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What is a cataract​
  • A cataract is a progressive clouding of the human lens inside the eye. It’s like looking through a steamed shower door. Glare becomes a problem especially in bright sunlight and when driving at night.
  • The human lens consists of a mixture of water and protein which is inside a capsular bag. As the lens ages, the proteins in the lens start to break down and clump together, eventually causing the cloudy vision.
  • During cataract surgery the capsular bag is cleaned by removing the hardened water and protein layers, and then an artificial lens is implanted into the empty capsular bag. The cataract procedure is fast, safe and successful.
  • Cataract surgery is the most common surgery of all other surgical disciplines performed over the world. It is also the most frequently performed surgical procedure at Visiomed Eye and Laser Clinic. It is thanks to advanced technology that cataract surgery has become so fast, effective and successful. Cataract procedures are performed on an outpatient basis and usually only requires a few hours of your time from beginning to end.

Most cataracts start to develop at any age from 40 years and older and it is almost guaranteed to have them if you live long enough. Cataracts are formed with age and oxidation due to sun exposure, smoking, alcohol, cortisone treatment, diabetes, injuries to the eye, etcetera. These factors change the cellular composition of your lens and discolour and cloud the lens and distort the light passing through. Symptoms of cataracts include impaired vision which is evident during driving, poor night vision, cloudy/blurry vision, double vision and glare/halo around lights.

In order to treat cataracts effectively the ophthalmologists at Visiomed Eye and Laser Clinic suggest regular eye examinations. If you are diagnosed with a cataract, the ophthalmologist is able to replace your lens, of which there are various options, including Premium lenses to suit your specific needs. As cataracts are irreversible, surgery is the only proven way to get back to enjoying your life style and all the adventures life brings without blurred, cloudy vision.

Your first consultation with your eye surgeon will last about 1 – 2 hours. Your eyes may be dilated to get full view of the back of your eye where the retina and optic nerve and blood vessels are, hence you need to bring a driver with. Your full medical history will be recorded and your surgeon will discuss your general health.

Your surgeon’s trained assistants will perform various scans and tests. This will include:

  • A refraction and ocular examination to determine the state and strength of your eyes and quality of your vision.
  • Biometry tests to measure your eyeballs and determine the right power for your artificial intraocular lenses which are implanted into your eyes after your cataracts have been removed.
  • A corneal topography test may provide additional details that the biometry tests can’t, such as the presence of keratoconus.
  • The overall health of your retina, the nerve layer in the back of your eye and your optic nerve will be checked with an optical coherence test (OCT). You will also be checked for glaucoma, aged related macular degeneration, signs of diabetes and many other eye diseases.
  • Should you have any eye infections, hypertension, undiagnosed diabetes with blood sugar levels and other systemic diseases that need immediate attention, this will first be treated, or you be referred to your GP or other specialists for treatment before surgery is done.
  • High blood pressure and sugar levels can mean a higher risk of bleeding at the back of the eye during surgery. High blood sugar levels can also put you at a higher risk of infection after surgery.
  • So understandably, the surgeon needs to ensure you’re in relatively good health to get the best possible outcomes of your surgery, hence he may require further eye tests if needed.

Your hobbies and life style will be discussed to determine which intraocular lenses will give you optical vision to suit your unique life style and needs.

On the day of surgery you need to provide us with your personal and medical information again, as given at the doctor’s rooms during your first consultation. The clinic and the doctor’s rooms are two different entities. It will help if you bring someone with you to help you with the forms as your eyes will be dilated and become blurred, which makes it difficult to read and write. You will be admitted into our pre-and post-operative ward where we will provide you with a comfortable theatre top and trousers. Your vital statistics will be checked. It will take around one and a half hour to instil various eye drops like anti-inflammatory, antibiotic- and eye dilatation drops into your eye to prepare your eye for surgery. This all happens while sitting on a comfortable recliner chair. Be ensured that our sisters will pamper you!

If you have two cataracts, we will only do one at a time. The second cataract will be removed a week later. The cataract surgery only takes 15 – 20 minutes per eye, however the preparation for surgery and entire process may take a little bit longer.  You will not be able to drive after the procedure is completed, as you may feel a bit sedated and disorientated for a while, so please arrange for someone to fetch you afterwards.

Cataract surgery normally requires no general anaesthesia where you need to be intubated. Your anaesthetist will administer intravenous sedation which leaves you in a blissful dream-like state, or even make you sleep. You may experience very little or no discomfort during your cataract procedure. The best technology is used to remove your cataract either with Phaco Emulsification or with our new AI Femto Laser Assisted Technology. Your surgeon will discuss which option of the two will benefit you the most.

Your ophthalmologist will make a small incision on your cornea – the outer dome shaped transparent window of your eye, through which the cataract will be removed. To remove the cataract, your doctor will break up the hardened protein layers inside your capsular bag and extract it with a technique called phacoemulsification and suction, or he/she will use low impact AI Femto Laser Assisted Cataract removal technique to break up your lens. An intraocular lens (IOL) will then be inserted through the same tiny incision into the cleaned and empty lens capsule to replace your natural lens.

The lens is made of a material that is flexible, which allows the ophthalmologist to fold and insert it through the small incision on your cornea with a special introducer or injector/syringe.

Once the cataract is removed, and the IOL is positioned in the clear capsular bag and light can once again travel unimpeded to the retina at the back of your eye. The retina is the nerve layer of your eye and receiver of the light images from outside. It changes them into electric impulses, which travel to your brain via the optic nerve, from where the brain interprets what you see.

After the procedure, you will receive an eye patch or transparent goggles in theatre to protect your eye, and after being wheeled back to the ward, your vital statistics will be taken again. You will receive some tea or coffee with a biscuit or two and rest for a short period before going home.

You will begin to notice an immediate improvement in your vision. Patients are typically able to heal very quickly with little to no discomfort as the cataract procedure is done with sophisticated technology causing minimal impact in the eye. (Click on the next section ‘restoring vision’ to explain the steps of cataract surgery)

Below, we have images detailing the major steps of the cataract procedure. This type of procedure is considered state-of-the-art for cataract surgery today. The procedure demonstrates cataract surgery as is done most generally.

Cross-section of the eye

A cataract is a clouding of the lens of your eye that causes blurred or distorted vision. If left untreated it can cause blindness.

Step 1

The pupil is dilated and the lens behind the iris is now exposed.

A 1.8 – 2.3mm incision is manually made into the cornea with a precision blade or with low impact AI Femto Laser Assisted technology. Due to the small size of the incision, the opening is generally self-sealing.

Step 2

A circular tear is manually made on the lens capsule or can also be made by low impact AI Femto Laser Assisted technology to create an opening from where the cataract can be removed.

Step 3

With conventional cataract surgery ultrasonic vibrations are used to break the cataract into smaller fragments that are then aspirated from the eye with a customized suction device.

With low impact AI Femto Laser Assisted Cataract technology the cataract is divided into smaller wedge shaped sections for easy and less invasive removal.

Step 4

After the cataract has been removed, a new lens is implanted. In most cases, a foldable lens is placed into a specialised injector or introducer and inserted through the circular opening previously made.

Step 5


As the foldable lens is inserted, it will automatically expand, open up inside the lens capsule, attach and secure itself to the lens capsule wall with specially designed hooks, resulting in……..

…….good, clear vision! Depending on the type of intra ocular lens inserted, you might only need a pair of spectacles either for distance or near vision, or no spectacles at all!

  • Visiomed Eye and Laser Clinic offers a wide range of cataract replacement lenses, of which also include Premium Lenses to correct your vision. These lenses can address anything from nearsightedness, farsightedness, presbyopia and astigmatism.
    Some of the most common lenses include:

 

  • Monofocal Intraocular Lens
    This lens will correct vision at a set distance but does not correct pre-existing corneal astigmatism. Patients with astigmatism will therefore wear glasses to correct distance and close up vision problems. Patients without pre-existing astigmatism require reading glasses.

 

  • Toric Intraocular Lens
    This advanced technology lens corrects both distance and astigmatic problems. Patients will require reading glasses to see up close.

 

  • Multifocal Intraocular Lens
    This advanced technological lens corrects both distance and close up vision problems which will assist in correcting overall dependence on glasses.
    Should any corneal surface conditions need to be addressed after cataract surgery, you will still be able to receive laser and corneal surgery and other surgery necessitated to optimise your vision.

The day after surgery your surgeon will examine your eye in the consultation room and you will proceed with eye drops as prescribed to you. It is of utmost importance that you always wash your hands before instilling your eye drops to prevent infection in your operated eye.

  • Your vision will be improved, although you may experience some inflammation and swelling as healing takes place, but healing is fast and you may proceed with your daily tasks as long as there is no unnecessary bending, no heavy objects are lifted and you do not partake in strenuous activity/exercise for at least 2 weeks.

 

  • You may read, use the computer and watch TV, but keep your eyes well lubricated and rest them if they feel strained.

 

  • Be sure to keep sweat out of your eyes and avoid all lotions, creams and eye makeup for seven days.

 

Your eye surgeon will schedule a few routine post-op visits to ensure your treatment is a success and you are 100% satisfied.

 

  • The artificial tears provided or suggested by your doctor will help ease any irritation you may experience after the Cataract surgery.

 

  • If you experience any irritation it is important not to rub, poke or touch your eyes, especially if your hands are not washed.

 

  • Follow your doctor’s instructions on using your steroid and antibiotic eye drops.

 

  • Use this time to rest and relax.

 

  • Do not strain your eyes through reading, computer work or watching TV.
 

Your eye will be close to fully healed and you will notice continued improvement to eyesight.

  • Typically, your ophthalmologist will request that you attend a post-op appointment between one and three months after your cataract surgery.

 

  • In some cases, after three months, your doctor may request an additional 90-day post-op check.

 

  • Vision stability will be realised in most patients at approximately three months.

 

  • Your surgeon will tell you when you can visit your referring optometrist for a refined eye test and have new glasses made for you should it be necessary. This happens at around 6 weeks post-surgery or after your eye has completely healed.
LASER PRECISION IN CATARACT SURGERY AND LENS EXCHANGE
Has your eye doctor recommended that you have the natural lens in your eye replaced with an arti­ficial one due to cataract formation? If so, we have good news for you: Cataract surgery and lens ex­change have undergone profound progress in the last few years and can now be performed without using a surgical blade.

Using an innovative new laser technology, we achieve ultimate precision and safety in cataract surgery. The following pages will tell you more about this new technology and help you decide if the laser precision method is right for you.

As always, ask your doctor if you have specific questions or concerns not covered on this website.

Cataract is the most common reason why the eye‘s natural lens should be replaced with an artificial lens. In most cataract cases, the aging natural lens becomes cloudy, blurring your eyesight and dimming colours. High, near­ or farsightedness and presbyopia may be other reasons to exchange the natural lens in people who would prefer to stop wearing glasses.

The femtosecond laser used in cataract surgery and lens exchange precisely breaks up the differ­ent tissue layers and structures in the eye using a powerful light beam. In conventional surgery, the surgeon creates incisions in the eye by hand and uses ultrasonic technology, developed in the 1970s, to break the clouded natural lens apart so that it can be removed before a new lens can be inserted.
Traditional lens exchange procedures are safe and common but cannot achieve the surgical precision of a procedure performed with a laser.

The laser used in Z­-Cataract procedures has an ac­tivation period of a few hundred femtoseconds. One femtosecond corresponds to 0.000,000,000,000,001 seconds. The tissue depth at which the femtosecond laser works can be adjusted by the surgeon allowing the laser to work precisely both on the surface of the eye and in deeper layers.The acronym LASER stands for ‘Light Amplification by Stimulated Emission of Radiation’. A laser is essentially a light emitter. Unlike incandescent light such as that from a common light bulb, laser light is directed into one focused beam which amplifies its intensity. These days there is a very broad range of applications for laser technology: DVD players, distance measuring instruments, cutting and welding tools as well as many clinical applications. The laser power interacts with the tissue only for a tiny fraction of a second which results in a gentle procedure.

  • Once the laser has been programmed and started, its job will be complete in less than one minute.
    During your treatment, the surgeon will be by your side and supervise every step of the operation.
    The integrated OCT system enables the surgeon a clear visualization of the eye’s surfaces – before, during and after the procedure.
  • The laser will divide your clouded lens into fragments like that of a pie, which will then be removed from the eye through a tiny tube that is only a few mil­limetres wide.
  • What can you expect during your femto­laser cata­ract procedure? First, you will have a preoperative examination where your eyes will be measured so that your doctor can select the proper artificial lens for you by measuring the length of the eye from front to back. This procedure is absolutely painless, doesn’t touch your eye and will ensure that you get the perfect lens.
  • Next, the information gathered will be programed into the femtosecond laser device so that the surgery is customized to your exact eye ana­tomy.
  • Before your surgery, you will be led to a comfort­able surgical bed where you will lie down. Your sur­gical team will disinfect and dress the area around your eye in a sterile fashion. Drops will be instilled into the eye so that you will not feel any pain during the
    Once your eye is anaesthetized, a liquid­ filled ring which centres the laser beam path is placed on your eye with a light vacuum so that the laser will be in the perfect position during surgery.
    • Laser offers ultimate precision in the micrometre range.
    • A more precise surgery makes it more likely that the artificial lens will remain stable and provide the best possible vision. Using the femtosecond laser, surgeons can achieve the perfect capsular shape, size and position for lens fragmentation. The high­ precision openings created help the surgeon to perfectly align the artificial lens in the eye.
    • It’s minimally invasive.
    • The femtosecond laser not only creates precise accesses to the interior of your eye, it also frag­ments the clouded lens in such a way that it can be ultimately be removed with very little or even no ultra­sonic power. This means less strain on the sensitive tissues and structures of the eye thereby helping to prevent an inflammatory response. 
    • It offers predictability of important surgical steps.
    • Your eye is carefully measured and the measure­ment data programed into the laser. By doing this in advance, the surgeon can plan, supervise and guide your unique and individual treatment from start to finish.
    • It offers individualized and combined treatment.
    • We provide treatment specifically made for your eye. The laser’s versatility allows us to precisely pinpoint the locations at which it will separate the tissues, ensuring a custom procedure perfectly designed for your eye. 
    • The following paragraph highlights the most important differences between the new AI Femtosecond Laser Assisted Cataract Surgery (FLACS) versus conventional lens implantation surgery.

    FEMTOSECOND LASER VERSUS CONVENTIONAL SURGERY

    • The femtosecond laser creates a step-shaped bladeless incision on the cornea to gain access to the eye. This unique step-shape opening on the cornea adheses more securely and heals sooner after surgery.
    • In conventional surgery an incision into the cornea is made with a scalpel or a diamond blade to create a straight opening to gain access to the lens.
    • The laser creates a predictable, precise, pre-determined sized circular opening into the lens capsule to gain access to the cataract. In conventional surgery a circular tear is made into the capsular bag by using a metal hook or forceps held by the surgeon. The precise outcome and size of the capsular bag cannot always be guaranteed. In the normal mono-focal IOL’s it’s not really a problem, but when it comes to Premium lenses where size, placement and fit is essential, it is advisable to remove the cataract with AI Femto Laser Assisted Cataract Surgery.
    • The femtosecond laser fragments the clouded lens into precise wedge shaped sections within seconds. In conventional surgery the clouded lens is broken up with ultrasound which is achieved by inserting an ultrasound wand into the lens capsule.
    • The femtosecond laser gently removes the fragmented lens with gentle suction in minimum and less invasive moves. In conventional surgery the fragmented lens is removed by aspiration and irrigation by the doctor’s hands and instrument.
    • The femtosecond laser places precisely shaped and positioned tubes in the eye to insert the new lens, whereas with conventional surgery the artificial lens is inserted with an injector.
  • Your safety and well-being during and after the surgery is our highest priority. This is why
    we chose the Ziemer FEMTO LDV Z8 laser device which offers the following features:
  • The laser can be used for many different applications and allows options in surgical planning. Since the laser performs operations with a comparatively low laser pulse power, the surgical intervention may be gentler for the eye.
  • Unlike other lasers, the Ziemer Z8 is mobile and can be moved to your bedside instead
    of you having to go to the laser. This provides you more comfort and convenience during your surgery.
  • The interface attaching the device to your eye was carefully designed to adapt to the shape of your eye. This reduces both eye reddening and the pressure the eye endures during surgery helping keep the procedure safe, and you more comfortable.
  • The Ziemer Z8 helps the surgeon plan and supervise each unique, customised surgery through special visualization features that enable a live view into the layers of the eye through imaging technology called OCT (optical coherence tomography).

In our fast spinning world, technology is constantly evolving. Being in the eye industry since 1996 it has always been our priority to keep abreast of the latest developments in technology so you can experience cutting edge surgery at all times. This way we can plan a customised treatment plan for you so your vision can reach its optimum potential and hereby optimise your quality of life. 

The combination of expertise, technology and deep interest in our patients’ wellbeing and care have made our team of surgeons and dedicated nursing staff most favoured by referring optometrists and all in need of eye care and surgery.

Our latest LASIK procedure is the Z-LASIK method, which uses the FEMTO LDV laser from Ziemer Ophthalmology.

Hover over each frame to give you enough time to read it. Click on the arrows left and right to see the different stages of Laser Eye Surgery.

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What is Refractive Lens Exchange (RLE)?
  • Also known as “clear lens exchange” or simply “lens implants”, a refractive lens exchange (RLE) procedure at Visiomed Eye and Laser Clinic is recommended to our patients with dry eyes or thin corneas. Some patients may not be ideal candidates for LasikHD surgery and therefore we would recommend we use our advanced RLE techniques.
  • The RLE procedure at Visiomed Eye and Laser Clinic uses laser technology that ensures accurate results, quick recovery and minimal risk or complications.
  • During the RLE procedure, your ophthalmologist removes the fatigued natural lens and replaces it with a new, synthetic one. The implants are made from a soft, flexible material and are custom-made to correct your unique vision challenges.
  • What eye problems does RLE surgery address?
  • The Visiomed Eye and Laser Clinic RLE surgery procedure will address nearsightedness, farsightedness, presbyopia and astigmatism.
  • Also known as “clear lens exchange” or simply “lens implants”, a refractive lens exchange (RLE) procedure at Visiomed Eye and Laser Clinic is recommended to our patients with dry eyes or thin corneas. Some patients may not be ideal candidates for LasikHD surgery and therefore we would recommend we use our advanced RLE techniques.
  • The RLE procedure at Visiomed Eye and Laser Clinic uses laser technology that ensures accurate results, quick recovery and minimal risk or complications.
  • During the RLE procedure, your ophthalmologist removes the fatigued natural lens and replaces it with a new, synthetic one. The implants are made from a soft, flexible material and are custom-made to correct your unique vision challenges.
  • What eye problems does RLE surgery address?
  • The Visiomed Eye and Laser Clinic RLE surgery procedure will address nearsightedness, farsightedness, presbyopia and astigmatism
  • Over age 40.
  • No prior ophthalmic procedures.
  • No history of eye disease such as glaucoma, iritis or diabetic retinopathy.
  • Lens exchange is a simple, day clinic procedure that takes just a few minutes.
  • The procedure provides immediate improved vision.
  • The lenses and technology used at Visiomed Eye and Laser Clinic usually allow you to return to your daily routine almost immediately.

LasikHD surgery reshapes the cornea on the surface of the eye, while the Refractive Lens Exchange (RLE) replaces the lens on the inside of the eye. Both procedures are minimally invasive and take approximately 35-minutes to complete. LasikHD surgery is typically done on both eyes at once while RLE procedure is performed on one eye at a time at 2-4 week interval. Recovery is extremely fast and typically delivers nearly immediate results.

  • No Reading Glasses. RLE addresses multiple complications in one simple procedure. The lens implant your Visiomed Eye and Laser Clinic ophthalmologist recommends for you can typically address your distance, intermediate and near vision at the same time. RLE is often the only option for patients wishing to get rid of their bifocals, trifocals or the hassle of carrying multiple pairs of glasses.
  • No risk of cataracts. RLE is the only effective method of preventing cataracts from ever developing. Cataracts occur when your lens becomes cloudy due to the aging process. At Visiomed Eye and Laser Clinic your ophthalmologist will replace your lens with a synthetic one. You therefore do not have to worry about the cost and inconvenience of cataract surgery in the future.
  •  

STEP 1

INITIAL EYE EXAM AT VISIOMED EYE AND LASER CLINIC.

A 90 minute consultation will determine whether you are a candidate for laser vision correction or not. Your ophthalmologist will perform various tests similar to a normal eye examination as well as a scan of the eyes to determine certain RLE related information.

During your consultation your ophthalmologist will:

  • Test your visual acuity and visual field (peripheral vision)
  • Measure your corneal thickness and topography (shape of the eye)
  • Read your previous eye prescription using your glasses lenses.
  • Exam your pupils for reactivity.
  • Evaluate the muscle function and dominance of your eyes.
  • Assess the health of eye using a pupil dilatation and slit-lamp test.
  • Check for Glaucoma assessing your eyes’ pressure.
  • Inspect the health of your peripheral retina.
  • Assess your overall medical health.
  • Discuss your hobbies and occupation.

Once completed, this assessment will determine your unique treatment at Visiomed Eye and Laser Clinic.

STEP 2

DETERMINING WHETHER YOU ARE AN RLE CANDIDATE

After the results from the initial eye examination, your doctor will suggest a treatment which is customised to your prescription, eye anatomy and personal needs.

RLE treatment at Visiomed Eye and Laser Clinic is recommended for:

  • Patients with presbyopia, nearsightedness, farsightedness and/or astigmatism.
  • Patients who are not ideal LasikHD cadidates.
  • Patients in their mid-40’s.
THE RLE PROCEDURE AT VISIOMED EYE AND LASER CLINIC.

The RLE procedure is completed one eye at a time at  2 – 4 week intervals to allow for stabilisation. The procedure only takes 30 – 35 minutes per eye. You will be allowed to go home immediately after the procedure to rest and relax.

STEP 3

POST-OPERATIVE CARE

At Visiomed Eye and Laser Clinic, your post-op care is very important to us. We therefore schedule visits with your ophthalmologists periodically after your treatment.

STEP 4

THE FIRST 24 HOURS AFTER THE RLE PROCEDURE.

The ophthalmologist will perform a post-op check-up and you will be given a pair of protective glasses which you will need to wear for several hours after the surgery.
Ensure you organise a driver home.
The artificial tears provided by your doctor will help ease any irritation you may experience after the ICL surgery.
If you experience any irritation it is important not to rub, poke or touch your eyes.
Follow your doctor’s instructions on using your steroid and antibiotic eye drops.
Use this time to rest and relax.
Do not strain your eyes through reading, computer work or watching TV.

Your vision will stabilize in 2-4 weeks after the RLE procedure as your eye heals and adjusts to the new lens.
Multi-focal lenses allow for near vision and diminishes the need for “readers”.

ONE WEEK AFTER THE RLE PROCEDURE:

Your one-week follow-up appointment at your surgeon will mark significant improvement to your overall vision.
Continue following your doctor’s recommendations regarding eye drops and be sure to keep water, soap and shampoo out of your eyes when showering.
You may read, use the computer and watch TV, but keep your eyes well lubricated and rest them if they feel strained. Be sure to keep sweat out of your eyes and avoid all lotions, creams and eye makeup for seven days.

ONE MONTH AFTER THE RLE PROCEDURE:

At this point, your eye(s) will be close to fully healed and there will be a noticeable improvement to your eyesight.

THREE MONTHS AFTER THE RLE PROCEDURE
You will now have complete vision stability.
Typically, your ophthalmologist will request that you attend a post-op appointment within one and three months.
In some cases, after three months, your doctor may request an additional 90-day post-op check.
Vision stability will be realised in most patients at approximately three months.

What are implantable contact lenses (ICL)/Artisan

Implantable contact lenses (ICL) or Artisan surgery is one of the best alternatives to LasikHD surgery. An ICL corrects your vision much like a contact lens with the exception that it is permanent. The ICL/artisan surgery does not require regular maintenance and is undetectable to the wearer and onlookers. Thanks to the ophthalmologists at Visiomed Eye and Laser Clinic, you can now enjoy clearer vision if LasikHD or PRK surgery is not right for you.

The Visiomed Eye and Laser Clinic ICL/Artisan surgery procedure will address nearsightedness, farsightedness and astigmatism.

 

  • Patients not suitable for PRK or LasikHD.
  • Patients with more than 1.5 diopter astigmatism.
  • Patients suffering from nearsightedness (myopia)
  • Patients under the age of 40.

While LasikHD surgery is performed on the surface of your eye using a cool laser beam to permanently reshape the cornea, the Implantable Contact Lens (ICL)/Artisan procedure does not reshape your cornea. Instead, a synthetic lens is gently placed inside your eye where it functions just like a contact lens without the need to ever remove it. ICL/Artisan is designed to permanently correct your vision and the lens can be simply removed and/or replaced if necessary.

  • Overall better quality vision is achieved.
  • Sharper, clearer and more vivid vision is evident.
  • Your vision will have greater depth and dimension than what glasses or contact lenses are able to provide.
  • No dryness, irritation or discomfort often associated with wearing contact lenses.
  • The procedure is suitable for mild to severe nearsightedness.
  • Comfort
    ICL/Artisan offers the very best in implantable contact lens technology. Made to be biocompatible with the eye and therefore not seen as a foreign object to the body.
  • Protection
    The collamer material that makes up the ICL/Artisan contains a UV blocker that prevents harmful UVA and UVB rays from entering the eye. This can prevent future eye problems such as cataracts.

Step 1

Initial eye exam at Visiomed Eye and Laser Clinic
A 90 minute consultation will determine whether you are a candidate for laser vision correction. Your ophthalmologist will perform various tests similar to a normal eye examination as well as a scan of the eyes to determine certain ICL related information.
 
During your consultation your ophthalmologist will:
 
  • Test your visual acuity and visual field (peripheral vision)
  • Measure your corneal thickness and topography (shape of the eye)
  • Read your previous eye prescription using your glasses’ lenses.
  • Exam your pupils for reactivity.
  • Evaluate the muscle function and dominance of your eyes.
  • Assess the health of eye using a pupil dilation and slit-lamp test.
  • Check for Glaucoma assessing your eyes pressure.
  • Inspect the health of your peripheral retina.
  • Assess your overall medical health.
  • Discuss your hobbies and occupation.
All of these factors will assist your ophthalmologist to determine whether you are a candidate for laser vision correction surgery and which procedure is best suited for you. Once completed, this assessment will determine your unique treatment at Visiomed Eye and Laser Clinic.

Step 2

Determining whether you are an ICL/Artisan candidate

Results from the initial eye examination will enable your doctor to suggest a treatment which is customised to your prescription, eye anatomy and personal needs. Patients not suitable for PRK or LasikHD find ICL a perfect alternative.

ICL/Artisan treatment is recommended for:

  • Patients with more than 1.5 diopter astigmatism.
  • Patients suffering from nearsightedness (myopia).
  • Patients under the age of 40.
Pre-operative consultation at Visiomed Eye and Laser Clinic

2 weeks prior to your ICL/Artisan procedure, your ophthalmologist will schedule a YAG Peripheral Iridotomy which will prepare your eyes for the procedure. The pre-op procedure will prepare your eyes to receive the implantable collamer lens and takes only 1-2 minutes. Your daily activity will not be affected by this.

Step 3

Post-operative care

As with LasikHD, you will see immediate results and the recovery time is short. A week after the procedure your will be able to resume regular activities without any restrictions or glasses/contact lenses.

Your ophthalmologist will prescribe eye drops and antibiotics as well as give you a pair of protective glasses to wear at night.

Your Visiomed Eye and Laser Clinic doctor will schedule a few routine post-op visits to ensure your treatment is a success and you are 100% satisfied.

Step 4 

Life after ICL/Artisan procedure


At Visiomed Eye and Laser Clinic, your post-op care is very important to us. We therefore schedule visits with our ophthalmologists periodically after your treatment.

The first 24 hours after the ICL/Artisan procedure

The ophthalmologist will perform a post-op check-up and you will be given a pair of protective glasses which you will need to wear for several hours after the surgery.
Ensure you organise a driver home.
The artificial tears provided by your doctor will help ease any irritation you may experience after the ICL surgery.
If you experience any irritation it is important not to rub, poke or touch your eyes.
Follow your doctor’s instructions on using your steroid and antibiotic eye drops.
Use this time to rest and relax.
Do not strain your eyes through reading, computer work or watching TV.
Two weeks after the ICL/Artisan procedure

Your vision will stabilise to its full potential after two weeks with an Implanted Collamer Lens in place.
After your initial ICL/Artisan is completed, the two-week point is typically when your ophthalmologist will complete the procedure on your other eye.
One Month after the ICL/Artisan procedure

One month from your initial ICL/Artisan procedure at Visiomed Eye and Laser Clinic, both eyes will have undergone treatment and your body will be nearing completion of the healing process.
Vision stabilisation is complete. Your Visiomed Eye and Laser Clinic team will perform a series of check-ups to ensure everything is progressing as expected before releasing you from care after around three months.
A few years after the ICL/Artisan procedure

With aging, you may develop cataracts which will need to be addressed by Visiomed Eye and Laser Clinic ophthalmologists.
The ICL/Artisan procedure causes no interference with the cataract removal procedures.
The ICL/Artisan is built to last a lifetime but can be removed in order for cataracts to be addressed.

What is Photorefractive Keratectomy (PRK) surgery?

Similar to the LasikHD surgery, PRK surgery corrects the way light enters the cornea in order to give you clearer vision. LasikHD surgery uses a laser to prepare the cornea for treatment while during PRK surgery the tissue is gently wiped from the cornea.

PRK surgery requires a slightly longer recovery time, but results are the same as with LasikHD surgery.

Following the PRK procedure, a soft contact lens is placed on the eye to act as a bandage. This allows patients to see and function while the corneal tissue regenerates and heals beneath it during the days immediately following the PRK treatment. Vision may be blurry during this initial recovery time and you may experience brief periods of discomfort or irritation.

Prescribed anti-inflammatory and lubricating drops will minimize post-procedural discomfort and speed up the healing process. As with LasikHD surgery, the result is always clearer vision.

Thanks to our ophthalmologists’ PRK technique at Visiomed Eye and Laser Clinic, PRK can offer distinct benefits to patients who clinically do not qualify for LasikHD due to thin corneas.

The Visiomed Eye and Laser Clinic PRK surgery procedure will address nearsightedness, farsightedness and astigmatism.

LasikHD candidates with thin corneas. Your Visiomed Eye and Laser Clinic ophthalmologist will perform a series of diagnostic tests to determine corneal thickness.
Patients who suffer from chronic dry eye.
Patients with extremely active lifestyles or professions.

Step 1

Initial eye exam at Visiomed Eye and Laser Clinic

A 90 minute consultation will determine whether you are a candidate for laser vision correction. Your ophthalmologist will perform various tests similar to a normal eye examination as well as a scan of the eyes to determine certain PRK related information.

During your consultation your ophthalmologist will:

  • Test your visual acuity and visual field (peripheral vision)
  • Measure your corneal thickness and topography (shape of the eye)
  • Read your previous eye prescription using your glasses lenses.
  • Exam your pupils for reactivity.
  • Evaluate the muscle function and dominance of your eyes.
  • Assess the health of eye using a pupil dilatation and slit-lamp test.
  • Check for Glaucoma assessing your eyes’ pressure.
  • Inspect the health of your peripheral retina.
  • Assess your overall medical health.
  • Discuss your hobbies and occupation.

 

All of these factors will assist your ophthalmologist to determine whether you are a candidate for laser vision correction surgery and which procedure is best suited for you. Once completed, this assessment will determine your unique treatment at Visiomed Eye and Laser Clinic.

Step 2

Determining whether you are a PRK candidate

Results from the initial eye examination, your doctor will suggest a treatment which is customised to your prescription, eye anatomy and personal needs. Your corneal thickness will determine if PRK is a more suitable option for you.

PRK treatment is recommended for:

  • Patients with thin or abnormal corneas.
  • Patients sufferings from chronic dry eyes.
  • Patients who have high impact, strenuous occupations or hobbies (Karate or Firefighters)

 

Visiomed Eye and Laser Clinic doctors understand the importance of tailor making treatment plans for its patients and take into consideration numerous complex factors to ensure you receive the treatment that is best suited for you.

The RLE procedure at Visiomed Eye and Laser Clinic

The RLE procedure is completed one eye at a time at a 2 – 4 week intervals to allow for stabilisation. The procedure only takes 30 – 35 minutes per eye. You will be allowed to go home immediately after the procedure to rest and relax.

Step 3

The PRK procedure at Visiomed Eye and Laser Clinic

On the day you are required to be at the Visiomed Eye and Laser Clinic rooms for about 2 to 3 hours. This will allow enough time for registration, preparation, treatment and final eye testing. The PRK procedure is very short and takes roughly 15 min per eye.

After the procedure, a contact lens will be placed on the surface of the eye which will assist healing and minimise discomfort. During your 5 day post-op consultation, your Visiomed Eye and Laser Clinic ophthalmologist will remove the contact lens after which you can resume your daily activities.

Step 4

Post-operative care

Vision will stabilise after 5 days and full results will be realised within 1 – 2 weeks.
Your ophthalmologist will prescribe eye drops and antibiotics as well as give you a pair of protective glasses to wear at night.
Your Visiomed Eye and Laser Clinic doctor will schedule a few routine post-op visits to ensure your treatment is a success and you are 100% satisfied.

Life after PRK surgery

At Visiomed Eye and Laser Clinic, your post-op care is very important to us. We therefore schedule visits with our ophthalmologists periodically after your treatment.

The first 24 hours after PRK surgery:

The ophthalmologist will perform a post-op check-up and you will be given a pair of protective glasses that you will need to wear for several hours after the surgery.
Ensure you organise a driver home.
The artificial tears provided by your doctor will help ease any irritation you may experience after the PRK Laser surgery.
If you experience any irritation it is important not to rub, poke or touch your eyes.
Follow your doctor’s instructions on using your steroid and antibiotic eye drops.
Use this time to rest and relax.
Do not strain your eyes through reading, computer work or watching TV.
Five days after PRK surgery:

A 5-day post-op consultation with your Visiomed Eye and Laser Clinic doctors is required to remove the protective contact lens.
Most patients are able to drive to their follow-up appointment however if you do not feel comfortable, please ask someone to drive for you.
You are now free to pursue any hobbies or activities that were part of your normal routine before the PRK procedure.
Continue following your doctor’s recommendations regarding eye drops and be sure to keep water, soap and shampoo out of your eyes when showering.
You may read, use the computer and watch TV, but keep your eyes well lubricated and rest them if they feel strained. Be sure to keep sweat out of your eyes and avoid all lotions, creams and eye makeup for seven days.
Two weeks after PRK surgery:

A two-week post-op consultation with your Visiomed Eye and Laser Clinic doctor is required to closely monitor your recovery.
As your cornea heals (typically a 14-day process) you will begin to notice additional clarity in your vision.
One Month after PRK surgery:

A post-op consultation with your Visiomed Eye and Laser Clinic doctor is required between one and three months after your PRK treatment. With a clean bill of health, you will be released from care.

What is Intrastromal Corneal Rings / Intacs?

Intacs is the trademark name for micro-thin prescription inserts which were previously used as a form of refractive surgery in the treatment of low levels of myopia or nearsightedness, but has recently received FDA approval for keratoconus.

Intacs are thin plastic, semi-circular rings inserted into the mid layer of the cornea. When inserted in the keratoconus cornea they flatten the cornea, changing the shape and location of the cone. The placement of Intacs remodels and reinforces the cornea, eliminating some or all of the irregularities caused by keratoconus in order to provide improved vision. This can improve uncorrected vision, however, depending on the severity of the keratoconus, glasses or contact lenses may still be needed for functional vision.

FDA Approval

Intacs were approved under a Humanitarian Device Exemption (HDE) by the FDA in July 2004, allowing Intacs to be used for treating keratoconus. As part of the HDE approval, Addition Technology, the manufacturer of Intacs, has implemented an extensive training program in which each surgeon will be required to participate.

What is a Humanitarian Device Exemption (HDE)?

The humanitarian device regulations were first established in October 1994. Humanitarian Use Devices (HUDs) are medical devices specially designated by the FDA for use in the treatment of fewer than 4000 patients per year with rare medical conditions. CPT Code is: Category III CPT code 0099T.

Intacs received a Category III CPT code 0099T from the American Medical Association. Category III CPT codes are temporary codes to designate emerging technologies and are not assigned a value. It is up to your medical aid to determine the amount to be paid. A Category III code has 5 years to become mainstream, whereupon it may be promoted to a permanent Category I code.

  • This procedure involves placing the plastic inserts just beneath the surface of the eye in the periphery of the cornea. The procedure itself takes approximately 15 to 20 minutes usually in theatre. Topical anaesthetic drops are used to numb the eye, and a clamp is used to hold the eye open throughout the procedure to prevent blinking.
  • There are 3 basic steps to the procedure:
  • Step 1: A single, small incision is made in the surface of the cornea. Instead of using mechanical cutting, our doctors also use a Femtosecond laser to make the incision.
  • Step 2: A centring guide is placed on the surface of the eye for several minutes to help stabilize the eye and ensure proper alignment of the Intacs’ insertion. During this time, the corneal layers are gently separated in a narrow circular band on the outer edge where the Intacs will be placed.
  • Step 3: The Intacs inserts are placed. Once this insertion is completed, the small opening in the cornea is closed with a suture.
  • Follow-up visits will be required to monitor the healing process and to evaluate the visual benefits of the procedure. Even after a successful procedure, glasses or contacts may be required.
  • As with any surgical procedure, there are some risks, including infection. Some patients experience visual symptoms including difficulty with night vision, glare, halos, blurry and fluctuating vision.
Corneal Transplant (Corneal Graft or Keratoplasty)

Your first consultation with your eye surgeon will last about 1 – 2 hours. Your eyes may be dilated to get full view of the back of your eye, hence you need to bring a driver with. Your full medical history will be recorded and Dr will discuss your general health.

Your surgeon’s trained assistants will perform various scans and tests. This will include:

  • A refraction and ocular examination to determine the state and strength of your eyes and quality of your vision.
  • Biometry tests to measure your eyeballs and determine the right power for your artificial intraocular lenses which are implanted into your eyes after your cataracts have been removed.
  • A corneal topography test may provide additional details that the biometry tests can’t, such as the presence of keratoconus.
  • The overall health of your retina, the nerve layer in the back of your eye, and your optic nerve will be checked with an optical coherence test (OCT) and you will also be checked for glaucoma, aged related macular degeneration, signs of diabetes and many other eye diseases.
  • Should you have any eye infections, hypertension, undiagnosed diabetes with blood sugar levels and other systemic diseases that need immediate attention, this will first be treated or you be referred to your GP or other specialist for treatment before surgery is done.
  • High blood pressure and sugar levels can mean a higher risk of bleeding at the back of the eye during surgery. High blood sugar levels can also put you at a higher risk of infection after surgery.
  • So understandably, the surgeon needs to ensure you’re in relatively good health to get the best possible outcomes of your surgery, hence he may require further eye tests if needed.
  • Your hobbies and life style will be discussed to determine which intraocular lenses will give you optical vision to suit your unique life style and needs.

The cornea is the clear, dome-shaped ‘window’ in front of your eye. Light passes through the clear cornea on its path to the retina in the back of the eye. Here the light is changed into electric impulses and travels to the brain via the optic nerve. The brain then interprets what you see.

Sometimes the corneal tissue is damaged either through disease or injury, to a point where light can no longer effectively pass through. This results in reduced vision. When other methods of treatment have failed to save the cornea, or if vision has been lost in the affected eye, a corneal transplant may be indicated. The procedure involves replacement of the damaged cornea with a healthy, clear donor cornea.

The cornea consists of 5 layers. When a corneal transplant is done, all 5 layers or only a few layers are affected. 

The 3 most common procedures done at Visiomed.

  1. Penetrating Keratoplasty (PKP) (transplant). The entire central cornea with all 5 layers are removed and replaced by the central section of a donor’s cornea with all five layers. The entire central area of the cornea removed is called a ‘button.’
  1. Deep Anterior Lamellar Keratoplasty (DALK) (corneal graft/transplant). This is a partial thickness corneal transplant and is performed to replace layers 1,2 and 3 (anterior or top section) of the cornea. This is typically done when you only have an anterior keratoconus or only the anterior section of your cornea is damaged. In this case layers 4 and 5 (posterior section or bottom layers) of your cornea remain Only layers 1,2 and 3 of the donor cornea are removed from the donor cornea and implanted onto layers 4 and 5 of your cornea (see picture above).
  1. Descemet Stripping Automated Endothelial Keratoplasty (posterior corneal graft) (DSAEK or DSEK). This is typically done in the case of Fuchs’s syndrome or other conditions where the fluid regulatory system in the 5 th layer of your cornea, the endothelium, is dysfunctional. This layer normally pumps fluid out of the cornea as fluid circulates to keep your cornea clear at all times. If the pumping mechanism doesn’t work, water accumulates and causes oedema of the cornea, causing very cloudy and hazy vision.

In this case only layers 4 + 5 (posterior cornea) are removed from your cornea while layers 1,2,and 3 (anterior section) of your cornea remain intact. Only layers 4 and 5 of the donor cornea are removed  and are implanted under the existing layers 1,2 and 3 of your cornea (see picture above).

A penetrating (total depth) corneal transplant takes much longer to heal, and the rejection rate is higher, even though cortisone drops are administered to prevent this. If this is the only option for you, it is important to constantly be aware of any visual changes post-surgery so that your surgeon can treat early signs of rejection as soon as possible to prevent it.

With DALK and DSAEK the healing process is faster and rejection rate is diminished because less donor tissue is transplanted. Although only PKP, DALK and DSAEK were discussed, there are other options too which will be discussed by your surgeon if necessary.

A corneal transplant, also known as a corneal graft, or as keratoplasty, involves the removal of the central portion (‘button’) of the diseased cornea and replacing it with a matched donor ‘button’.

A common indication for keratoplasty is keratoconus. The ophthalmologist must decide when to recommend keratoplasty for the patient with keratoconus. This is often not a simple, straightforward decision. Keratoplasty for keratoconus is highly successful; however, there is a long recovery period and a risk of severe ocular complications. A number of factors must be considered in deciding when to do a keratoplasty. One of the most important is the patient’s functional vision.

If the best acuity with their contact lenses prevents them from doing their job or carrying out their normal activities, a transplant must be considered. The actual measured visual acuity may be quite different for different patients. One patient may find that he/she cannot do his or her job with 20/30 acuity while another patient may be very satisfied with 20/60 acuity.

Very careful contact lens fittings are necessary before recommending a corneal transplant. One study found that 69% of patients with keratoconus, most referred for transplant, could be successfully fit with contact lenses if special lens designs were used. Thus, prior to corneal transplant surgery, every effort should be made to optimally fit the patient with contact lenses, especially if there is not significant corneal scarring affecting vision.

However, a few patients become intolerant to contact lenses, and require a transplant earlier than otherwise would be necessary. If the patient has a large area of thinning, a very red cone or significant blood vessel growth into the usually clear cornea, called neovascularisation, a transplant may be performed earlier than otherwise indicated by the visual performance, as these factors may require a larger than normal transplant button size and/or increase the chance of rejection if allowed to advance too far.

The healing process following transplant of a full penetrating corneal graft is long, often taking a year or longer – depending on what technology is used. The time from surgery to the removal of the stitches is commonly 6 to 17 months. The patient may be on steroids for months. Initially following surgery, the donor button is swollen and even following healing the button is usually thicker than the corneal bed in which it rests.

Graft rejection reactions occur in a small percentage of patients. Signs of graft rejection include red and watery eyes, blue haze around the iris, watery spots inside the cornea, light sensitivity, pain and discomfort and any other changes in your vision and eye sight when compared to the post-operative period. Glare and glittering of light and significant change in refractive error.

Signs of graft rejection are reported to occur from one month to five years following surgery. The rejection rate for bilateral grafts is higher than if only one eye is grafted. In the bilateral cases, when a rejection reaction occurs it is commonly in both eyes. If the second eye is to be grafted, there is usually a period of at least a year between grafts. If signs of rejection occur, aggressive treatment with steroids is begun. Usually the reaction is overcome and the graft remains clear.

Over 90% of the corneal grafts are successful with some studies reporting 97% to 99% success rates at 5 and 10 years (Kirkness et al 1990, Troutman and Lawless 1987, Epstein).

Large amounts of astigmatism (irregular corneal curvature) can be present after corneal transplant. The patient’s spectacle prescription may fluctuate for some months following surgery. Refractive changes and keratometry (measuring the curvature of the cornea), or corneal topography can be used to follow the healing process.

The latest Femtosecond Laser technology is used to create bladeless surgery. The laser can be set to remove just the damaged section or layers of recipient cornea and to remove the exact sections of healthy donor cornea to be implanted onto your cornea. This procedure is less invasive, it uses less heat and energy, the procedure is more accurate, precise and predictive, and healing is accelerated. With less corneal tissue removed and less donor corneal tissue needed to be transplanted, the rejection rate is diminished and healing is accelerated.

In the case of performing a full penetrating corneal graft with Femtosecond laser, the entire central area with all layers of the patient’s cornea (button) is removed with the laser, (a bladeless cut), but the way the precision laser ‘cuts’ the button is done in such a way that the donor cornea has a more snug and even fit onto the recipient’s existing cornea after surgery – again causing a better result. 

Most transplants have significant astigmatism and often some distortion, requiring correction with contact lenses made of rigid materials. Many factors make fitting contacts after transplant a challenge. It is common for the edge of the transplant to be slightly raised with respect to the surrounding cornea. The graft is usually steeper than the normal cornea, and may be tilted with respect to the surrounding tissue.

To combat high amounts of astigmatism, some of the sutures may be removed early. Following healing, a relaxing incision or a wedge resection may be done to decrease the astigmatism. In any case, there is usually some distortion of the transplant and most patients will obtain better vision with a rigid contact lens. Rigid corneal lenses, scleral (haptic) lenses, the SoftPerm lens and others are all viable options.

If a contact lens is required following keratoplasty, it is customary to wait at least three months after the surgery and preferably until after the sutures are removed, which may be up to a year, before fitting contact lenses – depending which technology is used.

Due to the irregularity of the cornea after transplant, soft contact lenses seldom give satisfactory vision. In addition, hydrogel lenses, scleral lenses and the SoftPerm lens may encourage vessel invasion into the graft. Therefore, rigid gas permeable corneal lenses are usually the lens of choice. Keratometer readings are seldom of any significant value in determining the base curve of the lens to use, but may be useful for baseline values to determine if any changes are occurring.

Corneal topography with a computerised topographer can be of some value in determining the shape of the transplant and surrounding cornea. However, diagnostic lenses must be used to fit these eyes.

Due to the size and shape of the button and the transition area between the button and the host cornea, it is often best to use a larger diameter lens to maintain lens centration. In the rare instance that a corneal transplant is placed off-centre, rigid corneal lenses are nearly impossible to properly fit. In these few cases scleral or SoftPerm lenses may be the only viable option.

Parameters of the lenses are assessed using the fluorescein pattern. The power of the final rigid lens is determined by an accurate refraction over the diagnostic lens. A lens material with good oxygen permeability should be used to minimize corneal swelling.

The corneal transplant patient should be followed closely, especially during the first year or two following surgery, to be sure corneal integrity is not compromised and that graft rejection is not occurring.

This is an extremely delicate microsurgical procedure. In the case of full penetrating corneal transplantation the procedure first involves removal of a round, button-shaped portion of the damaged cornea. This diseased cornea is removed with a special round cutting tool called a trephine. Then, a clear donor cornea, prepared to the same size, is replaced within the round opening. Finally, this donor cornea is stitched into place with extremely fine sutures.

The surgery itself is painless and usually done on an outpatient basis. First, you are given eye drops or medication to help you relax. Then, a local or general anaesthetic is used to prepare the eye. A patch is usually worn over the eye immediately following surgery. Other procedures like cataract removal may be performed at the time of corneal transplant surgery if necessary.

Some patients and surgeons prefer to use full general anaesthesia for this procedure where the patient is fully asleep.

Post-operative

A corneal transplant takes many months to heal. Often, the stitches are not removed until six to nine months after surgery. During that time, medicated eye drops are used to ensure the transplant heals properly and does not reject.

Possible Complications

As with any surgical procedures, complications and/or side effects may occur. One of the risks of any transplant is the possibility of rejection. Our body is able to sense things that are not natural parts of it. The body’s defense system tries to destroy these foreign tissues. Thus, it is natural for the body to try to destroy a transplant that is foreign because it comes from another person’s tissue. If a corneal transplant rejects, it loses its clarity and swells.

Often, corneal transplant rejection can be stopped with medication, but rejection is always a possibility for the rest of the patient’s life. If a transplanted cornea is rejected, another transplant may be done.

Donor Tissue

Donor corneas come from deceased people who have, while still alive, signed up to be a corneal or organ donor after death. Ophthalmologists work closely with their local Eye Banks to obtain fresh tissue, which is kept in sterile preservative culture media until use. If you are interested in becoming a cornea donor, you can contact the South African Eyebank on

Tel: +27 21 447 5151

Fax: +27 21 448 6086

Email: eyebank@iafrica.com

Website: www.eyebank.org.za

Keratoconus

Normal Eye

Keratoconus eye

Keratoconus is a disease of the cornea that causes a weakening of the cornea – (the outer dome shaped ‘window’ of the eye) – leading to a gradual outward bulging of the eye. Instead of having a rounded cornea the shape of a soccer ball, the cornea becomes the shape of a rugby ball when developing Keratoconus.
Corneal Cross Linking is a very promising new treatment for some patients suffering from Keratoconus.
Most often, this bulging is in the lower half of the cornea and first presents as astigmatism. (Astigmatism means ‘without a point.’) This prevents the cornea’s ability to converge the light rays into one focusing point, thereby producing moderate to severe blurred vision. However, not all astigmatism is due to Keratoconus. In mild or early stages of Keratoconus, (Forme Fruste Keratoconus) glasses or soft contact lenses may correct the astigmatic vision and produce clear vision. It might be advisable to consult an ophthalmologist during the early development of Keratoconus.

The blue image is a cross section of the eye. The irregular cornea is the outer section left bulging downwards and prevents light entering the eye to focus on one central point in the back of the eye on the retina.

Normal Eye

Keratoconus eye

During the treatment, custom-made Riboflavin (Vit.B2) eye drops are applied to the cornea, which is then activated by ultraviolet light.

This amazing simple process has been shown in laboratory and clinical studies to increase the amount of cross linking of collagen fibres in the cornea , which are the natural ‘anchors’ within the cornea and are responsible for preventing the cornea from bulging out and becoming steep and irregular.

  • Other treatments
  • Hard Contact Lens.

As Keratoconus advances, rigid-gas-permeable, scleral and other contact lenses now available on the market for keratoconic patients, might be the only non-surgical way to achieve clear vision. Discuss your options with an optometrist who is well skilled in this field.

Corneal Cross Linking can be done in the doctor’s rooms or in an operating theatre. If you are a candidate for this procedure, you will lie down on a bed, made comfortable, and music of your choice will be played. The preparation and treatment last about 30 minutes per eye, of which the cross linking procedure will take only 5 minutes.

Before the treatment is commenced, you will receive a sedative and local anaesthetic drops will be instilled into your eyes. You will experience no discomfort or pain during the procedure.

When the treatment is completed, you are discharged immediately afterwards. The doctor will prescribe eye drops and analgesic medication, for your eyes might feel quite sensitive after the local anaesthetic has worn out. This will last only for a few days.

View the Peschke PDF to see the Crosslinking device.

View the Peschke PDF
Glaucoma
Glaucoma is a group of eye diseases negatively affecting the eye’s optic nerve. Because the risk of glaucoma increases as you get older, it’s important to have your eyes tested regularly. Glaucoma often affects both eyes, usually in varying degrees. One eye may develop glaucoma quicker than the other. If glaucoma is left untreated it can cause blindness. However, if it’s diagnosed and treated early enough, further damage to your vision can be prevented. There are four main types of glaucoma: – open angle glaucoma (chronic glaucoma), – acute angle closure glaucoma (acute glaucoma), – secondary glaucoma, and – developmental glaucoma (congenital glaucoma).

Open angle glaucoma is the most common type of glaucoma. It develops very slowly, so you may not realise it is happening. Open angle glaucoma occurs when the drainage tubes (trabecular meshwork) within the eye become slightly blocked, preventing eye fluid (aqueous humour) from draining properly.

When the fluid can’t drain properly, pressure builds up (intraocular pressure) which can cause damage to your optic nerve and the nerve fibres from your retina. The term ‘open angle’ refers to the angle of space between the iris (coloured part of the eye) and the sclera (the white outer covering of the eyeball). The fact it is an open angle means there is no physical obstruction blocking the drainage: it is the tubes that have a blockage.

Acute angle closure glaucoma refers to a narrowing of the angle between your iris and sclera. The narrowing often happens quickly, causing a sudden and painful build-up of pressure in your eye. Acute angle closure glaucoma is rare but can lead to sudden onset of blindness if not treated as a medical eye emergency.

A secondary glaucoma may occur as a result of an eye injury or another eye condition such as uveitis. Secondary glaucoma can be open angle or closed angle.

Developmental glaucoma is rare, but it can be serious. It’s usually present at birth, or develops shortly after birth. Developmental glaucoma is caused by an abnormality of the eyeball.

Due to the rapid development of acute glaucoma, the symptoms are often severe. They include:

intense pain,
redness of the eye,
headache,
sore,
tender eye area,
seeing halos, or ‘rainbow-like rings’ around lights, and
misty vision.
As a result of these symptoms, some people may experience nausea and vomiting.

The symptoms of acute glaucoma are not constant, and they can last a few hours before disappearing again. However, each time the symptoms occur, your vision is damaged a little more. It is important that you contact your GP straight away if you experience any of the above symptoms because early treatment can prevent further damage from occurring.

If you experience symptoms outside of your GP’s normal working hours, visit your nearest accident and emergency (A&E) department. The healthcare staff will be able to relieve the pressure within your eye and treat any pain and discomfort that you are experiencing.

As secondary glaucoma is caused by other conditions, or eye injuries, it is possible that the symptoms of glaucoma itself may be confused with the original cause. However, the glaucoma may still cause misty vision, and rings, or halos, around light sources.

Developmental glaucoma (congenital glaucoma)

Recognising the symptoms of developmental glaucoma can be very difficult due to the young age of the baby, or child.

However, your child may display some symptoms, such as:

having large eyes, due to pressure causing the eye to expand,
being sensitive to light,
having a cloudy appearance to their eyes,
having watery eyes,
jerky movements of the eyes, and
having a squint, which is an eye condition that causes one of the eyes to turn inwards, outwards, or upwards, while the other eye looks forward.
If you notice any of these symptoms, you should visit your Ophthalmologist as soon as possible.

How the eye works

The eyeball is filled with a watery substance called aqueous humour, which creates pressure in the eye to give it shape. In healthy eyes, this fluid constantly flows in and out of the eye to nourish it. It drains back into the bloodstream at the same rate that it is produced in order to maintain the correct pressure.

Glaucoma occurs when the drainage tubes (trabecular meshwork) within the eye become slightly blocked, preventing the aqueous humour from draining properly. It can also occur if there is an obstruction within the eye.

An obstruction within the eye, such as a blood vessel blocking the trabecular meshwork, can also prevent fluid from draining properly.

When the fluid cannot drain properly, the pressure in the eye builds up and can cause damage to the optic nerves, and the nerve fibres from the retina.

It is unknown why the drainage tubes get blocked, or why other parts of the eye obstruct the tubes.

Other causes

There are various other factors that can lead to glaucoma. These are listed below.

Age – chronic glaucoma becomes more likely as you get older, affecting about 1% of people who are between the ages of 40-65, and 5% of people who are over 65 years of age.
Ethnic origin – people of African, or Afro-Caribbean origin, tend to have a greater chance of developing chronic glaucoma. Also, people of Asian origin are more likely to develop acute glaucoma.
Short sightedness – people who are short-sighted are more likely to develop to chronic glaucoma.
Family history – if you have a close relative, such as a parent, brother, or sister who has glaucoma, you may also have a increased chance of developing the condition yourself. You should therefore have regular eye tests in order to monitor the condition of your eyes.
Medical history -research suggests that people with diabetes are also more likely to develop glaucoma than those without the condition.
If you have glaucoma, it can take a long time before you realise that you have a problem with your eyesight. This is because glaucoma tends to damage the outer edge of the eye and work slowly inwards. You may not notice a problem until glaucoma is near the centre of the eye.

It is very important to have regular eye tests so that problems like this can be detected and treated as early as possible.

Once you are 40 years of age, you should have an eye test every two years. You should also have regular eye tests if you are over 30 years of age, and you have a close blood relative with glaucoma (for example, a parent, sister, or brother).

There are three glaucoma tests that your optician can perform. They are painless and quite quick. All three tests should be carried out during the same appointment in order to make sure the results are as accurate as possible.

The three tests for glaucoma are outlined below.

An eye pressure test (tonometry)

An eye pressure test (tonometry) involves a small amount of anaesthetic and some dye being put onto your cornea (the clear front of the eye). A blue light from the head of the tonometer is held against your eye to measure the intraocular pressure (IOP) in the eye. A tonometer is the instrument that is used to measure pressure within the eye.

An optic disc appearance test (opthalmoscopy)

An optic disc appearance test (ophthalmoscopy) uses a special torch and magnifier to look at the optic nerve at the back of your eye.

A visual field test (perimetry)

A visual field test (perimetry) checks for missing areas of vision. A sequence of spots of lights is shown to you, and you will be asked which ones you can see. Some dots will appear in your peripheral vision (around the sides of your eyeball) which is where glaucoma begins.

If the optician finds glaucoma, you will be referred to an eye specialist for treatment. The specialist will perform more detailed eye tests to discover how developed the glaucoma is, and how much damage it has done. Tests may also be carried out to check the cause of the glaucoma .

Any damage to your vision that is caused by glaucoma cannot be repaired. This is why it is so important for you to get an early diagnosis, so that glaucoma can be treated and prevented from developing further.

The aim of treatment for every type of glaucoma is to reduce the pressure in the affected eye.

Treating open angle glaucoma (chronic glaucoma)

Open angle glaucoma is often treated using eye drops. There are several different types of eye drops that may be given to you, which are outlined below.

Beta-blockers

Beta blockers help to reduce the amount of fluid produced in your eyes. However, if you have asthma, or heart disease, you should not use this type of eye drops because they can cause side effects which may worsen these conditions. Beta blockers are usually taken once, or twice, a day.

Alpha agonists

Alpha agonists also help to reduce the amount of fluid that is produced in your eyes, and help to improve the flow of fluid out of your eye.

Children should not use these alpha agonists because an active ingredient can cause nightmares in young users. Users of these eye drops have also reported side effects that include a dry mouth and generally feeling unwell. Alpha agonists are often taken two, or three, times a day.

Prostaglandin or prostamide analogues

Prostaglandin, also known as prostamide analogues, help to improve the flow of fluid out of your eye. Side effects include pinkness of the eye, which may last for several days.

Your eye colour may also change; it often gets darker. Your eyelashes may also grow thicker and darker. These eye drops are generally used once a day.

Carbonic anhydrase inhibitors

Carbonic anhydrase inhibitors reduce the amount of fluid produced in your eye. These drops may be taken two, or three, times a day, and may cause a bitter taste in your mouth.

Cholinergic agonists

Cholinergic agonists help the fluid to flow out of your eye more effectively. Using these eye drops may cause headaches, eye ache, and dark, or blurred, vision.

Cholinergic agonists should be taken three, or four, times a day. Sometimes, a cholinergic agonist gel can be applied at night in order to assist with the flow of fluid out of your eye. You therefore do not have to wake up during the night in order to put eye drops in.

Other treatments for open angle glaucoma

If the use of eye drops does not improve open angle glaucoma, a different type of treatment, such as laser treatment, or surgery, may be recommended.

Laser treatment can be used to open up the blocked trabecular meshwork (drainage tubes) within your eye. The procedure is usually quick and painless, although you may experience some mild discomfort.

The most common form of glaucoma surgery is a trabeculectomy. This removes part of the trabecular meshwork to allow the flow of fluid through the eye’s drainage system.

Other types of surgery include a viscocanalostomy and a deep sclerectomy operation.

Viscocanalostomy operations remove part of the sclera, enabling the eye fluid to filter out of your eye and into your body. A deep sclerectomy operation involves implanting a tiny silicone device in order to widen the trabecular meshwork.

Treating acute angle closure glaucoma (acute glaucoma)

As acute glaucoma develops rapidly, the condition needs to be treated quickly. The most common forms of treatment for this type of glaucoma include;

Eye drops – see above for further details.
Systemic medicines – these medicines are injected into your bloodstream and quickly reduce the pressure in your eye.
Laser treatment – this creates a hole in your iris (coloured part of the eye) in order to maintain some vision. Both eyes will need to be treated, even if only one has acute angle closure glaucoma. This is because this form of glaucoma always develops in both eyes at some point.
Surgery – a trabeculectomy is the most common form of surgery for acute glaucoma.
Treating other types of glaucoma

For other types of glaucoma, your specialist will usually recommend eye drops, laser treatment, or surgery, depending on the type of glaucoma that you have, and how advanced it is.

Macular degeneration

Macular degeneration is a painless eye condition that causes a gradual loss of central vision (the ability to see what is directly in front of you). You use your central vision during activities such as reading, writing and driving. See image below.

Light that enters the eye falls directly on the macula. The macula is the round disc in the centre of the retina – the nerve layer of the back of the eye responsible for vision.

The macula consists of a high density of cells and is responsible for central, clear vision with good colour definition.

If the macula degenerates, your central vision and colour vision become compromised.

There are two types of macular degeneration; dry and wet.

 

  • Dry macular degeneration affects your eyes gradually. Although there is no treatment for dry macular degeneration, there are ways you can learn to cope with it.
  • Wet macular degeneration is more serious than dry macular degeneration, and can develop very quickly. It is often wet due to bleeding and swelling of blood vessels in the retina due to diabetes and other diseases and requires treatment as soon as possible. It causes straight lines to appear crooked due to the macular swelling.

Macular degeneration most commonly affects people over 50 years of age. Macular degeneration in older people is referred to as age-related macular degeneration.

Approximately 2% of people over 50 years of age have age-related macular degeneration. In people over 65 years of age, the number rises to 8%, with about 20% of those over 85 years of age having the condition. In fact, in older people, age-related macular degeneration is the most common cause of visual impairment.

Macular degeneration is more common in women than in men, although the reasons for this are not fully understood.

In rare cases, young people can also be affected. This is usually caused by a genetic condition.

Macular degeneration is not a painful condition. In fact, some people do not even realise that they have the condition until their symptoms become more severe. Sometimes, if only one of your eyes is affected by dry AMD, your healthy eye will compensate for any blurring or loss of vision, which means that it will take longer before your symptoms become more noticeable.

If you have macular degeneration, your central vision will still be blurred, even when you wear glasses.

If you have dry age-related macular degeneration (AMD or ARMD), it may take between 5 and 10 years before you find that your symptoms are significantly affecting your daily life.

You may have dry AMD if you find that:

  • you need brighter light than normal when reading,
  • it is difficult to read printed or written text (because it appears blurry),
  • colours appear less vibrant,
  • you have difficulty recognising people’s faces, or
  • your vision seems hazy, or less well defined.

If you are experiencing any of these symptoms, you should make an appointment with your ophthalmologist or optometrist (a health professional who specialises in diagnosing vision problems and eye conditions).

If you have wet age-related macular degeneration (AMD), you may also experience other symptoms as well as blurred central vision. In wet AMD, the symptoms appear more suddenly than they do in dry AMD.

The typical symptoms of wet AMD are described below.

  • Visual distortions – for example, straight lines may start to appear wavy or crooked.
  • Blind spot – this usually appears in the middle of your visual field. The longer a blind spot is left, the larger it will become. This is known as a central scotoma.

You should seek immediate medical assistance from your ophthalmologist if you, or someone that you know, experience any sudden changes in their vision, such as those described above. It may be a sign you have wet AMD, which needs to be treated as soon as possible.

The back of your eye is made up of a layer of light sensitive tissue which is known as the retina.

The retina passes nerve impulses to your optic nerve (the nerve which connects your eye to your brain). The optic nerve sends impulses to your brain so that they can be converted into an image.

The macula is at the centre of your retina, and it is the part of your eye where incoming rays of light are focused.

Therefore, the macula is a very important part of your retina, because it plays an essential role in helping you to see the things that are directly in front of you. The macula is used for close, detailed activities, such as reading and writing.

The retinal pigment epithelium (RPE) is a layer of tissue that surrounds the outer surface of your retina. The RPE passes nutrients to your retina, and helps remove waste products from your eye.

In very rare cases, macular degeneration affects younger people. It is possible to have macular degeneration from birth. In younger people, the condition is almost always caused by an inherited genetic disorder. There are a number of different inherited disorders which can cause macular degeneration, including:

Best’s disease – a hereditary (runs in families) type of progressive macular degeneration which is also sometimes known as Best’s vitelliform macular dystrophy.
Stargardt’s disease – a condition that affects the macula (middle part of the retina) and, like Best’s disease, runs in families.
Sorsby’s dystrophy – an inherited condition that often begins at around 30-40 years of age and causes some loss of vision.
Inherited conditions such as these are very rare, and age-related macular degeneration is a far more common form of the condition.

Dry age-related macular degeneration

As you get older, the Retinal Pigment Epithelial (RPE) layer that covers your retina starts to get thinner as it begins to break down. This means that your retina can no longer exchange nutrients and waste products as efficiently as it used to.

Waste products start to build up in your retina and form small deposits, which are known as drusens. A build up of drusens, plus a lack of nutrients, cause the light cells in your macula to become damaged and stop working.

If the light cells in your macula are damaged, your central vision becomes blurry and less well defined.

Wet age-related macular degeneration (AMD):

Wet AMD often starts in the same way as dry AMD, as the RPE begins to break down. However, with wet AMD, tiny new blood vessels begin to grow underneath the macula.

It is thought that these vessels may grow in order to help the retina to get rid of the waste products that build up when the RPE layer deteriorates. However, the exact cause for the growth of these abnormal blood vessels is not known.

The new blood vessels can leak blood, or fluid, into your eye, causing the more serious symptoms that are often associated with wet AMD, such as visual distortion and blind spots.

A number of risk factors may increase your risk of developing macular degeneration. Some of these factors are listed below.

  • Age – the older you get, the more at risk you are of developing macular degeneration. The condition usually affects people who are over 50 years of age.
  • Gender – macular degeneration is more common in women than it is in men.
  • Genetics – it is thought a problem with a certain gene (the information you inherit from your parents) may play a role in macular degeneration. However, the specific genetic problem has not yet been identified.
  • Smoking – some studies have shown that smoking can increase your risk of developing macular degeneration.

Sunlight – if you are exposed to lots of sunlight during your lifetime, your risk of developing macular degeneration may be increased. To protect yourself, you should wear sunglasses in bright sunlight. Also wear anti-glare glasses when working or reading on digital devices.


If your optometrist or GP suspects that you have macular degeneration, you will be referred to an ophthalmologist (a doctor who specialises in diagnosing and treating eye conditions). The ophthalmologist will be able to carry out a series of tests in order to help confirm a diagnosis of macular degeneration.

The ophthalmologist will first carry out a routine check of your eyes. They will look at the back of your eyes, where your retina and macula are located, using a magnifying device which has a light attached to it. This will allow your ophthalmologist to look for any initial abnormalities around your retina.

Amsler grid: (As seen above)

One of the first tests that your ophthalmologist will probably carry out when trying to confirm a diagnosis of macular degeneration involves asking you to look at a special grid, known as an Amsler grid. The grid is made up of vertical and horizontal lines.

If you have macular degeneration, it is likely that some of the lines will appear faded, broken or distorted. By telling your ophthalmologist which lines are distorted, or broken, it will give them a better idea of the extent of damage to your macula.

Fluorescein angiography:

If your ophthalmologist suspects that you have wet age-related macular degeneration (AMD), they may carry out a fluorescein angiography. This is a special type of test which can help to confirm the type of AMD that you have.

During a fluorescein angiography, the ophthalmologist will inject a special dye into a vein in your arm. They will use a magnifying device to look into your eyes, and take a series of pictures of your eye using a special camera.

These images will allow your ophthalmologist to see if any of the dye is leaking from the blood vessels behind your macula (which is the cause of wet AMD).

Optical Coherence tomography (OCT):

Optical Coherence Tomography uses special rays of light to scan your retina and produce an image of it. This can provide your ophthalmologist with detailed information about your macula. For example, it will tell them whether your macula is thickened, or abnormal in any way, which may be an indication of macular degeneration.

Dry age-related macular degeneration:

There is currently no cure for dry age-related macular degeneration (AMD). With dry AMD, the deterioration of vision is very slow. You will not go completely blind as a result of dry AMD, and your peripheral vision (outer vision) should not be affected.

There is help available to help make tasks such as reading and writing easier. Getting practical help may help improve your quality of life, and make it easier for you to carry out your daily activities.

You may be referred to a low vision clinic. These clinics are run by optometrists and occupational therapists. They can provide helpful advice and practical support to help minimise the affect dry AMD or any low vision has on your life. For example, things that may make it easier for you to carry out close detailed work include:

  • magnifying lenses,
  • large print books, and
    intensive (very bright) reading lights.
  • Special computers to enlarge the words of a book you read.

Wet age-related macular degeneration:

There are a number of treatments that can help to stop the progression of wet AMD. It is very important that wet AMD is treated as soon as possible, in order for the treatment to be effective. Once sight has been lost, it cannot usually be restored. Some of the treatments available for this type of AMD are outlined below.

Photodynamic therapy
Photodynamic therapy is a treatment which was developed in the 1990s. It involves having a light-sensitive medicine called verteporfin injected into a vein in your arm. The medicine is able to identify the abnormal blood vessels in your macula (the part of your eye responsible for central vision), and attaches itself to the proteins in the vessels.

The next stage is to have a laser shone through your eye – this usually takes around one minute. This activates the verteporfin, which works by destroying the abnormal vessels in your macula, without harming any of the other delicate tissue in your eye. This stops the vessels from leaking blood or fluid, therefore stopping the damage the vessels are causing to the macula.

Anti-VEGF medication
Anti-VEGF medication is a newer type of treatment which can also help to stop the progression of wet AMD.

VEGF stands for ‘vascular endothelial growth factor’. It is one of the chemicals responsible for the new blood vessels which form in the eye as a result of wet AMD. Anti-VEGF medicines work by blocking this chemical, stopping it from producing the blood vessels.

The anti-VEGF medication has to be injected into your eye using a very fine needle. You will be given a local anaesthetic so the procedure should not be painful. The procedure may have to be carried out every few weeks in order for the treatment to be effective.

There are currently three anti-VEGF medications used in this type of treatment:
ranibizumab (brand name Lucentis),
pegaptanib (brand name Macugen), and bevacizumab (brand name Avastin).

Ranibizumab:
Until recently, many people had to pay to have anti-VEGF treatment carried out on a private basis. However, some anti-VEGF treatments, are now approved and paid by some medical aids.

Other anti-VEGF treatments:

Anti-VEGF medication is primarily used to stop wet AMD from getting worse. However, in some cases, anti-VEGF medicines have also been shown to restore some of the sight which may have been lost as a result of macular degeneration. It is important to be aware that your sight will not be restored completely, and not everyone will experience an improvement.

Anti-VEGF treatment does not normally cause any side effects. However, you may experience the following symptoms following your injections which your ophthalmologist will discuss with you before this type of treatment is carried out.

Vitamins and minerals:

Some research has found that high doses of certain vitamins may help to slow down the progression of AMD. The research found that vitamins A, C, E and beta-carotene helped, as did the minerals zinc and copper, lutein and ziaxanthin.

The research suggests that you should try taking these supplements if you are at a high risk of developing advanced AMD, where your eyesight is severely affected.

Although these vitamin and mineral supplements can be purchased from pharmacies and other retailers, you should only take those which are recommended to you by your GP or ophthalmologist. High doses of these vitamins and minerals can result in side effects, and if not taken at the correct dosage, may do more harm than good.

There also needs to be more scientific research carried out into the effects of vitamins and minerals on AMD before their effectiveness can be definitively proven.

For more information please contact:

Retina South Africa

Sharecall number: 0860595959 (SA only)
Telephone: +(27) 114501181
Email: headoffice@retinasa.org.za

 

Diabetic retinopathy

Diabetic retinopathy is one of the most common causes of blindness in the RSA. Retinopathy means damage to the tiny blood vessels (capillaries) that nourish the retina, the tissues in the back of the eye that deal with light. Damage to these vessels causes blood leakage (haemorrhage), which may be small and confined to the retina or may extend forward into the jelly that fills the main cavity of the eye (the vitreous gel). This can seriously affect your vision.

Another feature of diabetic retinopathy is that new, fragile blood vessels grow on the surface of the retina, particularly around the head of the optic nerve (the optic disc). These new vessels bleed easily.

The main cause of diabetic retinopathy is diabetes. It can occur as a result of all types of diabetes and if left untreated can lead to blindness.
It is important to have regular routine eye examinations because if new blood vessel formations are detected early, they can be treated effectively. Any new blood vessels can be dispersed by applying multiple laser burns to the periphery (outside edges) of the retina.

There are three main types of diabetic retinopathy:

The least serious type of retinopathy to affect your eye sight but this should still be regularly monitored by your optometrist or eye specialist (ophthalmologist). If you have background retinopathy, small red dots will appear on your retina due to tiny swellings in the blood vessel walls. Proteins in the blood may also lead to small yellow patches developing on the back of your eye.

This is when your retina swells and leaks blood. This can start to obstruct your vision (for example, reading small print may become particularly difficult).

This rarely causes symptoms until it is too late. Symptoms, such as blurred vision, are likely to indicate that severe vitreous bleeding has developed, usually causing a sudden loss of vision.
For more information and support please contact:

Retina South Africa

Sharecall number: 0860595959 (SA only)
Telephone: +(27) 114501181
Email: headoffice@retinasa.org.za

Although diabetic retinopathy is entirely painless, it often causes sudden blindness. It does this when the fragile new blood vessels bleed into the vitreous gel (jelly that fills the eye). This appears as a dark cloud within your eye which can obscure your vision. The blood may slowly be absorbed, so that after a period of time – sometimes weeks or months – your vision may be restored.
Other symptoms of diabetic retinopathy can include:
– tiny dots appearing in your vision,
– dark streaks appearing, sometimes blocking your vision,
– blurred vision,
– poor night vision, and
– having difficulty adjusting to bright or dim light.


Severe bleeding into the vitreous gel can lead to the growth of new blood vessels and fibrous strands. This can be very serious because these fibrous strands can contract and pull off the retina – a form of retinal detachment that is difficult to correct. Treatment can sometimes repair this damage but, in other cases, blindness may be permanent.


Diabetic retinopathy is caused by diabetes. You are more likely to develop diabetic retinopathy if you do not control your diabetes closely.
Having a high blood sugar level and high blood pressure can cause your blood flow to increase. This thickens a membrane in your eye, preventing the flow of essential fluids in and out of your retina.

Damaged cells then begin to release special chemicals that encourage the formation of new blood vessels. These new blood vessels tend to leak more fluid. If left untreated, these growing vessels will begin to obscure your vision and perhaps lead to complications within the eye structure.
You are at increased risk of diabetic retinopathy if

  • you have high blood sugar levels,
  • when you have increased blood sugar levels for a prolonged period of time,
  • you have been diabetic for a long time and take regular insulin treatment,
  • you have high cholesterol levels,
  • a high level of a fatty acid called triglyceride in your blood,
  • you have high protein levels in your urine,
  • you have high blood pressure, or
  • you are pregnant.

The Department of Health has set up a national screening (testing) programme for diabetic retinopathy. If you are over 11 years of age, and you have diabetes, you should be offered screening annually.


The screening programme was introduced because if diabetic retinopathy is detected early enough it can then be treated effectively by using laser treatment.

Often, by the time diabetic retinopathy begins to cause noticeable symptoms, it can be much harder to treat.
If you think you are over-due for a screening appointment, contact your optometrist or ophthalmologist.

During screening, eye drops are used to make your pupils large, and then photographs are taken of your retina. As the photographs are being taken, you will see flashes of bright light, but it is not normally uncomfortable.


The eye drops can cause a slight stinging, and your vision may become blurred about 15 minutes after the screening ends. The blurring can last between two and six hours, depending on what sort of eye drops are used.


The blurring will affect your ability to drive, so you will not be able to drive from your screening appointment. You will also find that everything looks very bright during this time, so you may want to take sunglasses with you to your appointment.


Very rarely, the eye drops can cause a sudden rise in pressure within your eye. However, this only occurs in people who are already at risk of developing the condition. It will require prompt treatment in an eye unit.


If, after screening, you experience any of the symptoms outlined below, contact your screening centre or go to an accident and emergency department:
– pain, or severe discomfort in your eye,
– redness of the white of your eye, or
– constant blurred sight, sometimes with rainbow haloes around lights.


You will not receive the results of your screening straight away, as the pictures need to be studied by a team of professionals. The screening staff should tell you how long this will take.
You will be called back for further assessment if:

  • staff find sight-threatening retinopathy which requires follow-up treatment,
  • the degree of retinopathy needs checking more than once a year,
  • the photographs are not clear enough to give an accurate result, or
  • other eye conditions – such as glaucoma or cataracts are detected by chance (screening for retinopathy will not always detect other eye conditions).


Treatment for diabetic retinopathy will vary depending on which particular type you have:


Background retinopathy – requires no treatment, but you should have regular eye examinations by your ophthalmologist (eye specialist) to spot any developments of the condition early.


Pre-proliferative retinopathy – often this also does not require treatment, but laser treatment can be an option if leakage begins to threaten your vision. Laser treatment cannot restore any lost vision, but can be used to prevent further deterioration.


Proliferative retinopathy – laser treatment is used to ‘burn’ the abnormal blood vessels to prevent further growth. The laser treatment does not target the blood vessels directly, but destroys those around your retina that have become starved of oxygen.


A course of laser treatment involves one or more visits to a laser treatment clinic.
Treatment is normally available on an out-patient basis.
Drops are put into your eyes to numb the surface. Then a special contact lens is placed on your eye to hold your lids open and focus the laser beam on your retina.


The treatment involves focusing a laser to burn the abnormal blood vessels to prevent further growth. The laser is not targeted directly at the blood vessels but to the outer part of your retina. This is the part of the retina than allows you to see to the side (peripheral vision) and in the dark.The treatment is usually not painful, but you may feel an occasional sharp pricking feeling when certain areas of your retina are treated.


If you have had a number of laser sessions in the past, you may feel some discomfort during the treatment. If you have felt discomfort in the past, ask the doctor to give you painkillers or a mild sedative. Alternatively, take these yourself an hour before the appointment.
Your vision will be blurred after treatment, but this should return to normal after a few hours. A lot of treatment can cause your eyes to ache. Over-the-counter painkillers such as paracetamol should ease the pain.


Because of the damage to the outer retina there is some chance that your night and peripheral vision may be affected. Over 50% of people treated noticed some difficulty with their night vision, and 25% noticed some loss of peripheral vision.
You should get medical advice if you have any new eye problems after the treatment.


Laser treatment for early proliferative retinopathy will prevent severe sight loss in 90% of cases.

Eye surgery:
In rare cases, eye surgery may be considered if there is severe bleeding into your eye. This is usually the case if proliferative retinopathy has been diagnosed at a late stage. Eye surgery may also be an option if laser treatment has proved ineffective.

Whatever treatment is necessary to preserve or save your sight, your ophthalmologist will do everything in his power to assist you on the road ahead. Also consider seeing a low vision optometrist and occupational therapist to help you cope with vision loss.

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