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VISIONMARCH 2008

An open road ahead

Drivers with poor eyesight can be adanger to themselves as well as otherroad users

page 5

Laser eye treatment

Everything you need to know aboutlaser eye surgery and the clinics whichcarry it out

page 8

Through the lens

The simple use of contact lenses canhelp restore the confidence ofteenagers who wear glasses

page 9

Under pressure

One of the most common conditionsaffecting eyesight, glaucoma is a disease that is often misunderstood

page 12

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CONTENTS

He can see clearer now 4

Clearing the view in the Third World 4

A open road ahead 5

Eye-catching eyewear 5

My new Laservision 6

Laser treatment: what you ought to know… 8

Through the lens 9

In the shade 10

caring for a child’s eyes 10

Under pressure 12

What is an optometrist? 13

Diabetes-related eye conditions 14

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VISION – A TITLE FROM MEDIAPLANET

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Welcome to this Vision supplement produced in con-junction with the AOI, the Association of Optometrists,Ireland, writes Martin O’Brien.

The AOI is the professional repre-sentative body for Irish Op-

tometrists. Members of the AOI arehealthcare professionals who havesuccessfully completed a rigorousdegree [or equivalent] in Optometry,followed by strict professionalexams to ensure that the public canexpect their eye examination to becarried out to the highest standards.All AOI members also have agreedto be bound by the Association’sCode of Conduct which is in place toprotect the public and to ensure thatIrish Optometrists strive to maintainthe highest professional standards.

We are often asked what is an op-tometrist? Up until recently Op-tometrists were known as

Ophthalmic Opticians, but the newterm has come into use lately.

What does your optometrist actu-ally do? Well your optometrist isyour first port of call for all youreyecare needs. Your optometrist willtest your sight to check if you needglasses or not. Your optometrist willcheck the health of your eyes andscreen for problems such as Glau-coma, Cataract and Macular Disease.For kids the optometrist will checkfor conditions such as a lazy eye , asquint or turn in the eye and, ofcourse, whether your child is long orshort sighted. The AOI recommendsthat everyone should have an eyeexamination at least every two years.It is also vital for people with condi-

tions such as Diabetes to have theireyes examined on a yearly basis tocheck for the early signs of damageand prevent blindness developing.

AOI members are delighted tohelp children, teenagers, and thosenot so young, providing the high-est quality of eye care at yourlocal independent practice. Yourlocal AOI member will use theskills, experience and modernequipment to make sure your vi-sion and eye health are at theirbest; where there is a problem,they will refer you for the medicalattention you need.

With the advances in contactlenses over the last few years nearlyeveryone can now wear lenses, fromoccasional wearers to those who justneed help with reading; there is acontact lens out there for you, justask your optometrist.

Virtually every optical practice inthe country has a contract to pro-vide eye tests and glasses though themedical card and PRSI schemes, somost people in the country are eligi-ble to get their eye examination freeand an allowance towards glasses.

We hope you find this supplementuseful. For more information contactyour local optometrist.

Welcome to Vision

Angela’s Lenses… are anti-reflectiveAngela Keogh (pictured right) loves

lenses, not because she is managingdirector of Limerick-based Essilor, theworld’s largest manufacturer of ophthalmiclenses but because advanced lens technol-ogy has made fashionable eyewear possi-ble across a wider range of prescriptions,meaning that thicker, heavier lenses arenow a thing of the past.

“Lenses and coatings now match pre-scriptions, lifestyles, occupations and hob-bies,” she says.

“One of the greatest innovations to comeon the market is the anti-reflective coating.We now recommend it to all spectaclewearers. The application of the coatingmeans improved visual clarity and in-creased visual comfort. The coating notonly improves the performance of the lens,but also the appearance of the glasses

themselves. The layers on the lens block re-flected light; this reduces glare, annoyingreflections and halos around lights. It’s atremendous safety benefit when driving atnight and also reduces strain associatedwith VDU use.

“Thanks to a new Scotchgard protectorbuilt into the coating, the lenses are nowanti-static, anti-smudge, scratch resistantand cosmetically enhanced which meansall you see are the eyes. For people with astronger prescription it’s extremely benefi-cial to combine this coating with hi-indexlenses; it makes their spectacles look andfeel as thin as possible. When combinedwith a polarised lens in sunglasses, it pro-vides the ultimate in protection from thesun’s harmful rays,” she adds.

Explaining that lenses are to glasseswhat software is to the mobile phone, dig-ital camera or the iPod, Keogh says it’swhat’s in the body of the product thatmakes the difference to the reception we re-ceive and the impression we give.

“The frame is the outer wrapping; thelens is what makes the eye function better.

When customers go for an eye test, theygenerally make a beeline for the framessection first; it should be lens first, framesecond. The prescription strength and lenstype dictate the suitability of a frame’sshape and size,” she adds.

More in-depth lens information can bedownloaded from www.essilor.ie. Informa-tion leaflets on eye care are available freeof charge from Essilor-stocked opticiansthroughout Ireland.

� Martin O’Brien, B.Sc. (Hons.)M.C.Optom., President of the Association of Optometrists, Ireland

Focus on your eyesAll you need to know about good eyecare

Steve, how often should I get myeyes tested?It is important to get your eyes testedevery two years or more frequently if re-quired. Some people will have their eyestested every year to ensure their prescrip-tion is up-to-date, as vision can changeat any time. Drivers in particular need tohave their eyes tested regularly to ensurethat their eyesight is meeting the legal vi-sual standards. This is why Specsaverscreated a joint initiative with the RoadSafety Authority in. Last year, the Spec-savers Focus on Driving campaign withthe Road Safety Authority found that

46% of people examined during the cam-paign did not meet the legal driving re-quirement which highlights the necessityof regular eyetests for drivers. Havingyour eyes tested is not only important foryour general eyecare but can also detect avariety of health problems. These can in-clude conditions, such as, high bloodpressure or diabetes and eye conditionslike, glaucoma and cataracts.

What is Glaucoma?Glaucoma is a condition where pressure inthe eye can increase, which results in thenerve at the back of the eye being dam-

aged. Early detection is important as thepressure can be easily controlled by usingsimple eye drops, which reduces the pos-sibility of vision damage. Glaucoma cancause blind spots but sufferers often donot notice any change in their vision untilsufficient damage has already been done,so regular eye examinations are crucial.

How does getting older affect eye sight? When people reach 40, their eyesight be-gins to change more dramatically com-pared to when they were younger.Presbyopia or blurred near vision happensto us all when we get older. People over40 may find that they need to hold news-papers, books, magazines and most read-ing material at arm’s length in order tofocus properly. This can lead to eyestrainor headaches. The main cause of presby-opia is basically related to age and is dif-ferent from astigmatism, near-sightednessand far-sightedness. These are related tothe shape of the eyeball and caused bytrauma, disease or genetic factors. Presby-opia develops from a gradual loss of flex-ibility in the natural lens inside the eye.

Can the presbyopia be managed?At Specsavers Opticians nationwide thereare several ways in which presbyopia canbe managed. Reading glasses are normallythe most practical choice for those that do

not need a distance prescription. However,for those that need a reading and distanceprescription, they can use either bifocal orvarifocal glasses. These can be a great ad-vantage to people who would find havingtwo pairs of glasses inconvenient. Varifo-cal contact lenses are also used by theover 40s and are particularly useful forthose that enjoy active sports.

Lastly Steve, what do you think isthe most important eyecare tip? I would have to say having your eyeschecked regularly is the most importantaspect of maintaining healthy eyes. It isonly when your eyesight starts to deteri-orate that you realise how important yourregular eye examinations. Also it is vitalthat people realise that regular eye testscan not only save your eyesight but yourlife as many ailments can be detectedthrough regular eye checks.

If you are worried about your vision orthat of a relatives’, call into Specsavers.

With 32 locations nationwide Spec-savers is always near by to answer all

your eyecare needs. For further informa-tion log on to www.specsavers.ie.

WHEN it comes to looking afteryour health your eyes should be oneof the main focuses. To highlight theimportance of good eyecare SteveSchokman (left), Specsavers storedirector and qualified optometrist,answers all your eyecare questions.Steve is a qualified optometrist andhas more than 25 years’ experienceworking in the eyecare field.

Frames designed for kids

Available at your local opticians nationwide

Distributed exclusively by

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But today, almost 12 monthsafter that shocking diagnosis,

the deterioration in Jimmy’s eye-sight has been halted and his goodeye has improved to the point wherehe has no difficulty driving, watch-ing his beloved GAA or gardening.

Age-related macular degeneration(AMD) is the leading cause of irre-versible blindness in people over 50years of age, affecting an estimated80,000 people in Ireland alone witha further 140,000 at risk currentlycosting the state an estimated

€133m every year. It is particularlyfrustrating because it results in aloss of central vision. In otherwords, someone with AMD can seeeverything except what he/she islooking at, and is therefore unableto read, watch TV, recognise faces ordrive. There is currently an epi-demic of AMD, largely because weare all living so long!

There is a growing and com-pelling body of evidence that alack of macular pigment in the eyeincreases an individual’s risk ofdeveloping AMD, and that appro-priate supplements reduce one’srisk of this condition. Indeed, a re-cent study published by the Macu-lar Pigment Research Group atWIT has shown that people at riskof developing AMD, includingolder people, cigarette smokers andpeople with a family history of thedisease, are deficient in this im-portant eye pigment.

Jimmy’s remarkable improvementis due to a revolutionary new sup-plement, Macushield, which, for thefirst time, provides a dietary supple-ment containing all three key ingre-dients that make up the macularpigment at the back of the humaneye. Macushield comprises lutein,zeaxanthin, and a further element,meso-zeaxanthin and is the onlyfood supplement containing all threecarotenoids found in the eye.

Prevention, and the importance ofdiet, will be key to addressing AMDin the future but if you feel you arepresently at risk of developing thecondition you should contact yourlocal eye care professional forscreening and advice.

He can seeclearer nowFormer Cork club hurler Jimmy Ahearne wept whenhe was told he would be blind within three yearswhen he was diagnosed with age-related maculardegeneration (AMD).

a unique supplement to support eye healthMACUSHIELDContains Mezo-Zeaxanthin, the only carotenoid found exclusively in the macula

MEZO-ZEAXANTHIN FORMULAMESO-ZEAXANTHIN, ZEAXANTHIN, LUTEIN This formula combines powerful antioxidants that help protect tissues against the potentially damaging effects of free radicals and is designed specially to support macular health.

West Midland Optical Available from leading pharmacies and opticians

CLEARING THE VIEW IN THE THIRD WORLD

Conjunctivitis, or 'pink eye', is an inflammation of the eye caused by allergies,bacterial or viral infection, and sometimes spread by contact lenses or dirtymake-up. It is usually a mild, treatable condition, and for most of us in thefirst world, it's as close as we will come to experiencing temporary discom-fort in our eyes. For those in developing countries however, simple eye in-fections can lead to permanent blindness.

According to the World Health Organisation, 28m people are unnecessar-ily blind, because of diseases like trachoma, which are linked to extremepoverty and poor sanitation. Trachoma was still present in Ireland up to the1940’s. Today, it's largely confined to the world's poorest countries in Africa,South America, India and Bangladesh.

Sara Dale works with Orbis Ireland, a charity that aims to eliminate tra-choma in southern Ethiopia over the next five years. “The crisis there is par-ticularly acute - one in seven people are infected with trachoma, and manyof these will go blind if left untreated,” she says. Orbis, and other charitieslike Sightsavers, are using antibiotics, surgery and environmental improve-ments to tackle the problem. Long term, access to clean water and educationare the only way to end avoidable blindness across the globe.

� The macula is the central regionof the retina responsible for centralvision. When the macula is dam-aged, the result is a loss of vital cen-tral or detail vision which is referredto as AMD.

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Those with poor eyesight couldbe a hazard not only to them-

selves, but also to other people. Al-though an eye test is a pre-requisiteto acquire a provisional driving li-cence, it is not required for subse-quent licence renewals, or to obtaina full licence.

It is vital, therefore, that drivers –indeed, everyone – has regular eyeexaminations to determine if thereare any problems. Even for thosewho have slight short-sightedness,for example, it may be too late tosee a pedestrian on a dark night.

“The current mix of changeableweather and the short days of the

year puts added stress on the eyeswhile driving – so if a driver’s sightis defective, this poses a significantrisk to him or her, to other driversand to pedestrians,” says Peter Cole-man of the Irish Association of Op-tometrists.

“A driver may be only 17 or 18years of age when undergoing theeye examination for the provisionallicence. This individual’s eyesightcan change very quickly and in onlya few years they may no longermeet the vision requirements todrive with uncorrected vision.

“Certain vision problems will onlypresent themselves when the driver

is tired or has had even one alco-holic drink,” he continues. “Thedriver may feel they have perfecteyesight, but these types of defectscan only be picked up by proper eyeexaminations carried out by a qual-ified eye care professional such asan optometrist.

“Poor vision compromises roadsafety and for this reason, our Asso-ciation is calling for a change to thecurrent legislation to introduce com-pulsory eye sight testing for driversat regular intervals throughout theirdriving career.”

Compulsory eye examinationswould help to prevent eyesight-re-lated accidents, and would of coursebe beneficial to drivers in the rest oftheir daily lives by helping to iden-tify the onset of any sight problemsor eye conditions.

Just as random breath testing hashelped to reduce the number ofdrink-drivers on the roads, an an-nual eye examination could alsohelp to keep roads safe for everyone.

An open road aheadIt is well known that the conditions driving in Irelandare currently in a state where much could be improved.Issues surrounding drivers with provisional licences,the state of roads, and drink-driving regularly hit theheadlines. One major – indeed, potentially life threat-ening – issue that is rarely discussed, however, is thatof drivers with poor eyesight.

EYE-CATCHING EYEWEARWhy should Bono have a monopoly on groovy glasses? Trends in eyewearhave come a long way from the flesh-coloured, plastic frames favoured byschoolchildren and pensioners in the 80s - most glasses wearers now sportdifferent models for work and play, and the range of colours, shapes andstyles is as wide as fashion itself. Glasses are no longer just an optical ne-cessity but a statement of taste, and designers such as Jasper Conran, RalphLauren and Tommy Hilfiger are all in on the act with their own eyewearranges at high street prices.

While the trend in shades has been towards ever-larger frames, clear-glassprescription lenses are getting smaller and lighter, with a swing towards rect-angular shapes and frameless glasses for the barely-there look. Bolder framesare also available in tortoiseshell, Burberry pattern, metallic or even lumi-nous pinks and greens, to suggest you could be up for clubbing after busi-ness-as-usual at the office. One thing's for sure, wearing glasses no longersuggests a fuddy-duddy, absent-minded genius. Forget Clarke Kent - thinkSophia Loren, Michelle Pfeiffer, Jarvis Cocker, Ralph Schumacher - the rightglasses can look cool, sophisticated and sexy, and you don't even need badeyesight to get your own pair.

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Below are Mr Fenton’s caserecords and Nuala’s account of

the procedure. Nuala had asked MrFenton for his perspective on herlaser eye surgery for this article.

Mr John Fenton ConsultantOphthalmic Surgeon LaserVisionOn initial examination Nuala wasmoderate short-sighted with a re-fractive prescription of -3.50 righteye /-3.00 left eye.

On examination, her distance vi-sion was only 6/24 or 25% withouther glasses but normal with herglasses on, in both eyes.

Her cornea was healthy with nor-mal thickness and contour and shehad a good tear film function .Herintra-ocular pressure was normaland her retinal examination washealthy.

Review of her wavefront scan al-lowed some pre-operative modifica-tion of her laser beam profile foroptimum clarity and night vision .

The differences between lasik andlasek were discussed and Nualaopted to have lasik performed be-cause of the speed of visual recov-ery ( 24 hours )

We agreed that Nuala was a suit-able candidate for laser eye surgery.She specifically chose our Wavefront- guided lasik procedure, a cus-tomised surgery to eliminate anynight- driving glare she had previ-ously experienced with her glasses.

We discussed what she would ex-perience during and after the proce-dure and I reassured her about

long-term safety/efficacy and thepossibility of any additional treat-ments and aftercare. We signed theconsent together and she booked infor the procedure.

Surgery November 30 On the day of surgery we repeatedsome additional measurements. Theroom conditions of temperature andhumidity were checked and con-firmed and the systems checked.

Our laser platform in Dublin is themost highly regarded worldwide.The Visx Laser Technology has beenproven to get the best results in FDAindependent trials with the least in-cidence of potential optical aberra-tions. It incorporates dynamic eyetrackers, variable beam technologyand iris registration to reshape thecornea with extreme precision in amatter of seconds.

Nuala was brought to the operat-ing room by our Nursing assistantand seemed a little nervous. Wechatted for a while until I felt shewas comfortable enough to proceed.A little music and conversation is al-ways helpful and we try to keepthings as relaxed as possible.

The surgery was smooth, painlessand routine. The flap was created,lifted and replaced into positionafter the laser removed 55 micronsof tissue or 10% of the corneal tis-sue. Called "flap and zap" in the USover 17 million of these procedureshave been carried out worldwide.

The camera allows us to see andtrack eye movement and the laser

beam at all times. Fixation was goodand we expect a perfect result. Finalchecks with the microscope beforebeing brought from the room are ex-cellent and already her vision is im-proving - she can see the time onthe clock on the surgery wall!

The post-operative do's and don'twere explained and clear eyeshieldsplaced across the eyes with strict in-structions not to rub the eyes thatnight .Antibiotic, anti-inflammatoryand lubricant drops are providedand I made sure she had the on-callnumber in case of any concerns

Post op check December 1Nuala’s refractive measurementswere -0.25 right and left. She has20/20 vision in both eyes An excel-lent measurement on day one. Shehad no symptoms of dry eye and theflap had healed fully and perfectly. Itwas even hard to see where the flaphad been performed- no scar.

She has permission to drive nowwithout glasses.

One month post-op January 10Nuala still has 20: 20 vision, nocomplications. The quality and con-trast in her vision continues to im-prove. Her surgical outcome isadded to our audit. Discharge isplanned after review in 3 and 9months.

Nuala’s account My big worry was that I would jumpwith fright during the procedure andthe laser instrument would jam inmy eye! I'm glad to say that can'thappen. My eye is kept in place andeven if I move, the machine auto-matically tracks the movements. Ialso know it won't hurt. Mr Fentondemonstrated the level of pressuremy eye will feel by pressing my eye-lid. He certainly knew what he was

talking about. This seems like sec-ond nature to him.

Surgery November 30 I can't say surgery was easy. But itwas all mind over matter. It was thethought of what was being done thatscared me. I could hardly sign mysignature on the approval form andwas given two Valium to calm mynerves.

I was brought down to the surgery- cold and sparkling and full of bigmachines. My eyes were washed,checked and I was brought into thenext room with even more machines,complete with blue hat and shoes.Ray, the technician, saw the bundleof nerves that had arrived and gen-tly sat me down and explained whatwas going to happen. Mr Fenton ar-rived and Noreen. The only thingnow I had to do was approve theirchoice of music. Yes, Diva would begreat. As the laser fired into action,the crescendo of her voice reached apeak. I heard Ray's voice "20 secondsof surgery, 10...." and one eye wasdone! I was wheeled over to quicklycheck all was ok .The patch wasswapped, clamp on left eye (this was,as I was warned, the worst bit) but10 seconds of uncomfortable pres-sure later, it was gone, it was back tothe laser again. "20 seconds, 10..."...my surgery was complete! Mr Fen-ton checked my eyes, gave a final

'brush' on one and then I was backup the stairs to reception. At most, 5minutes was all it took! My sisterdrove me home and I realised I couldalready read a car reg!

I hardly remember getting intobed. Two hours later, I woke andwanted to rub my eyes. I was terri-fied to open them. I did and feltawful and hungry and scared. I gotup slowly and came into my frontroom. I could see across the road, Icould see clearly and make out peo-ple! It wasn't a blur. I'll never forgetthat feeling. I had coffee and some-thing to eat and went back to bedfor two peaceful hours of sleep. I gotup, showered and went to a dinnerparty. No one believed what I haddone that day!

Post op check December 1It's a miracle! I was so caught up inthinking about the procedure I'd for-gotten about the result.

Had my post surgery check thisam - 24 hours later - and alreadymy sight is perfect. I could evendrive today if I want! I am on a high.I just want to tell everyone theyshould get this done.

One month post-op January 10Had my one month post –op con-sultation with Mr Fenton –they arevery happy with results and I nowhave perfect visionJ

My new LaservisionNuala O’Duffy was short sighted and had been wearingcontact lenses for over twenty years. She finally de-cided to have laser eye surgery in LaserVision at theLeeson Eye Institute with Mr John Fenton FRCSI, Con-sultant Ophthalmic Surgeon.

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Paul Byrne is the clinic managerat Optilase in Dublin, which

opens at night and weekends to caterfor growing demand. He attributesthe surge in popularity to a combi-nation of factors including improvedtechnology, endorsement by celebri-ties such as Tiger Woods and JessicaSimpson, and word-of-mouth – 60percent of their clients have been re-ferred by previous patients.

The original procedure involvedthe complete removal of the outerlayer of the cornea, which was thenreshaped and allowed to grow back.It was an intensive operation, andoften took several months for the eyeto heal. However the development of'Lasik' surgery means surgeons can

now peel back a flap of the cornea,operate underneath, and then replacethe corneal layer which heals over ina matter of days. For the vast major-ity of patients, it's a painless proce-dure, which transforms their life forthe better, allowing them to throwaway their glasses or contact lensesand enjoy 20/20 vision.

But as any qualified ophthalmol-ogist will tell you, there are risks.First of all, not everyone is eligiblefor the procedure - if you're underthe age of 18, pregnant, have largepupils, thin corneas or any predis-position to eye disease, you cancount yourself out. However evenpatients who are deemed perfectcandidates can suffer side-effects,

and I speak from experience.I underwent laser surgery in 2004,

to correct moderate short-sighted-ness in both eyes. The procedure it-self was painless and successful, andfor about a year I enjoyed perfect vi-sion. But four years later, the rarecondition of progressive myopiameans I have become mildly short-sighted again, and need to wearcontact lenses for the cinema andfield sports. I also experience the ef-fect of 'halos', or slightly fuzzy nightvision. I will probably have an en-hancement operation at some stage,but there's no guarantee that myshort-sightedness won't return.

Dr Arthur Cummings, consultantophthalmologist at the WellingtonEye Clinic in Dublin, says up to fivepercent of patients can experiencedry eye, double vision, night-timeglare or some form of inflammationor infection after surgery. But headded: “Practically every problemcan be rectified within a few monthsby an enhancement procedure,which is included in the initial cost.

The instances of long-term problemswhich we can't fix comes to lessthan one percent.”

Laser eye surgery in Ireland is ad-vertised at prices ranging between€500 to €2,500 for one eye, de-pending whether you go for a so-called 'business-led' commercialclinic or a well-established centre.However, some ophthalmologistswarn that many of the discount clin-ics use 'bait and switch' tactics,which involves advertising surgeryat a low price, then telling peoplethey have a refractive error or othercondition which can double theoriginal cost.

“Ring around in advance, andensure the surgeons are registeredwith the Irish Medical Council,”says Optilase’s Paul Byrne. DrCummings is also sceptical aboutdiscount clinics, which he saysoften fly doctors in and out of theUK within 24 hours to carry outprocedures, without providingcontinuity of care.

“Your eyesight is precious', hesays. “If you're taking a parachutejump, would you choose the cheap-est parachute or would you invest inthe best one you could find?”

The medical consensus is largelyin favour of laser eye surgery - al-most a third of consultants in theAmerican Society of RefractiveSurgery (of which all Irish ophthal-mologists are members) have under-gone the procedure themselves.Anyone considering laser eyesurgery should beware of discountprices, talk to their own optician andinform themselves fully before opt-ing for the treatment.

You should also chose a clinicwith a good established record,which offers a full eye examination,continuity of care, and includes theprice of any follow-up enhance-ments in the initial price. The cost ofsurgery can be reduced by declaringit against income tax, but the pro-cedure is not covered by the mainhealth insurers in Ireland.

Laser treatment: whatyou ought to know…An estimated 60,000 laser eye surgery procedures havebeen carried out in Ireland since it was first practicedhere in the late 1980s, writes Jessie Magee. The numberof clinics specialising in the field has quadrupled in thelast five years, with at least twenty centres now operat-ing across the country.

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The very act of placing the small lens on the eyecan be tricky enough, and many would rather

their children did not go poking around there. An-other consideration is hygiene – cleanliness is vitallyimportant when handling and wearing contact lenses.

However, contact lenses can also be hugely ben-eficial for a teenager. In terms of giving a teenagerthe freedom to play sports or do other activities inwhich glasses could get in the way, they can pro-vide safe, clear vision.

For those who are concerned about their looks –bodily appearance can be a major worry for thosestill navigating their way through the unchartedterritory of puberty – contact lenses can provide agreat confidence boost.

“Teenagers are definitely interested in wearinglenses today,” says Ken Murray of Greystones EyeCentre. “However, in terms of how young people canbe when they start wearing them, there is a differ-ence between what they would like and what is rec-ommended, and it also depends on whether or notthey have to wear glasses full time. For younger,short-sighted teenagers, they could want to startwearing contact lenses from the age of 12 upwards.In my personal opinion, I would prefer to have aminimum age of at least 16.

“Some teenagers require contact lenses for sport.In such cases, an assessment would be carried out,and a lens would be fitted to gauge if it fitted com-fortably or not. A trial period of wearing the lenswould then take place, just to make sure there wereno adverse effects.”

Whether or not a teenager can wear lenses de-pends on a number of factors will be determined by

Through the lensChildren who wear glasses may find, for one reason or another, that they want to wear contact lenses as they enter their teenage years. As children become more aware of their own personal ap-pearances, and as fashion concerns become an increasingly important aspect of their lives, many will come to the conclusion that glasses are not a good look, and that they would prefer contactslenses. Parents, who are still usually the ones actually paying for the teenager’s eye care, will obviously be wary of contact lenses for a number of reasons.

an eye examination. Contact lenses in Ireland cannotusually be purchased from a non-optician source.Eye tests will always be required before lenses canbe prescribed, with an annual check-up required toensure good eye health and adherence to the contactlens maintenance regime.

“Wearing contact lenses depends on the eye itself,”says Murray. “Put simply, the optometrist takes ameasurement from the front of the eye, which ex-amines its curvature. Most contact lenses are de-signed to fit adult-sized curvatures, so it is better towait until later teenage years.”

How long should contact lenses be worn for? Oneof the major concerns for parents is that their chil-dren will wear them for too long, or will fall asleepin them.

“Bodily appearance can be a majorworry for those still navigating their

way through the uncharted terri-tory of puberty”

“Contact lenses are changing,” says Murray. “Withnew materials available, a lot of the new lenses aremade of silicone hydrogels, which can be worn forlonger periods in the day – up to 14 or 15 hours.”

Wearing lenses does mean that a teenager has tohave a high level of personal responsibility – notleast because they will need to pay extra attentionto their own eye health. However, teenagers will beteenagers, and mistakes will undoubtedly happen. Inresponse to this, Murray advises wearing disposable,rather than monthly lenses that involve cleaning.

“Personally, I recommend disposable daily-wearcontact lenses, primarily because I do not advise full-time wear of the lenses for teenagers,” he says. “Also,disposable dailies mean that there are no problemswhen it comes to using cleaning solutions – so theyare always going to be hygienically worn. Popping ina fresh lens when required avoids most of the risks ofnot carrying out the cleaning process properly.”

Contact lenses are a major step for teenagers’ con-trol of their eyesight. Wearing lenses is not a deci-sion that should be taken lightly, and teenagersshould be counselled about the obligations thatcould mean the difference between a new freedom tosee clearly, and serious eye problems in the future.

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In fact, sunglasses should block out harmfulultra-violet (UV) radiation from the sun that

could damage the eyes with long-term expo-sure. However, how can you be sure that yoursunglasses are doing what they are supposedto, and not just making you look good?

Don’t believe that a pair of designer sun-glasses that costs three times as much as thepair on the other rack in the shop is going tobe more effective at protecting your eyes. Aslong as the lenses are designed to protectagainst UV rays, then they will be adequate.

Just as UV rays can cause sunburn, or evendiseases like skin cancer(not to men-

tion increasing the aging process), so UV candamage the eyes, raising the risk of damagingthe retina, causing cataracts or even burningthe eye itself.

So what should you choose? Look for sun-glasses that offer 100 percent protection –preferably wraparound models, that can pre-vent UV rays from entering from the sides. Ifthe sunglasses are to be worn for driving,make sure they are not colour-tinted, and nottoo dark.

Just a couple of simple checks mean thatyou are not damaging your eyes, nor break-ing your bank balance.

In the shadeWhen we’re lucky enough to get a day of sun, sunglasses are an es-sential item for protecting the eyes from its glare.

CARING FOR A CHILD’S EYESThe health and wellbeing of a child is obviously one of the most important concerns of any par-ent. When it comes to children’s eyesight, however, diagnosing any problems can be less straight-forward than dealing with any other health issues.

Any child can develop problems with their eyesight, from minor short-sightedness, to moreserious issues. What is important is that such conditions are diagnosed and treated as soonas possible.

One major issue to be aware of is that a child, particularly a younger one, may not understandwhat is happening to his or her eyes, or have the vocabulary to express any concerns. It is vital,therefore, to ensure that all children have regular eye examinations.

As with all children, actually getting to the core of a problem can be a tenuous process of in-vestigation and interpretation. For example, if problems start to occur at school – a particular issuewith keeping up with the rest of the class, or if a child becomes withdrawn, what could be caus-ing this? There are a myriad of possible answers, but it could be something as simple as the factthat he cannot see the teacher’s whiteboard clearly enough. Unlikely as it may seem, poor eyesightcan easily be interpreted as a learning problem.

Vision Express, the well-known opticians, has a comprehensive policy towards dealing with chil-dren’s eyesight. As the eyes are generally fully developed by the age of eight, its advice is to makesure that problems that occur before then are dealt with straightaway.

‘Your child's first eye check is usually a post-natal check at one year. They should then be re-ex-amined before they start school by an optometrist. This will pick up any problems that may leadto problems that may lead to poor development at school. At primary school, your child's eyesightshould be assessed by the local health board. However, only 60 percent of schools [in the UK] nowprovide eye examinations, so it is important you register your child with an optometrist,’ is the ad-vice from Vision Express.

Pre-school-age children, and those of national school age who have been referred from bothchild health and school health services are eligible for free eye examinations. In addition to this,for any referral treatment that is carried out at the outpatient department of a public hospital, nocharges are applied.

When selecting a pair of glasses for a child, it is important to take into account their own feel-ings. Having to wear glasses can often be hard for a child, with a whole new set of responsibilitiesfor caring for the glasses that other children do not have to deal with.

For both boys and girls, sturdiness is important – glasses will often be disregarded whenrunning around a playground or doing impromptu sports. Fun, colourful styles can be great, butcan be more expensive too. Finding the right balance between good quality and style (a con-sideration for even the youngest of children, these days) is key, and any good optician will beable to advise on this.

Vision Express offers the following care advice for children’s glasses:• glasses should always be taken off with both hands to stop them bending out of shape• never put glasses 'lens down' on surfaces, as they may scratch• always keep glasses in a case when they are not being worn• clean glasses daily for clearer vision

As children get older, continued eye examinations will be vital to monitor any deterioration ineyesight. Older children have different needs – they may spend more time in front of computerscreens, or longer hours studying. Playing contact sports will also be more of a consideration, withappropriate eyewear such as sports glasses or contact lenses a better choice for such activities.

Wearing glasses need not mean a dramatic change to a child’s lifestyle. Indeed, incorporatedinto part of a daily routine of care and maintenance, glasses will last for longer, and result in lessexpense.

Caring for children’s eyesight is one of the most important parts of their healthcare. Figuressuggest that around 80 percent of a sighted child’s development relies on their eyesight. If yourchild has not had his or her eyes tested recently, it should be done as soon as possible.

NCBI provides information, support and services to people experiencing difficulties withtheir eyesight. About 18 per cent of people using our services are completely blind, while82 per cent have varying degrees of usable vision.

Services offered around the country include:• Practical and emotional support• Low vision service• Guidance on choosing aids and appliances • Mobility training• Daily living skills• Peer counselling and professional counselling• Employment advice• National Braille, large print and audio library• Assistive technology advice

Who can use NCBI’s services? Anybody experiencing significant problems with their eyesight, to the point where every-day tasks are becoming harder to carry out, can be referred to NCBI for an assessment.

NCBI can provide practical advice and emotional support, as well as a wide range ofother services, including a low vision assessment, which recommends magnification andtechnical aids to enable people to continue to carry out tasks independently, like readingand keeping in touch with friends and family.

For more information on NCBI’s services contact: NCBI, Whitworth Road, Drumcondra,Dublin 9. Phone: 1850 33 43 53 Or visit: www.ncbi.ie Or email: info@ncbi.ie

Picture: French Connection/PRshots

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The common element of all theconditions that come under the

definition of glaucoma is the effectof varying pressure in the eye. Sim-ilar to the way that there is pressurein the flow of blood around thebody, there is a body of fluid in theeye that passes through the pupil,

and out into the bloodstreamthrough small drainage ways be-tween the cornea and the iris. Glau-coma becomes an issue when thatfluid cannot be drained away as fastas the eye produces it. As pressurebuilds in the eye, the optic nerve isthen damaged.

There are four types of glaucoma.The main one is chronic open-angleglaucoma, when the drainage be-comes slowly blocked over a num-ber of years, and vision starts toreduce. Acute angle closure glau-coma occurs when the drainage isblocked much faster. This conditioncan cause pain, and runs the risk ofcausing permanent damage to theeye if not treated in time. Secondaryglaucoma occurs if the eye pressureis caused by another problem; de-velopmental glaucoma is a congen-ital problem suffered by babies witheyes that have not been formed cor-rectly in the uterus.

Many people who have a routineeye examination have been testedfor glaucoma, even if they were notaware of it at the time. A commontest used by opticians is to measurethe pressure in the eye with atonometer – a yellow-tinted slightlyanaesthetising eye drop is placed inthe eye before the optician touches

the cornea with a probe to determineif there are any problems. A morecommonly known test is the use ofan ophthalmoscope to shine lightinto the eye to look through thepupil to assess any issues.

One of the major treatments forglaucoma is Xalatan. In the form of afluid that is dropped into the eye,Xalatan is designed to reduce higheye pressure by opening blockeddrainage channels. Very similarly tousing ordinary eye drops, the treat-ment involves one drop each day toreduce and maintain regular eye pres-sure to prevent the onset of glaucoma.

Glaucoma does not necessarilypresent itself with overt symptoms.Often, the first time a person isaware that they have the conditionis when it is diagnosed by a medicalprofessional. If treated, the effects ofglaucoma can be minimised verysuccessfully. If not treated, it canand does lead to blindness that can-not be cured.

The very first World GlaucomaDay was held on 6th March. As partof a campaign to promote awarenessof the condition, events were heldacross the globe to provide informa-tion about the causes, symptomsand treatments of glaucoma.

For more information on glaucoma, visit

www.alleyesonglaucoma.com.

Under pressureOne of the most common conditions affecting eyesight,glaucoma is a disease that is well known, if little un-derstood. In actual fact, glaucoma is actually a collec-tive term for various different types of eye problems,but which all have the effect of damaging the mainoptic nerve - the pathway from the eye to the brain.

� Glaucoma damages the optic nervewhich carries information to the brain

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Less well known but very impor-tant functions of optometrists

include detection and referral toophthalmologists and GPs of vari-ous eye diseases such as cataracts,glaucoma and macular degenera-tion. Optometrists are also able todetect ocular signs of systemic con-ditions such as high blood pressureand diabetes. At the moment op-tometrists working in Ireland cannottreat eye conditions as they could doif they were working in England.

The eye examination is a vitalhealth check and should be part ofeveryone's normal health regime.

The profession of optometry hasadvanced over the years. The di-versity of services optometristsprovide include the fitting of con-tact lenses, safety eyewear and lowvisual aids, the assessment ofcolour vision, occupational vision,and binocular vision.

The importance of some of theseassessments may not be immediatelyapparent. Colour vision assessmentprovides valuable information whenchoosing a career path or in child-hood, as colour is often used as aneducational tool, particularly in theearly stages of education.

Binocular vision assessment is ofparticular importance in childhood,the detection of a lazy eye at ayoung age can prevent loss of vi-sion. Adults and teenagers may suf-fer visual discomfort due to inabilityto coordinate the eyes properly. De-tection and management of thebinocular conditions which causethese symptoms can alleviate thediscomfort and improve reading ef-ficiency.

B.Sc. (Optometry)The Dublin Institute of Technologyprovides the only undergraduateprogramme in Optometry in the Re-public of Ireland. Students consid-ering applying for the degree arestrongly advised to speak with acurrently practicing Optometrist.

The first two years gives studentsa good foundation in biological sci-ences and physical sciences associ-ated with light and optics. Thisknowledge underpins an under-standing of the normal visual sys-tem, systemic and ocular disease,and the behaviour of light and theoptics of lenses. This combination ofapplied sciences creates a studentand graduate who is a problemsolver in all aspects of vision relatedchallenges. These problem solvingskills are put into practice in a realclinical environment by the thirdyear of the programme, when stu-dents rotate into the clinics run bythe National Optometry Centre(NOC) at DIT. The NOC is a state ofthe art optometry clinic opened in2005. The NOC offers a number ofoptometric services to the generalpublic some of which are free ofcharge. The services offered includecontact lens fitting, sight testing,colour vision assessment and furtherinvestigative tests for the detectionof ocular conditions such as glau-coma and age related macular de-generation.

There is also a period of Super-vised Practice within the programmewhere students are placed in an out-side practice.

A number of key skills are es-sential for a career in optometry: • The ability to understand and

apply scientific principles andmethods

• A high degree of accuracy • Good organisational and adminis-

trative skills • The ability to keep up to date with

scientific and technological devel-opments

• Attention to detail • Manual dexterity • The ability to do repetitive tasks • Strong interpersonal and commu-

nication skills Once optometrists have qualified

they have the opportunity to developtheir interests in specialist aspects of

practice such as paediatrics, contactlenses, low vision, and sports vision.

Entry requirements for the B.Sc. (Optometry)The minimum admission require-ments are:• Leaving Certificate in six subjects

with grade C3 or higher in at leasttwo subjects at Higher Level, atleast one of which must be se-lected from the following: Physics,Biology, Chemistry, Physics andChemistry (combined).

• Applications are processed in theusual way via the CAO- with anannual intake of 25 students.

• The points required are generallyin excess of 500.

Research @ DITLecturers at the department are ac-tively involved in research in areassuch as macular pigment and its re-lationship to visual performance andassociation with age related macu-lar degeneration; development of in-strumentation for the assessment ofvisual function and the effectivenessof contact lenses in protecting theeyes from UV radiation.

Job OpportunitiesJob prospects are excellent for newlyqualified Optometrists with 100%employment record for several years.Most choose to work in establishedpractices though many graduateshave also set up their own practices.

Eva Doyle, Head, Department of Optometry, DIT+353 1 402 4751eva.doyle@dit.iewww.optometry.dit.ie

Other useful websites includewww.opticiansboard.iewww.cao.iewww.optometrists.iehttp://optometry.dit.iewww.dit.ie/DIT/prospective/index.html

What is an optometrist?DIT has offered a course to train ophthalmic opticiansor optometrists for more than 50 years. Optometristsare health care professionals who provide primary eyecare services, especially the examination and diagnosisof vision defects including myopia (short-sightedness),hyperopia (long-sightedness), astigmatism and the dis-pensing of spectacles and contact lenses.

Call for an information pack, or come in and view our training video For younger patients we can correct your vision with Wavefront Lasik or Lasek

For older patients we can correct your near vision with Near Vision CK Patients with adequate VHI cover will now be eligible to receive a 15% discount

on the cost of their corrective all laser surgeryFully automated all laser, lasik available at very competitive prices

Suite 1, Ardfallen Mall Douglas Road, CorkE: ardfalleneyeclinic@eircom.net T: (021) 4291 705 Fax: (021) 429 1724

Please visit our website www.cwell.net

There are also opportunities for post-graduate academic research or re-search in an industrial environment.Jobs in hospitals are rare in Irelandbut are quite common in the UK.

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How does diabetes affect theeye? Diabetes can affect the eye in vari-ous ways. The most serious effectshowever are through problems inthe retina. This problem is called di-abetic retinopathy.

Having diabetes does not mean thata person will have eye problems, butit is important that regular eye exam-inations are carried out to ensure thatany potential problems are diagnosedearly. Sight loss from diabetes canusually be prevented if retinopathy isdiagnosed and treated early.

Diabetic RetinopathyThe prevalence of diabetic retinopa-thy increases with the age of the pa-tient and the duration of diabetes.

After 20 years of diabetes 99 percent of Insulin -dependent Diabeticsand 60 per cent of non-insulin de-pendent diabetics show some degreeof retinopathy.

Stage 1: Non-proliferative Diabetic Retinopathy (NPDR)After a number of years of diabetes,blood vessels may show signs ofbeing affected. They can bulge toform micro aneurysms, and leak ei-ther blood in the form of smallhaemorrhages or fluid in the formof hard exudates. The nerve fibrelayer of the retina may become af-fected as infarcts.

If the central area of the retina be-comes affected by diabetic retinopa-thy the condition is called a

maculopathy. If this happens, thecentral vision may be affected. Thiscondition is often slowly progressivewith increasing loss of vision, butvery seldom does this result in totalvision loss.

Stage 2: Proliferative DiabeticRetinopathy (PDR)As the severity of the retinopathyincreases, some retinal blood vesselsmay become blocked. The retina, inan attempt to heal itself, promotesthe growth of new leaky blood ves-sels which start to grow on the sur-face of the retina.

These blood vessels may leak fluidor blood which causes loss of vision.This visual loss may be suddenthrough a large bleed (vitreoushaemorrhage) or more gradualthrough scarring (traction) and evenretinal detachment.

Education There are many good support net-works to help educate and informDiabetics about their illness so thatthey can take measures to improvetheir care. The Diabetes Federationof Ireland www.diabetesireland isone of the best.

The FutureNew pharmacological treatments arebeing investigated at present to pre-vent and treat complications ofretinopathy. At microscopic and cel-lular levels, diabetic blood vesselcells produce exciting factors (an-giogenic factors) that result in newabnormal blood vessels forming.New injectable medicines that in-hibit these factors have the potentialto reduce vision loss in carefully se-lected patients. There is optimism inthe ophthalmic community aboutthe success of these new treatments.The future for prevention, early in-tervention and successful treatmentsis bright.

Screening for Diabetic Eye Conditions at the Leeson Eye Institute Mr John Fenton FRCSI is a Consul-tant Ophthalmic Surgeon at the Lee-son Eye Institute. Mr Fenton trainedin retinal and diabetic surgery inNew Orleans with Professor G. Pey-man, an internationally recognizedexpert on diabetic laser eye surgery.Professor Johnny Moore, a co-founder of the Leeson Eye Institute,has several years of experience de-

veloping and using online diagnos-tic technology. They have developeda Diabetic Diagnostic and Treatmentprogram which is available to allGPs, Optometrists, Health Care insti-tutions and diabetic organizations toexamine diabetics and direct futuretreatments.

The Leeson Eye Institute followsthe Early Treatment of DiabeticRetinopathy Study (ETDRS) guide-lines when managing diabetics withlaser photocoagulation. This studysponsored by the US National EyeInstitute has shown that early laserintervention when clinically signifi-cant macular oedema is present canreduce the risk of moderate visualloss by 50 per cent.and severe visualloss for those with new blood ves-sels and haemorrhage (PDR) by 50per cent

There are new intelligent softwareapplications which allow surgeonsat remote locations to diagnose pa-tients and direct referrals for lasertreatment.

For further information on thismobile diabetic telescreening unit,

telephone 01.6674778 or emailinfo@laservision.ie

Diabetes-related eye conditionsDiabetes affects approximately 1 in 25 patients in thedeveloped world. The incidence of Diabetes in Ireland isincreasing and it is expected that up to 6% of the pop-ulation will become affected by 2015. In Ireland, Dia-betic retinopathy accounts for 12% of all new cases ofblindness each year and is the leading cause of blind-ness in patients between 20 and 65 years of age – Mr John Fenton FCRSI

Untreated wet-AMD causesblindness within two years

Age-related macular degeneration (AMD) is a degenerative eyedisease that affects the macula – the central part of the retinathat is responsible for the “straight ahead” vision and gives theability to see in fine detail. It is necessary for everyday activitieslike reading, driving, telling time watching TV, shopping orrecognising faces. In people with AMD, the macula becomesdamaged and central vision deteriorates and is eventually lost.

AMD is the leading cause of legalblindness for people over the age of

55 in the Western world. Indeed, eventhough not as well-known as cataract orglaucoma, AMD is quite common. MichaelGriffith, Chief Executive of Fighting Blind-ness said “40 million people globally areaffected by the condition.

There are no specific numbers for AMDin Ireland but it is estimated that at least60,000 people in the country are affected,and there are 7,000 new cases of AMDevery year with about 1,500 of thesewhich are treatable”. He added: “Unfortu-nately, only a quarter of these are reachinga centre where they can be treated ontime; therefore it’s very likely that there isa lot of unnecessary blindness occurringin the country.”

Risk factorsIncreasing age is actually the biggest riskfactor for AMD, which generally affectspeople over the age of 50, while over theage of about 65-70 years both forms ofmacular degeneration, dry and wet, take adramatic increase.

Smoking is another important risk factor.The correlation between smoking and blind-ness is now very well established. Accordingto Michael Griffith, evidence shows that thelink between smoking and AMD is actuallyas strong as the link between cancer andsmoking. “Many separate studies haveshown that smokers are three to four timesmore likely to develop AMD than non-smokers,” he said. But the good news is that“someone who has stopped smoking for 10years has the same risk as a non smoker”.

AMD is also much influenced by nutri-tion, and a diet lacking in certain vitamins,minerals and anti-oxidants may increaseAMD risks. “Yellow pepper and carrots arevery beneficial against AMD” said MichaelGriffith. He also pointed out that anti-ox-idants such as lutein have been shown tobe very protective against the condition.This again might be due to cardiovascularbenefits of antioxidants.

Genes also play a role. Although thereis not a single gene involved like in CF,several genes have been identified whichare related to AMD. “Everybody shouldhave their eyes tested; but if AMD is in thefamily people are strongly advised to beparticularly careful to have regular eyechecks,” said Michael Griffith.

In spite of our relative knowledge of therisk factors, there is no known way to pre-vent the onset of AMD. Early detection ofthe condition and appropriate treatmentand management is currently the best op-tion available to affected people to preventsevere vision loss.

Early diagnosisOne of the key early signs of AMD is thedistortion of straight lines.

One of the typical symptoms of wetAMD are decreased visual acuity (patientsare unable to see images sharply), distor-tion (metamorphopsia) where straightlines, such as doorframes appear bent, andblind spots (central scotoma). Many pa-

AMSLER GRID

1 If you wear glasses or contact lensesfor reading leave them on but do notwear varifocals or distance glasses

2 Hold the Amsler Grid approximately 12inches (30cm) in front of your eyes

3 Cover one eye with your hand andfocus on the centre dot with your un-covered eye. Repeat with other eye

4 If you see wavy, broken or distortedlines, blurred or missing areas of vision,you may be displaying symptoms ofAMD and should visit your optician

AMD FROM A PATIENT’S PERSPECTIVE

Rosemary Smythe has had a macular hole for about 18 years. She

explained: “It comes under the same umbrella as AMD but it’s a nat-

ural hole in the macula itself, and it’s more stable”. Even though she

had been registered blind for 14-15 years now, “I was fine”, she said.

However, 13 months ago her sight took a deep plunge. She thought

it was the side effects of some tablets, but her specialist told her it

was wet AMD.

Blindness is not easy to come to terms with. “When I was registered

blind I felt like a different person; now I’m disabled” Rosemary said.

One of the first things that comes to mind in relation to loss of

central vision is the loss of the ability to read. “You automatically

think about newspapers, but you also can’t read a personal letter, you

can’t read your bank balance, you can’t go into a shop and read la-

bels” she said. And it’s not just about reading. “To give you an idea

of how things do happen, I have sprayed my hair with furniture pol-

ish because it happened to be in the same colour as my hair spray; I

cleaned my teeth with a shaving cream because somebody had

moved the tooth paste; I used a tin of plums in the spaghetti because

somebody put the plums where I usually put the tomatoes,” said

Rosemary.

“So it’s a completely new learning task curve for the person who

has it and the family and friends,” she concluded. “Your whole life

changes”.

She used to be a fitness teacher and would take 7 classes a week;

“that had to gradually go”, she said. But in fact it’s not just the big

things that she is missing; it’s the little things she finds very diffi-

cult. “I can’t see my husband’s face across the table. I can’t read a fa-

cial expression. I can’t even see my face properly in the mirror”. The

other thing to mention is the lack of privacy associated with the con-

dition, having to get someone to read out private letters and fill out

forms for you can be difficult.

One of the problems she stressed is that when you get older you

don’t like to change your life; so you’re not prepared to adapt. There

are a number of helping devices available, such as reading machines

or computers that can talk. However, as pointed out by Rosemary,

older people don’t particularly want to get to know how to use them.

“You have to be prepared to work on these things,” she said. It took

Rosemary a long time to find a magnifying glass that suited her, she

currently uses various types of magnifying glasses for everyday use.

About a year and a half ago she applied for a dog. It took her three

years to make up her mind and then six months to get one. “I had

quite a few falls including a bad one that shook my confidence a

great deal and I thought it was time”, she said. “We always had dogs

anyway so this just an extra number of the family”. Clint is an “Apri-

cot shade” Golden Doodle (cross between a Golden retriever and a

Giant poodle). “One of the main things he has done while walking I

have at last stopped apologising to dust bins and parking metres”.

So Rosemary has managed to adapt. “I was lucky I was young

enough to regard it as a challenge”, she said. She even took up bowl-

ing two years ago where she had to use a binocular to see the jacks.

She won a cup last year in a championship in her club.

Thus, as she put it, life does not exactly end. However, it is dis-

rupted, it affects your family and you need a great deal of commit-

ment to make it work for you.

What is AMD?AMD is a condition that can affect your eyes, as you get older. AMD is not as well known as

other eye diseases such as cataracts or glaucoma but it is the leading cause of legal blindness

for people over the age of 50 in the Western world, It is thought to affect 1 in 10 people over

the age of 50 every year in Ireland.

AMD affects the macula - a small part of the eye responsible for central vision, which al-

lows you to see detail. AMD usually starts in one eye and is highly likely to affect the other

eye at a later stage. The macula is located in the centre of the retina at the back of the eye.

As you read, images are focused onto the cells of the macula. From here information is passed

to the brain where it is converted into a picture of what you are seeing. This central vision al-

lows you to read, drive, and perform other activities where recognising detail is important.

What is Wet and Dry AMD?Dry AMD is the most common form of the condition and develops slowly, eventually leading

to loss of central vision. Wet AMD is caused by leaky blood vessels inside the eye. It is less com-

mon than dry AMD but it can cause more rapid loss of vision.

What causes AMD?The exact causes of AMD are still unknown. However, we do know that risk for AMD increases

if you have a relative with this condition, or if you smoke. Therefore, if close relatives have suf-

fered with sight loss in the past, it may be worth getting your eyes checked more regularly.

Other factors such as high blood pressure and poor diet can also lead to a greater risk. Indeed,

recent research suggests that dietary antioxidants may protect against progression of AMD.

How common is AMD?Today in Ireland, there are thousands of people with AMD. However, fewer than 1 in 7 of these

will have wet AMD, the type of AMD that will cause rapid sight loss. The chances of getting

AMD increase as you get older. However, most people develop the dry form, which is currently

untreatable. Wet AMD - the type that causes rapid vision loss - can in many cases be treated

and sight loss limited, but early diagnosis is vital. In both cases, help and support is available

from low vision services.

How does AMD affect vision?The most obvious symptoms of AMD are distortion and blurring of central vision, people with

AMD have difficulty in recognising detail and this can show itself when reading, driving and

even when trying to identify a familiar face.

How is it treated?There are three clinically proven treatment options for wet AMD patients: laser photocoagu-

lation, photodynamic therapy (PDT) and anti-VEGF therapies Macugen (pegaptanib) and Lu-

centis (ranibizumab)

In laser photocoagulation heat from a thermal laser light is used to destroy the abnormal

leaky blood vessels that occur in wet AMD. However, the treatment also destroys overlying

healthy retinal tissue and may result in an immediate and permanent loss of some vision.

Photodynamic therapy (PDT) is used to stop the leaking blood vessels at the back of the

eye to help prevent further vision loss. It is a two-step process involving the infusion of a

light sensitive drug verteporfin, followed by application of a non-thermal laser that activates

the drug.

Anti-VEGF therapies bind to vascular endothelial growth factor (VEGF), which is thought to

play a role in the development of the abnormal growth of blood vessels that occur in the eye

in wet AMD, with the aim of blocking its effect to try and prevent more blood vessels from

growing. Anti-VEGF therapies are administered via injections into the eyes. Prior to the in-

jection patients receive anesthesia and an antibiotic, and the injection is carried out under ster-

ile conditions to prevent infection in the eye.

Q&A BY MR STEPHEN BEATTY, CONSULTANT IN OPHTHALMOLOGY, WATERFORD REGIONAL HOSPITAL

tients also experience a decrease in con-trast sensitivity (ability to see objects orpatterns that have a similar shade) whichis likely to make it more difficult to seefaces, road signs and everyday objects.

There is a simple test available, using anAmsler Grid which can identify early symp-toms of AMD, a definitive diagnosis canonly be made by an ophthalmologist. Butbecause the speed of vision loss is muchmore rapid with wet AMD, there is only a“short window of opportunity “(between 3-6 months) for the ophthalmologist to inter-vene and halt the disease progression.

Early detectionEarly detection of the disease is essential toallow prompt referral to a retinal specialistand reduce the risk of severe vision loss. TheAssociation of Optometrists Ireland rec-ommends that everyone have their eyeschecked at least every 2 years. People athigher risk including older people, patientswith diabetes or those who have a familyhistory of glaucoma should have more fre-quent check-ups. The Association of Op-tometrists Ireland stresses that most peoplein Ireland may avail of a free eye examina-tion through the PRSI and Medical Card.

Additionally, it is recommended that pa-tients at risk of developing AMD – eitherwet or dry – should carry out self-moni-toring in conjunction with regular eyetests in order to help detect the disease asearly as possible.

To receive a copy of a free informationbooklet on wet-AMD please send a letter

to P.O. Box 979, Naas, Co. Kildare. Alternatively ring this freephonehelpline number: 1800 302045