Eye problems may present themselves at different ages, causing significant distress, but Stephanie Fsadni finds some of these are not only treatable, but also preventable.
Like any other organ, the eyes are subject to disease. Different conditions present themselves at different ages – from squints (strabismus) and lazy eyes (amblyopia) in the early years to glaucoma, cataracts and diabetic eye disease (retinopathy), which tend to show up in later life.
The good news is that, like other diseases, some eye problems are not only treatable, but also preventable.
“The most common condition that can be readily prevented is diabetic retinopathy,” claims ophthalmic surgeon Mario Vella.
“Eye problems tend to be directly related to how well patients manage their blood glucose levels, meaning poor diabetic control will result in progressive diabetic eye disease, which can lead to blindness, and vice versa; while good control means less likelihood of the disease.”
Mr Vella says many conditions are treatable and will result in “complete resolution of symptoms if treated early and appropriately,” such as in the case of eye infections.
Treating other conditions like glaucoma (raised pressure in the eye) in its early stages “will limit eye damage to a minimum”.
However, there are other incurable diseases, such as some tumours that result in destruction of the eye, with loss of vision, and the globe may need to be removed surgically to prevent or limit its spread to the rest of the body.
In recent years, ophthalmologists have seen an increase in the rate of age-related macular degeneration (ARMD), which, as the name implies, is the result of the thinning of the retina from wear and tear as one grows older, resulting in defective central vision.
Patients sometimes present themselves for a visit when it’s already too late and damage is irreversible
The reason for this is twofold, according to Mr Vella. “First, we have an ageing population, making it more likely for the condition to present itself, and, secondly, ARMD tends to be related to damage induced by exposure to UV light along the years.” A modern-day phenomenon, stress, may also induce loss of vision in susceptible individuals.
“Loss of vision may result from an occipital cerebrovascular accident (a stroke affecting that part of the brain directly involved with vision), or from a central or branch retinal vein occlusion/thrombosis, following spikes in blood pressure, resulting in areas of poor circulation (ischaemia) and swelling (oedema) of the retina, reducing vision,” explains Mr Vella.
Improving vision
“Another cause is ARMD. There are two types – the dry and the wet. In the latter, there is leakage of blood vessels, which again results in loss of central vision.”
Anti-VEGF (vascular endothelial growth factor) intraocular injections are used in cases of very poor circulation of the retina – the nerve layer we see with – to shrink new blood vessels, which tend to leak in areas of poor circulation. But these injections are not a cure for these conditions.
“Some patients may be able to improve their vision or prevent further vision loss from these conditions. However, in other cases, the damage from the original condition can be so severe that vision loss may be permanent.”
It is imperative to check our eyes regularly, even if we experience no problems.
There are no hard and fast rules as to when one should visit an eye doctor for the first time if one has no symptoms, but Mr Vella suggests that if there is, for example, a family history of amblyopia, “it is wise that children are checked from the age of four to five onwards, as if caught early, sometimes it may be treated”.
On the other hand, young adults and those around the age of 30, who have never had any problems, should still do routine checks, because certain conditions like glaucoma may not have any signs or symptoms, and vision is preserved despite damage to the optic nerve.
“Patients sometimes present themselves for a visit when it’s already too late and damage is irreversible,” says Mr Vella.
“If diagnosed early, glaucoma can be treated with just drops, or in resistant cases, surgery can be carried out to control the intraocular pressure.”
Who should I visit?
If I have blurred vision or think I have an eye infection, who should I visit? An ophthalmologist, an optometrist, an orthopist or an optician? The following definitions may help clarify some confusion.
Ophthalmologists are doctors of medicine. These doctors complete the medical school course plus pre-registration training. After they become registered doctors, they undergo specialist postgraduate hospital training. This consists of medical and surgical speciality training specifically in eye care. Ophthalmologists provide complete eye care services, which include:
• Vision services, including eye examinations.
• Medical eye care such as for glaucoma, iritis, chemical burns and orbital cellulitis.
• Surgical eye care for trauma, squints, cataracts, glaucoma, tumours, among others.
• Diagnosis and treatment of eye conditions related to other diseases, like diabetes and diabetic retinopathy, arthritis and iritis, or brain conditions such as multiple sclerosis and optic neuritis.
• Eye disease and injury preventive services.
• Traditionally, ophthalmologists in Malta also prescribe spectacles.
Optometrists are trained to diagnose and treat vision conditions like short-sightedness, long-sightedness and astigmatism. They are trained in prescribing eyeglasses, contact lenses, eye exercises, low vision aids and vision therapy.
Orthoptists do all the above optometric work, but also assess squints in both adults and children. They are also trained to identify cataracts, glaucoma and retinal disease, and then refer to the ophthalmologist should specialist treatment be required.
Opticians or dispensing opticians assist patients in an important way: they fill the lens prescriptions that ophthalmologists and optometrists recommend. They help decide which form of lens best fits a patient’s needs. They take facial measurements and dispense, adjust, repair and replace glasses, frames and contact lenses.
Being a relatively small country means there is a small community of ophthalmologists, optometrists, orththopists and dispensing opticians in Malta, and should anyone go to the wrong person, he or she will be redirected appropriately.