an outbreak of conjunctivitis. Take extra steps to notify your child's teacher or daycare specialist if they have been diagnosed with pink eye so that they can sanitize their areas properly.

·       Children are not allowed to return to school or daycare until their pink eye is no longer contagious. Make sure you work with your optometrist and school to make sure your child goes back to school at the right time.

Spread the word, not the condition. Call on 9290 1899 for an appointment for you or your child.

Glaucoma comes in two common forms – open-angle and angle-closure, chronic and acute – and can be extremely difficult to detect, especially chronic, open-angle glaucoma. But no matter what, early detection and treatment can help save your sight. Naturally, damage that has been done to the optic nerve cannot be undone (yet), but further damage can be prevented.

In order to save your sight, know the most common forms of glaucoma and their associated symptoms.

Open-Angle, Chronic Glaucoma

This type of glaucoma is difficult to detect on your own because the symptoms are vague and gradual. It is absolutely necessary to see your eye doctor regularly to be tested for this type of glaucoma. The major symptom of open-angle glaucoma is a gradual tunneling of the vision. At first, it is just a subtle loss of peripheral vision on one or both sides (usually both). Then, in the advanced stages, vision is completely “tunneled.”

People with diabetes, and people over age 60 are at greater risk for developing this kind of glaucoma – therefore, annual screenings are necessary for you if you fit into these categories. Prevention is superior to cure, even in modern medicine – and the case is the same when considering glaucoma.

Lack of peripheral vision is difficult to notice on your own – it's not something you think about or notice until it's almost completely gone.  Studies have shown that if a patient comes in for an eye test and complains of vision disturbance that is directly related to Open-Angle Glaucoma, it is likely that they have lost 60% of their vision at that stage!

Angle-Closure Glaucoma

This type of glaucoma is more dramatic – but can be confused with other conditions. That's why it's important to seek emergency treatment right away if two or more of these symptoms occur simultaneously:
    •    Severe eye pain or pain in the eyebrow (referred pain)
    •    Nausea and/or vomiting that accompanies the eye pain
    •    Reddening of one or both eyes
    •    Blurred vision
    •    Seeing halos that look like rainbows or prisms around lights
    •    Sudden visual disturbances, often seen in low lighting conditions

Because these symptoms are not just associated with acute angle-closure glaucoma, and can be symptoms of other serious conditions, it is imperative to get emergency care as quickly as possible if two or more of these symptoms occur.

 

Primary or Secondary Glaucoma?

Sometimes you'll hear glaucoma referred to as primary or secondary. These aren't types of glaucoma, necessarily – they are terms used to describe the conditions of the glaucoma. If the cause is unknown, then it is called primary. If the glaucoma can be traced to a root cause, such as a tumor or injury, then the term secondary is used.

Glaucoma will result in blindness if left untreated, and any damage it does prior to treatment is permanent. Regular eye exams can lead to early detection and treatment, which can save your vision and arrest glaucoma's further development.

Don't wait for damage to occur – it won't go away on its own.

Conjunctivitis comes in many types.

We've mentioned before that we were going to have a closer examination of other types of conjunctivitis. This one is important for contact lens wearers, and those who have stitches (sutures) in their eye, or artificial eyes (prosthetics) and implants.

It's called Giant Papillary Conjunctivitis (GPC).  Primarily, the major population affected by GPC is contact lens wearers. Additionally, although it can happen to any contact lens wearer, the greatest affected group is?

Those who wear soft lenses, especially the silicon hydrogel variety.  Hard contact lens wearers rarely exhibit GPC.  In fact one of the treatments for GPC is to swap from soft contact lenses to the hard variety.

Essentially, GPC is a type of inflammation of the under-surface of the eyelid, which comes from constant blinking against the contact lens or foreign object. That surface, normally as smooth as silk, becomes irritated and rough, and forms papillae (bumps) all along the surface. The more you blink, the more it rubs, and the more it rubs, the more the whole eye gets irritated, causing the conjunctiva to get inflamed, hence – conjunctivitis.

Possible Causes

There are several possible causes of GPC –

·       constant rubbing of lenses against the eyelids (as described above)

·       allergic reaction to contact lens solution, drops, and cleansers

·       deposit build up on the lenses from extended wear, or improper cleaning techniques, or from wearing the lenses longer than they should be worn (like wearing 30 day disposable lenses for 60 days or 14 day contact lenses for 30 days.)

These causes will create an atmosphere of aggravation for the eyelid, causing papillae to form.

Symptoms

GPC is not contagious – but it looks and feels awful. Symptoms of GPC are similar to other conjunctivitis symptoms –

·       an itchy, gritty feeling in the affected eye

·       burning sensation in the affected eye

·       increased mucous output

·       redness

·       blurred vision from mucous sticking to the lens

– but with an exception...the bumps underneath the eyelid.

   

Treatments

The Eye Practice has a variety of treatments available, and we have a great deal of experience with different types of contact lenses, so that you might not have to give up wearing contact lenses at all. In fact, our specialty is contact lenses, so when you come in for treatment for GPC, we encourage you to follow our advice to the letter – we may be able to help you stay in your lenses or find ones that won't aggravate your GPC.

GPC can be very stubborn to settle down, so there are a variety of treatment approaches we use in order to get your vision and comfort back to optimal operation. Treatment options begin with stopping wearing your current lenses so that the inflammation can subside.It does not stop there though.  Judicious use of prescribed anti-inflammatory eye drops will really make the difference in bring the GPC to its knees.

Once the irritation heals, we can work with you to find the right lens system that will keep GPC at bay, and help you to build back up to enjoying the many advantages of contact lenses.

Call for an appointment on 9290 1899 for help. 

Glaucoma for the majority of people that are diagnosed early means very simple treatment with as little as one eye drop in each eye just before going to bed - no big deal.

About one in ten people do not respond to traditional glaucoma treatment – in the form of eye drops and oral medications – and that used to mean they would go blind for sure.

Luckily, modern science and technology has brought about three newer treatment options for treatment-resistant glaucoma. They are laser therapy, and two types of eye surgery.
But before we have you look at the alternatives, let's have a look at the traditional, conservative treatment for glaucoma – eye drops and oral medications.

Primary Treatment – Pharmacotherapy

Eye drops and oral medications help relieve intraocular pressure (IOP) through biological changes to the eye structures (that's the ultra-simplified version of what those medications do). They either increase drainage of eye fluid to release the pressure, or they prevent additional production of eye fluid (also known as aqueous humor).

Sometimes they don't always work for a variety of reasons. If you have a tremor in your hands, or you have very painful arthritis in your hands, you understand that eye drops can be extremely difficult to administer. This can interfere with treatment of glaucoma through drops. Another reason for medications not working is due to the fact that if you can't “see” the problem, you'll forget to take your medicine! Some other reasons for medications not helping to treat glaucoma are the inability to cope with side effects of the medications, or they simply aren't responding to the medications they are given.

When it becomes obvious that medication will not help, it's time to look at the alternatives.

Laser Therapy

Known as laser trabeculoplasty, a laser is used on the eye in order to relieve IOP. This is a non-invasive procedure that will cause an increase in eye fluid drainage. This treatment is effective for roughly 60% of patients. For the remaining 40%, additional medications or surgery is required within five years of the initial laser treatment.

        

Filtration Surgery

Termed as trabeculectomy in the medical field, this procedure is surgical, creating a drainage channel for eye fluid. The excess fluid will be reabsorbed by blood vessels around the eye, and a drainage flap with adjustable sutures can be created by the surgeon which will control IOP.

Drainage Implants

For those who would not do well with a trabeculectomy (or have not done well with it) and their IOP is not under control, or if they have other eye problems preventing filtration surgery as a viable option, there are drainage implants. Another surgical option, these are drainage tube implants that are placed in the front chamber of the eye (called “shunts”). Small plates are then sewn into the side of the eyes, and the drainage tubes direct fluid to those plates. Then, the excess fluid is absorbed by the tissues that surround the plates.

As knowledge and research continues to grow on the subject of glaucoma, more effective medications and therapeutic options are coming out that can help arrest the development of glaucoma.

It is also reasonable to say that maybe we already have adequate treatment options for glaucoma.  What we need is better education.  Better education of the patient so they are more likely to be compliant with their medications and better education of undiagnosed patients so that they have regular eye examinations.

At The Eye Practice, Dr Jim Kokkinakis has lectured to both university students and to qualified optometrists about glaucoma, its diagnosis and its treatments.  Make an appointment for your regular eye test now on 92901 1899 or BOOK AN APPOINTMENT ONLINE HERE.

Conjunctivitis - Do Home Remedies Help?

Before we get too involved with home remedies for pink eye, also known as red eye or conjunctivitis, we need to warn you ahead of time that these are never to be used as an exclusive treatment.

If you suspect you have pink eye, come in and see us at The Eye Practice for a confirmation diagnosis. As we have said in other articles, conjunctivitis can be a symptom of an underlying disease (that can be quite serious in some cases), or is stand alone but needs to be treated in our office (such as with an antibiotic or iodine treatment).

Once you've been properly diagnosed, you may get sent home with medications, or not, depending on your diagnosis and treatment course. If you have medications, take all of them exactly as prescribed, and for as long as prescribed. Don't stop treatment just because you feel better. Symptom relief is great, true, but the symptoms can return if you don't follow the entire course of treatment. Set reminders for yourself if you're forgetful.

Now that you're at home, being good and taking your medicine, or being good and riding it out, you may find that you're still having discomfort from conjunctivitis. There are a few things that you can do to alleviate the irritation.

  

If you wear contact lenses, remove them. You will only irritate your eyes further and increase your discomfort by continuing to wear them. Switch to glasses as needed, and throw away disposable lenses that have been in your eyes during or prior to the infection. If your lenses are not disposables, you will want to clean the lenses thoroughly (we can instruct you on how to do that during your visit), or purchase a new pair of lenses. You will need to also clean your lens case, and replace your cleaning solution to avoid reinfection in some cases.

Cool and warm compresses help. For bacterial and viral conjunctivitis, many patients use warm compresses to soothe their affected eye. If that doesn't feel good, you have allergic conjunctivitis, or if it increases swelling, you will want to use a cool compress. Use a lint free cloth over the affected eye that has been soaked in warm or cool water and wring it out completely. Use separate cloths for each eye to prevent cross-contamination, or just one over the affected eye, not letting it touch the unaffected eye.

Eye drops can help. If you are still uncomfortable, talk to us about obtaining eye drops for the pain, or getting a recommendation on over-the-counter drops that can help relieve the pain of pink eye. For allergic conjunctivitis, antihistamine drops can provide some relief, but check with us first, to make sure that you aren't putting something in your eyes that will make it worse or interfere with your other medications.Often prescription eye drops are the only way to go.  Dr Jim Kokkinakis is a therapeutically qualified optometrist, who can prescribe medication to get the conjunctivitis under control.

Remember, don't mess around with conjunctivitis. Get an accurate diagnosis and proper treatment as soon as symptoms present themselves.

If your eyes are red and irritated call on 9290 1899 now.  Online appointments can also be made.

Diabetes if not controlled can affect the eyes, the feet, the kidneys, can cause strokes as well as other problems.  The best treatment for all of the associated conditions is to tightly control the diabetes but if the eyes are finally affected with diabetic retinopathy what can be done?

Significant diabetic retinopathy dramatically slows down the blood flow to the retina.  The body has an instinctive defense mechanism when it perceives that there is not enough blood flow to a given area - it creates new blood vessels to try and redirect blood, nutrients and oxygen to the starved areas.

These new blood vessels are stimulated into growing by the release of a natural chemical called vascular endothelial growth factor (VEGF).  Unfortunately these blood vessels even though they are formed for the good of the retina, tend to be very fragile and can leak or haemorrhage.  This in turn creates a vicious cycle, which causes more damage to the retina.  Left untreated it can ultimately lead to blindness.

Treatments

Historically diabetic retinopathy has been treated with laser. It is called laser photocoagulation.

The irony of laser is that it actually burns and destroys retinal tissue so that there is less demand on the blood flow to the remaining surviving retina.  Typically this restricts peripheral vision so that the central vision is spared.  Central vision is required to read, watch TV and recognise faces. 

Laser surgery can also be performed in the central part of the retina called the macula if there is leakage there.  It is done in a much more gentle fashion called focal grid laser, so again the central vision can be spared.

The most famous study that was conducted to show the benefit of laser treatment for diabetic retinopathy was performed in the 1990's.  It was called Early Treatment Diabetic Retinopathy Study and was sponsored by the National Eye Institute - NEI showed  (USA government funded to promote Eye Research).  This massive study went on to show that laser photocoagulation had a big role to play in trying to preserve the sight of people that were suffering from diabetic retinopathy.

So what is new?

As mentioned before damage to retina occurs because of fragile new blood vessels that form due to the presence of the chemical VEGF.  Wouldn't it make sense then if this chemical could be blocked, new vessels would be less likely to form and hence the retina less likely to be damaged.  This in turn would preserve vision.

A recent study again sponsored by the NEI showed that by injected an anti-VEGF drug into the eye called Lucentis on a regular basis did in fact protect eyes from the damage of diabetic retinopathy.  What was interesting was that the results were superior to laser.

The issue with anti-VEGF therapy at the moment is that ongoing injections are required to maintain vision.  Apart from being very inconvenient and costly, there is a small risk each time that a major complication could occur.

Ultimately this type of therapy is likely to be evolved into some sort of slow release implant that will be effective over a long period of time - say five years.

Treating eyes with anti-VEGF injections has become the mainstay treatment for macular degeneration now for a few years.  Surgical centres have become overwhelmed with treating these patients as many of them require injections every month.

If we add diabetic retinopathy to the system as well every month or two, treating eye disease will become an extremely labour intensive procedure.  Either more eye surgeons will need to be trained, or maybe optometrists will be trained at either the diagnostic or treatment level if slow release implants do not come to fruition. 

It might be scary to imagine having an injection in your eye every month, but what is even scarier is the thought of going blind!

Most patients will tell you that even though the injection process is not pleasant it is far from tortuous.  They are delighted that something can be done to protect their most precious sense - THEIR VISION!

At The Eye Practice we test the eyes of diabetics all the time.  We are equipped at the highest possible level to detect the beginnings of diabetic retinopathy.  We also have great working relationships with the best diabetic retinal surgeons, who we would refer you to immediately if treatment was indicated.

Call us on 92901 1899 or BOOK AN APPOINTMENT HERE for your diabetic retina check.  This should be done yearly if you are diabetic.

 

Glasses or Spectacles are relatively simple when you are under 45 years of age.  One lens allows you to see from down the road to as close as reading the small print on a medicine bottle.

The problems start usually after 45 when most of us start to lose the ability to be able to change our focus from down the street to reading a book.  The condition is known as presbyopia.  The lens that is inside the eye, when we are younger is quite supple and an internal eye muscle called the ciliary body is able to squash the lens, which in turn focuses our vision from distance to near.

As time goes on the lens starts to become more rigid so that the eye muscle is not able to change its shape any more.  When this occurs we lose our ability to read.  There are of course solutions to this problem but it will mean either two sets of glasses - one for distance and one for reading, which is inconvenient or multifocals, which have all sorts of problems but mainly a very small reading area, which makes reading a chore sometimes.

Finally in the USA a couple of companies have come up with electronically activated glasses, which automatically change the focus from distance to near just by gently pressing the side arm of the glasses called the temple.

The video below is an advertisement of one of the brands called emPower.  The other brand that has been released is called PixelOptics.  No doubt there will be subtle differences but from what we see they seem to work in similar ways.

The first generation glasses have been just released in the USA.  They are a bit heavy looking and unfashionable but like everything they will evolve very quickly once they establish a market for themselves.  Progressive research requires cash flow from earlier generation products.  Here's hoping the take up is quick, so that the competing companies have incentive to evolve the technology.

At the Eye Practice we will be stocking these unique inventions as soon as they are available in Australia.  Being in the Sydney CBD many of our patients are office workers.  If you ask any office worker that wears multifocals how they feel about their glasses they will tell you that they are a necessary evil.

We believe that the electronically focusing technology will eventually supplant the lenses that we have been using for over 50 years now.  The best analogy we can come up with, is the large cathode ray TV set which has now been fully replaced by Plasma and LCD technology.  Glasses are likely to follow a similar path.

Stay tuned, as soon as the electronic glasses are available in Australia we will start promoting them immediately.

Macular Degeneration is more likely to occur as we get older. What is also more common as we get older is that we will be advised by our doctor to start taking a low dose of aspirin.

Low dose aspirin is known to thin the blood so the likelihood of blood vessel blockages is significantly reduced hence life expectancy is increased - what a great thing!  But...

A recent study published in a world recognised medical journal (Ophthalmology) concluded that there was a significant risk of more severe macular degeneration in a group of people taking aspirin daily.  Potentially this is a huge issue if proven to be a real risk factor.

              

The study involved over 4000 participants who were all at least 65 years of age.  Like any study there were some limitations but some very solid data was able to be extracted with a high level of confidence.

As the frequency of aspirin increased so did the likelihood of more dramatic macular degeneration. 

Patients taking aspirin monthly or less had a similar rate of macular degeneration than those not ever taking aspirin. 

Patients taking aspirin at least weekly but less than daily had an increased risk of macular degeneration of around 30%, whilst the group taking aspirin daily, increased the risk to greater than 2 times.

The best conclusion that can be made from this study is (with the advice of your doctor and your expert optometrist or ophthalmologist) to consider at least reducing your intake of aspirin for the time being, until a more definite study gets published.

If you have a high risk of stroke and do not have any signs of macular degeneration then continuing with aspirin is absolutely advisable.  On the other hand if your risk of stroke is low and you have moderate macular degeneration then a reduction of dosage with the supervision of your treating practitioners might be advisable.

Never change your medication without the direct supervision of the prescribing doctors.

What is amazing about this study is that aspirin had been hailed as a miracle drug to the point that some people had recommended its use in everyone over the age of 40, irrespective of health.  As usual the best perspective is one of balance. 

Another classic example of balance is UV exposure and the risk of melanoma.  In Australia especially, we have the highest rate of melanoma in the world - this is for a number of reasons.  Over the last 20 years the has been a huge education program in getting out of the sun.  This has probably resulted in a huge increase in Vitamin D deficiency, which is possibly related to an increased risk in bowel cancer!

We just can't win, but what seems to be clear is that moderation is the key and every person is unique in how they react.

An individualised approach to every patient with macular degeneration is the best way to minimise the risks for that individual.

If you are concerned about macular degeneration make an appointment to see Dr Jim Kokkinakis at the Eye Practice.  He will guide you in the right direction.  Call 9290 1899 or Book Online.

Glaucoma affects around 2% of the population but as we age the risk of developing glaucoma becomes greater.  In other words in an age group of 20 to 30 years of age the risk of developing glaucoma could be 1/100 people but in an age group of 70 to 80 it could be as high as 1/10. 

These numbers are not meant to be exactly accurate but to give you an idea of how much more likely you are to develop glaucoma as you age.

What is for certain though is that the earlier one is diagnosed with glaucoma and begins treatment the greater the chance of not losing your eyesight.

It is Glaucoma week in America at the moment.  We urge you to view the video below but then most importantly make a habit of getting your eyes tested for glaucoma every year or two.

Glaucoma can be treated fairly simply.  The earlier it is diagnosed the simpler the treatment normally is.  Most patients require a drop in each eye just before going to bed.  How simple is that!

 

Keratoconus can be a very frightening diagnosis to get if your vision has recently deteriorated.  What is even scarier is that it can be hard to get some good news. 

Here is the bottom line - you do not go blind from keratoconus.

At The Eye Practice keratoconus is what we do.  After more than 20 years of treating patients with keratoconus we have a pretty good understanding of what to expect and exactly the appropriate treatment options at the appropriate time.

The best time for us to see a patient with keratoconus is usually when no one else has tried any treatment.  This by no way is trying to downgrade other practitioners, but the reality is keratoconus is absolutely unique with every individual. It is only after treating thousands of patients that an eye practitioner  will have a great understanding of what option to choose and at what time.

                                   

Our experience at The Eye Practice has revealed the following:

• NO ONE GOES BLIND FROM KERATOCONUS

• If an ophthalmologist or an optometrist has advised you that you cannot wear glasses, there is at least a 30% chance that this is not true.  How can this be?  Like anything, practice makes perfect.  Having seeing thousands of patients with keratoconus we have developed a skill in measuring glasses for keratoconus.  This does not mean everyone we see can wear glasses - it means of those that have been told they cannot wear glasses about 30% of the time we can find a very useful pair of glasses.  In these cases it is like winning the lottery!

• If you have failed in trying contact lenses elsewhere, we can fit you successfully 80% of the time.  Why such a dramatic difference?  Again it is about experience and options.  The average optometrist does not have any contact lens templates to try - At The Eye Practice we have over 50 different trial sets under 6 different categories.  Our specialty is keratoconus therefore we have invested in all possible options to give you every opportunity to succeed. 

• It is imperative to follow a process and not leap frog options. The process involves simple options followed by more complex ones.  Why would you want to try a complex option without having first tried a simple option?

• Referral to an experienced corneal surgeon is critical to a good result when surgical intervention is required.

• Only 5% of patients with keratoconus will require a corneal transplant.  Make sure you have failed in contact lenses before moving on to corneal transplantation.  This is because of two reasons:

1. A significant percentage will require contact lenses to see properly after corneal transplantation.
2. 50% of corneal transplants will fail by 15 years. Another corneal transplant can be done, but the second and third transplants will usually fail at an earlier time.

• Collagen cross-linking is very fashionable at the moment.  If you are over 30 years old and are offered this procedure make sure you have progressed in the disease as after 30 it is likely that keratoconus stabilises in most cases.  Crosslinking on average is better suited to some one under 25 years of age and has been documented as having progressed.

• Intacs or Kera Rings have been disappointing procedures.  Before trying them make sure an expert contact lens specialist has tried a number of options, as trying to fit contact lenses over the top of these devices is more complex - it can be done but maybe we have leapfrogged a simpler procedure in the past.

• Keratoconus is an inconvenience it is NOT A LIFE SENTENCE!

Call us on 9290 1899 or Book an Appointment Online Now.