Eye health (cataracts, glaucoma etc) - expert Q&A

For nannynormal (I get double vision in y right eye if I have been reading or looking at my phone. It lasts for a long time, but it is always there slightly.)

Answer - It is worth being assessed in an eye department to look for signs of a squint. It may be that you are losing control of the eyes for close focusing and one is drifting. At the hospital you would see an orthoptist and an eye doctor to assess this.

For baubles (My infant grandson has a coloboma in the iris of his left eye. He’s been referred to the ophthalmology department but as yet hasn’t been seen. It runs from the pupil to 5 o’clock. I realise that you can’t tell if his vision will be affected but what can you tell me about it in general terms please?)

Answer - In general people with an iris coloboma do very well with essentially normal vision in the eye. This is assuming that the eye is otherwise normal and that is the main reason for assessment to ensure that no other abnormalities are found in the eye. The hospital department will usually monitor the visual development in children with eye problems until they reach the age of around 6 or so, which is when the wiring from the eye to the brain is virtually complete and visual development is more predictable.

For watermeadow (I’m another one with cataracts, nearing the stage of needing removal, plus useful vision in only one eye. Apart from being left blind if anything goes wrong, I’m very worried how I will cope after the operation on my good eye. How much will I be able to see until I can have new glasses? Would I be best kept in hospital overnight when my good eye is covered?)

Answer - It is possible to have just a clear shield over the operated eye overnight so you can still see through it. When cataracts are removed, the new lens that is inserted into the eye is calculated to give good distance vision without glasses, so the vision should be pretty good straight away. For reading a pair, off the shelf +3 strength glasses will work well, while you are waiting a few weeks for a proper pair to be made. A senior surgeon should be involved with your care (you can request this) as you only have one useful eye and this should make it even safer.

For lili2 (What are the signs of cataract forming please. Can you still read with cataracts? drive?)

Answer - In the early stages, some forms of cataract change the focus of the eyes – this can sometimes mean that you can read without glasses for the first time in years! As they progress and the lens inside the eye becomes cloudy, then blurring of vision occurs which is not fixable with glasses. It can happen slowly so not always obvious in the early stages, but if the cataract doesn’t affect the vision then it doesn’t matter.

Driving vision (distance vision) can be affected – as long as you can see a number plate at the required distance you can drive but sometimes this is possible with some types of cataract which can affect the vision in different ways- such as increasing glare from headlights/low sun etc. The important thing is to be safe so if the driving is affected it is worth discussing the possibility of cataract surgery.

For grandmamoira (I have recently been diagnosed with cataracts. My vision is not blurry but suffer a lot from glare which is causing me migraines lasting several days. Is this common and can anything be done, apart from reactive or polaroid glasses which I now have.)

Answer - Glare is fairly common with some types of cataract. Dark glasses or tinted driving glasses can help but if it is a major problem and is affecting your daily life then it is reasonable to talk to an eye surgeon to discuss cataract surgery. If the glare is due to the cataract then the surgery should sort it out.

For Bluebelle (Short sighted -12 ish both eyes, I wear soft contacts for 40 years Astigmatism in both eyes and had torn retinas after a blow to the head some years back repaired twice been ok for a while Now have cataracts and been advised to wait until I really can’t manage because of my previous eye problems I m 74 does this sound right please? Secondly one granddaughter Very long sighted about +10 or 11 had a turn which isn’t noticeable in either her glasses (thinned glass very expensive) or contacts is there laser treatment for long sight yet ?)

Answer - 1). In general, that is a reasonable attitude to cataract surgery but the difficulty is knowing when you are not managing as the cataract can creep up on you slowly and people tend to adapt. In general cataract surgery is a safe procedure with only a small increased risk from being short-sighted. If your retinal tears were due to vitreous detachment (shrinkage of the vitreous jelly inside the eye) which they usually are, then this reduces the risk significantly. Find an experienced surgeon and it would be reasonable to have the surgery when you feel you need it.

2). Yes, laser surgery is available for long sight but not as accurate as for short sight. It is also more accurate (as is that for short sight) for lower levels of short sight. It is always sensible to wait until the eyesight stops changing (usually around the early twenties) before any laser surgery is considered.

For granny2 (I find that when I’m doing any close work I automatically close my left eye, which is the eye I had a cataract removed from. The optician doesn't seem to take any notice when I tell him. It’s driving me round the bend.)

Answer - Ask for a referral to an eye department. You may be getting some double vision from an eye drifting (squint). This can be assessed in a hospital eye department where you would see an orthoptist who assesses this sort of thing.

For mumagain (Hi, for many years I have suffered from Uveitis and as a result of oral medication (steroids) I have suffered from cataracts. The one on my left eye was removed September 2017 and the one on my right eye is nowhere near ready for removal. I expected my eyesight to improve greatly after the removal of the left eye cataract and was very disappointed to find that it didn't. I asked one of the many doctors I see at the eye hospital every few months about this and was told ' Oh you can't expect a good improvement as the optic nerve has been permanently damaged due to the inflammation. I was very surprised by this as this was the first time I'd been told this. Was there any point then in the cataract op, and is there any point in a future op on the right eye?)

Answer - Eventually, cataracts will cause complete blindness, so removing them prevents this happening. There are tests that can be done of optic nerve function so this could be done for your right eye to determine if there is any damage. However, even if there is, (your consultant should be able to determine this) it can still be worth removing the cataract, but your team should be able to determine roughly how much improvement you could expect.

For labaik (I've been told that I have a cataract developing in one eye. Early stages. Is there anything I can do to slow down the progression; wearing sunglasses etc)

Answer - There is no known way of halting the progression of cataract but it tends to be slow. Although in some studies sunlight is implicated in their causation, there is not much evidence about progression.

For paul2706 (I have been told I have cataracts developing and feel my glasses often look dirty or Misty my optician days there is nothing to worry about but would advise against removal as I have a lazy eye minimal to no vision and feels the procedure would be too risky I would value your opinion on this.)

Answer - The risk is the same as for someone with two good eyes but obviously, the implications of something going wrong are greater. I would discuss it with a local ophthalmic consultant who would be able to weigh up any particular risk in your case. Make sure you have an experienced surgeon doing your operation (you can ask for this) and the risk is low.

For mcem (Cataracts. Postcode lottery or outdated opinions when it comes to "being ready"?
My ophthalmologist believes that the op should take place just as soon as the cataracts are diagnosed and that there is no justification for the idea of "ripening".
Do you agree?)

Answer - Ripening of cataracts used to be an excuse used to put off cataract surgery as it was a poor operation many years ago. Now, it is a good, safe, low risk operation and can be offered at any stage of the development of a cataract. My way of deciding is to ask the person who has them if they are interfering with everyday life. Most people tend to adapt to slowly progressive cataract so it can be difficult to tell. Symptoms such as not being able to see road signs so easily, or getting lots of glare whilst driving at night, or difficulty reading without a bright light, can all be suggestive that it is reasonable to consider a cataract operation. No operation is completely risk free, but cataract surgery is very low risk.

For Bradfordlass72 (I thought I needed new glasses and, as I couldn't afford them, did nothing about my deteriorating eyesight. Many years later, having been diagnosed as diabetic, I was entitled to a free eye test and they discovered I had AMD. (there was and still is no damage from diabetic retinopathy) Since that time I have been having injections of Avastin in my eyes, originally every month, then 2 months and now, after 8 years of regular injections we have come as far as we can. I simply go for checks every 4 months. I would encourage everyone with any sort of eye problem to have a test because had I been aware of AMD, the ophthalmologist may have been able to slow down my AMD at a much earlier stage. I also took part in a trial by Auckland (NZ) University. They were looking for early signs of AMD, and, I believe, found them. 
www.auckland.ac.nz/en/about/news-events-and-notices/news/news-2016/03/new-test-for-early-detection-of-eye-disease.html
I do feel there should be much more publicity about catching AMD early. I can no longer read, paint or drive (books and research were my life, painting and carving my passion and of course my car enabled me to go anywhere) but I had 63 years of these treats and created heirlooms over the years. All my treatment has been free so I am not really complaining.)

Answer - I am sorry about your problems and I agree regular eye tests should be encouraged after the age of 40 or if there is a relevant disease such as diabetes. It is probable that your AMD came on later in life (it usually does) but nonetheless, any visual problem should encourage attendance at an optician or eye department to determine its cause.

For Charleygirl5 (I have had Fuchs Endothelial Dystrophy for a few years now as well as dry AMD since 2009. I can still drive but those days are numbered. I also have mild cataracts- I was led to believe that having Fuchs was a contraindication to having cataracts removed as and when. Has that changed? That to me would mean that cataracts would be most likely to cause severe visual impairment before the other two diseases.)

Answer - The cataract should be removed when it is judged to be causing significant visual disturbance. If the cornea subsequently “decompensates” (goes cloudy) due the Fuchs, then you can have an operation called DSEK which is to replace the inner lining of the cornea. This treats the Fuchs. Sometimes the two are done together, but if the cornea is not too bad from the point of view of the Fuchs dystrophy, then, removing the cataract when it is significant is fine.

For grandma2213 (I had a macular repair with vitrectomy a few years ago and it accelerated cataract development for which I had another operation. After this my vision was much clearer (right eye) though the scarring from the macular repair resulted in some distortion. I was discharged from the hospital as a result. Now I find vision in my right eye is blurred even with glasses. Is it possible that the new lens has clouded over? And can it be
replaced? I also have glaucoma which is controlled with Timoptol.)

Answer - It is unlikely that the lens itself has clouded over but quite possible that the capsule holding the implant has gone cloudy. This not uncommon and is easily treated with a YAG laser which is quick, completely painless and restores the vision immediately (it won’t improve the distortion though). It is worth being referred back to have this assessed or your optician can also assess it to see if it is the cause of the drop in vision and can refer you back to the hospital for laser via your GP.

For bamm (I have been diagnosed with pigment dispersion syndrome and have to attend the eye hospital to have the eye drainage channels assessed. My appointment is over five months away. Is the risk of Glaucoma such that I should worry about this ?)

Answer - Glaucoma tends to be a very slowly progressive condition if you have it. Waiting 5 months for assessment should be OK as your Optician will have assessed the urgency of your referral and would have asked for an urgent one if necessary. If your appointment is cancelled or moved it would be worth following it up to make sure it is rebooked soon.

For fizzers (Both my parents had glaucoma, what are my chances of getting it? what age range for the onset of glaucoma? I might add I go annually for eye testing and have done for many years)

Answer - The normal incidence of glaucoma is 1 in 100. If you have a first degree relative with it (Mother/Father/Brother/Sister) then your chance of getting it is 10 in 100. So, 10 times increased risk but, still a 90% chance of not getting it!

Annual eye checks are adequate to pick it up and you get free eye tests after the age of 40 if either parent has it. If picked up early (and it would be if you have annual check-ups), it is very much a manageable condition in most people.

For Willow500 ( I am highly myopic with astigmatism in both eyes and very thin retinas - I had laser treatment for a Neovascularization about 15 years ago which has left a blind spot just below the macular in my left eye. I wear varifocal gas permeable contacts and can see fairly well at the moment - my prescription hasn't changed for the last 3 years (still -15.72 & -16). Glaucoma also runs in the family and a scan at my last optician appointment showed PVD in the left eye and to a smaller degree in the right. I haven't noticed any symptoms with this. I'm concerned that if cataracts develop (none so far) surgery could cause more damage - I understand I wouldn't be able to have corrective lenses inserted but would clear lenses be possible?)

Answer - Cataract surgery in high myopeds is slightly more risky than in normal sighted eyes but with an experienced surgeon the outcome is still usually excellent. There is no reason why you cannot have your myopia corrected by the new implant. This is done routinely. In some units the astigmatism is also corrected by the implant if it is above a certain level (often around 2 dioptres and above). Each person’s eye is measured before the operation and a calculation done to insert a lens which will leave the eye with good distance vision without glasses. That is what is aimed for - not always achieved, but the myopia should be greatly reduced in any event. If you already have a vitreous detachment then that is protective against a retinal detachment and so this is one less risk for the cataract surgery.

For NinatheNana (I have had 5 or 6 injections in one or other eye over the last few months for diabetic retinopathy. Is it likely that I will be able to go longer than 4 wks between check ups soon? Interesting that that TwiceAsNice was told that improving blood sugar levels could help reverse the problem. I haven't been told that. I am on insulin for T2 )

Answer - Good blood pressure and sugar control are the best ways to protect the body’s organs against the damaging effects of diabetes. The interval between injections for retinopathy depends on many things but as things improve the gap should get longer. If your sugar control improves over the long term then you may be able to stop the need for injections altogether. You should discuss the control issues with your eye doctor and GP.

For TwiceasNice (I am diabetic and in Nov my last retinopathy exam showed “background retinopathy” . I have since lost weight and tightened up a lot on my diet, so my question is can background retinopathy be reversed? My GP says with blood glucose improvement (my levels are ok but am hoping my next review next week show them as much improved) my next test could be normal again. Is this true?)

Answer - Yes, background retinopathy can certainly improve with better blood pressure and sugar control. It can take some time (up to 2 years) but it is certainly worth it in the long term as controlling blood pressure and sugar are the best ways to protect the eyes (and the rest of the body).

For zoxal (Would love to know your opinion on having clear lens extraction to treat primary angle closure.... I will have had my right eye done on 17th April.)

Answer - This is now a well-established operation for eyes that are at risk of angle-closure glaucoma. If you are over the age for needing reading glasses, then you wont miss the ability to focus close as you can’t anyway. If you are younger than this then you will need reading glasses for anything closer than 2-3 feet away. Multi-focal lenses (only available privately) are probably not the best thing after a clear lens extraction as the visual quality may not be as good with these as with the standard monofocal lenses (which can be set so that you have good distance vision with no glasses but you will need reading glasses).

For moses and the follow up from travelsafar (I have had a few floaters for years, but they have just been a bit annoying. Over the past year however they have increased to the point that they are impacting greatly on my life. They make reading a book really difficult & I can't read a screen comfortably as the brightness makes it worse. I work in a school, so this is really making life difficult & depressing. I'm constantly moving my eyes back & forth to shift them. Can I have a laser treatment on the NHS to get rid of them?)

Answer - Laser treatment is not widely available in the UK and has a low success rate (around 30%). There is an operation called a vitrectomy which cures floaters. It does carry some small risks but is a well-established operation, routinely used in most eye departments for a range of eye diseases and can be used for floaters if they are troublesome enough.

For travelsafar (Hi i also have 'floaters' due to detachment of the gel at back of the eye.I am finding that bright lights or sunshine make this worse. I have been told i have cataracts forming in both eyes and sometimes my eyesight seems misty. I asked if they are ready to be operated on and was told not yet, how long or rather how bad do they have to be before they are??)

Answer - Cataracts can be removed at any stage of their development. Some Clinical Commissioning groups try to ration cataract surgery by only funding the surgery when the sight drops below a certain level on the sight chart (usually driving standard). However, this is not clinically justifiable and the Royal College of Ophthalmologists and NICE both say that cataracts should be removed when they interfere significantly with the patient’s lifestyle.

MiniMoon

Hello Larry, thanks for this opportunity to ask a question.
I have recently suffered posterior vitreous detachment of my left eye, the right eye had the same symptoms two or three years ago. I would like to know if the large, opaque floaters ever disappear. I know that the brain forgets to see them after a while, but will they ever disintegrate?

The floaters which are just part of the detached vitreous jelly usually do disappear with time as they move further forward in the eye. If not, and if they are troublesome, they can be removed by surgery (Vitrectomy) which cures them. You need to see your local eye department for this.

I will be contacting the RNIB but the GransNet team should bring the response on from Larry Benjamin or explain why not.