Cataracts result in loss of transparency of the natural clear lens which results in patients finding it increasingly difficult to see. The first sign may be an increased reliance upon reading glasses. These can be removed through a simple quick operation. A choice exists of types of intraocular lenses available to replace the cataract with new types of intraocular lenses.

Intraocular Lens Procedures

An intraocular surgical procedure is used to treat patients who are either not suitable for laser surgery because their refractive error is too great or they have a corneal problem. The two principal types of intraocular procedure include phakic IOL implantation or clear lens extraction.

• Phakic IOLs gain their name on the basis that a person retains their own lens within the eye and these lenses are additional. They can be thought of as implantable contact lenses.
• Clear Lens Extraction is particularly suitable for people over the age of 40 where their natural lens is becoming less flexible and unable to change shape and focus. The procedure is reserved for patients with large refractive errors who are not suitable for laser refractive surgery

Cataract results

In 2007 alone Cathedral Eye Clinic has currently carried out more than 900 cataract operations. The results of these surgeries are constantly being audited with the aim to ensure that results are of the highest standard possible and where possible to fine tune and constantly improve these results.

Postoperative overall visual results of cataract surgery carried out by The Cathedral Eye Clinic demonstrated that greater than 90% of patients resulted in a best corrected vision of 6/12 or better. This compares well with similar studies carried out in the UK with the final visual acuity in some patients very much related to the degree of co-morbidity.

The first column represents the visual results published from the most commonly reported national UK study of cataract results called the National cataract survey published by Desai in the BJO, this represents the visual results from 15787 patients. The second column represents the visual results from 400 consecutive cataract patients treated in 2007 by the Cathedral Eye Clinic in conjunction with 352 medical consulting.

Best Corrected Visual Acuity Post surgery:

UK NCS

Cathedral Eye Clinic / 352
All patients 86% >/= 6/12
92.5%>/=6/12

Desai; P, Minassian DC & Reidy A. National cataract surgery survey 1997−8: a report of the results of the clinical outcomes. Br J Ophthalmol 1999; 83: 1336−1340.

Age related macular degeneration is the leading cause of visual loss in the over 65s in the developed world. As the elderly population increases the incidence of this disease consequently also increases. Various different treatments have been evolving to manage this condition over the years.

Diabetes is very common, affecting approximately 1 in 25 patients in the developed world. In the UK up to 9% of the whole NHS budget is used to treat diabetes and its related complications.

The condition can start in childhood or later in life. It can affect many different parts of the body, but particularly the eye.

How does diabetes affect the eye?

Diabetes can affect the eye in various ways. The most serious effects however are through problems in the retina. This problem is called diabetic retinopathy.

Diabetic retinopathy occurs as a consequence of diabetes and can result in loss of vision either through leaky blood vessels causing swelling of the retina or by causing the production of abnormal blood vessels which result in bleeding within the eye and scaring of the retina.

Screening is essential to detect vision threatening stages prior to loss of vision.

Having diabetes does not mean that a person will have eye problems, but it is important that regular eye examinations are carried out to ensure that any potential problems are diagnosed early. Sight loss from diabetes can usually be prevented if retinopathy is diagnosed and treated early. After diagnosis the condition can be graded by a person’s eye specialist depending on its severity.

Treatment

The most important aspect of management of diabetes is to ensure that good cooperation exists between each patient and the team of health professionals who are involved in managing their care. The general practitioner is key to proper management of all systemic medical factors. However, the ophthalmologist as a diabetic retinopathy screener in addition to directly managing retinal problems should provide support to the GP by helping to communicate the value of good systemic medical management. Strategies for treatment combine optimization of systemic risk factors such as blood glucose control, blood pressure management, reducing blood lipid levels.

Evidence for the value of controlling these factors includes:

Glycaemic Control:- Diabetes Control and Complications Trial (DCCT) demonstrated a 26% reduction in the risk of developing macular oedema where there was intensive insulin treatment

Blood Pressure Control:- UK Prospective Diabetes Study (UKPDS) reported a 47% reduction in loss of vision from macular oedema in Type II diabetics where there was tight blood pressure control

Blood Lipid Control:- The DCCT and the ETDRS studies have demonstrated positive correlations between lipid profiles and the development of macular oedema in patients with type I Diabetes.

Smoking:- This is a well recognized risk factor for diabetic micro- and macrovascular problems. No diabetic should smoke.

Local Ophthalmic Treatment

The Cathedral Eye Clinic follows the Early Treatment of Diabetic Retinopathy Study (ETDRS) guidelines when managing diabetics with laser photocoagulation. This study sponsored by the US National Eye Institute has shown that early laser intervention when clinically significant macular oedema is present can reduce the risk of moderate visual loss by 50%.

In addition to the ETDRS study guidelines the institute advocates using larger spot sizes with longer durations and lower energy profiles. This is in response to more recent studies demonstrating effectiveness of this technique while minimising any side-effects of the laser treatment. (Roider J et al, 2000, BJO 84(1):40-47)

What is glaucoma?

Glaucoma is a disease which results in progressive damage to the optic nerve.

The prevalence of this disease has been estimated through various studies to be in the region of 2% of the population. This rate rises considerably with age so that over the age of 80 greater than 12% of the population may be affected.

Often glaucoma goes undetected until significant visual loss has occurred