The cornea…but not as we knew it

Patients often tell us that at each visit we unveil some new exciting gadget or piece of technology for investigating the health of their eyes. It seems like that to us too! In this ever changing tecnhological world though, where our tools to image your eyes are constantly improving, what doesn’t usually change is our understanding of the structure of the eye……until now…

dua

The transparent cornea at the front of the eye is merely 0.5mm thick , and has always been understood to have five distict layers. When you put your chin on the slit lamp during your consultation we can identify these separate layers which provides vital information as to the severity of your eye condition. However Prof Harminder Dua of Nottingham university has discovered a new layer in the cornea. At only 0.001mm thick the layer was discovered by experimentation on human eyes donated to research banks.

The implication of this discovering could be very important for corneal surgery and the understanding of eye conditions such as acute hydrops, descemeteocele and some corneal dystrophies effecting the deeper layers of the cornea.

During corneal surgery tiny air bubbles are injected into the corneal stroma. If these bubbles burst then damage is caused to the patients eye, but by injecting under the strong Duas layer we may reduce the risk of tearing and damage.

Prof Dua suggests that many of the eye conditions that we know to affect the back of the cornea could relate to the presence of this new found layer. Corneal hydrops is one such condition. It is a buildup of fluid in the cornea that is common in patients with keratoconus and might be caused by a tear in Dua’s layer.

 

Glaucoma Simulator App

If you would like to appreciate for yourself the impact that Glaucoma can have on your vision then there is now a clever App that can simulate the progressive visual loss that can be caused by Glaucoma.

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Glaucoma affects around 2% of the white Caucasian population in Scotland with approx 80,000 people living with the condition.

In an attempt to increase awareness of the disease MSD UK, Moorfields Eye Hospital and the International Glaucoma Association (IGA) have developed a free app with 3 elements to it.

The app uses the photo facility on the phone / tablet to simulate how the photo could look if you had glaucoma. You can adjust the slider at the bottom of the photo  to simulate different severities of glaucoma. There are also imformation slides looking at the anatomy of the eye and explaining the disease process.

 

To download the app look for Glaucoma SIM or go to www.glaucomasim.co.uk for more information.

 

While Glaucoma can not be cured their are many treatment options available to prevent the development or progression of visual loss. The Early stages of disease are commonly symptomless so regular eye examinations for all are key. There is a higher incidence of glaucoma in those over 40 years old, with a close family history of Glaucoma, and in asian and afro carribean populations.

 

The OCT scanner that we have had in the practice for a number of years is proving to be one of the most effective ways available to detect the subtle , early eye changes of Glaucoma.

 

 

Computer games could be good for your eyes

It’s not the sort of advice you might expect from your optometrist but current research from  McGill University in Canada suggests that playing the video game Tetris may be an effective way of improving a lazy (amblyopic) eye.

Good vision requires more than just a healthy eye. The eye sends electrical signals via the optic nerve to the part of the brain used for visual processing. We call this process the visual pathway or visual system. The visual system is not fully developed at birth. Good development requires each eye to be seeing well in order to build the connections between the eye and the brain. If one eye sees better than the other, the connections it builds will be stronger, leading to a dominant eye that suppresses the other one. This development continues from birth until about 8 years old.

During this time there is a chance to balance the two eyes by covering the stronger eye forcing the weaker eye to behave better. This is only successful in some children and generally accepted not to work in adults at all. The earlier that treatment is started the better the outcome. This is why eye testing from about 3 years old is advised in all children. This should be even earlier if you have a family history of eye problems, if you think you see a squint in your child’s eyes or have any concerns that they are not seeing well.

So could video games offer the answer to improving vision in adults who currently have no other treatment options? By connecting differently shaped blocks as they fall in Tetris, the eyes are forced to cooperate with each other, alleviating suppression of the weaker eye and retraining the brain to use both equally. Results from recent research suggested promising improvements in the vision of the weaker eye and in 3D perception.

Unfortunately kids, this has not been trialed on children yet, although an American trial is planned for later this year. So while we are not advising video games over homework quite yet, this might bag you another few minutes on your DS!

Ian & Gillian lecture on eye disease

Both Ian and Gillian have been lecturing to other optometrists about eyelid disease. Our advanced qualifications in eye disease and its treatment (the ‘DipTP(IP)’ after Ian and Gillian’s name) means we see a lot and know a lot about all types of eye disease including eyelids.

The eyelids form a key part of a healthy visual system and are because they are constantly on the move and exposed to the elements are prone to a whole host of conditions, some serious some benign.

Gillian spoke at the York Local Optical Society and Ian at Optometry Tomorrow, the annual conference of the College of Optometrists. Feedback was positive and a number of the audience said they now properly understood eyelids and their management for the first time in their career.

It’s a complex business so if you’ve got problems with your eyes or eyelids, come and see and expert.

Take Omega 3 Fish Oil for eye health

Many of us, myself included, take vitamins and supplements as part of our daily quest for a healthier lifestyle. Why are they good for us though, and which ones should we take to improve the health of our eyes?

b- oil

Omega-3 essential fatty acids (EFAs) are essential nutrients which our bodies cannot make or store. Current research suggests they offer many health benefits such as reducing blood pressure, protection from heart disease, improving cognitive function in Alzheimer’s, and protecting our bones and joints.

If you suffer from dry-eye you will be pleased to learn that the properties of Omega-3 can help you too. They have anti inflammatory properties that reduce the uncomfortable symptoms of dry eye, as well as improving the quality of the tear film. Research also suggests that a daily dose may reduce the risk of wet AMD and play a role in prevention of cataract.

The two critical Omega-3 EFAs are EPA and DHA . You will see them listed on the back of your supplement bottle. The best sources of these Omega-3 EFAs are oily fish and fish oil supplements and they supply the preferred Omega-3 EPA and DHA that the body can most readily use. Flaxseed, found in nuts and dark leafy vegetables will also provide Omega-3, but not in the form that is most readily converted by the body.

Our typical British diets of processed foods tend to have the wrong balance of EFA’s, having more Omega-6 than 3. While Omega-3 reduces inflammation, Omega-6 can cause inflammation. These 2 fatty acids compete for the same space in our body, so I would suggest you avoid supplements that provide both and opt only for Omega-3 fish oils. Supplements can be found readily in supermarkets and health food shops in both tablet and liquid form. Otherwise, embracing the Mediterranean lifestyle of a diet rich in unprocessed oils and oily fish should do the trick (and some more Meditarranean weather would help too I reckon). Please contact the practice if you would like any further advice.

Eye scan can monitor the extent of MS

As you may have noticed at your eye appointments over the last couple of years, in addition to taking a retinal photograph of your eyes we offer a scan of the deeper retinal layers, using our Optical Coherence Tomographer (OCT) scanner.

Being one of the first practices or hospitals to have this equipment in Edinburgh we have been learning more and more of the value of these scans as our experience grows and research continues. The most recent neurological research suggests that OCT measurement of the retinal thickness may offer a fast and effective way to monitor progression of Multiple Sclerosis (MS) The research suggests that patients with relapsing MS had rates of retinal thinning up to 42% quicker than those without replases. Perhaps as more therapies are developed to slow MS progression testing retinal thickness will be a useful tool in monitoring how effective these treatments are.

As ever, the eye provides a window to the health of the rest of the body. While we use the OCT more commonly to detect and monitor early signs of eye disease, particularly glaucoma and all types of macular degeneration , we also see the value in having these scans done in your healthy eye to establish baseline data that could be invaluable in the future.

2nd Edinburgh Keratoconus Group meeting

The Keratoconus Group is resourcing and self help group for people with keratoconus. Cameron Optometry has long been a supporter and we have often travelled to Glasgow to attend and speak at meetings.

With Ian’s help an Edinburgh based group was set up and has just had it’s second meeting here at the practice. Ian spoke about the latest advances in contact lenses and answered all sorts of questions about keratoconus.

They hope to run another meeting on another topic in Spring and we’ll keep you updated here. If you are interested in keratoconus or have the condition, you should join the group online at www.keratoconus-group.org.uk

AAO Phoenix 2012 – Day 3: A tale of 2 weather systems

I kid you not, this is the weather in Phoenix. It’s hard to beleive it is almost November – I dread to think what it’s like here in summer. In fact it’s hard to believe it’s on the same planet heated by the same sun. Fortunately for my patients (unfortunately for my tan), I’ve been inside all day in darkened rooms listening to eye lectures.

More retinal stuff this morning, but at a much more civilised 10am (I managed to sleep until 7.30 today which means I’m finally getting into Phoenix time with only 2 days left). It was titled ‘Things you don’t want to miss’ and included some quite scary case histories – always good to stop you being complacent. That was 2 hours long so a break for lunch before more on optic nerves where the focus was on differentiating between glaucoma and other types of optic nerve disease. Interesting and useful but 2 hours felt like 4.

To round out the day I spent some time looking at epiretinal membranes (ERM) which are areas of thickening on the retina that can impair vision (kind of like hard skin on the back of the eye). They are quite common and we use the OCT to find see them and monitor them. Many of you will have these in your eyes that we may have told you about. I’m not quite sure we got the whole story about them, the lecturer seemed to miss out some things that I think are quite important when talking about ERM and said some things that I’m not sure are quite 100% correct. Nonetheless, some useful points to bring back.

I went to the supermarket for a few bits and bobs and ‘went native’ by buying some Twinkies. If you don’t know what they are, they are one of the least natural food products you can possibly imagine – however I quite like them and it made me feel very American to buy them. I blended right in with my pasty skin and funny accent…

PS. My wife tells me it’s snowing in parts of Edinburgh which is frankly impossible to comprehend in this heat.

American Academy of Optometry 2012 – Phoenix, AZ

1 hour to London and then 10 hours to Phoenix. It’s a long way to travel but if you are serious about getting access to the best optometry education in the world, it’s got to be America and it’s got to be the AAO, which this year comes to Phoenix.

It’s my first time in Phoenix and actually my first time at the AAO. I’ve been to other American optometry meetings which have been fantastic but already I think the AAO is the best one yet.

There are about 5000 optometrists here from all over the world (there are only about 1000 optometrists in the whole of Scotland) and there are 10 streams of lectures every day given you a massive choice of things to listen to. The scale of place is big even by American standards and because of its size, it attracts some real experts in very detailed sub specialities we just don’t have in the UK.

As you can imagine it is a big investment for a small business when you include time away, travel and accommodation but at CamOpt we are dedicated to being the highest qualified and most experienced optometrists in the UK and that means this is the place we need to come to hear what’s new.

As always in America early starts are the order of the day so it’s 7.15am for a breakfast meeting on contact lenses to get me up and away. No big deal as Phoenix is 8 hours ahead I expect I’ll be up at 5am twiddling my thumbs anyway.

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