Eye Tests & Examinations – ProVision

Dry Eye – a big issue for Australians

provision — Wed, 05 Feb 2020 03:03:01 +0000

Dry eye disease affects more than 4 million Australians and it’s on the rise.

Dry eye is a big issue with Australians and is increasing with our ageing population. In January 2020, Optometry Australia reported 77% of Australians have suffered dry eye, yet only 26% have seen an optometrist about the plethora of new treatment options available.

It’s about the quality and quantity of your tears.

Dry eye begins with a lessening in the quality or quantity of tears. Your tear film keeps your eyes moist and protected. The top oily layer helps to prevent evaporation of tears. The middle, watery layer is the thickest layer and the sticky bottom layer helps the tear film to adhere to the eye. If the tear film is disturbed or altered, it can evaporate or become unstable. This results in dryness and inflammation of the front of the eye. The resulting symptoms may be sore, itchy, blurry or watery eyes.

Chronic dry eye is a condition that persists for a long time or is constantly recurring.

Because chronic dry eye occurs over a long period of time and is experienced regardless of environment or activities, it often has an underlying cause that can be difficult to identify. Each tear component is produced by different glands on or near the eye. A problem with any of these sources of tear film components can result in tear instability and dry eyes. More than 80% of dry eye disease comes form these meibomian glands not functioning the way that they should be. In some cases they can stop functioning altogether.

What causes dry eye disease?

Dry eye disease is caused by an imbalance in the different components of the tear layer that coat and protect the eye surface. An adequate and consistent layer of tears on the surface of the eye is essential to keep your eyes healthy, comfortable and seeing well.

No two dry eye cases are exactly the same or respond the same way to treatments, or present in exactly the same way. Dry eye disease is not something that happens overnight. It is a chronic issue that may have been in existence for some time before the symptoms actually started.

A normal tear film consists of three important components and each component has a critical purpose.

An oily component – is produced by meibomian glands in the eyelids
A watery component – is produced by lacrimal glands in the upper eyelids
A mucus component – is produced in the cells that cover the white of the eye

Dry eye disease is a multi-factorial disease. Often people have more than one influence that is producing their concern for dry eye. In years gone past it was considered an age-related condition but we are now seeing people come in much younger than they used to with dry eye disease and so we think there are a lot of environmental factors such as:

Working in air-conditioned offices
Using digital devices for extended periods of time
Pollution
Smoke, the bush-fires lately have been a provoker of dry eye disease

A number of factors can increase your risk of dry eye:

Contact lens wear
Ageing
Autoimmune disease
Smoking
Health conditions such as diabetes, thyroid diseases, arthritis and lupus contribute to dry eye problems
Medications
Aeroplane travel
Eyelid problems
Menopause

Many of the dry eye issues come from the meibomian gland dysfunction. Meibomian gland dysfunction involves the meibomian glands and these are what are described as finger shaped glands we have in our upper and lower eyelid. We have about 30 in our bottom eyelid and about 60 in our top eyelid. They produce an oil that is a very principled part of our tears. A problem with any of these sources of tear film components can result in tear instability and dry eyes.

What symptoms do optometrists see in dry eye patients?

Often there a number of people out there who already have an element of clinical dry eye but they haven’t experienced the symptoms yet. Then, environmental changes or workplace changes will push them over the edge from being asymptomatic to becoming symptomatic.

The tear layer is quite a protective layer to the eye, it protects the eye from microbes, it protects the eye from physical things irritating their eye. It protects the eye from chemicals and pollution that’s in the air. So if we don’t have an efficient tear layer on the eye then we are far more susceptible to getting irritation, the grittiness, the soreness, and the redness, from the dry eye disease.

People who may have dry eye disease will describe a burning or a grittiness in the eyes, or a pain in their eyes, almost like a foreign body sensation that they get during the course of the day.

Dry eye patients may discuss even getting some pain or having inflamed or red eyelids. They may say they feel like they have sand or grit in their eyes.

Many people get confused when they come in talking about their eyes watering a lot, as that can be another principal symptom that can lead us towards the desire to look for dry eye disease, which people don’t realise can also be a watery eye problem.

There are a lot more allergic conjunctivitis cases now too in conjunction with dry eye disease and in most cases we try to suppress the allergic conjunctivitis before we start treating the dry eye disease.

Certainly, with all the different seasons there can be different presentations, but with this bush fire season, particularly this catastrophic one that we have had, where there has been smoke lingering around for days and weeks at a time and people become more symptomatic presenting with blurry vision. Even blurry vision is a symptom of dry eye.

Optometrists spend time examining the meibomian glands and looking at the quantity and the quality of the secretions of those glands produced.

Find your nearest optometrist now

How is dry eye treated?

Optometrists offer a comprehensive assessment of your dry eyes and have a wide range of management options to provide you with the most effective solution.

Dry eye is a chronic and progressive condition, and correctly diagnosing the cause is essential to a successful management plan so that both greater eye comfort and sharper vision can be achieved. When we are looking specifically at dry eye disease, it will involve considerable examination of the eye lids, the eye lashes, exploring for inflammation, and factors that would contribute towards inflammation. We we will look at the tear stability, and tear quality closely. Treatment depends on the type and severity of the condition. Treatment can include ocular lubricants to relieve the symptoms of dry eye .We may also prescribe eye drops or recommend omega-3 supplements to help reduce inflammation of the cornea. Tiny plugs can also be inserted into the tear ducts to increase the amount of tears at the eye surface.

There is considerable variety in the causes and ways that dry eye presents, so the investigative pathway is not always the same. The diagnosis and management of dry eye disease is complex, and requires specialised equipment and clear protocols for assessment and management.

The post Dry Eye – a big issue for Australians appeared first on ProVision.

Put an eye test on your back to school checklist

provision — Wed, 04 Dec 2019 00:13:32 +0000

Why are children’s eye exams important?

Eyesight is the most important of our senses and provides 80% of the information used for learning and education, as well as coordinating our movement in and around our surrounding environment. Children require good eyesight and good eye coordination so they can reach all their developmental and educational milestones.

Eye defects often make it difficult for children to achieve their full potential

According to ProVision optometrist and University of Melbourne Senior Fellow Dr. Graham Lakkis, eye examinations can be performed on children at any age.

We asked Dr. Lakkis to unpack everything we need know about children’s eye exams and explain why it is wise to add one to your back to school checklist.

When should you have your child’s eye examined?

Eye examinations can be performed on children at any age, from babies and infants up to adolescents and older teenagers. The type of examination performed depends on the signs and symptoms that the child is experiencing and is tailored to the age group of the child and the level of their development.

In babies and infants, the optometrist looks for issues such as blocked tear ducts that haven’t opened properly, congenital cataracts and childhood tumours that can form inside the eye ball, as well as crossed eyes and droopy eyelids that can cause the development of amblyopia (lazy eye).

From the age of two and a half to three years old, children are usually able to match shapes on the letter chart so that optometrists can assess their level of eye sight (visual acuity) to detect if one or both of the eyes have reduced vision. An assessment is also made of the child’s refractive error (long sighted, short sighted, astigmatism) to ensure that any errors are at the age-expected level. It is an excellent time to have the child examined as a lot of good and reliable data can be collected, and treatments commenced well before the child has to start school.

Between the age of five to seven years old, a full examination can usually be performed at the same level as an adult eye exam. This checks for higher level visual functions such as depth perception, binocular vision eye coordination, and speed and accuracy of changes in focus.

Older children need to be regularly checked for the development of myopia (short sight) and keratoconus (irregular cornea) which greatly impact the ability to see clearly into the distance. Children with special needs such as premature babies and those with Down Syndrome often have poorer vision than the general population and need to start eye examinations at a younger age and have exams more frequently than other children.

General practitioners, child care nurses and paediatricians do not perform eye examinations

What will a comprehensive eye examination involve? How is it different to a general check by a GP?

General practitioners, child care nurses and paediatricians do not perform eye examinations but sometimes conduct “vision screenings” which are a basic test looking for a difference in vision between the two eyes. Unfortunately vision screenings fail to detect a large number of eye problems that are readily detected in a comprehensive eye examination performed by the optometrist, and screenings do not check at all for any eye health issues.

The ideal time to have the child examined is at the beginning of each school year to ensure that their visual development is proceeding normally

Depending on the child’s age group and level of development, the eye examination consists of a large number of tests that assess various aspects of vision and visual acuity, eye coordination and binocular vision, and ocular health. Some of the tests performed are distance and near visual acuity in each eye, subjective and objective measurement of the refraction (prescription) of the eye, stereopsis (3D vision), colour vision, eye coordination, accuracy of focus and ability to shift focus to different positions, and internal and external eye health. A comprehensive eye exam typically takes 30 to 45 minutes to perform.

Because 80% of learning comes through eyesight, it is important for the child’s vision and eye coordination to be optimised so there is no detrimental effect on learning and school performance.

Why is a comprehensive eye examination recommended for your back to school checklist?

Because 80% of learning comes through eyesight, it is important for the child’s vision and eye coordination to be optimised so there is no detrimental effect on learning and school performance. The ideal time to have the child examined is at the beginning of each school year to ensure that their visual development is proceeding normally, and for the optometrist to treat any underlying conditions that may impact learning. This is why it is critical to add an eye exam to your back to school checklist.

Children’s eyes continue to develop until the late teens and early 20’s, and sometimes large changes in vision can occur within a short space of time. Depending on the type of eye condition present, your optometrist will advise the best timing for the next eye exam as some children require more frequent visits during the school year.

Can poor vision interfere with a child’s learning and social development?

Eyesight is our primary sense and is intimately involved in our ability to develop, learn, walk and play. Vision problems can impact many areas of a child’s development depending on the type of issue involved. Children who have uncorrected hyperopia (long sightedness) often find reading uncomfortable and avoid books and near work, but tend to be more social and outgoing. On the other hand, myopic (short sighted) children often spend a lot of time reading and on technology to the detriment of sporting development and outdoor play, so they tend to be more introverted than other children. Amblyopia (lazy eye) often leads to poor depth perception and poor judgement of distance which can impact their ability to play sports that involve catching and hitting fast moving balls.

Are there any eye conditions in children you are observing that are on the rise?

In terms of human visual development, the eyes are at rest when looking at objects that are far away. Modern society has changed such that children spend the majority of their day performing tasks and looking at objects that are close to them, typically within arms length. Because the human visual system was never designed to do this for long periods, there has been a rapid rise in the development of myopia (short-sight) over the last few decades. In some areas over 90% of children are short-sighted by the time they reach adulthood, and it predicted that half of the world population may become short-sighted over the next 20 years.

My child loves screen time, is this damaging their eyes? How much screen time is too much?

Children spending excessive periods of time looking at screens such as phones, tablets and computers will often develop myopia (short-sight). Not only does myopia caused blurred distance vision, it also leads to the development of numerous eye diseases later in life that can damage the eyes. These eye health problems are potentially blinding and include cataracts early in life, macular degeneration, detached retina and glaucoma. Holding mobile phones very close to the eye for long periods has also resulted in some children developing permanent crossed eyes that required correction through surgery.

It is wise to limit screen time to short periods such as 20-30 minutes, and then have the child spend some time looking at further distance such as playing outdoors, before returning to their screen based equipment. Avoid allowing the child to spend hours on end playing or reading on their screens as this is often a trigger to the development and worsening of myopia. Scientific research shows that children who spend two to three hours a day playing outdoors are much less likely to develop myopia.

As children get older and their homework and study demands increase, it is still important for them to take regular breaks every 30 to 60 minutes so they can stretch their legs and walk outdoors for a few minutes prior to returning to their studies.

It is wise to limit screen time to short periods such as 20-30 minutes

Will a comprehensive eye exam necessarily mean a new pair of glasses?

Optometrists treat eye problems in a number of different ways depending on the nature of the issue detected, and the prescription of new glasses is not always required after an eye exam. Many children have a normal eye examination and require no treatment at all other than regular review visits each school year. If a problem is detected, some of the treatments used include behavioural and lifestyle changes such as outdoor play, vision therapy to train lazy eyes/poor eye coordination, and eye drops and overnight corneal reshaping for myopia management. The optometrist will only prescribe new glasses if that is the most appropriate treatment plan for the child, if there is a worsening of the child’s prescription, the spectacles have become scratched or damaged, or the child requires a second pair of glasses for home and school.

Dr Graham Lakkis is owner of Lakkis Optometry. Dr Lakkis completed a postgraduate degree in Ocular Therapeutics at the University of Melbourne in 2001 to enhance the management of complex eye disease. He was awarded fellowship of the Australian College of Optometry in 2012 for his contributions to the profession of Optometry. Currently Dr Lakkis is Senior Fellow in the Department of Optometry at the University of Melbourne, and lead optometrist of the University Glaucoma Clinic, with responsibility for lecturing and clinical teaching in glaucoma and other eye diseases. Dr Lakkis has also lectured at conferences in Australia and overseas on topics such as macular degeneration, complex contact lens fitting, glaucoma, and scanning laser tomography.

Find your nearest optometrist now

The post Put an eye test on your back to school checklist appeared first on ProVision.

How to treat glaucoma

provision — Wed, 18 Sep 2019 21:42:02 +0000

Glaucoma is a collection of eye diseases that if left undetected and untreated, can lead to optic nerve damage and permanent vision loss. It is one of the leading causes of irreversible blindness worldwide. Although we don’t have a cure, we have excellent medical and surgical treatments that can stabilise and save vision. Most people with the glaucoma are able to manage their condition successfully with the use of eye drops and at times, laser treatment. At the time of diagnosis the information from tests, assessments and lifestyle, along with condition type provides the information which will determine initial treatment.

Approximately 300,000 Australians have glaucoma
50% of people with the condition in Australia are undiagnosed

What is glaucoma?

Glaucoma is a disease where the pressure inside the eye is too high for the optic nerve, leading to nerve damage and vision loss. The optic nerve is located at the back of the eye and connects the light-sensitive retina to the brain. It’s job is to transfer visual information from the eye to the brain.

According to ProVision optometrist and University of Melbourne Senior Fellow Dr. Graham Lakkis, glaucoma has no significant symptoms so can sneak up on you, going undetected until it’s too late. That is why the condition is known as the “silent thief of sight.” Regular eye exams with your optometrist are key to early detection and prevention of vision loss.

We asked Dr. Graham what we need to know, and what we need to do to treat Glaucoma.

What causes glaucoma?

Glaucoma usually occurs when the pressure inside the eye rises to a level that causes damage to the optic nerve. Lifestyle and behavioural choices don’t contribute greatly to the development of the condition, therefore genetics and the ageing process are the main causes. As the eye ages, it is more difficult for the natural fluids inside the eyeball to drain out, leading to an increase eye pressure. Glaucoma is also more common if you a relative with the disease, so genetics plays a large part.

Who is affected by glaucoma?

Approximately 300,000 people currently have glaucoma in Australia. Due to our rising population and longer life expectancy, this figure will rise in the future. At age 40, 1 in 200 people have the condition, and this increases to almost 1 in 10 at age 80.

Family history and age are the main risk factors, are there any others?

Glaucoma has been associated with a number of risk other risk factors. For example, races such as African and Asian descent are more likely to get certain forms of the condition. Other risk factors include direct trauma to the eyeball and being very short sighted (myopia). Diseases in other parts of the body and medications such as steroids also increase your risk. Even such things as getting regular migraine headaches and having sleep apnoea are risk factors.

What are the signs and symptoms of glaucoma?

Most people are unaware they have glaucoma. This is because a gradual rise in eye pressure can’t be felt, and rapid rises in eye pressure are usually rare.

The symptoms will depend on the type of glaucoma. The most common kind is called ‘open angle glaucoma’ which causes two-thirds of cases. It has no early warning signs that vision loss is occurring due to the gradual rise in eye pressure and gradual loss of peripheral vision.

Another type is called ‘angle closure glaucoma’, where the fluid drainage angle of the eye becomes narrow and then closes up. If the angle closes rapidly, there is a sudden pressure rise which causes the vision to become blurred with coloured rainbows around lights, and headaches and nausea.

There is also another type called ‘normal tension glaucoma’. Even though the patient has eye pressure in the normal range, optic nerve damage still occurs in the same fashion as those with higher eye pressures. This is believed to be caused by poor blood circulation to the optic nerve.

With worsening glaucoma, the patient will start to have eyesight problems especially in their peripheral vision and they may experience difficulty walking down stairs and have trouble reading. Glaucoma is usually a slowly progressing disease. It doesn’t cause vision loss immediately but over years and decades, however the vision loss caused is permanent and can’t be recovered with current medical treatments. Very few people actually go blind from glaucoma if it is detected early and managed properly. The people that lose vision are usually the ones that are not getting their eyes examined regularly and glaucoma is diagnosed late when the vision has already been permanently lost.

How is the condition diagnosed?

All optometrists check eye health at every comprehensive examination, looking for the three most common eye diseases cataracts, glaucoma and macular degeneration as well as other less common problems.

There is no single test for detecting glaucoma, so the optometrist looks at the results of a number of tests such as medical and family history, eye pressure, optic nerve assessment and drainage angle appearance to find patients that are suspicious for having the condition. These ‘glaucoma suspects’ are then examined with specialised instruments such as OCT scans, corneal ultrasound and visual field testing to make the diagnosis. Sometimes these tests have to be repeated over a number of months or even years to determine if deterioration is occurring.

How is glaucoma treated?

Once a diagnosis is made, treatment needs to be commenced. While most optometrists can detect and diagnose glaucoma, a number of optometrists have the equipment and expertise to treat it as well. At our clinic we treat all of our own glaucoma patients, and receive referrals from other optometrists to manage their patients as well.

Treatments includes medicated eye drops, laser, and surgery, however the vast majority of glaucoma is treated with eyedrops.

Glaucoma eye drops contain a pressure lowering medication, like blood pressure tablets but in liquid form, that are instilled once or twice a day. Eye drop treatment reduces the pressure by about one-third to protect the eye from further damage. There are about 10 different varieties of eye drops and some patients need to use multiple medications to control their glaucoma effectively. In cases where the patient becomes allergic, the eye drops don’t work or the patient is forgetful and doesn’t use them as directed, the optometrist needs to consider other treatments. These include cataract surgery with drainage stents, selective laser trabeculoplasty (SLT) or drainage surgery called trabeculectomy. To access these treatments your optometrist will refer you to a surgeon.

Although surgery is not frequently required, it can be a better option than drops to keep eye pressures under control. SLT laser surgery lowers pressure a similar amount to eyedrops but the effect from laser only lasts for about 2 years then has to be reapplied. Drainage stents and drainage surgery are longer lasting treatments that are useful at keeping eye pressures low for the long term.

Do you advise young people to have vision checks too?

Although glaucoma is not common earlier in life, it can still occur, even in babies. Young people need eyecare, especially for optimising their vision and reducing eye strain while they read, work and study. Vision problems such as myopia are also increasing in young people due to excessive screen use.

Many people don’t go to the optometrist unless they have blurred vision, and if they don’t wear glasses they miss that opportunity to get their eye health checked. We encourage people to go to the optometrist regularly so that if there are any early signs of problems, they can be detected and treated before they become major issues.

For long term healthy eyesight, it is vital to have a comprehensive eye exam every 2-3 years. If over 65 years of age, annual exams are recommended. If there are other risk factors, more regular checks may be required and your optometrist will advise you on how often you should attend.

Is there any good news about glaucoma?

There have been great advances in glaucoma in recent years due to extensive scientific research. With new diagnostic equipment, practitioners are detecting the condition and starting treatment at earlier stages than in the past. Medications, stents and lasers have all improved to become safer and better tolerated. There are new drops and injections due to arrive in the near future.

The best news is that glaucoma rarely causes blindness anymore. With regular eye exams, early detection and modern treatments, the condition can be well-managed to ensure lifelong good vision for our patients.

The post How to treat glaucoma appeared first on ProVision.

What is an OCT scan?

balanceinternet — Thu, 03 Jan 2019 01:40:16 +0000

An OCT scan (Optical Coherence Tomography) uses an important piece of technology that allows your optometrist to capture cross-sectional images of your retina, located at the back of the eye.

How does an OCT scan work?

This advanced diagnostic tool uses a scanning laser (an eye-safe near infrared light) to analyse the layers of the retina and optic nerve. Using this technique, the OCT technology is able to capture higher resolution images of the structural layers of the back of the eye. This plays a vital role in the prevention and treatment of eye disease, as tracking the health of your eyes over time allows your optometrist to pick up early signs of eye disease that are not noticeable until the disease has progressed significantly when treatment is no longer possible.

What can I expect?

An OCT scan involves you sitting comfortably in front of an OCT machine, placing your head in a chin rest in front of you. Remaining still, you will look at a coloured light inside the machine which will allow the machine to map the back of your eye safely using harmless light waves similar to a bar code scanner.

Advantages of an OCT include:

Safe, quick and pain-free
Non-invasive
High quality, instant images of the form and structure of the eye tissue
Baseline for optometrist to monitor eye health over your life
Usually does not require dilating drops

Do I need an OCT scan?

Depending on the health of your eyes, family history and age, your optometrist might recommend an OCT scan at least every 2 years to monitor your eye health, particularly if you are in a high risk group.

Book an eye test today

75% vision loss is preventable or treatable. Our community of independent optometrists pride themselves on having the latest diagnostic tools so that they can see more, and ultimately give you and your family the best care possible.

Find your nearest optometrist now

The post What is an OCT scan? appeared first on ProVision.

What is retinal imaging?

balanceinternet — Thu, 03 Jan 2019 01:39:07 +0000

Retinal imaging is a high-resolution digital image taken of your retina, blood vessels and optic nerve located at the back of your eyes. This important piece of technology assists our optometrists to detect any eye health problems or signs of disease early by looking out for any changes over time. It is commonly used for the early detection and management of eye diseases such as glaucoma, macular degeneration, diabetes and hypertension, which we know to be critical in the prevention of serious eye disease progression and vision loss.

How does a retinal scan work?

Just like a regular photo, a retinal scan is completely pain-free. It involves an invisible beam of infrared light being directed into your eye as you look through the eye piece at a coloured dot. It then maps the unique patterns of your retina so that the optometrist has a benchmark to compare against in the future, to ensure even the subtlest changes in the health of your eyes over time can be picked up.

Advantages of retinal imaging include:

Safe, quick and pain-free
Non-invasive
High quality instant digital image
Detailed images of retina and the important sub-layers of the back of the eye
Baseline for optometrist to monitor eye health over your life

Do I need a retinal scan?

Depending on the health of your eyes, your optometrist might recommend a retinal scan, particularly if you are at risk of a retinal detachment or tear.

Book an eye test today

Our community of independent optometrists pride themselves on having the latest diagnostic tools so that they can see more, and ultimately give you and your family the best care possible.

Find your nearest optometrist now

The post What is retinal imaging? appeared first on ProVision.

What is advanced eye testing?

provision — Wed, 22 Mar 2017 01:04:55 +0000

Advanced eye testing is often used to complement your 360° eye consultation in the early detection of eye disease. Our optometrists invest in leading eye testing technologies to provide you with best-in-class eyecare. These advanced eye testing tools allow them to take an in depth look at your eye health.

Retinal Imaging

Retinal imaging is a digital image taken of the retina, blood vessels and optic nerve located at the back of your eyes to assist in the early detection and management of certain eye diseases, such as glaucoma, macular degeneration, diabetes and hypertension. It is a painless test, no different to having your picture taken, and takes a few minutes to complete. It will provide your optometrist with not only a health assessment of your eye, but also a benchmark of what a normal image looks like for your eye in order to better detect any changes in the future. Retinal imaging is not currently covered by Medicare. The additional fee will be discussed with you beforehand.

OCT Scanning

Optical Coherence Tomography (OCT) Scanning is used in the early detection and management of eye diseases. The OCT scan is so detailed that it has even been likened to an MRI of the eye. This scan allows your optometrist to see detailed images of the retina (the inner most layer of the interior eye), enabling them to accurately detect, monitor and control changes to the retina. This procedure is currently the only one that shows in-depth images of the eyes internal structures. Other procedures only show the surface of these structures. The scan only takes minutes and the equipment never touches the eye so you will feel no discomfort.

Optomap Retinal Photography

The Optomap takes an ultra-widefield view of the retina for the detection and management of common eye diseases such as glaucoma, diabetes, macular degeneration and even cancer. Unlike traditional imaging methods, it captures a staggering 80% of your retina while traditional methods capture only 15%. The image of the retina is captured in only a quarter of a second! It’s just like having a picture taken. Dilation drops may be required.

Safeguard your eye health

Prevention is key when it comes to avoidable vision loss. If you’d like to learn more about how an advanced eye test can benefit you, get in touch with one of our expert optometrists.

Find your nearest optometrist now

The post What is advanced eye testing? appeared first on ProVision.