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

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 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 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 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 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 greciangirl (I sometimes experience bright wavy lights to the side of my eyes. Also occasional flashing lights. Is it anything serious.)

Answer - If the bright wavy lights last a few minutes and then go, they are likely to be a form of migraine. Occipital migraine (which affects the seeing part of the brain) is not usually associated with any headache (although the head can feel a bit fuzzy for a while). Classically the waves or lights grow in size or move and then disappear. This is nothing to worry about. If there is any long term affect on the vision, then it is worth seeing an eye doctor about it but if it goes back to normal each time, then not.

For Wallers5 (Why do I wake up with red eyes all the time?)

Answer - The eyes can look red in the mornings sometimes but with no other symptoms/problems it is unlikely to be serious or significant. When lying down the veins on the white of the eye will fill more with blood than when standing up.

For Hazeld (I almost always wake up in the mornings with red eyes, the actual eyeball itself is very red with red veins. What causes this and is it anything to worry about please?)

Answer - The eyes can look red in the mornings sometimes, but with no other symptoms/problems it is unlikely to be serious or significant. When lying down the veins on the white of the eye will fill more with blood than when standing up.

For Meg54 (My eyelids on both eyes itch like fury top and bottom. I have used Blephasol, Sodium Cromoglicate, warm eye pads and baby shampoo, all to no avail. This has gone on now for over 3 years, and each morning I wake up feeling like I have been punched in the eyes! Is there anything I can do?)

Answer - Itching usually denotes allergy. If the eyelids are red/swollen as well as itchy then you may have a contact allergy (eg to the soap powder you use on your pillows/make up/make up removers/face creams – anything really!). It is worth getting this looked at by an eye doctor or dermatologist to try to work out if it is an allergy. It is always difficult to make a diagnosis without seeing the problem first hand so an appointment for this would be good. It could also be a chronic allergic conjunctivitis but again needs to be seen to be analysed.

For ginamat (I have suffered with dry eyes and blepharitis for several years and have done all the things I am supposed to do - warm the eyelids, gently massage them and use eye drops, mainly artificial tears. I also use chloramphenicol when needed 
as I often get infections. The trouble is that my eyes are very sensitive and don't like me messing about with them too much. Is there anything else you can suggest please as it's driving me mad!)

Answer - Blepharitis is a chronic condition which needs managing – it is often controllable rather than curable. You need to be seen in an eye department if you have not already and they might suggest trying an oral antibiotic such as Doxycycline which can sometimes help with the lids if used for 3-6 months. If other methods are not working, occasional topical steroid cream can also be used but needs supervision in an eye department as it can have other effects on the eye.

For Dannirae () I have dry eyes but strangely enough they mainly only trouble me when I am even slightly stressed. For example, I can be perfectly fine, the phone will ring and if the call is anything stressful POW I have dry eyes. How can this be? I visited an optician to do with my dry eyes - she did a very thorough examination - but when I told her of my selective dry eye problem she said she had never heard of it. I am sincerely hoping that you have and can help me.)

Answer - It may be that stress makes a pre-existing mild dry eye worse for various physiological reasons. There is no syndrome as far as I know to explain this but would suggest using the artificial tears more often when it happens. Using a preservative-free drop (such as Blink or one of the hyalotears preparations) is useful as they can be put in whenever needed, with no side effects.

For Christalb (I have been diagnosed with 'narrow angles' and advised that I should have a Laser Iridotomy within two years. Is this necessary, and if it is, how soon should I get it done. Should I have it done now and not wait two years??? Thank you.)

Answer - It is not possible to predict exactly when this should be done... The reason that it is time dependent is that the lens of the eye grows throughout life getting thicker and thicker. In eyes with narrow angles, the drainage channels which sit in the angles can become obstructed causing an acute form of glaucoma as the lens grows. Putting holes in the iris stops this happening (as does having a cataract out when one is older). If it needs doing there is no particular reason to wait as it reduces the risk of the acute glaucoma happening to almost zero.

For immiesnana (I had a Macular hole and lens implant operation in July 2018 and my Consultant is pleased with the result. I however feel that the vision is still slightly distorted which my Consultant says is due to scarring. I would like to know if it will improve with time.)

Answer - Distortion is usually due to a kink or scar in the retina caused by the macular hole. It can sometimes improve a little with time but is unlikely to get back fully to normal. It also should not get any worse with time.

For candelle (I had macular hole surgery a few years ago. I was recently 70 and was required to undertake a DVLA eye exam during which I had to score 100% in the peripheral vision test*. I understand my license will need to be renewed in three years (as with everyone my age) but could you please tell me if I will have to take the DVLA test again? *I was told I had three attempts at this test and then.... no license! 
Shaking like a leaf, I first scored 119/120 but told this was a fail. I had to re-take, managing 120.)

Answer - It is unusual to have to get 100% on the Easterman field test. There are rules that need to be met but odd missed points are usually allowed. DVLA don’t allow more than two missed points together within the 20 degrees of central fixation (the spot you are looking at centrally) and there are rules about the periphery too but it would be unusual for a maculkar hole in one eye to cause a problem, as most people can drive legally with one in terms of the field of vision. As the Easterman test is carried out with both eyes open you should pass it easily assuming the other eye is normal.

For annanan (My 12year old grandson has extreme sensitivity t9 light so much so that his dread on going to the dentist is more from fear of overhead light than the drill. Is that normal and does it carry some risk for future eyesight?)

Answer - Extreme light sensitivity is not usual. It is worth getting it looked at in an eye department where they can rule out known causes. It is possible that it is normal but just extreme but I would get it checked.

For Shabby (Following a cataract operation on my left eye in September 2017 I have been diagnosed with negative dysphotopsia. Although my vision in this eye is fairly good the effects of the condition are not good i.e. the shadow/dark strip on the left side of the eye and my reaction to sunlight and artificial light. Shopping can be a nightmare because of the lighting in shops. For various reasons it has taken some time to diagnose this condition because it is quite rare - my optician has never heard of it in 40 years of practicing! The discomfort I can feel varies from day to day and on a scale of 1-10 can be one or 10 with no discernible reason for the change. My consultant has offered a lens replacement using a different type of lens and has said he will place the lens slightly differently. However this is not without complications and because it is not known who or why negative dysphotopsia affects neither he or I will know if it will be successful - it could make matters worse. At my last visit to see the consultant he offered a different solution which is I have a cataract in my right eye and he thinks if my lens in my right eye was replaced it could make it the dominant eye which could lessen the problems I have in my left eye. He has no way of knowing however if I could suffer the same condition in both eyes so it would be a leap of faith on my part to have this done. I really would appreciate your thoughts on negative dyphotopsia and possible solutions to the condition.)

Answer - I see a number of such cases and they have so far all been cured by replacing the existing lens with one in what is called the cilairy sulcus. This is a space between the lens and the iris. I use a 3-piece lens (one with thinner legs) which is necessary because of its new position and to date all have been successful. It is likely that you would get the same symptoms in your second eye if you use the same implant so I usually suggest to people to have their second eye done and have a lens placed in the ciliary sulcus. I use an Alcon MA60AC 3 piece posterior chamber lens in the ciliary sulcus not in the capsular bag. Your surgeon will understand this. If this is successful then think about having the first eye lens replaced with a similar one, knowing it will work. There are potential risks with a lens exchange but they usually work well.

For razzy (Do you find retired professional pilots are more likely to have faster deteriorating vision? Are there any long-term effects of the lower oxygen at altitude?)

Answer - There is a little bit of evidence for pilots getting cataracts a bit earlier and this is thought to be due to increased radiation levels (many different wavelengths) found at high altitudes but difficult to prove. Other than cataract formation I haven’t come across any other particular issue.

Cari I agree, thank you so much, that was very much appreciated.

Hi Cari ......Please thank Larry for his helpful reply.

Hi Cari please thank Larry for his reply. I feel more confident about making a decision now that I have his opinion.

I have recently discovered damage to the Macula in my weakest eye (operation for lazy eye age 5 )
The photograph taken in eye hospital shocked me as it looked as if something had burst through it. They explained it as looking “ like a crumpled piece of paper “
Will it repair itself or is my sight likely to deteriorate?
I am currently waiting for a follow up appointment but it seems I might have quite a wait.
In the main time I’m worrying.

I am not an expert but I do understand from my eye history that glaucoma has a significant family history.
I think if you have a family history and at about 40 yrs you can get your eye tests free. Or could.

There is run of 5 females in my family to my knowledge.

Please thank Larry for his response to my question

Many thanks to Larry for his response. I will now do something about my vision loss, armed with this knowledge rather than think I am just being fussy and a nuisance.