Macular degeneration in elderly eyes
Optometrists provide eye examination and they undertake screening for any eyes or general health conditions. They also prescribe spectacles and contact lenses
To qualify for a free eye test the following criteria apply:
- Patients who are over 60 years of age
- Patients who are diabetic
- Patients who suffer from glaucoma
- Patients who are entitled to pension credit guaranteed credit
- Patients who are registered blind or partially sighted
- Patients who receive pension credit guaranteed credit are entitled to a voucher which provides some help towards the cost of the spectacles
The importance of an eye examination is not only to ascertain the correct spectacle prescription, but to screen for general medical conditions and eye disease
The most common medical conditions that can affect the eyes are hypertension and diabetes
The consequences of diabetes on the eyes can be related to mild capillary leakage called diabetic retinopathy to complete loss of vision. So it is important to have regular eye examinations to prevent sight loss
Hypertension can also lead to eye problems and consequently strokes. A good healthy diet and regular exercises are important for the health of the eyes
Macular Degeneration
The most pressing issue now with old age is macula degeneration with 25,000 new cases of wet maculopathy developing annually in the UK
Wet maculopathy represents only 20% of cases but leads to 80% of vision loss
The early diagnosis of this condition is vitally important as treatment can be administered urgently with all the eye clinics given funding for treating wet macula degeneration free of charge
The symptoms of Wet Macula degeneration are:
1. Blurred vision when reading or watching television
2. Waviness of straight lines
3. Distorted faces
4. May feel their eyesight has changed and think they need new spectacles
5. Unable to judge distances when driving and hitting the road kerb
6. Difficulties with pouring water in a cup and accidentally scalding their hands with the hot water
For us, the optometrist, it is not always very easy to diagnose macula degeneration and a clear history of when the sight loss was noticed and the problems encountered are important markers. Vision assessment will reveal:
- Poor vision on the test chart as well as poor reading vision
- Amsler grid shows distorted lines on the chart
- Amsler chart may reveal central black spot in the middle of their vision
- Important diagnosis is made by observing the back of the eye with an instrument called the ophthalmoscope
- This is then backed up by a fundus camera, which will reveal either bleeding or fluid or plasma leakage at the centre of the eye
- This is referred to as serous or exudative maculopathy
- A much more versatile instrument the OCT makes the diagnosis of wet macula degeneration with minimum fuss. It scans the eye rapidly without touching the eye and is therefore a non-invasive pain free procedure
- This image which shows a neovascular membrane which is a new vessel that develops in this condition
- Since these new vessels have thin walls they are likely to leak blood or fluid into the surrounding tissue
Once the diagnosis is made, the optometrist will urgently organise a referral to an ophthalmologist for immediate treatment with Lucentis injection
Treatment
Lucentis is the brand name for ranibizumab, a drug injected into the eye to slow vision loss in people who have “wet” age-related macular degeneration (AMD)
Lucentis is an anti-vascular endothelial growth factor. In essence, it prevents formation of neovascular membrane by opposing the stimulant called the vascular endothelial growth factor it works like a sponge absorbing all the leaked blood and fluid from the retina
Initially, 3 injections are applied over a period of 3 months and then assessment are undertaken by the hospital every 6 weeks to see if more injections would be necessary.
Exciting therapy which is undergoing clinical trials is a rejuvenating laser for dry macular degeneration. This laser does not destroy or affect the retinal layers but it helps rejuvenate parts of the retina affect by dry macula degeneration. Clinical trials are under way and the results should be available in 18 months from the London Hospital
Award winning Optometrist Kirit Patel owns and operates Radlett Opticians. His professional and easy going attitude has built up a loyal patient base since 1991. The practice provides service to a population of around 15,000 people
Tel: 01923 855888
Kirit is a winner in two categories of the National Optician Awards 2012
- Technology practice of the year 2012
- Optometrist of the year 2012
