Cataract

Cataracts are formed when the clear lens inside your eye becomes cloudy or misty. This is a gradual process that usually happens as we get older. It does not hurt. The early stages of a cataract do not necessarily affect your sight. The only proven treatment for a cataract is surgery. If the cataract gets to the stage where it affects your sight, your optometrist will refer you to a hospital to have this done. The surgery is carried out under a local anaesthetic and has a very high success rate.

What causes cataracts?

The main cause is ageing and most people will eventually develop a cataract in both eyes, although one eye may be affected before the other. Both men and women can develop cataracts. Younger people can develop cataracts if they have an injury to the eye. Some medical conditions such as diabetes, or taking some sort of medication such as steroids, may also cause cataracts. A very small number of babies are born with a cataract.

Will cataracts affect my vision? If you have cataracts you may notice that your vision is less clear and distinct. Car headlights and streetlights can become dazzling, and you may experience difficulty moving from shade to sunlit areas. Colours may look different too, and become faded or yellowed. If you experience any of these symptoms, make an appointment to see your optometrist. If you are long-sighted, you may even notice that you need your glasses less than you did before you had the cataract! It may be that the cataract is causing a change to your long or short sight, and your sight can be improved simply by changing your glasses. We have more information, and a video of how cataracts may affect your vision, Useful Link lookafteryoureyes.org/amd. Can I prevent cataracts? There are various supplements on sale which claim to help slow the progression of cataracts and some eye drops are sold as a treatment for cataracts. There is no scientific evidence to suggest that any of these can prevent or treat cataracts. Smoking and prolonged exposure to ultraviolet (UV) light increase your risk of developing cataracts.

Blepharitis

What is blepharitis? Blepharitis is an inflammation of your eyelids. It can make eyelids red and eyelashes crusty and make your eyes feel irritated or itchy. It can also lead to burning, soreness or stinging in your eyes. In severe cases, your lashes may fall out, and you can develop small ulcers or styes as well. You may find your eyelids become puffy. The symptoms tend to be worse in the morning and when you wake up you may find your lids are stuck together. Blepharitis is a chronic (long-term) condition. This means that once you have had it, it can come back even after it has cleared up. It normally affects both eyes. You can usually treat it by keeping your eyelids clean. You may need to do this for several months.

Why do I get blepharitis? There are two types of blepharitis. Anterior blepharitis – this affects the outside front edge of your eyelids (near or among your eyelashes). It may be caused by staphylococcus bacteria. Posterior blepharitis – this is also called meibomian gland dysfunction (MGD). MGD is caused when something affects the inside rim of your eyelids, just behind your eyelashes, which contains your meibomian glands. Your meibomian glands produce part of your tears. You may also get blepharitis as a complication of seborrhoeic dermatitis, which makes your skin inflamed or flaky. This can involve the scalp (when it is called dandruff), lashes, ears and eyebrows. Seborrhoeic dermatitis can cause both anterior blepharitis and MGD. Blepharitis is a chronic (long-term) condition. This means that once you have had it, it can come back even after it has cleared up.

Who is at risk of blepharitis? Blepharitis is more common in people aged over 50, but it can develop at any age. As you get older, the glands in your eyelids that secrete part of your tears become blocked more easily. Your tears contain fewer lubricants and your eyes can feel gritty and dry, so seborrhoeic blepharitis and MGD tend to happen more in older people. How will I know I have blepharitis? Your optometrist, GP or eye specialist can spot the signs of blepharitis by looking closely at your eyelids. A doctor may decide to take a swab which can be sent away to be checked for a bacterial infection. How should I look after my eyes if I have blepharitis? It is possible to make your eyes more comfortable, but blepharitis often cannot be totally cured.

If you have blepharitis, avoid smoky atmospheres and eye make-up, particularly eyeliner and mascara. There are treatments that can help you reduce the effects of blepharitis. However, there is no strong evidence that any treatment can completely cure the condition. You may need treatment for several months.

AMD

Overview The macula is an area at the back of your eye that you use for seeing fine detail such as reading a book. Macular degeneration (MD) covers a number of conditions that affect the macula. The conditions affect your ability to do certain tasks such as reading and watching television but do not affect your ability to walk around as your side vision is not affected. One of the most common symptoms of MD is noticing that straight lines appear wavy or that there are patches missing from your vision. You may not notice this if it happens in one eye as your other eye will compensate, so it is important to regularly check your vision in each eye separately. You can do this by looking with each eye separately at the straight lines on a door frame or Venetian blind. If you notice the lines are distorted or there are missing patches, you should see your optometrist straight away.

What is macular degeneration? Macular degeneration (MD) happens when the macula at the back of your eye becomes damaged. This can make it harder to see fine detail, such as recognising faces or to read or watch television. However, this does not normally affect your ability to walk around as the edge of your vision should not be affected. One of the most common symptoms of MD is noticing that straight lines appear wavy or that there are patches missing from your vision.

Will I go blind if I have MD? MD is the leading cause of sight loss in the UK. However, most people with MD still have their peripheral (side) vision and so can see well enough to get around. However, they may not be able to see well enough to read without strong magnification. Does it happen more as you get older? The most common forms of MD happen more as you get older and are known as age-related macular degeneration (AMD). Around one in 10 people aged 65 or over show some signs of AMD. Some younger people may have MD caused by a genetic condition but this is less common than AMD. What are the symptoms of AMD? Some people simply notice that things appear blurry or they have difficulty reading, even with their normal reading glasses. Other people may notice that they have a smudge in their central vision which does not go away, or they may notice that straight lines are distorted or wavy. The most common forms of MD happen more as you get older and are known as age-related macular degeneration (AMD). Some people with AMD may notice that they become sensitive to bright light, or that they find it difficult to adapt when going from a dark to a light environment. Some people notice that colours can fade. These symptoms are more noticeable if you look for them with each eye separately, because, if you have both eyes open, the better eye may compensate for the other one. We recommend you regularly check your vision in each eye separately by looking at some detail, such as a book or magazine, and covering each eye in turn. This will help you notice any changes in your vision early. You can find more information, including a video showing how AMD may affect your vision, on our website, at lookafteryoureyes.org/amd

We recommend you regularly check your vision in each eye separately by looking at some detail, such as a book or magazine, and covering each eye in turn.

Presbyopia

There are two main parts of your eye that are responsible for focusing light onto your retina at the back of your eye so that you can see clearly. These are your cornea, which is the transparent dome-shaped part at the front of your eye which covers your iris, and the lens inside your eye. The lens inside your eye changes shape to allow you to see things that are close to you. As you get older the flexibility of the lens inside your eye reduces. This means that you are less able to focus on things that are close to you, so you may need to have reading glasses. This leaflet explains why this happens and what the various options are for correcting it.

What is presbyopia? When you are looking at something that is far away, your eye – if you are perfect-sighted – is shaped so that the object is clearly focused on your retina. This means that the image is clear. When you look at something close up, for example, to read a book, the muscles inside your eye that surround the lens contract to make the lens change shape. This focuses the light from the book onto your retina. The lens inside a child’s eyes is elastic, and so can change shape easily to enable them to change focus from looking at something far away to looking at something close up. As we get older, however, the lens naturally stiffens and so it changes shape less easily. This means that we can no longer focus on things that are close to us and have to hold them further away to see them clearly. Cornea Pupil Iris Retina Lens Optic nerve Vitreous humour or ‘jelly’ A change in focusing tends to become more noticeable when we reach our late thirties or forties

Are there exercises I can do to stop needing reading glasses? Presbyopia is not caused by muscle weakness but by the lens stiffening as we age. There are no exercises that can help this. Will presbyopia affect my distance vision? If you are emmetropic (perfect-sighted), presbyopia will only affect your ability to see close up (reading, for example) and middle vision (using a computer, for example). It does not affect your distance vision, so you will still be able to drive without glasses. If you are hyperopic (long-sighted), as you get older and the lens stiffens, both your distance vision without glasses and your near vision will become worse. You will then need to wear separate glasses for both distances and near vision or have bifocals or varifocals, to see clearly. Our optometrist will tell you which applies to you. If you are hyperopic (long-sighted), as you get older and the lens stiffens, both your distance vision without glasses and your near vision will become worse.

Will presbyopia affect my near vision? If you are myopic (short-sighted), you will find that you can read more easily by taking your (distance) glasses off, although if you are very short-sighted you may have to hold things very close to see them clearly without your glasses. This is because your natural focus is close up, so you can see things clearly at this distance without your glasses. You may prefer to have bifocals or varifocals to stop you from having to take your glasses off when you want to read. I notice I mainly need my reading glasses at night – why is this? It is very common to find that, if you need glasses, things are more blurry without them in dim light. This is because your pupils get bigger in poor light and you have less depth of focus. This means that you notice the blurriness more. The opposite effect is that you will often see better in bright light, for example outdoors in the sunshine when your pupils become smaller. This increases your depth of focus so that you don’t notice the blurriness as much. You may also find that you are more tired at night, so your muscles find it more difficult to contract to change the shape of your lens. It is very common to find that, if you need glasses, things are more blurry without them in dim light.

Will wearing glasses make my eyes worse? No. As presbyopia is caused by the lens stiffening, and not the muscles weakening, wearing glasses will not make your eyes worse. However, you may notice that when you take your glasses off, things appear to be worse without the glasses than they were before you had them. This is simply because you are noticing how clear and comfortable vision should be. Before you had the glasses, you were unaware of how blurry your vision really was because it changed slowly over the years. Presbyopia will get worse as you age until you reach your late fifties when you will have no natural focusing ability left.

Myopia

Overview What is myopia? Myopia means short-sightedness. If your child is myopic (short-sighted), this is usually because their eye is slightly longer than usual (from the front to the back). This means that light focuses in front of their retina at the back of their eye, rather than focusing directly on it.

Who is affected by myopia? Around a third of people in the UK are myopic. The condition usually starts in childhood (between six and 13 years of age) and tends to get worse until the eye has stopped growing. Myopia can also develop in younger children and adults. People are more likely to become myopic if their parents are also myopic. What are the symptoms of myopia? If your child is myopic, they will have problems seeing things in the distance clearly without glasses or contact lenses, but will be able to see things that are close to them. There are varying degrees of myopia. How is myopia treated? Myopia is usually easy to correct with glasses or contact lenses (or both). Some adults with myopia have laser surgery to correct it. There are some treatments that may slow down myopia during childhood. This is called myopia management. How myopic may my child become? The exact causes of myopia are not fully understood, so it is difficult to predict accurately how myopic any child may become in the future. Researchers know that the following things may make it more likely that a child will eventually become myopic: • having one or both parents with myopia; • being of east-Asian ethnic origin; • spending limited time outdoors. Becoming myopic before nine years old may increase the risk of developing a high level of myopia. If a person has a high level of myopia, they will be at a slightly greater risk of losing their sight later in life due to conditions such as retinal detachments, glaucoma and myopic retinal degeneration. Can I reduce how myopic my child will become? Trying to slow down how quickly myopia gets worse is called myopia management. A number of treatments have been developed for this, including specially designed contact lenses or glasses, and atropine eye drops, but not all are commonly available in the UK. Current evidence suggests that using special contact lenses or atropine eye drops may reduce the progression of myopia by 40% to 60% after one to two years (some manufacturers’ studies suggest a reduction in its progression over three years). Using specially designed glasses can also help to slow down the progression of myopia. If myopia management is successful, this may mean your child grows up with a lower level of myopia than they would have had without treatment. This means that they may not depend on their glasses as much as they would otherwise have had to, and the prescription for their glasses will be lower, so their glasses will be thinner and lighter. Being less myopic may mean your child is slightly less likely to be affected by conditions such as retinal detachment and myopic retinal degeneration.

Lifestyle & Eyes

Overview Your eyes are affected by your lifestyle and health conditions elsewhere in your body. This leaflet highlights the effect your lifestyle and health can have on your eyes.

Stopping smoking is the single best thing that you can do for your eyes and to improve your current and future health. Many smokers want to quit, and you do not have to do it alone. In some areas, optometrists work with the NHS to provide services to help you quit. Ask your optometrist if they are able to help you in this way or if not, can point you to someone who can. We have produced leaflets on macular degeneration and cataracts. Ask your optometrist for a copy, or visit lookafteryoureyes.org to find out more. Nutrition Although there is no strong evidence about the effect of diet on AMD, eating a wide variety of fruit and vegetables, including dark green leaves, is good for your general health and may support good eye health. There are lots of dietary supplements on the market which claim to be beneficial for eye health. There is no good evidence that the general population should be taking these supplements. Eating a wide variety of fruit and vegetables, including dark green leaves, is good for your general health and may support good eye health. replace information that is given to you by a healthcare professional. If you have any questions about your eyes, please speak to your optometrist.

Smoking There is good evidence that smoking causes sight loss. Tobacco smoke has up to 4,000 active compounds. Most of these are toxic and potentially damaging to the eyes. Smokers are up to four times more likely to develop age-related macular degeneration (AMD) than non-smokers. AMD is the leading cause of sight loss in the UK. Macular degeneration is when the macula at the back of your eye becomes damaged. This affects your ability to see detail, such as recognising faces or reading or watching television. Smokers are also more likely than non-smokers to develop cataracts. Cataract is when the lens inside your eye goes cloudy. It does not always affect your vision in the early stages, but tends to get worse as you get older. If it affects your vision you will need an operation to remove the cataract. Stopping smoking is the single best thing that you can do for your eyes and to improve your current and future health.

Diabetes People who have diabetes are more likely to develop cataracts than people who do not, and some evidence suggests they are also more likely to develop glaucoma. Glaucoma is when the pressure inside your eye damages the optic nerve at the back of your eye. We have produced a leaflet on glaucoma. Ask your optometrist for a copy, or visit lookafteryoureyes.org to find out more. People who have diabetes may develop diabetic retinopathy. Diabetic retinopathy is when the small blood vessels in your retina leak blood and fluid into the retina. Although this does not affect your vision in the early stages, if it is left untreated it may lead to sight loss. You can reduce your risk of developing diabetic retinopathy by keeping your blood sugar under control. With a few exceptions, the NHS arranges for all people who have diabetes and are aged 12 and over to be invited to have screening for diabetic retinopathy. This is to reduce the risk of sight loss, so it is important that you have the screening done if you are eligible. The screening involves putting drops in your eyes to make your pupils larger. You will then have photographs taken of the retina at the back of your eye. The NHS arranges for all people who have diabetes and are aged 12 and over to be invited to have screening for diabetic retinopathy.

It is very important that you have this done regularly, as treatment is more effective if diabetic retinopathy is detected early. Most people will need to have the screening done every year. If you have not been invited to have your retinal screening done within the past 12 months you should speak to your general practitioner (GP) about this. The retinal screening only checks to see if you have diabetic retinopathy. It does not check for other eye diseases such as cataracts or glaucoma. It is important that you continue to have regular eye examinations with your optometrist to make sure that you can see clearly and comfortably, and also that you have no other eye disease. Your optometrist will tell you how often you should have this done.

Glaucoma

Overview Glaucoma is a group of eye diseases in which the optic nerve, which connects your eye to your brain, is damaged by the pressure of the fluid inside your eye. This may be because the pressure is higher than normal, or because the nerve is more susceptible to damage from pressure. This may affect one or both of your eyes. There are two main types of glaucoma – chronic glaucoma, which happens slowly, and acute glaucoma which happens quickly. Chronic glaucoma is much more common than acute glaucoma. The most common form of chronic glaucoma is called primary open-angle glaucoma (POAG).

Will I go blind if I have glaucoma? If glaucoma is not treated you may develop tunnel vision and blindness, but most people who go blind from glaucoma are those where is was detected at a late stage. This means it is important to detect glaucoma early. How is chronic glaucoma detected? The early stages of chronic glaucoma do not cause symptoms. It is important to have regular eye examinations so glaucoma can be detected before it affects your sight. This is because once your sight is lost, it cannot be restored. There are three main tests to see if you may have chronic glaucoma. The first one is where your optometrist looks at the nerve at the back of your eye using an ophthalmoscope, or a slit lamp to shine a light into your eye. They may also take a photograph or a scan of the nerve. This can be useful for future visits, to help them see if things have changed. Because the early stages of chronic glaucoma do not cause symptoms, the best way to detect it early is to have regular eye examinations.

Flashes And Floaters

What are floaters? Floaters appear as black spots or something that looks like a hair or small pieces of a cobweb. These can be semi-transparent or dark and appear to float in front of your vision. If you have had these for years, your eye and your brain learn to ignore them. Sometimes the number of floaters increases as you get older. Occasionally an increase in floaters can be a sign of problems inside the eye. Because they ‘float’ in the jelly of your eye, you will find that if you move your eye to try to look at a floater, it will move away in the direction you move your eye. You might only see the floater if you are staring at a light coloured surface or at the sky during the day. There is a video showing how floaters may affect your vision at lookafteryoureyes.org/floaters-andflashes.

Floaters are more common than flashes, and look like small, dark spots or strands that appear to float in front of your eyes. Floaters are very common and are normally harmless. They are more common if you are short-sighted or as you get older. Some people notice they see flashes of light. These can be due to movement of the gel inside the eye. Very occasionally, flashes or an increase in floaters can be a sign of a retinal detachment, which needs treating as soon as possible. This is more common as you get older, or in people who are short-sighted or have had eye surgery. If you get any of the following symptoms and you cannot contact your optometrist, you should get urgent attention, ideally from an eye casualty department at the hospital. It is important that you get advice as soon as you can if you have: • a sudden increase in floaters, particularly if you also notice flashing lights; • a new, large, floater; • a change in floaters or flashing lights after you have had a direct blow to your eye; or • a shadow spreading across the vision of one of your eyes

Dry Eye

What is dry eye? Dry eye is a chronic (long-term) condition. This means that once you have had it, it can come back even after it has cleared up. It often affects both eyes, but one eye may be worse than the other. There are several treatments for dry eye, and you can do some of these at home. Dry eye does not normally cause permanent problems with your sight, but in severe cases it can become very painful and cause permanent damage to the front of your eye. Who is at risk of dry eye? Dry eye is more common in women and in people aged over 65. It is often just a symptom of getting older. This is because as you get older, your eyelids are not as effective at spreading your tears across your eyes when you blink. Also, the glands in your eyelids that produce the oily part of your tears become less effective as you get older. In some people these glands, which are called meibomian glands, can become blocked and the lids may become red and uncomfortable. This is a condition called blepharitis, and we have produced a separate content on this. Dry eye does not normally cause permanent problems with your sight, but in severe cases it can become very painful and cause permanent damage to the front of your eye. Some drugs or health problems may affect your tear film. In women, changes in hormone levels, for example during the menopause, pregnancy or while using the contraceptive pill, can increase the risk of dry eye.

Dry eye is a common condition that may be caused because your eyes do not produce enough tears, or because the tears that you have evaporate too quickly or do not spread evenly across the front of your eye. The symptoms are usually in both eyes. Dry eye can make your eye feel scratchy or irritated. In severe cases it may temporarily make your vision blurry. It can be uncomfortable, but rarely causes serious eye damage. This content aims to help you understand the causes of dry eye and what you can do to help yourself.

Driving

Tinted lenses do not wear tinted lenses at night or when visibility is poor. Although you may be tempted to wear tinted lenses at night to reduce the brightness of oncoming headlights, the tint will also reduce the brightness of the surroundings. You will find it more difficult to see in the dark than in the light, so making everything darker when there is already limited light will make it even more difficult to see. If you find headlights particularly dazzling, ask your optometrist if they can recommend anything to help. A useful tip is to look at the patch of light the headlights make on the road rather than the headlights themselves. Sunglasses Sunshine can dazzle drivers, particularly when the sun is low in the sky. If you wear glasses, you may find it helpful to have a pair of prescription sunglasses in the car, or to wear clip-on sunglasses over your prescription glasses. If your glasses have photochromic lenses that go darker in the sunshine, you will probably find that they do not go as dark in the car. This is because the darkening is triggered by the ultraviolet radiation in sunshine, and much of this is absorbed by the windscreen. If your photochromic lenses do not go dark enough for driving, you may find it helpful to wear clip-on sunglasses over them, or wear prescription sunglasses for driving. Sunshine can dazzle drivers, particularly when the sun is low in the sky. If you wear glasses, you may find it helpful to have a pair of prescription sunglasses in the car. When choosing frames for driving, try to avoid those that have thick, heavy sides. This is because they will block your vision to the side (like the blinkers you see horses wearing). Frames with thinner sides are better for driving as you will be able to see to the side more easily. Your vision can deteriorate slowly without you noticing it, particularly if this happens in one eye only, as you will still see clearly with the other eye. We recommend that you know what is normal for you in each eye separately (with glasses if you need them), and visit your optometrist if you notice any changes. Even if you do not notice any changes in your vision, we recommend regular eye examinations to make sure your eyes are healthy and you are seeing as clearly and comfortably as possible. For most people, we recommend an eye examination at least every two years.

Driving safely – Having good vision is important to help you to drive safely. Here are our top tips to help you see clearly when driving. If your optometrist has told you to wear glasses for driving, make sure you wear them, even for short trips!. If you need to wear glasses for driving, we recommend keeping a spare pair in the car in case something happens to your main pair. This is a legal requirement in some countries outside the UK. If you wear contact lenses, it is important to have a pair of glasses in the car in case you need to take your lenses out for any reason. Even if you don’t need to wear glasses all the time, you will probably find they are helpful when the lighting is poor, such as driving at night. They should also make it easier to see during the daytime as well. You may also find that having an antireflection coating on the lenses of your glasses helps to reduce the dazzle from oncoming headlights at night.

It is important that you can see clearly to be able to drive safely. This content gives you information about vision and driving, including what to do if you feel you can’t see well enough to drive, or if your optometrist tells you to stop driving. If you have any questions about your eyes.