Using technology to better examine your eye health
For years the standard way of checking the health of the back of your eyes has been either direct ophthalmoscopy (when we get really close with the bright light) or slit-lamp ophthalmoscopy where you have your chin on a chin-rest and we look inside the eyes using a microscope, a bright light and a super-powerful magnifying lens.
All optometrists are highly skilled at recognising anything that may be wrong, the only problem with this is one of comparison. Judging whether the appearance of someone’s retina two or more years ago has changed or not, can be difficult, even when comprehensive notes are kept. That’s where photographs can be invaluable.
Many eye conditions can be particularly hard to detect because the changes in the appearance of the back of the eye can be very subtle and slow. If we take glaucoma as an example, the appearance of what’s called the optic disc, where the optic nerve joins the back of the eye, is one of the things that we monitor very closely. Glaucoma damages the optic disc and it’s shape and size change slowly as the damage occurs over time. If we have images to compare, then this damage can be picked up a lot earlier than would otherwise be the case. This is not just true of glaucoma, the detection of diabetes and other problems hugely benefit from this too. At Patrick and Menzies, we were early adopters of this technology, known as Fundus Photography over 15 years ago.
Since fundus photography became commonplace, a newer, more advanced technology became available, known as Optical Coherence Tomography or OCT. From the patient’s perspective the procedure is very similar to fundus photography. However instead of a flat 2D photograph of the retina, OCT uses scanning light beams to create a 3D image, not unlike an ultrasound, of the retina. The advantage of this is that we can see the deeper layers of the retina, nerve fibres and blood vessels underneath, things that can’t be seen on a conventional fundus photograph. Conditions like Glaucoma, diabetes and many others can be picked even earlier than before, enabling treatment before any significant sight loss or other complications can occur. We installed OCT in all our practices over 5 years ago and they have proved invaluable.
Our Braintree practice also has something called Optomap. These machines give us an ultra-widefield image of the back of the eye, enabling easier detection of any problems in the peripheral areas of the retina.
These more advanced ways of examining your eyes are a standard part of our private eye examination, and included if you are part of our VisionPlan scheme.
For anyone who receives a basic NHS check, they are available as an upgrade for a small fee.
Case Study | Mr Manton
The quick thinking actions of one of our optometrists proved to be life saving for our first-time customer Neil Manton.
Earlier this year Neil was driving home from Yorkshire in grey and rainy weather when he noticed a strange shimmering sensation in his right eye. Putting it down to tiredness, initially Neil wasn’t too worried, but when that shadow didn’t seem to go away after a few days he decided to book an appointment at Patrick & Menzies Braintree branch.
At Neil’s appointment our optometrist Charlotte Wearmouth listened carefully to Neil’s concerns and gave him a thorough examination which took almost two hours but couldn’t come to a definitive conclusion. Charlotte said, “Despite not finding any obvious cause, I was aware that Mr Manton’s symptoms were serious, especially as they developed suddenly and were not improving.”
Realising that the problem needed further investigation Charlotte sent the images of Neil’s eye and her findings to Broomfield Hospital with a request for them to follow up. Three or four days, later Neil was called into Broomfield for a further battery of tests, including a brain scan, which revealed that the carotid artery in Neil’s neck was 84% blocked, restricting blood flow to his eyes, and putting him at imminent risk of stroke or fatal heart attack.
Neil was admitted urgently for a 5-and-a-half-hour operation which resolved the issue and Neil was allowed home the following day.
Neil couldn’t be more grateful. “Patrick & Menzies are life savers! I really can’t praise them enough for the professionalism of the service I have received,” he says. “If Charlotte hadn’t been so thorough and taken so much time over my appointment when I went to her, I might not be here to tell the story today.”
Neil returned to Patrick & Menzies just six weeks ago for a further check-up and we are delighted to report that his eye health is even better now than it was before the operation.
Our eyes really are windows to our wellbeing, so if you have any concerns or notice any anomalies with your eyes or vision, please do make an appointment to see one of our optometrists today. We really do go the extra mile to make sure our patients stay well and happy and perhaps enjoy the odd game of golf, as Neil does!
Back to School | Why Eye Examinations Are Important for Your Child
A survey last year by the Association of Optometrists showed a quarter of school-age children had not been taken for a sight test by their parents. But why is it so important?
Why do I need to get my child’s eyes examined?
Your child’s eye health is, of course, an important indicator of their overall health, but even if there are no concerns, regular eye examinations ensure your child has no vision problems that could affect their school performance and enjoyment of life. Early eye tests are important for several reasons: Not only because we need to ensure the visual skills that are essential for optimal learning are in place – a child who is unable to see what’s on the whiteboard can become easily frustrated – but also because children’s eyes are fully developed by the time they are 8 years old, so any problems must be detected before then. By demonstrating the importance of looking after one’s eyes we also help to create healthy habits that will hopefully mean your child continues to have their eyes tested regularly right through adulthood.
My child can’t read yet – how can you check their eyesight?
You don’t have to wait for your child to be able to read to bring them in for an examination – at Patrick and Menzies we have ways of testing that can be used with preschool children who cannot read, but even if you have no real concerns, we usually advise to bring them in for a full eye test before they start school just to make sure there aren’t any issues with their vision that could affect their early learning.
What should I be concerned about?
Once children start school it can be easier to spot the signs of a possible eye problem. If you notice any of the following, pop in and schedule an examination with us:
- complaining of headaches or sore or achy eyes
- hold books close to their face or sitting too close to the TV
- problems with hand-eye coordination – being unusually clumsy
- regularly rubbing their eyes
- complaining that they can’t see the board at school
What can I expect at the appointment?
We’ll be able to work best with your child when they’re happy and alert – so for younger children an appointment straight after school when they’re tired and hungry may not work best, but generally an eye examination can actually be quite fun and interesting for a child. We have lots of different ways to check how well your child sees at different distances, but we’ll also check their eye movement, the back of the eye and how well they respond to light, amongst other things – our optometrists are experienced in making it a pleasant experience for your child and make sure your mind is at rest too.
Should your child need glasses we have an excellent range and are sure to have a style that will appeal, so do give us a ring or pop in to book your child’s appointment – that’s another thing you can tick off the ‘back to school’ to-do list!
Prescriptions | What does all that information mean?
For many of us, an eye examination is more about the immediate concern of whether your current prescription has changed or, indeed, whether you actually need glasses to help you see better, than anything else!
At the end of your appointment your optometrist will issue you with your prescription: A piece of paper with a series of numbers on it that tell us the sort of lens you need to correct your eyesight. It’s rather grandly known as your ‘refractive error’. The perfect eye projects a sharp, clear image onto the retina, known as ‘emmetropic’. If your eyes don’t do this (and most don’t) it’s most commonly because they have a refractive error and that means the image you see is blurry.
You may have heard the terms ‘short-sighted’, ‘long-sighted’, ‘astigmatism’ or maybe even ‘prisms’, but do you really know what they mean?
What’s a ‘Normal’ Eye?
The power of your lens is measured in units called ‘dioptres’ and most prescriptions are relatively low in power – for comparison, the NHS considers a complex prescription to be anything over 10 dioptres.
A ‘standard’ eyeball has a focusing power of +60 dioptres. This brings light rays coming from a distance to focus on the retina at the back of the eye which is considered to be 22.22mm in length. Around +45 dioptres is provided by the cornea (the front, curved, clear part of the eye) and around +15 by the lens inside the eye. Problems occur with this system if any of these numbers differ from the norm.
Let’s start with the most common problem: Short-sightedness. Short-sightedness is correctly known as myopia, which means you can only see objects close to you: The closer you have to be, the more short-sighted you are. If you have myopia then objects at a distance create a blurry image on the back of the eye. This happens because the parts of the eye that bend the light rays are too strong or the eyeball is too long. When you get closer to the object, the light rays arriving at the eye start to diverge, which counteracts the ‘over convergence’ of the light rays and pushes the focus back onto the retina.
Someone who has a myopic prescription will have a minus figure at the start of their prescription, meaning the lenses in their specs (or contact lenses) are diverging: This counters the eye which is effectively over-plussed.
Now let’s get onto the more difficult one! Long-sightedness! Hyperopia (sometimes called Hypermetropia) is more difficult to explain. If short-sightedness means you can see things up close, then being long-sighted means you can see things far away, right? Well, not really… although sometimes, yes, that is true! Bear with us!
In this case those light rays coming from a distant object are focused behind the retina. This happens because the parts of the eye that bend the light are not strong enough and the eye effectively doesn’t have enough power to bring the rays to the correct point on the retina.
Some people with a relatively low amount of long-sightedness can see objects clearer if they are really far away – for example, we hear of sailors saying they can see a buoy on the horizon, but they struggle to see the TV, or an HGV driver who can see motorway signs in the distance but not the train times on the monitors at the station.
Someone who is long-sighted will have a plus figure at the start of their prescription, their lenses are plus powered (converging). This compensates for the fact that the eyeball is too short.
Ok, now let’s get into the tricky diagnosis: Astigmatism. If you have an astigmatism then your eyes don’t produce a single point focus, but actually produce two ‘line foci’. Effectively the eye has two different powers at 90 degrees to each other. This is caused most commonly by the cornea having two different curvatures. In an astigmatic eye the curvature of the cornea will vary: It will have two different curves, one steeper than the other, at 90 degrees to each other.
These curves mean that the eye may be more shortsighted in one meridian than the other, or more longsighted in one, or even long sighted in one and shortsighted in the other, which, as you can imagine, requires a more complex prescription.
Our eyes produce two images and send these back to your brain. These images are also upside down just to make things more complicated! So how do we see one of everything, the right way up?
Well, that relies on the precise co-ordination of both eyes and the fact that they both line up and point at the same object at the same time. The eyes do in fact produce two very slightly different images and that is how we perceive depth properly, but the difference between them is only slight. The images have to fall in corresponding areas on the right and left retinas for you to only see one of the object you are looking at. If the images fall partly or wholly outside these areas, the brain cannot match them up properly and they become blurred, or even double. The direction of gaze and how well controlled it is, is governed by six muscles around each eye which move left, right, up, down and obliquely. If you have a problem with one or more of those muscles, then it can mean that the images produced become too different from one another.
As the brain senses this mismatch it will tell the muscles to work harder to overcome the problem, sometimes they can but often this will lead to eyes feeling tired (it’s hard work!) or achy. Sometimes this can cause headaches too.
If we detect this issue in an eye examination, then in some circumstances we’ll prescribe prism. This allows the eyes to take up their comfortable position, thus removing the symptoms; and shifts the images on the retina, lining them up so the eyes don’t have to work so hard. In the vast majority of cases you wouldn’t know someone with prism has this correction as the deviation of their eyes is so small it’s not cosmetically noticeable.
You don’t need to worry too much about what your prescription says – that’s our job. But you do need to make sure you’re having regular check-ups to keep the information correct. Pop in and see us at any of our branches for an appointment so we can keep your sight crystal clear.