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!
Lens Treatments | Options and Benefits
When you buy a new pair of glasses it’s not just the frames that come in a myriad of options – these days your lenses can be ‘upgraded’ with various tints, coatings and treatments. But there are so many it can all be a bit confusing – let us break down the most common options and the benefits they bring:
Anti-reflective coating (also called AR or anti-glare) is perhaps the most commonly offered lens treatment, and with good reason: AR coatings not only benefit vision and reduce eye strain, but they can also improve your communication skills! That’s because they make the lenses in your glasses look nearly invisible, so people can see your eyes and expressions more clearly, and you can make better eye contact with them.
An AR coating virtually eliminates reflections from the front and back surfaces of your lenses, meaning more light passes through, allowing your eye to receive a higher percentage of the actual light available – up to 99.5 percent. This means less glare, sharper vision and greater comfort. AR coatings are also a good idea for sunglasses, because they eliminate glare from sunlight reflecting into your eyes from the back surface of tinted lenses when the sun is behind you.
As an additional benefit, most anti-reflective treatments have a special layer that prevents spots and makes them easier to clean, although any scratches do tend to be more obvious on AR coated lenses, so be sure to only use products and cleaning methods we would recommend!
Photochromic lenses automatically darken in bright sunlight (triggered by ultraviolet radiation) to make your eyes more comfortable. Because UV rays penetrate clouds, photochromic lenses may darken on grey days as well as when it’s sunny and they will not darken inside a vehicle because the windscreen glass blocks most UV rays. However, some newer types of photochromic lens activate with both UV and visible light.
An added benefit of photochromic lenses is that they shield your eyes from 100 percent of the sun’s harmful UVA and UVB rays and because exposure to sunlight and UV radiation has been associated with cataracts later in life, it’s a good idea to consider photochromic lenses for children’s eye wear as well as for the spectacles of outdoor-loving adults.
Polarized lenses are anti-glare and virtually eliminate bright light from reflective surfaces and so are especially popular with fishermen and sailors.
Untreated lenses are surprisingly fragile, and it’s very easy to scratch them by storing them incorrectly, placing them down hastily or even cleaning them with some kitchen roll rather than the proper cloth! Luckily, lenses that are treated front and back with a clear, scratch-resistant coating have a much harder surface that is more resistant to scratching and more durable. It’s worth asking about this, because scratches are not only unsightly but can also seriously compromise the clarity of your vision. Nowadays some lenses have a built-in scratch-resistant coating, but double check that this is the case with your prescription.
Lots of options, then! Pop in a have a chat with us to choose that which best suits your lifestyle.
Finding the Right Frames for Your Face
While it’s wonderful that we have so much choice these days in terms of frames it does make the process of choosing the right pair for you somewhat more complicated!
If you’re finding it hard to narrow down the choices, then a good place to start is thinking about your face shape. Generally speaking, people tend to fall into one of five categories: Round, heart shaped, oblong, square and oval:
Round – a softly curving face that is as wide at the forehead as it is at the jaw and with wide cheekbones.
Heart-shaped – sometimes called an inverted triangle. Wider at the forehead and gently tapering to a more pointed chin.
Oblong – sometimes called narrow. A face that is longer than it is wide.
Square – a broad forehead and squarish jaw line.
Oval – a well-balanced face with defined cheekbones and no one dominant feature.
Most people have probably never thought about which shape their face most closely aligns to, and it may be that what you instinctively think you are isn’t quite true. Rather than relying on a friend cocking their head to one side and looking at you quizzically, it’s often easiest to look in the mirror and use a lipstick or a water-based felt tip pen to draw around your reflection (please don’t pick up a permanent marker by mistake!).
Once you’ve established which shape you most align to then see if these suggestions help you find a frame that suits your contours!
Frames for a Round Face
You may find rounder, smaller frames (think John Lennon) just make your face rounder still, so try out square and rectangular frames with strong angles for balance. Ray-Ban Wayfarer or Clubmaster-type styles (think James Dean and JFK) can also work well, if you prefer a quirkier look.
Frames for a Heart Shaped Face
Heart-shaped – over-sized, pilot-styles and half-rimmed frames don’t work on this type of face as well as oval shapes do, but rimless glasses in particular will also work incredibly well for you. (Think Kate Beckinsale and Richard Gere)
Frames for an Oblong Face
Now, pilot styles do work for those with narrower faces (Brad Pitt and Tom Cruise are particularly fond of these!) as well as square, angular frames. Steer clear of narrow frames as they can make your face appear longer.
Frames for a Square Face
Continuing on the opposites attract route, square faces should opt for round and oval frames that soften the angles of the features. (Think Kendall Jenner and Justin Bieber) Or go for browline frames for a vintage look. Anything too strong or geometric won’t work as well for you.
Frames for an Oval Face
We should be so lucky! Anything goes for ovals so just enjoy having the freedom to explore the entire range Patrick & Menzies has to offer and pick whatever makes your heart sing!
Whatever your face shape, pop into any of our branches to start your selection!
Everything You Ever Wanted to Know About Dry Eyes
The subject of dry eyes and the associated symptoms is so vast whole books have been written about it, but today we’ll try to tackle the basics of an increasingly common problem for all ages.
What do tears do and why are they important?
The tear layer sits on the front of your eye, over the cornea and the white of your eye. It’s there to do several jobs – it lubricates the eyelids as you blink (if you had no tears it would be like blinking with two bits of sandpaper! Ouch!), it protects the eye from dust and particles to minimise irritation. It is also the first thing that starts the process of refraction to produce a clear image, because the light hits the tear layer before anything else. In addition, the tear layer allows the cornea to absorb oxygen.
The cornea (the clear bit over your iris and pupil) has no blood vessels in it, but its cells still need oxygen to stay healthy, so the eye diffuses it from the air, into the tears, then into the cells. (Aha! I hear you ask, what about when you’re asleep?! Well, at night it’s the same process but the oxygen diffuses through the thin vessels on the inside of your eyelids. At much lower levels but just enough to sustain the system while you’re asleep). So, you see, tears are essential for healthy, comfortable eyes, and good vision.
What are tears made of?
Tears are actually quite a delicate balance of three different types of fluid: The bulk of tears are made of water, but equally important are the mucous layer and the lipid (fatty) layer. The mucous layer sticks the tears to the front of the eye and stops them falling off and running down your cheeks. The lipid layer helps prevent the tears from evaporating too quickly, so both are essential to maintain a good quality tear film. An imbalance in these different layers is what gives rise to the many different types of problems associated with dry eyes.
What type of problems do dry eyes cause?
One of the most common problems we see are people complaining of their eyes ‘watering’, especially if it’s windy outside. It seems counter-intuitive to say this is a dry eye problem but technically that’s what it is. If your eye is missing the mucous layer then the cornea is exposed – the wind irritates the eye, so it responds by watering (as it thinks it has a foreign body in it), that water won’t stick, so the tears run off, and the problem spirals.
We often see people with intermittent blurry vision and uncomfortable eyes which can stem from the lipid layer being missing or inadequate. The watery layer evaporates, leaving the mucous layer, which as the name perhaps indicates, gives rise to smeary vision, varying with the blink (a bit like putting petroleum jelly on a camera lens).
People often complain of sore eyes, poor vision and eyelids being stuck together when they wake up in the morning. Assuming infection has been ruled out, this is again happening because the tears are inadequate. If you go to sleep with little or no tear film, what you have got evaporates overnight, and as you don’t produce tears while you’re asleep, you’re left with a mucous residue that stick the lids together and sore eyes as the eyelids haven’t been able to absorb much oxygen.
People with allergies, particularly hay fever, can have dry eye issues as they tend to over-produce the watery part of the tears which washes out the other layers, making the tears badly balanced and unstable.
All of these issues can cause uncomfortable eyes which can look red and sore depending on the severity of the problem. Blinking with reduced tears is a really big irritant and in very severe cases it can actually damage the cornea leading to potentially sight-threatening infection. Thankfully this is rare and the vast majority of people come and see us or their GP before things got to that stage.
What causes dry eyes?
It’s true that dry eyes are more of a problem in older people. This is because as you age you tend to produce a reduced volume of tears and lose elasticity in the eyelids: Droopy lower eyelids expose more of the part of the eye below the iris which not only increases irritation but more importantly, if the lid is falling forward the mechanical support for tear volume is lost and tears run off the eye.
Some medical conditions such as Sjogrens syndrome and other auto-immune diseases in the spectrum of arthritis can reduce the amount of tears we produce. Some medications, including some cancer treatments, also reduce tear production.
Most commonly though lid hygiene is a big factor: the fatty and mucous layers of the tears are produced by tiny glands on the inside of the eyelids just behind the line of the lashes. These ducts are very fine and are easily blocked, so if make up isn’t removed very well, or the lids aren’t cleaned very well, over time the ducts can get blocked with dead skin cells, make-up, dried tear residue etc. This obviously results in inadequate tear production and an unstable tear layer.
The lids can also be affected by something called Blepharitis, an inflammation of the edges of the eyelid which is again more prevalent in older people and leads to a dandruff-like appearance which blocks the ducts and affects tear production.
Environmental factors also play a part. With increasing use of screens, both desktop and handheld, people find themselves staring at these for most of the working day. Each time you blink, you refresh your tears, but when you stare at a screen your blink rate goes down, increasing the amount that the tears evaporate. But it’s not just air-conditioned offices – people on long drives often complain of dry, uncomfortable eyes after staring down the motorway for hours (although this can also be because they need specs!) We also see a spike in dry eye problems when the weather gets cold and everyone cranks the central heating up.
Finally, we have to mention Demodex. Demodex is a tiny mite which we all have on our skin, it lives in harmony with us and is harmless. However, it does like to hide in hair follicles, particularly eyelash follicles, causing inflammation and clogging up the lid margins. Don’t be horrified – we do all have them, and mostly they don’t cause a problem, but if there are too many present they can be the cause of a stubborn dry eye problem that keeps recurring as the mites multiply.
What can be done to resolve dry eye issues?
The best way to tackle dry eyes is to try and find out what’s causing it in the first place, which is sometimes very hard to pin down. An appointment with one of our opticians gives us an opportunity to really have a look at your tear layer and lids and see what the issue is. We can measure your tear break-up time (how fast it evaporates), the tear volume (how much there is and if it’s too thin) and see why it is the way it is: Most of the time there is no one clear answer or treatment, and in some cases, while the problem cannot be ‘cured’, it can often be very well managed.
Options include hot compresses to clear blocked eye ducts, eyelid wipes to remove blockages and kill any mites that are present, drops to re-balance the tears, lifestyle and health advice. There is some evidence to suggest some vitamin supplements can increase tear production, and for some chronically blocked ducts, steam treatments are sometimes used. Sometimes just understanding why something is happening can make one feel better and remove some of the frustration felt.
If you have any of the issues detailed above don’t hesitate to come and see us at any of our branches. We have specific dry eye consultation appointments available where your optician will focus on dry eye issues and help you find ways to improve the symptoms. Pop in or give us a call.