Sight Conditions

Age-related macular degeneration (AMD) affects a tiny part of the retina at the back of your eye, called the macula.

AMD causes changes to the macula, which leads to problems with your central, detailed vision. AMD doesn’t cause pain and doesn’t lead to the total loss of sight.

AMD affects the vision you use when you’re looking straight at something, for example when you’re reading, looking at photos or watching television.

Your central vision can become distorted or blurry, and over time, a dark or missing area may appear in the centre of your vision.

Symptoms & When to Seek Help

Everyone can have slightly different symptoms, but usually the first thing you’ll notice is that it’s harder to see detail, such as small print. You may find that your vision has a small, blurred area in the centre. Straight lines may look distorted or wavy, or like there’s a little bump in them. You may also find that you’re more sensitive to bright light.

You should have your eyes tested by an optometrist (also known as an optician) if you experience any of these in one or both eyes:

• You have difficulty reading small print despite wearing reading glasses.
• Straight lines start to look wavy or distorted. You can check this by looking at door and window frames, or tiles in your home.
• Your vision isn’t as clear as it used to be.

Your optometrist can measure any changes in your vision and look at the back of your eye. They may see ‘drusen’ when they examine your retina. Drusen are small deposits under the retina, which they can see as yellow dots. Drusen can be present as a normal part of ageing and are not always a sign that someone has AMD. Your optometrist might say you have early AMD if you have a few medium sized drusen in one or both your eyes.

If your optometrist finds any changes to your macula or any cause for concern, they’ll send a letter to your GP or sometimes directly to the hospital. Based on your optometrist’s letter, the hospital will judge how quickly you need to be seen by the ophthalmologist (also known as a hospital eye doctor) and arrange an appointment for you.

The Different Types of AMD

AMD can be further classified as ‘early’, ‘intermediate’ and ‘late’. In early and intermediate AMD, there may be no vision loss and there may be no symptoms. Early and intermediate AMD are often picked up in a routine eye examination by the optometrist due to the presence of drusen at the macular area.

There are two main types of late or advanced AMD, “dry” AMD and “wet” AMD. They are called “dry” and “wet” because of what happens inside your eye and what the ophthalmologist sees when examining the inside of your eye, not because of how your eye feels or whether you have a watery or dry eye.

Dry AMD

This is also known as geographic atrophy, where there is central vision loss because all the cells at the macula have degenerated so much that they no longer work. It is the more common type of AMD.

Dry AMD develops very slowly and causes a gradual change in your central vision. It usually takes a long time – sometimes years, to get to its final stage. At its worst, dry AMD causes a dark or missing area in the centre of your vision in both of your eyes. It doesn’t affect your peripheral vision, so it never leads to total blindness. Some people with this stage of AMD may go on to develop the wet form of AMD.

Wet AMD

About 10 to 15 per cent of people who develop late AMD have wet AMD, often having had dry AMD to begin with. You develop wet AMD when the cells of the macula stop working correctly and your body starts growing new blood vessels to fix the problem. As these blood vessels grow in the wrong place, they cause swelling and bleeding underneath the macula – this is why it’s called “wet” AMD. This new blood vessel growth is medically known as neovascularisation. It causes more damage to your macula and eventually leads to scarring. Both the new blood vessels and the scarring can damage your central vision.

Wet AMD can develop very quickly, causing serious changes to your central vision in a short period of time, over days or weeks.

Treatment is available for wet AMD, which stops the new blood vessels from growing and damaging your macula. This treatment usually needs to be given quickly before the new blood vessels do too much damage to your macula. If the blood vessels are left to grow, the scarring and the sight loss they cause is usually permanent. Wet AMD doesn’t affect your peripheral vision, so it doesn’t lead to total blindness.

Treatment for AMD

Early or intermediate AMD has no treatment. There’s some evidence that high doses of vitamin A, C, E, the minerals zinc and copper and the micronutrient lutein when taken together may help slow down the progression of intermediate AMD, particularly if wet AMD has already caused vision changes in one eye. However, there is no evidence that taking high doses of these vitamins can prevent you from developing AMD in the first place.

There are several vitamin products available which have been designed for people with dry AMD and you can usually buy these over the counter or from your pharmacist. A balanced diet with plenty of fresh fruit and vegetables is good for your general health and may also help your eye health.

Treating Late AMD

Unfortunately, at the moment there is no way to treat late dry AMD. Although research is going on to try and find out why the cells of the macula stop working, this has yet to lead to a proven treatment.

Treating Wet AMD

The treatment available on the NHS for wet AMD is a group of medications called anti-vascular endothelial growth factor (anti-VEGF) drugs. As new blood vessels form in your eye, your body produces a chemical which encourages further new blood vessel growth. Anti-VEGF drugs interfere with this chemical and stop the vessels from growing, minimising further damage to your sight.

A cataract is a clouding of the lens inside your eye. Developing cataracts will cause your sight to become cloudy and misty. Cataracts are treated by surgery, during which the cloudy lens is removed and replaced by an artificial lens.

Living Well with Cataracts

For most people, reduced vision due to cataracts is temporary, and sight improves once the cataracts are treated, as long as no other eye conditions are present.

If cataracts are affecting how well you can see, or you are waiting for surgery, there are some things you can do to help make the most of your sight in the meantime. For example, making screens bigger, brighter and bolder.

These adjustments can help with reduced vision while you wait for surgery.

Below, you will find ways to help you live well with cataracts temporarily while waiting for treatment, including getting around, adjusting your mobile phone, making home adjustments, and supporting your mental health.

Driving

Check with your optician to find out if you still meet the standards for driving with some simple eye tests.
It’s a legal requirement to notify the DVLA if you don’t meet the standards. You should ask your optometrist if you are unsure if you need to notify the DVLA or not. You can call their medical helpline on 0300 790 6806.
Remember to also notify your insurers to make sure your insurance is still valid.

Public Transport

Take time before your journey on public transport to familiarise yourself with it as much as possible. You can also let transport providers know ahead of time of your sight impairment and receive appropriate assistance.

Lighting

Ensure you have enough lighting around your home, particularly around trip hazards such as stairs, so you can see as well as possible.
Use blinds at windows to shield from bright sunshine.
Ensure your room lights have diffusers so that there are no bare bulbs.

Reading

Use a magnifier for small print or instructions on packaging or medication.
Sit with your back to the sunlight when reading
Explore audiobooks or eBooks with adjustable font sizes. You might enjoy RNIB’s Talking Books Service or BorrowBox, your library in one app.
Request large print our audio library books.

Watching TV

If you are struggling to enjoy TV programmes because of your vision, try enabling audio description (AD).
Sit closer to the TV to help.
Try adjusting settings such as contrast to see if you can see the screen better.

Mental Health

Living with reduced vision due to cataracts can be overwhelming, especially when faced with the prospect of surgery and managing your diagnosis alongside other responsibilities, such as caring for loved ones.

Here are 3 strategies to help you cope with the emotional aspects of your cataract journey:

• Stay Informed: Knowledge is power. Understanding your condition and the steps involved in treatment can help to reduce anxiety and empower you to make informed decisions about your care.
• Lean on Support: Don’t hesitate to reach out to friends or family members, for emotional support and encouragement.
• Practice Self-Care: Prioritise self-care activities that promote physical and emotional well-being. Participate in activities that bring you joy and relaxation, such as reading, listening to music, exercising, practising mindfulness, or spending time in nature.

If you are anxious about the surgery itself, here is a video detailing what you can expect on surgery day.

Charles Bonnet Syndrome (CBS) is a common condition among people with vision impairments. It causes people who have lost a lot of vision to see things that aren’t there – medically known as having a hallucination. CBS hallucinations are caused by vision impairments and are not a sign that you have a mental health problem. The amount of sight loss that people with CBS have can vary.

Types of Charles Bonnet Syndrome

The types of hallucinations people with CBS may experience fall into two main areas:

• Simple repeated patterns or shapes, such as grids or brickwork patterns or colours
• Complex hallucinations of objects, such as people and landscapes. When images of people are seen, they are often in elaborate costumes with large hats or headdresses like Military, Edwardian, or Tyrolean.

CBS hallucinations are silent and do not involve any of the other senses. You cannot hear, smell or touch the images. Although they can be disturbing or frightening, people are usually aware that what they are seeing isn’t real.

The hallucinations usually get less frequent with time, although may not stop completely. A study found that it is not unusual to still hallucinate even five years after they first started. There may come a time when the hallucinations stop, but they may come back if your sight gets worse. Everyone is different in their experience CBS and for some people the hallucinations remain with them intermittently throughout life.

Developing Charles Bonnet Syndrome

CBS occurs in people who have varying amounts of sight loss from any eye condition. As sight loss is more common in older people, many people who have CBS also tend to be older. However, anyone of any age may develop CBS following sight loss.
It’s difficult to know how many people in the UK have CBS because often people are unaware that sight loss can cause hallucinations. They think they might be developing a mental health condition so don’t always want to tell doctors that they are experiencing hallucinations.

Research suggests that about one in five adults who experience sight loss develop CBS. This means that at least 1 million adults in the UK are living with CBS. Research has only just begun into CBS in children. Children with sight loss are just as likely to develop CBS as adults but they have never been included in research until now. This means the number of people living with CBS is actually higher. It’s not yet known why some people with sight loss get CBS and some people don’t, but if you have an eye condition which might cause sight loss, it’s helpful to know about CBS so that you are prepared if it does occur.

Causes of Charles Bonnet Syndrome

CBS is caused by loss of vision and the way your brain reacts to this loss. Exactly how sight loss leads to hallucinations isn’t really known, but research is slowly revealing more about how the eye and the brain work together.
When your sight is good and you are seeing real things around you, the images are detected by the retina (the light sensitive layer at the back of the eye) and signals are sent via the optic nerve to the area of the brain called the visual cortex. The route the light takes from being detected by the eyes through to being processed in the brain is known as the visual pathway.

Any eye condition that causes damage to any part of the visual pathway can cause sight loss. If your visual pathway works well your eyes stop the brain from creating its own pictures. When you lose sight, your brain isn’t receiving as much information from your eyes as it used to. Your brain can sometimes fill in these gaps by creating new fantasy patterns or pictures. When this happens, you experience these pictures as hallucinations. CBS tends to start in the weeks and months following a big deterioration in your sight but can develop at any time.

Signs of Charles Bonnet Syndrome

It’s natural to be worried, confused or frightened when you see things that aren’t really there. You may be concerned that seeing things is a sign of a mental health problem, or you might think that you have dementia, until you know what’s happening. CBS is caused entirely by sight loss and the hallucinations aren’t a sign of any other health problem. If you have lost sight due to any eye condition and you start to see things that aren’t there, then you may have CBS.

There isn’t one specific test that your doctor can do to find out if you have CBS. Your doctor will want to rule out other causes of hallucinations, usually by talking with you and in some cases, carrying out tests. If there are no signs of any other conditions that might be causing your hallucinations, and you have recently lost some sight, then it’s most likely that you have developed CBS.

There are some medical conditions, such as Parkinson’s disease, Alzheimer’s disease, strokes, serious mental illnesses, and other brain conditions, that can affect the parts of the brain concerned with seeing and may cause some people to hallucinate. Sometimes, if you have sight loss and one of these conditions as well, it can make your hallucinations more frequent. It’s important to remember that having CBS doesn’t mean you’re more likely to develop any of these conditions.

CBS hallucinations are different from the hallucinations caused by other conditions. CBS hallucinations only affect your sight, which means that you don’t hear, smell or feel things that aren’t there. Usually, with CBS you’re aware, or can learn to recognise, that what you’re seeing isn’t real even though it’s very vivid.

People with CBS don’t develop any complicated thoughts (delusions), or ideas about why they are seeing things. Even though you may see images which are disturbing or frightening, you would not think that the people or animals you are seeing want to harm you.

If you suddenly find that you’re seeing a pattern, person, animal, building or a landscape that you know is not really there, then don’t be afraid to tell your GP, ophthalmologist (eye doctor) or optometrist (optician), who should be familiar with CBS. You may find it useful to take a copy of this information along with you.

Even though there is no cure for CBS, letting people know that you have this problem or talking about it may offer you some peace of mind, especially if you are anxious about what you are seeing.

What You May See

When you have lost a large amount of your vision it can be difficult to see everyday things, but your CBS hallucinations may be very detailed, and much clearer than your everyday vision. CBS hallucinations can be of almost anything – from simple patterns, shapes or colours, to vivid detailed pictures of people, animals, objects or buildings. The images appear very suddenly, lasting for just a few minutes or in some cases, several hours.

As mentioned before, the kinds of images you may see with CBS generally fall into two types: simple repeated patterns or shapes, or complex hallucinations of people, objects and landscapes.
You may have one type of hallucination more than another or have both types of hallucination at the same time or one after another.

Simple Repeating Pattern Hallucinations

Your CBS hallucinations may be of patterns or shapes laid on top of everything you see or growing across any surface you look at. You may see grids or shapes or lines, which can be quite vivid in colour, for example, bright green dots surrounded by vibrant pink squares. You may also see brickwork or simple repeating patterns across your vision. People can also see patterns that look like a network of branches or roots from a tree.

Complex Hallucinations

Your CBS hallucinations may be of more complicated things like faces, people, places, insects and animals. The faces may be distorted or grotesque and move up in front of you.

You may hallucinate entire scenes, such as landscapes with waterfalls, mountains or a garden full of flowers. At other times you may see a single person or animal, or groups of people. You may see people dressed in costume, like Edwardian families, Roman soldiers or small children in bonnets. The figures of people in your hallucinations may be life size, larger than life sized or very commonly, tiny.

At times, the hallucinations may fit with your surroundings such as seeing people working in your garden. At other times the hallucinations can appear very odd, such as double-decker buses in your kitchen. Sometimes the images can be totally unreal, like fantasy pictures of dragons or unicorns.

CBS hallucinations don’t usually include familiar people or past events that you may have experienced. Not all the images that you see are threatening or unpleasant, but of course, most people are frightened when they first start hallucinating.

Over time, the more you see the images, the more comfortable you may become with them. You may begin to recognise the same things appearing in your hallucinations, such as the same tiny people, or the same field of flowers.
Sometimes the hallucinations may be in black and white and at other times in colour. They may move or stay still.

Charles Bonnet Syndrome Over Time

When you first develop CBS, your visual hallucinations may happen quite often; you may see images every day and for long periods of time. However, everyone has a different experience of CBS, for some people the hallucinations may get less frequent over a few months. They may eventually stop, but for others the condition may continue for years or lifelong.

If your hallucinations do stop, it’s possible that they may come back if you lose more sight. Many people also find that their hallucinations can come back or get worse if they are unwell with an infection, such as a bladder infection (also known as a water or urinary tract infection) or a chest infection. If you find that your hallucinations do come back or get worse, speak to your GP who can check for reasons such as infections.

You may also find that your hallucinations get worse when you are anxious, isolated or stressed. You can contact your GP if you are struggling with feelings of anxiety or stress or call our helpline so that we can offer emotional support, advice and information to help with your situation to reduce your stress, access befriending services and emotional support.

Treatment for Charles Bonnet Syndrome

Currently there is no medical cure for CBS, but this does not mean there is nothing that can be done to help. Sometimes just knowing that the condition is not a mental health problem, nor a symptom of another disease can help a lot. Knowing that CBS usually improves with time (even if it doesn’t go away completely) and having information on CBS as well as sharing your experiences with friends or family can also help. There are also ways to manage CBS that are described below.
Everyone with CBS should have a general health check to look for other factors that may be making the hallucinations worse. This includes ruling out memory problems and infections as well as thinking about the medication you are taking. Some medications given for other conditions may have side effects which make CBS worse. It is always worth checking with your GP if your medications may be making your CBS worse. There may be alternatives that you could take instead. It is important not to stop taking any prescribed medications without talking to your GP first.

Anticholinergics are a group of medications which can sometimes make hallucinations worse, especially in older people. They can be prescribed for lots of different health conditions including motion sickness, bowel and bladder problems. If you are taking more than one type of anticholinergic it can sometimes make your hallucinations worse. Some eye drops can also increase CBS.

If you have CBS, you’re likely to have very poor vision, or some amount of sight loss. Trying to make the most of the sight you have can help to make the hallucinations less frequent. This may mean making things bigger by using a magnifier, using brighter lighting, or using colour (contrast) to make things easier to see. A low vision assessment can explore these things with you. Your GP, optometrist or ophthalmologist can refer you to your local low vision service for an assessment. Wearing any spectacles your optometrist has prescribed for you is also important to help you make the most of the sight you have.

For those people with very troubling or distressing CBS there are medications that can be tried. There’s no proven drug you can take to stop CBS hallucinations. Some drugs prescribed for other conditions, such as epilepsy, Parkinson’s disease, dementia and mental health problems have been tried to help manage CBS hallucinations. However, all these drugs are very strong and can have serious side effects. Most people with CBS wouldn’t need them, but they may be useful for some people (if used carefully).

Managing Charles Bonnet Syndrome

Hallucinations can be frightening, particularly when you’re also dealing with losing your sight. Although the hallucinations may not be of anything frightening, it’s natural to feel anxious and confused just by having the experience of a hallucination.

Talking about Charles Bonnet Syndrome

If your hallucinations make you anxious, you may feel like keeping them to yourself. However, even though there’s no cure for CBS, letting people know you have this problem or talking about it may help give you peace of mind.

Describing your hallucinations and how they make you feel may help you cope with them. Most people find that talking about their hallucinations with their GP, optometrist, ophthalmologist, family, friends or carers can help.

Family and friends can support those experiencing CBS hallucinations by allowing them to talk openly about what they are seeing.

It’s helpful if you don’t ‘play along’ with the hallucination the person is seeing, but to instead, gently remind and reassure them that what they are seeing isn’t real.

Although CBS isn’t connected to mental health problems, professionals who work in the mental health field have a lot of experience in helping people deal with hallucinations. If your hallucinations become upsetting, your GP could refer you to the local mental health team for further help. Talking over your feelings with a counsellor, psychologist or psychiatrist may provide you with ways to reduce the anxiety the hallucinations may cause.

Dealing with Hallucinations

For most people there isn’t just one way to deal with their hallucinations, but there are a few things that you can try to do that may help.

Change what you are doing – Many people find that their hallucinations appear when they are sitting quietly without much occupying their mind. Putting the TV or radio on, or standing up and moving around, or going into a different room can sometimes make the hallucination disappear. Moving your head slowly from side to side, dipping your head at each shoulder may also help.

Change the lighting – If your hallucinations happen in dim light, then try opening the curtains, turning on a light or the television. Lighting conditions in certain rooms may also mean that you see the hallucinations more often in one room than another. For example, you may find that you rarely get your hallucinations in your garden or kitchen, but that you often see them in your living room. This may be because the kitchen and garden are much brighter and this is helping to control the hallucinations. If your hallucinations happen when there’s a lot of light, then switching off a light may also help.

Making sure that the lighting is the right level for your sight condition in all the rooms in your home will help you make the most of your sight and might help with your hallucinations. Look directly at the image or reach out to it. Some people also find that looking directly at the image they are seeing or reaching out to touch it or brush it away causes it to fade.

Eye movements and blinking – Sometimes moving your eyes or blinking rapidly can also help. A study has shown that a specific eye movement exercise may help. When a hallucination starts, look from left to right about once every second for 15 – 30 seconds, without moving your head. As a guide to how far to move your eyes, imagine two points about a metre (three feet) apart on a wall in front of you and look from one point to the other when standing about a metre and a half away (five feet). Your eyes should be held open during the movements. If the hallucination continues, have a rest for a few seconds and try another 15 – 30 seconds of looking left and right. If you’ve tried four or five times and the hallucination is still there, then it’s unlikely to work, but you may want to try again another time or when you have a different type of hallucination.

Relaxation or mindfulness – Some people find that their CBS hallucinations are worse when they’re tired or stressed. It is important to make sure you have enough sleep at night and have time to relax.

Familiarise yourself with the images – Sometimes it can help to get to know your hallucinations so that you become familiar with them. You may find that this means the hallucinations become less frightening and easier to cope with. This could mean you have some control over the way you feel about the images you are seeing.

Food supplements – The addition of real ginger or Omega 3 in your diet has been found to be helpful by some people but it is important that you check with your GP before trying this because this can interfere with some medications.
Is it too detailed to be real? – When you see something that is frightening or makes you unsure, ask yourself “Is this too detailed to be real?” The fact that the image is detailed and vivid compared with the way you usually see, is a clue that this is an hallucination. As well as these general points, here are a few more tips which may help you deal with certain types of hallucinations.

Diabetes is a lifelong condition and can cause several health complications it can lead to problems in various parts of the body. Your eyes are one part of your body that can be affected.

Diabetes & Eye Conditions

Not everyone who has diabetes develops a related eye condition, so it’s possible that your diabetes won’t cause any changes to your vision. However, when diabetes does affect the eyes, it can do so in other ways. This includes Diabetic Retinopathy.

Diabetic Retinopathy

Over time, diabetes can affect the network of blood vessels supplying the retina at the back of the eye, and this damage changes how well the retina works. This is known as diabetic retinopathy. There are different stages of diabetic retinopathy and how your vision is affected will depend on the severity of the changes to the retinal blood vessels and the area of the retina that is involved.

The Stages of Diabetic Retinopathy

A healthy retina needs healthy blood vessels to deliver oxygen and nutrients and remove its waste products. The high blood glucose levels caused by diabetes can damage the blood vessels in the retina, so that they can become blocked, they leak, or they grow incorrectly. This can lead to complications in the eye known as diabetic retinopathy. There are different types of retinopathy:

• Background diabetic retinopathy: Background retinopathy does not usually affect your sight, but your eyes will need to be monitored carefully to make sure your retinopathy doesn’t progress and get worse.
• Proliferative diabetic retinopathy: If background retinopathy gets worse, many of the retinal blood vessels become damaged or blocked. When these changes happen over a large area of your retina, it will have an insufficient blood supply. This is known as ischaemia. As retinal ischaemia increases, the body tries to make up for the lack of oxygen by growing new blood vessels on the retinal surface or into the vitreous gel. Unfortunately, these new vessels are weak, and they bleed very easily. Ischaemia can damage the retina, causing areas of sight loss where the retina cannot work properly.
• Diabetic maculopathy and diabetic macular oedema: When diabetic retinopathy affects your macula, it’s known as diabetic maculopathy. If the blood vessels near the macula are leaky, fluid can build up and cause macular swelling. This is called diabetic macular oedema (DMO) and it can cause vision to be blurred and distorted, as well as making colours appear washed out.

Reducing the Risk of Developing Retinopathy

If your blood sugar levels are continually high, there’s a greater chance the blood vessels in your eyes will become damaged and that more serious diabetic retinopathy will develop over time. There is also some evidence that for some people, a sudden and intensive reduction in a previously high blood sugar level can also cause problems, so speak to your diabetic medical team if you have any questions about how best to manage your condition. However, the more consistently your blood sugars stay within your target range, the lower your risk of developing serious problems with your eyes. Looking after other aspects of your health is also important, such as managing your blood pressure and cholesterol. There are things you can do to help control your risk of developing retinopathy, or stop it from getting worse. These include:

• Doing your best to keep your blood glucose level in your target range as consistently as you can.
• Controlling your blood pressure to keep it within your target range.
• Controlling your cholesterol levels.
• Keeping as fit as you can with regular exercise and a healthy diet to help maintain a healthy weight.
• Giving up smoking. Nerve damage (known as neuropathy), kidney disease and cardiovascular disease are more likely in smokers with diabetes. Smoking increases your blood pressure and raises your blood sugar level, which makes it harder to control your diabetes.
• Attending regular diabetic eye screening appointments as advised. Early detection and treatment will protect your sight.

Some factors that you cannot control can increase the risk of developing retinopathy. These include the length of time you’ve had diabetes and your age, as you’re more likely to develop diabetes as you get older. If you’re pregnant, you’re more at risk if you already have diabetes or have had gestational diabetes before.

If you or your family are from India, Pakistan, Bangladesh or Sri Lanka (South Asian communities) or from an African-Caribbean background, you’re more likely to get type 2 diabetes. The factors behind this aren’t fully understood but are thought to involve insulin problems, genetics, diet, and lifestyle.

Treatment for Diabetic Retinopathy

Diabetic retinopathy can be treated with a laser. This is known as laser photocoagulation. The laser used to treat proliferative diabetic retinopathy treats large areas of the edge of the retina (peripheral retina) and is known as pan-retinal photocoagulation (PRP). This treatment is given to prevent further sight-threatening complications.

If your maculopathy causes diabetic macular oedema (DMO) which does not affect the centre of the macula, laser treatment can be given in some cases as a targeted treatment to a small, localised area of the macula.

Laser treatment does not make your sight better; its aim is to protect your vision from becoming a lot worse.

Dry eye is an eye condition caused by a problem with your tears.

Dry eye can make your eye feel uncomfortable, red, scratchy and irritated. Despite the name, having dry eye can also make your eyes watery. Typically, dry eye doesn’t cause a permanent change in your vision. It can make your eyesight blurry for short periods of time, but the blurriness will go away on its own or improve when you blink.

Causes of Dry Eye

Dry eye is caused by a problem with your tears. You can develop dry eye if you don’t produce enough tears, or the tears aren’t of the right quality or if they don’t spread across the front of your eye properly.

Dry eye is usually more common as people get older. As we age, our eyelids aren’t as good at spreading tears each time we blink. The various glands in our eyes that produce tears may also become less effective. It is not always known what causes your eye to become dry but essentially, the quality of something known as your tear film gets worse.

It is sometimes difficult to determine the exact cause of dry eye. Dry eye is multifactorial, which means that that there can be many factors that contribute to the condition. Sometimes dry eye can be connected to other conditions affecting your body such as diabetes or rheumatoid arthritis. The condition is common in both men and women with advancing age but women in particular, especially after the menopause. Changes in hormonal levels such as in pregnancy and menopause can contribute to dry eye.

The following can also affect your tear film and contribute to dry eye:

Blepharitis and Meibomian Gland Dysfunction

Blepharitis and meibomian gland dysfunction (MGD) are the most common causes of dry eye. Blepharitis is an inflammation of the eyelid margins and can sometimes be caused by a bacterial infection. It can be divided into two types based on the location:

• Anterior blepharitis is when the inflammation is primarily around the eye lashes and in front of the lid margin.
• Posterior blepharitis is when there is inflammation present behind the eye lashes and is often caused by MGD.

MGD happens when the glands lining your upper and lower lids are blocked. You have about 30 of these small meibomian glands on each upper and lower lid located just behind your lashes. These glands secrete the oily layer onto the front of your tears. If the oil is of poor quality or there isn’t enough oil being produced as the glands have become blocked, the tears tend to evaporate quickly leaving your eyes dry and uncomfortable.

Medication

If you’re taking certain drugs, such as antihistamines, antidepressants, pain medications and oral contraceptives, you may develop dry eye symptoms. Eye drops which contain preservatives may also contribute to dry eye, especially if you are using them frequently.

Contact Lenses

Using contact lenses can cause you to develop dry eye. The length of time you wear your contact lenses along with other factors such as using computer screens, air pollution and wearing make-up can make the symptoms of dry eye worse. You should follow the advice for wearing contact lenses issued by your optometrist in terms of replacement frequency, wearing time and cleaning regime.

Other Health Conditions

There are several health conditions, particularly inflammatory conditions, that are associated with dry eye, such as rheumatoid arthritis and Sjögren’s syndrome. Sjögren’s syndrome is a condition that may cause you to have dry eye and a dry mouth.

Eye Surgery or Injury

If you have surgery on your eye (for example laser eye surgery) or an accident which affects or scars your eye, you may develop dry eye. Your dry eye symptoms usually improve once the eye has healed, but this can take time.

Environment

There are environmental factors that may cause or make your dry eye symptoms worse. These include dusty or smoky environments as well as heavily polluted areas or wearing make-up. Using air conditioners in the car and office as well as heaters may make your dry eye symptoms worse. Trying to identify and address these environmental factors are often recommended as a first step in helping to reduce your dry eye symptoms. Using air purifiers and humidifiers might help.

Treatment for Dry Eye

There’s no cure for dry eye but there are treatments that can help your eyes feel more comfortable and keep your symptoms at bay.

If your dry eye is caused by medication, then your GP may consider switching your medication to another. If your dry eye is caused by wearing contact lenses, then having a break from your lenses or asking your optometrist about trying a different type of contact lens may help the dry eye to improve.

Often dry eye is caused by getting older, which can’t be helped, but there is treatment that can help with your symptoms. There are three main ways to help your dry eye:

• making the most of your natural tears.
• using artificial tears (eye drops).
• reducing the draining away of the tears.

Helping with Dry Eye

Having dry eyes can be difficult. Eyes that are red, uncomfortable, and painful for long periods can be tiring. When your eyes first become dry, you may feel upset and worried. However, dry eye doesn’t usually cause any damage to your eye and typically doesn’t lead to permanent changes to your vision. There are many things that you can try to help you manage it better:

• Use your prescribed eye drops regularly. Finding eye drops that work for you can make a huge difference.
• Adjust your environment. Lowering temperature and using a humidifier may help, as central heating and air conditioning can worsen your symptoms.
• Avoid dusty, windy and smoky areas or use wrap-around glasses when you are exposed to these environments.
• Take rest periods and remember to blink often when you are using the computer, watching television, and reading.
• Try to have a healthy balanced diet, with flax seed as well as foods containing omega 3 and 6, such as oily fish, nuts, seeds, eggs, green leafy vegetables, etc.
• Avoid using eye make-up when there’s infection or inflammation present, or when your eyes are sore.
• If you wear contact lenses, have regular eye follow-ups. You may need a break from wearing contact lenses if your eyes are dry or explore different types of lenses which may be more suitable for dry eye.

Finding the right eye drops to suit you and trying different things to help cope with the symptoms of dry eye can take some time and commitment. Although there is no cure for dry eye, most people will learn how to manage their dry eye so that it doesn’t have too much impact on their everyday lives.

Glaucoma is the name given to a group of eye conditions where there is damage to your optic nerve. This may be because your eye pressure is higher than normal, or because of a weakness in the structure of your optic nerve.
Your eye needs a certain amount of pressure to keep the eyeball healthy and in the right shape. But if the pressure is too high, it can cause your optic nerve to become damaged at the point where it leaves your eye. This damage is called glaucoma.

Types of Glaucoma

Primary Glaucoma

These types of glaucoma occur without a known cause and aren’t caused by any other eye condition.

• Primary Open Angle Glaucoma (POAG) where damage to the optic nerve occurs slowly over a long period of time due to your eye pressure increasing to more than 21mmHg. This is the most common form of glaucoma.
• Normal tension glaucoma when an eye pressure of less than 21mmHg still causes damage to the optic nerve.
• Primary closed angle glaucoma is caused when the angle, where the aqueous fluid drains from the eye, narrows or closes. It can be chronic (gradual onset) or acute (where damage to the optic nerve can happen very quickly due to a sudden rise in eye pressure).

Secondary Glaucoma

Secondary glaucoma occurs as a result of another eye condition, an injury to the eye or due to medication.

Childhood Glaucoma

Glaucoma which affects babies and children is rare. There are two main types of childhood glaucoma:

• Primary congenital glaucoma which occurs when the aqueous drainage system hasn’t developed properly before birth.
• Secondary glaucoma which is caused by another developmental anomaly of the eye, a syndrome or another eye condition.

Primary Open Angle Glaucoma (POAG)

This is the most common type of glaucoma in the UK. It’s also known as chronic open angle glaucoma which means the damage to your optic nerve and changes to your sight happen very slowly over time.

Symptoms of POAG

You can’t ‘feel’ primary open angle glaucoma; it doesn’t cause any symptoms and the eye pressure doesn’t cause any pain. You may not notice any difference in your vision because glaucoma affects your peripheral vision (side vision) first. As your peripheral vision is not as sensitive as your central vision, it’s difficult to notice any early changes to your vision, even though your sight is being damaged.

Because you may not notice a problem until your glaucoma is more advanced, it’s important to have regular eye examinations as this is the only way to know if you have it. The earlier your glaucoma is picked up and treated, the more your sight can be protected.

Effects of POAG

If there is damage to your optic nerve, blind spots can begin to form in the outer edges of your vision. You may miss things in your peripheral vision, but often you will have no symptoms until the condition is advanced.

Without treatment, sight loss can slowly progress so that your field of vision becomes very narrow, your night vision becomes poor and it can appear as if you’re looking through a tunnel. Finally, if left untreated, your central vision may be affected too, causing blind spots to appear when you look straight ahead.

Unfortunately, once sight loss occurs, it can’t be reversed as there are currently no treatments which can restore the damaged nerve. This means that it’s important that your glaucoma is picked up and treated early to prevent optic nerve damage in the first place and to avoid sight loss.

Treatments for POAG

All treatment for glaucoma aims to lower your eye pressure to prevent damage to your optic nerve and your sight.

Treatment to lower your eye pressure usually starts with eye drops, and for most people with glaucoma, this is all the treatment they will ever need. These drops will need to be used long term or for life.

When you are first diagnosed with glaucoma, you may be offered laser treatment as your first treatment option. If you have already started on drops as treatment for your glaucoma, the ophthalmologist will only recommend laser treatment if the drops are not controlling your eye pressure properly.

In a very small number of people with glaucoma, where eye drops haven’t been successful in keeping the eye pressure stable, or where the glaucoma is advanced, surgery may be an option. The most common surgery for glaucoma is called a trabeculectomy.

Normal Tension Glaucoma

This type of glaucoma occurs when your eye pressure is within normal range but causes damage to your optic nerve.

It’s not entirely known why some people’s optic nerve becomes damaged even though their eye pressure is at a normal level. It’s thought that perhaps some people’s optic nerve may just be weaker or have a more fragile blood supply and be unable to cope with an eye pressure within the normal range.

Normal tension glaucoma is treated in the same way as open angle glaucoma – by lowering your eye pressure to a level which is right for you, to protect your sight.

Ocular Hypertension (High Eye Pressure)

Some people naturally have eye pressure above the normal range, but this pressure doesn’t cause any damage to their optic nerve. This is described as ocular hypertension rather than glaucoma.

Different people can have different optic nerve strengths, and some people’s optic nerves stay healthy at higher than normal eye pressures.

If you have ocular hypertension, it can increase your risk of developing glaucoma, so this needs to be monitored. Sometimes you may be prescribed eye drops or offered laser treatment to help reduce your eye pressure and reduce your risk of developing glaucoma. If this is the case, you’ll be followed up at the eye clinic regularly to monitor your eye pressure. You may be discharged from the eye clinic if you don’t require eye drops and tests show that there is no sign of glaucoma. However, it’s important for you to visit your optometrist (optician) regularly for your eyes to be checked so that any future changes can be picked up.

Managing Glaucoma

Having glaucoma may mean you need to make a few changes to your everyday life to prevent sight loss. For many people, this includes using eye drops daily and for most people having to attend regular eye clinic visits.

The most important thing you can do to protect your sight is to keep to the treatment that has been recommended for you. For many people with glaucoma, this involves putting in eye drops daily. It may help to make putting in your drops part of your daily routine, such as brushing your teeth, so that you don’t forget. It’s important to remember to use your drops regularly as prescribed, to prevent glaucoma from getting worse and causing damage to your sight.

It’s also very important to attend all your appointments at the eye clinic to make sure your eye pressure stays stable. This is because changes in eye pressure have no symptoms, and without regular checks you won’t be able to tell that your treatment is working. It also gives you a good opportunity to ask your ophthalmologist any questions you may have about your glaucoma treatment. How often you need to be seen at the eye clinic will depend on how well your treatment is working.

Coping

It’s completely natural to be upset when you’ve been diagnosed with glaucoma and it’s normal to find yourself worrying about the future and how you will manage with a change in your vision.

Help to See Things Better

If glaucoma is picked up and treated early, you may not experience much of a change to your vision. You can carry on with everyday activities such as reading, watching television, and using the computer – these things will not make your glaucoma worse.

If you do have some sight loss, a low vision assessment can explore how to make the most of your sight. This may mean making things bigger, using brighter lighting, or using colour to make things easier to see. Your GP, optometrist or ophthalmologist can refer you to your local low vision service for an assessment.

Nystagmus is a condition which causes uncontrolled eye movement. If you have nystagmus, these movements cause your eyes to move constantly (sometimes described as ‘wobble’).

This can be in a side to side, an up and down, a circular motion, or a combination of these. This uncontrolled movement can affect how clearly you can see. Many people with nystagmus have reduced vision.

Different Types of Nystagmus

There are two main types of nystagmus:

• infantile or congenital nystagmus which appears in the first few months of life, and
• acquired nystagmus, which develops later in life.

Infantile or Congenital Nystagmus

Infantile or congenital nystagmus is also known as early onset nystagmus or infantile nystagmus syndrome (INS). It is usually diagnosed in very young children, in the first few months of their life. This type of nystagmus can be associated with another eye condition or with a problem with the parts of the brain which control eye movements. Sometimes, children develop nystagmus without any of these issues.

The way the brain and eyes work together is known as the visual system. When a baby is born, its visual system is not fully developed. In the first few years of life, our vision develops through our eyes and brain being stimulated by what we see. If a baby is born with an eye condition which is affecting how well they can see, their visual system may not develop normally. The following are examples of eye conditions that a baby may be born with:

• Congenital cataracts
• Ocular albinism
• Retinal dystrophies, such as cone dystrophy, congenital stationary night blindness, or Leber congenital amaurosis
• Optic nerve conditions, such as optic nerve coloboma or hypoplasia
• Aniridia.

These conditions can lead to nystagmus. The more an eye condition affects a child’s sight, the worse their nystagmus is likely to be.
Nystagmus can also occur in children with learning disabilities and other medical conditions, such as Down’s syndrome, or neurological conditions such as cerebral palsy.

However, many children with nystagmus don’t have any problem with their eye, brain or health. When a cause for the nystagmus can’t be found, it is called idiopathic infantile nystagmus or idiopathic nystagmus syndrome. Some of these children may have a faulty gene known to cause nystagmus.

Acquired Nystagmus

Nystagmus that develops later, mostly in adults, is called “acquired nystagmus”. Anything that damages the areas of the brain that control eye movements can result in acquired nystagmus.

Acquired nystagmus is usually a sign of another underlying condition such as stroke, multiple sclerosis, brain tumour, head injury or the effects of certain prescribed or recreational drugs.

The Effects of Nystagmus

If you have nystagmus, your eyes are always moving, although it may not always be obvious to you or others. The way that nystagmus affects vision varies from person to person; however, it doesn’t lead to total loss of sight.

Managing Nystagmus

Currently there is no cure for nystagmus, but some of the underlying conditions which cause nystagmus may be treatable. Having nystagmus can cause reduced vision but there are things which can help manage the condition and make the most of your sight.
Glasses and contact lenses will ensure that you, or your child, have the best vision possible. They can’t correct nystagmus but can correct for any refractive (focusing) error you may have. In young children with infantile nystagmus, treatment with glasses is important to help their vision develop as fully as possible.

A low vision assessment will look at ways to help people make the most of their vision. This may mean making things bigger, using brighter lighting, or using colour or contrast to make things easier to see. The assessment gives people a chance to discuss any practical problems they are having with their vision with a low vision specialist. The specialist can explore things like magnifiers, lighting, colour contrast and other adaptations that may help, such as tinted glasses which may be useful to control glare.

There are also some other options which can sometimes help to manage nystagmus. These options don’t work for everyone as their suitability varies from person to person. The options are:

Surgery cannot correct the nystagmus, but it can be used to change the position of the muscles that move the eye. This can be helpful in reducing the amount a person needs to turn their head to get to their null zone, making it more comfortable to keep their head in the best position. Surgery doesn’t work for everyone and it usually isn’t considered until a child is older and when the null zone is more stable.

Medication and drugs may be used in some specific cases of acquired nystagmus, for example if the nystagmus is caused by multiple sclerosis. Drugs can sometimes help control eye movements and reduce the symptoms of oscillopsia. However, for many people the side effects of these drugs may outweigh the benefit they provide.

Botulinum toxin (Botox) injections into the eye muscles may occasionally be used to help some people who have acquired nystagmus that is caused by a neurological problem, such as multiple sclerosis. Botox weakens the eye muscles and helps to slow down the movements. The effects are only temporary but can sometimes help to reduce the symptoms of oscillopsia in the short term.

However, Botox can weaken all eye movements and not just the eye movements relating to the nystagmus, so this can cause its own problems which limits the usefulness of this treatment.

You may hear of research into other management therapies such as acupuncture or biofeedback, which aims to reduce nystagmus through audio signals. However, it’s uncertain whether any of these therapies work and more research is needed.

Coping

Although nystagmus can cause problems with your sight, with the right support at the right time, most people can lead full and independent lives.

For children with infantile nystagmus, having the right support at school can make a big difference. Your local authority (LA) should have at least one qualified teacher of the visually impaired (QTVI) to work with you and your child both at home and at school. A QTVI is a qualified teacher who can provide support with development, play, learning and education. At an early stage, ask your local authority to put you in contact with a QTVI. They will support you and your child as soon as a visual impairment is suspected or diagnosed.

Depending on how much of a person’s sight is affected by nystagmus, they may be eligible to be registered as sight impaired (partially sighted) or severely sight impaired (blind). An ophthalmologist would be able to tell you whether you or your child are eligible. Registration can act as a passport to expert help and sometimes to financial concessions.

Low Vision Assessments and Making the Most of your Sight

A low vision assessment looks at ways you can make the most of your sight. This may mean making things bigger, using brighter lighting or using colour to make things easier to see. Your GP, optometrist (also known as an optician) or ophthalmologist (also known as a hospital eye doctor) can refer you to your local low vision service for an assessment.

Posterior vitreous detachment (PVD) is a condition where your vitreous gel comes away from the retina at the back of your eye.

Causes of PVD

Your eye is filled with a clear gel called the vitreous. The vitreous helps to keep your eye’s shape. It is made up mainly of water and a protein called collagen.

As you age, it is common for the vitreous to become waterier and less like a gel. When the vitreous gets too soft, it loses its shape, and comes away from the retina and shrinks in towards the centre of your eye. Once the vitreous detaches, it does not reattach again.

This is not a problem as we don’t need the vitreous attached to the retina to see well. PVD is a natural change in the eye and is not a sign of another eye health problem.

The most common cause of PVD is age. Most people with PVD are over the age of 50 but you can have a PVD in your 40s, particularly if you’re short-sighted or if your eye has been injured or you’ve had previous eye surgery.

It’s normal to get PVD in both eyes, although often it will occur in one eye at a time. Usually people get PVD in their other eye between six months to a couple of years after the first eye. As PVD is a natural change, there is no way to prevent a PVD from happening.

Symptoms of PVD

PVD can cause several symptoms:

• Floaters for the first time or more floaters than you had before. The new floaters are usually noticed suddenly. There may be lots of new floaters or commonly a large cobweb-like floater.
• Flashes of light in your vision, usually like brief streaks of light in your peripheral (side) vision.
• Blurred vision.

As the process of a PVD can last some weeks to some months, your symptoms may be ongoing for this period. Generally, your floaters and the flashes of light will gradually calm down and become less obvious to you. You might be aware of your floaters in the long-term following a PVD, although they are generally not as noticeable as when they first began. As long as the symptoms are not worsening after your eyes have been checked and PVD is diagnosed, then they are not usually a cause for concern.

If you’re worried about any symptoms that don’t go away, speak to your optometrist or ophthalmologist about it.

Floaters

Floaters are very common and many people have them, even if they don’t have PVD. They’re floating clumps of cells that form in your vitreous. You can see them because they cast shadows on your retina when light comes into your eye. These floaters do not harm your eye.

Floaters can be different shapes and sizes – dots that can look like flies, threads, circles, clouds, spiders or cobwebs. You may notice that your floaters move around a lot, or they may not seem to move much at all. They tend to be more obvious on a sunny day or when looking at a bright computer screen or a white or lightly coloured background.

You may only have a few floaters or you may have many of them. Floaters may appear quite suddenly, and they may be very frustrating or worrying to you. When they’re at their most intense, you might think that your floaters will always interfere with your vision, but for most people, they become less obvious over time. Floaters never leave the eye but become less noticeable as the vitreous settles down and your brain learns to ignore them.

Flashes of Light

When your vitreous pulls away from your retina, your retina reacts to this stimulation by sending a signal to your brain. Your brain processes this signal as a small, short flash of light. You’ll often see more in dark or dim lighting as they will show up more against a darker background. These flashes of light won’t affect you for as long as floaters, and they will probably become a lot less frequent once the vitreous has fully come away from your retina.

Coping with Floaters

If you have a large floater, moving your eyes gently around in circles may help. This moves the vitreous inside your eyes and can sometimes move the floater out of your direct line of vision so you’re less aware of it.
If your optometrist has advised you to wear glasses, wearing these when you need to will help you to see what you’re doing more easily. When your vision is clearer, you’re more likely to be able to concentrate on the task, rather than on the floaters.
Wearing sunglasses in bright conditions will make your floaters less noticeable. The tinted lenses reduce the amount of light entering your eyes, which means that your floaters cast a fainter shadow on your retina.

If your floaters are distracting you when you’re using a computer or tablet, reducing the brightness of the screen may make them less noticeable.

Treatment for PVD

There isn’t any medical treatment for PVD and there’s no evidence that eye exercises, diet changes or vitamins can help. Given that the symptoms of PVD improve over time and that the vitreous does not need to be attached to the retina to see well, PVD does not need to be treated.

You may have heard that it’s possible to treat PVD either with a laser or with surgery to remove the vitreous from your eye. Very few ophthalmologists offer laser treatment for floaters, and in the UK it’s not a routine treatment. The laser may make large floaters smaller but it’s still not clear whether it’s safe or makes your vision any better. It’s very unlikely to be funded by the NHS so you’d usually have to pay for this privately. If you’re considering laser treatment, make sure you ask about the risks beforehand.

There is surgery called a vitrectomy where your vitreous is removed from your eye. Although this can reduce your floaters, it’s a major operation and there are risks from having this surgery. Because of this, it is necessary to discuss the operation carefully with a surgeon before considering a vitrectomy.

Complications of a PVD

In most people with PVD, the vitreous comes away gently from the retina without any problems and does not cause any long-term changes to your sight. A very small number of people may experience complications from their PVD.

In a small number of people, PVD can lead to a retinal tear. This is because the vitreous may be more firmly attached in certain places to the retina. As your vitreous moves away from your retina in PVD, it can pull on your retina, causing it to tear. The risk of this happening tends to be highest when the symptoms of PVD first begin and in the first six weeks. Once the vitreous has fully detached from the retina, the risk of developing a tear from PVD goes back down.

Retinal tears can be successfully treated to prevent them from developing into a retinal detachment which can cause sight loss, but they do need to be treated promptly. Retinal tears from PVD are much rarer than PVD alone and only 10-15 per cent of people have a retinal tear following PVD. An even smaller number of these people go on to develop a retinal detachment.

If someone does develop a retinal tear from a PVD, it tends to occur when the PVD symptoms first begin or if the symptoms noticeably increase. Having your eyes examined on the same day or within 24 hours of the start of new or worsening symptoms means that your ophthalmologist or optometrist can look for any signs of retinal tear or detachment.

It’s important to remember that most people who have PVD do not develop any complications.

Activities with PVD

Most people with a PVD can carry on with their normal day-to-day activities with no restrictions because there is no evidence to show that certain activities can cause complications with your PVD. Some ophthalmologists advise that high impact exercise should be avoided during the first six weeks after the start of a PVD as this is when the risk of having a retinal tear or detachment is highest.

There is no evidence either way that any of the following activities will cause any problems with your PVD, but some people may be advised to or choose to avoid:

• Very heavy lifting, energetic or high impact exercises, such as running or aerobics.
• Playing contact sports, such as rugby, martial arts, or boxing.
• Inverted positions in activities such as yoga or Pilates.

You should always ask your ophthalmologist for advice about what activities you should avoid doing and for how long as the advice given may depend on whether they feel your retina may be particularly at risk, for example if you are very short sighted or have a history of eye surgery.

You can carry on with daily activities such as walking, gentle exercising, reading, watching TV, cooking, and using your computer. There is no evidence to suggest that flying in an aeroplane will harm your PVD or make it worse. Wearing contact lenses or makeup will also not affect your PVD.

A PVD will not usually cause your prescription to change, and it’s ok to have an eye examination for new glasses while you have a PVD. However, if you have a lot of floaters affecting your vision, you may wish to wait until these have settled before having an eye examination.

If you are a driver, you do not have to notify the DVLA that you have had a PVD. You can usually continue driving (if no other eye conditions are affecting your sight) but it’s best to speak to your ophthalmologist or optometrist for advice.

A retinal detachment is when your retina separates from the inside of your eye.

Your retina needs to be attached inside your eye to stay healthy and work properly. If it remains detached, it will stop working and affect your sight.

A retinal detachment can be repaired with surgery, but it needs to be detected and treated quickly, or it can cause sight loss in the affected eye.

A retinal detachment is an emergency. It needs to be assessed as soon as possible so that your ophthalmologist (hospital eye doctor) can make decisions about your treatment.

How well your sight recovers can depend on how much and in what areas your retina have detached. Most people have a good level of vision following surgery to re-attach the retina if it is carried out quickly.

Types of Retinal Detachment

There are three main causes of retinal detachment.

Retinal holes and tears – Most retinal detachments happen because a tear or hole in the retina allows fluid to leak between the retinal layers, lifting the retina away from the back of the eye and causing it to detach. Tears happen because the retina has been pulled and torn. The most common cause of a retinal tear is posterior vitreous detachment (PVD) where the vitreous gel naturally comes away from the retina as we get older. the vitreous gel coming away from the retina (known as acute posterior vitreous detachment or PVD). In most people with PVD, the vitreous comes away gently from the retina, but in some people, the vitreous may be more firmly attached in certain places to the retina. So as the vitreous moves away from the retina, it can pull on it, causing it to tear.

Scar tissue – Eye conditions such as diabetic retinopathy can cause scar tissue to form on the surface of the retina and inside your vitreous. This scar tissue can then lead to traction (pulling on the retina), causing a detachment.

Fluid – A rare type of retinal detachment happens when fluid from the blood vessels behind the retina leaks between the retinal layers without there being a hole or tear present. This type of detachment happens because of conditions which cause inflammation in the eye or tumours in the eye.

Facts & Figures

Only about 10 – 15 per 100,000 people have a retinal detachment each year. Retinal detachments are very rare in children and are most likely to occur in people between 40 to 70 years old. Natural ageing changes in the vitreous gel from PVD, known as PVD, can cause retinal tears and PVD is more common as you get older.

Anyone can develop a retinal detachment, but certain people are at higher risk. These include people who:

• are short-sighted (the more short-sighted you are, the greater the risk).
• have had trauma (an injury or a blow) directly to your eye.
• have already had a detachment in one eye (about 1 in 8 people with retinal detachment develop a retinal detachment in the other eye).
• have a family history of retinal detachment.
• have had previous eye surgery in that eye, such as cataract surgery.
• have certain other eye conditions such as diabetic retinopathy or inflammation inside the eye.

Symptoms of Retinal Detachment

The following symptoms can be the first signs of a retinal detachment:

• floaters.
• flashing lights.
• a dark shadow in your vision.
• blurred vision.

You may have these symptoms but not develop a retinal detachment, but there isn’t a way to tell what is causing these symptoms unless your eye is examined.

A retinal detachment can cause a permanent loss of vision so it’s best to be cautious and have these symptoms checked, as soon as possible, within 24 hours of noticing any new symptoms. You can do this by having your eyes examined urgently by your optometrist (optician) or by attending Accident & Emergency (A&E) or eye casualty. You can also call 111 for advice about your symptoms and where to go to get your eyes checked.

Floaters

Floaters are caused by floating clumps of cells that form in your vitreous gel which cast a shadow onto your retina. The brain then sees this as something floating around in your vision. Floaters are very common, and most people develop some as they get older. They can take many shapes, for example, black dots, rings, spiders’ legs or cobwebs.

Many people naturally have some floaters in their eyes, which are nothing to worry about, but new floaters or changes to the ones you have already should be checked.

If you start to see floaters or notice a change or increase in the floaters you already have, you should have your eyes examined by an optometrist (optician) or an ophthalmologist as soon as possible. If you see an optometrist and they find, suspect, or can’t rule out a tear in your retina, then they will refer you urgently to an ophthalmologist.

Flashing Lights

In most cases flashing lights are caused by a change in your vitreous gel (PVD). This is where the vitreous gel inside the eye moves across and tugs or stimulates the retina. These flashes of light are brief, white and vertical, occurring in the edges or sides of your vision. They may be worse when you move your eye or head and are more noticeable in darker or dimmer environments.

A PVD itself is not harmful, but in some people, it may cause a retinal tear. That’s why if you suddenly experience new flashing lights, you should have your eye examined by an optometrist or ophthalmologist as soon as possible.

Dark shadow

If your retina does detach, this means that it cannot work properly anymore, and you will see this as a solid dark shadow moving in from the edge of your vision. You will not be able to see round or through this shadow. If more of your retina detaches, then the shadow will keep moving towards the centre of your vision.

If you experience a dark shadow moving up, down or across your vision, you must attend your local hospital Accident and Emergency (A&E) department straight away.

Blurring of Vision

Your vision can gradually become blurred for many reasons, and a visit to the optometrist will help you find out why. If your vision suddenly becomes blurred, especially if you also have any of the other symptoms of flashing lights, floaters or a shadow, then this is more serious. You should have your eyes examined straight away.

Checking Your Eyes

It’s important to have someone examine your eye if you start to have any of these symptoms and in most cases, it is best to have your eyes checked within 24 hours.

Sometimes it is easier get an appointment with an optometrist on the high street, but they may refer you straight away to your local A&E department so that you see an ophthalmologist as soon as possible. A&E departments should have an ophthalmologist on call who can examine your eye and decide what to do next. You can also call 111 for advice about where to go to get your eyes checked.
If you have been checked for retinal detachment in the past, you should have been given clear instructions on what to do if you have further symptoms. You should follow these if more symptoms develop. This usually involves contacting the hospital eye clinic if you have any concerns.

Treatment for Retinal Detachment

Retinal detachment can be treated by surgery to re-attach the retina to the back of the eye. The sooner surgery is carried out the better the results are likely to be. If your retinal detachment isn’t treated, then you are likely to lose all the vision in the affected eye.
Once your ophthalmologist has examined your eye, they will decide how quickly surgery needs to be done – this may be within 24 hours or within a few days.

There are three main types of surgery used to reattach the retina. They all aim to make your retina lie flat against the inside of your eye again.

Surgery for retinal detachment is complicated and individual to each person’s eye. The type of treatment surgery you may need depends on the type and cause of the detachment, and any complicating factors, such as any other eye conditions you may already have. Your ophthalmologist will decide on what type of surgery is most appropriate for your individual circumstances, and they may combine different options depending on the extent of your detachment.

Vitrectomy

The most common surgery used for a retinal detachment in the UK is a vitrectomy. During surgery your ophthalmologist removes some of the vitreous gel in your eye and replaces it with a gas bubble. Removing some of the vitreous gel helps to remove the traction (pulling) of the gel on the retina. The gas bubble holds your retina in place against the inside of your eye while it heals. The gas slowly disappears over time; it may take between two to 12 weeks depending on the type and concentration of gas used.
Your ophthalmologist may choose to use clear silicone oil instead of a gas bubble. The silicone oil is heavier than gas and is effective for longer at keeping s your retina in the right place while it heals. However, but unlike the gas bubble, you will need further surgery to remove the oil at some point in the future. Silicone oil is generally used for more complex retinal detachments.

Scleral Buckle

Your ophthalmologist may use a scleral buckle to treat your detachment. The sclera is the white outer layer of your eye.
A scleral buckle involves attaching a tiny piece of silicone sponge or harder plastic to the outside white of your eye. This presses on the outside of the eye, causing the inside of your eye to slightly move inwards. This pushes the inside of the eye against the detached retina and into a position which helps the retina to reattach. Cryotherapy or laser treatment is then used to seal the area around the detachment. The buckle is usually left in place permanently and can’t be seen once surgery is finished.

Pneumatic Retinopexy

If your retinal detachment is small and uncomplicated, a gas bubble can be injected into the vitreous of the eye, without removing any of the vitreous. This bubble then presses the retina back in place. Like with vitrectomy, the gas is reabsorbed over a period of weeks. This type of surgery has been found to be less successful than other types and is not often done in the UK but may be carried out for a small number of straightforward and small retinal detachments.

Success Rates of Surgery

Surgery is usually very successful at reattaching the retina, but how well your vision recovers depends on:

• how much of your retina detached.
• if your macula (the central part of your retina, used for seeing detail and reading) was detached.
• how long your retina was detached.
• if you have another eye condition, such as diabetic retinopathy.

If your macula, which allows you to see fine detail, remained attached, then results are often very good, and your central vision may not be affected at all.

If you had a shadow in your peripheral vision, this should disappear after surgery. You may be left with some changes in your peripheral vision, which can be picked up by an eye examination, although you may not notice these on a day-to-day basis.

If your macula detached, but surgery was carried out quickly, then your central vision can return, but it may be distorted. You will probably adapt to this distortion with time, especially if you have good vision in your other eye.

Unfortunately, for some people, surgery may be successful at reattaching the retina, but it may not bring back detailed central vision or areas of peripheral vision. This can happen in any circumstance, but the risk is higher the longer the retina has been detached without any surgery.

If Surgery isn’t Successful

Around one in 10 people may need more than one operation to treat a retinal detachment. The reasons for this are new tears forming in the retina, or the formation of scar tissue which contracts and pulls the retina off again.
In these cases, it is possible to have more surgery to reattach the retina. At each stage, your ophthalmologist will discuss with you the likelihood of success and the need to have more surgery or treatments.

Managing Changes

If your retinal detachment is detected early and treated successfully, you may not be left with any long-term problems with your vision once your eye has recovered from surgery.

If your retinal detachment has left you with sight loss in one eye, you may still have useful vision in your other eye. It can take a few months to get used to seeing with only your good eye, because sometimes the eye with poor vision will interfere with clear vision. With time, the brain learns to ignore the eye with poorer vision in most situations.

If a retinal detachment has caused sight loss in your good eye and you have reduced sight in your unaffected eye, then you may be left with sight problems. There are lots of things you can do to make the most of your remaining vision. This may mean making things bigger, using brighter lighting or using colour to make things easier to see. A low vision assessment can explore how to make the most of your sight. Your GP, optometrist or ophthalmologist can refer you to your local low vision service for an assessment.

Coping

It’s completely natural to be upset when you’ve been diagnosed with a retinal detachment. Often there can be a lot of changes, including surgery, in a short space of time. You may find that you are worried about the future and how you will manage with a change in your vision.

An inherited retinal dystrophy (IRD) is a genetic eye condition which affects the light sensitive cells in the retina at the back of your eyes, which over time, stops them from working.

Retinitis pigmentosa (RP) is the most common group of IRD, but there are others that have different names, and which may lead to different patterns of sight loss. The way in which your sight is affected depends on the type of IRD you have. Most IRDs cause progressive and permanent changes that reduce your vision, but these changes usually happen slowly, taking years to develop.

Symptoms of Retinitis Pigmentosa

As RP affects the retinal rod cells first, the first symptom you’ll notice is that you don’t see as well as people without a sight condition in dim light, such as outside at dusk, or at night. This is often called “night blindness”. People without a sight condition can usually fully adapt to dim light in 15 to 30 minutes, but if you have RP, it will either take you much longer or it won’t happen at all. You’ll start having problems seeing things in your peripheral vision. You may miss things to either side of you and you might trip over or bump into things that you would have seen in the past.

As your RP progresses, you’ll gradually lose more of your peripheral sight, leaving a central narrow field of vision, often referred to as having “tunnel vision”. How long your central vision is preserved will depend on the type of RP that you have. This may be into your 50s or beyond. However, advanced RP will often affect your central vision, so that reading or recognising faces becomes difficult.

RP is a progressive condition, which means that your sight will continue to get worse over the years. Often, after your vision has been stable for a while, it can get worse suddenly over a short period of time. This new level of vision may then remain stable for quite some time. However, there may be further changes to your vision in the future. This may mean that you have to keep re-adapting to lower levels of sight. The type of RP that you have can affect how quickly these changes develop.

Are the symptoms of other IRDs the same as RP?

There are many IRDs, some with similar symptoms to RP and some that are very different. Some IRDs affect the whole retina while others only affect the macula in the central retina. IRDs such as RP are called rod-cone dystrophies because the retinal rod cells are affected more than the retinal cone cells, but the whole retina is ultimately affected. Leber congenital amaurosis (LCA) is the name given to a group of more severe rod-cone dystrophies that lead to greater sight loss in very early childhood, often detected at birth.

Cone-rod dystrophies affect the cones earlier and more severely than the rods so that central vision is affected more than peripheral vision.

Macular dystrophies primarily affect your central vision, usually leaving peripheral vision intact.

Choroidal dystrophies (also known as RPE dystrophies) mainly affect how the rod and cone cells work, but they also affect the choroid and the retinal pigment epithelium (RPE) which both lie underneath the retina. Peripheral vision is affected first with central vision affected later on. Chloridaemia and gyrate atrophy are examples of this type of dystrophy.

Some IRDs have specific names and some form part of a syndrome, such as Usher syndrome and Bardet-Biedl syndrome where, in addition to sight loss, other aspects of general health are also affected.

Causes of Inherited Retinal Dystrophies

IRDs are hereditary conditions caused by a fault (mutation) in one of the genes involved in maintaining the health of the retina.
You inherit genes from your parents. Your genes give the cells in your body the instructions they need to work well and stay healthy. If a gene has a mutation, there is a fault in their instructions and the cells using those instructions don’t work as they should.
Having an IRD means that the faulty gene involved stops your retinal cells from working correctly and results in these cells eventually failing over time. Researchers have identified many of the genes that are associated with different IRDs, but there are still other genes to discover.

How are IRDs inherited?

About half of people with an IRD have a relative who also has the condition. The way in which these genes are passed on from one generation to another can tell you who in your family has had the condition, how severely your vision could be affected, and the chances of your children being affected. Genes usually come in pairs. You inherit one gene from each of your parents to make each pair. When you have children, you only pass on one gene to them. You can inherit IRDs in different inheritance patterns:

• Autosomal dominant (AD) – An IRD that is passed on with AD inheritance is a condition where only one of the genes in the relevant gene pair needs to have a fault to cause the condition. This gene fault can be inherited from either your mother or your father. Usually, this parent will also have the condition. If you have an IRD that is AD, there is a 50% chance of passing on the faulty gene every time you have a child and for that child to have the condition.
• Autosomal recessive (AR) – IRDs that are passed on with AR inheritance require both genes in the relevant pair to be faulty. This means you need to inherit one faulty gene from your mother and the other faulty gene from your father to have the condition. If your parents have one faulty gene and one normal gene, they will only be carriers of the condition and their vision will be unaffected by it. If both parents pass on the gene fault to you, you will inherit the condition and your sight will be affected. Someone who has an IRD that is AR will pass on a faulty gene to all their children. However, if these children also inherit a normal copy of the gene from their other parent, they will only be carriers of the condition.
• X-linked (XL) – To have an X-linked IRD, the faulty gene is located on the X chromosome. For a male, who has only one X chromosome in each of his cells, if there is an XL gene fault on this X chromosome, he will have the condition. A female, who has two X chromosomes in each of her cells, may have a faulty gene on one X chromosome but a normal copy of the gene on the other. If the normal copy is enough for her to have no symptoms at all or to be only mildly affected, she is a carrier of the condition, and the inheritance pattern is X-linked and recessive in nature (X-linked recessive or XLR). X-linked IRDs can affect some women more severely but this is very rare. A man with an X-linked IRD will pass on the faulty gene to all his daughters but not to his sons. His daughters are likely to be carriers of the condition, but his sons won’t be affected.

About half of people with an IRD don’t know of any other members of their family with the condition. This may be because their relatives were carriers of the IRD and haven’t shown signs of the condition themselves. Sometimes, a person can have an IRD because the fault in the relevant gene has happened spontaneously by itself after conception, without being directly inherited from their parents. If there is no known relative in your family, it may not be possible to find out how your IRD has been inherited without the help of genetic testing to find out which genes are faulty.

Genetic Testing

Genetic testing can be carried out to identify the specific faulty gene that is causing your IRD. As your test results can indicate the inheritance pattern, it can help to show how likely it is for other members of your family to have the condition as well as indicating whether you could pass on a faulty gene to your children. It may also be useful in predicting how your vision will change over time and with what speed.

Genetic testing uses a blood test to look at your genes to see if any faults are present. Testing for an IRD is complicated and doesn’t always identify all forms of these conditions as new gene faults are still being discovered. Ask your ophthalmologist or GP to discuss genetic testing with you.

Genetic Counselling

Genetic counselling aims to provide you with the information you need to understand your condition and to enable you to make informed decisions relating to it. Genetic counselling can be invaluable before genetic testing is carried out, to give you an understanding of the implications the results might have. A genetic counsellor can help you understand how a condition is passed on within your family by considering your family tree in detail, as well as offering you guidance and support in making any future decisions relating to your condition; for example, knowing the chances of passing on any condition you have can help if you are thinking about starting a family.

Tests for IRD

An optometrist (also known as an optician) can examine your retina by looking into your eyes. If you have the early signs of classic RP, there will be tiny but distinctive clumps of dark pigment around your retina. Any changes to your peripheral vision can be detected by a field of vision test. If your optometrist is concerned after your eye examination, they can refer you to an ophthalmologist (hospital eye doctor) for more tests.

There are various tests that can diagnose an IRD. These tests can also monitor how your condition changes over time. Your ophthalmologist may be able to say that you have an IRD when they’ve got the results of these tests, but it may not be possible to know the specific IRD you have and what the long- term effects on your vision will be without genetic testing. Some of the tests you may need to undergo include:

• Examination of the retina at the back of your eye.
• Retinal photographs, optical coherence tomography, and autofluorescence imaging – your retina may be photographed using a special camera. By comparing the photographs taken on different visits, your ophthalmologist might be able to monitor how your condition is changing over time.
• Visual field test which checks how much of your peripheral vision has been affected by an eye condition.
• Colour vision tests.
• Electro-diagnostic tests which can tell your ophthalmologist how well your retina is working. They check how your retina responds electrically to patterns and different lighting conditions. Different tests can be carried out to show the results of your retina’s electrical activity. These test results will indicate which layers of your retina have been affected.

Treatment for IRD

While much progress has been made in the past few years in the understanding of the genes involved in RP and other IRDs, there is currently no cure for these conditions. However, ongoing research funded by sight loss charities is taking place all the time and the types of treatment currently being investigated include:

Gene Therapy – The aim of gene therapy is to introduce normal genetic material to the affected retina which will override the fault in the gene which has caused the IRD. For this to have any chance of success, there must be some retinal cells that are still working. Gene therapy relies on knowing which specific gene is faulty as a different therapy is required for faults in different genes. Gene therapy is ongoing for many IRDs in the hope of finding future treatments. There are different approaches within gene therapy which include gene replacement, gene editing and optogenetics (see below).

Gene Replacement – Where normal genes created by genetic scientists are injected into the retina at the back of the eye and the genetic material is carried into the retinal tissue using a harmless virus, known as a vector. The aim is that the instructions from the normal genes will lead to vision that improves or stops getting worse. The first gene replacement therapy, Luxturna (voretigene neparvovec), has been approved as a treatment for IRDs caused by faults on the RPE65 gene.

Gene Editing – Where scientists “cut out” the faulty section of genetic material within the larger gene and replace it with a normal section instead. This approach to treatment needs further development as it is not yet precise enough to ensure that normal genes are not damaged in the process.

Optogenetics – Where the aim is to make retinal cells that are not photoreceptors able to respond to light where an IRD is more advanced. Optogenetics is still in the early stages of research.
Stem Cell Therapy – Stem cells are cells that have not yet specialised to form a specific tissue in the body. If stem cells could be turned into retinal photoreceptors, it may be possible to replace the cells that have stopped working as a result of an IRD, particularly in the more advanced stages of the condition where more cells have been affected and gene therapy would not be an option. Currently, early phase clinical trials are taking place for stem cell treatments but at the time of writing this information, there are no approved stem cell treatments available for any IRDs.

Growth Factors – Growth factors are chemicals that support cells to grow and repair. Research into the use of growth factors to treat retinal disease has been investigated and is ongoing to see if they may be able to preserve retinal cells for longer. However, there is currently insufficient evidence that growth factors would have any long-term benefit in preserving sight.

Technology known as Artificial Vision – There are electronic microchips that have been successfully implanted within the human retina that are able to bypass the damaged retinal photoreceptor cells, stimulating the remaining retinal nerve fibres, which form the optic nerve. If it is also healthy, the optic nerve can conduct a signal to the brain, allowing the person to see patterns of light or outlines of objects. These implants don’t bring your vision back or stop your vision from getting worse and you’d still need the other aids you have, such as your cane or your guide dog. Artificial vision systems are still being investigated and there isn’t a system which is able to be easily implanted which returns high levels of vision. No artificial systems are currently available on the NHS.

Coping

It’s completely understandable to be upset when you or a family member are diagnosed with an IRD and it’s normal to find yourself worrying about the future and how you or your relative will cope.

Having a progressive IRD means that you’ll eventually lose sight, but there are things you can do to make the most of your remaining vision. This may mean making things bigger or smaller, depending on how your vision is affected. Using brighter lighting or using contrasting colours can make things easier to see. A low vision assessment can explore how to make the most of your sight and your GP, optometrist or ophthalmologist can refer you to your local low vision service for an assessment.

Assistive technology can also help, including in-built software on smart phones and tablets, specific apps and low vision devices, as well as computer software programmes that can be installed.