Eye Conditions

The five main causes of vision loss in Australia are uncorrected or under-corrected refractive error (62%), cataract (14%), age related macular degeneration (10%), diabetic eye disease (2%) and glaucoma (3%).

Prevention is better than cure

Early diagnosis and treatment would benefit those with common eye conditions, but even more important is the potential for prevention.

Early detection and treatment/management programs

Many older Australians already have early stages of eye disease although many are unaware that they have a problem.

Early stages of vision loss caused by age-related macular degeneration (AMD), glaucoma and diabetic retinopathy have no early symptoms, and current treatment and prevention rely on early detection.

Refractive Error

More than half of vision impairment is caused by refractive error and it is predicted to cause vision impairment in 22% of the population over 40 years of age.

Long sighted or short sighted vision, astigmatism and presbyopia (loss of vision due to age) can be detected by routine eye examination. These types of refractive error are a major cause of vision loss, however, it is predicted that prescription of the correct spectacles or contact lenses would correct the problem in most cases.

Cataract

Cataract is caused by the clouding of the crystalline lens of the eye and it is part of the natural ageing process. It is reported that everyone will develop cataracts if they live long enough. Cataracts can be detected by routine eye examination and if required can be corrected by replacing the lens with an artificial lens during cataract surgery.

There are a number of relevant risk factors which are likely to be involved in the development of cataracts: eye injury, age, lower socioeconomic group, smoking, increased alcohol consumption, increased exposure to sunlight (UVB), and diabetes.

The avoidable risk factors for developing cataract are: heavy alcohol consumption, sun exposure, smoking, eye injury, medical conditions such as diabetes, and prolonged drug therapies such as steroids.

Cataract is the leading cause of hospitalisation for eye conditions requiring surgery (60%) and the most common treatment is cataract surgery.  In 2004, it was estimated that approximately 1.5 million Australians over 55 years had untreated cataract.

Glaucoma

Glaucoma is called the ‘sneak thief of sight’, because there is no early warning to vision loss. Approximately 300,000 Australians are estimated to have glaucoma, but only half are diagnosed. It is predicted to affect 1 in 50 people over the age of 40.

It has been estimated that 1 in 11 Australians will develop glaucoma, and of 210,000 Australians who have glaucoma, half do not know. The first line of treatment for glaucoma is therapeutic eye drops, but if these do not work surgical intervention may be required.

Glaucoma is linked to age, family history, intra-ocular pressure, extreme short sightedness and ethnicity, but also to hypertension and cardiovascular disease.

For more information visit the Glaucoma Australia website:

www.glaucoma.org.au

Diabetic Retinopathy

Diabetic retinopathy (DR) is caused by uncontrolled blood glucose levels, which can lead to leakage of blood from damaged small blood vessels in the retina. If the disease progresses, new blood vessels can grow across the retina eventually causing damage of the retina. Laser surgery can be performed to slow this process.

In Queensland 1,100 people are diagnosed with diabetes each month, including 20 children although it is estimated that this represents only half of those with the disease. Currently 7% of the adult population in Queensland have the condition and the majority have diabetes type 2 - the fastest growing disease in developed countries. Diabetic retinopathy is a consequence of poorly controlled diabetes, and is the most common cause of blindness in people 30-69 years of age. It has no early symptoms and people with diabetes have 25 times the risk of vision loss.

The main treatment for DR is laser surgery or vitrectomy. Of those hospitalised because of diabetes in Australia, 5.5% were for diabetic retinopathy requiring surgery.

Early detection and treatment with laser photocoagulation can prevent substantial damage.

Diabetic retinopathy is associated with lifestyle and dietary factors contributing to poorly controlled diabetes, high blood pressure and high blood cholesterol.

Macular Degeneration

Macular Degeneration (MD) is the leading cause of legal blindness and severe vision loss in Australia. It is estimated that 1 in 7 Australians over the age of 50 have the disease with the incidence increasing with age.

MD results in the progressive, permanent loss of central vision by either a slow process called an atrophic change (Dry MD) or a faster more severe process called neovascularisation (Wet MD). If Wet MD is undetected or untreated central vision can be lost in a short period of time. It has been reported that 17,700 Australians per year are diagnosed with Wet MD, where early detection is paramount, and for which a promising anti-VEGF treatment ‘Lucentis’ appears to preserve sight or prolong visual function in those affected. There is currently no medical treatment for the dry form of MD yet research has shown that taking a high zinc and antioxidant supplement may slow the progression of the disease.

MD is primarily age-related but other risk factors include family history and smoking. There is a 50% chance of developing MD if you have a family history and those who smoke are three times more likely to develop the disease. There are some positive lifestyle steps that can be followed that may help to reduce the risk of MD or help to slow the progression of the disease, such as nutrition and exercise.

 Visit www.mdfoundation.com.au for more information.

Retinitis Pigmentosa

RP is the name given to a group of hereditary diseases which damage the retina. The nerve cells in the retina begin to degenerate, or die, and this causes the vision to diminish. Then the eye specialist (ophthalmologist) uses special instruments to look into the eye of a person with RP, they usually see scattered areas of pigment throughout the retina which are derived from the retinal pigment cells. In a normal sighted person, the pigmented cells are covered by the living nerve cells. This pigmented appearance gives rise to the name – retinitis pigmentosa.

One of the earliest symptoms of RP is difficulty seeing at night or in dimly lit places (night blindness). Later there is a reduction in side (peripheral) vision. More rarely, there is a loss of central (macular) vision, which means that it becomes more difficult to read and distinguish colours. Cataracts may also occur. These are opacities which occur in the lens near the front of the eye. The symptoms of RP become more apparent over the years. When other members of a family are also affected, the rate of progression is often similar within that family.

If a family member is diagnosed with RP, it is strongly advised that other members of the family also have an eye exam by a physician who is specially trained to detect and treat retinal degenerative disorders. Discussing inheritance patterns and family planning with a genetic counsellor can also be useful.

For more information about RP and other retinal diseases, please visit
www.retinaaustralia.com.au
www.retinaqld.org.au
or contact Retina Australia (Qld) on 07 300 300 65. Freecall (outside Brisbane) 1800 000 999.

Keratoconus

Keratoconus (or “conical cornea”) is a disease of unknown origin that leads to a progressive thinning and bulging of the cornea. Typically it affects both eyes, although it usually advances at different rates in each eye. It is estimated to affect at least 10,000 people in Australia.
 
Keratoconus is characterised by blurred vision and spectacles cannot correct the resulting severe vision distortion, except in the very early stages. Specialised contact lenses, usually rigid gas permeables (RGPs), can achieve remarkable results in restoring functional sight to people who would otherwise be effectively disabled by keratoconus. 

About 15-20% of patients with severe keratoconus will require a corneal transplant, which is usually successful in restoring at least useable vision. Keratoconus patients comprise the single largest group of corneal graft recipients.
Although the exact cause of keratoconus remains unknown, it has been associated with a number of risk factors including:


1.    An inherited corneal abnormality. About ten percent of those with the condition have a family history of keratoconus.

2.    An eye injury, i.e., excessive eye rubbing or wearing hard contact lenses for many years.

3.    Certain eye diseases, such as retinitis pigmentosa, retinopathy of prematurity, and vernal keratoconjunctivitis.

4.    Systemic diseases, such as Leber's congenital amaurosis, Ehlers-Danlos syndrome, Down syndrome, and osteogenesis imperfecta.

For more information please visit the Keratoconus Australia website: www.keratoconus.asn.au 

Albinism

Albinism is a rare genetic condition affecting approximately 1 in 17,000 people. It is caused by a lack of the pigment melanin, and people with albinism often have pale skin, hair and eyes. There are different forms of the condition, depending on the genetic cause, but all forms are associated with vision problems.

The Albinism Fellowship of Australia provides support for people living with albinism, and also works to raise awareness of the condition in the community and among health professionals. For more information, please visit the AFA website: www.albinismaustralia.org

Stargardt Disease

Stargardt disease is a form of macular dystrophy and is the most common form of juvenile macular degeneration. It is reported to affect approximately 1 in 20,000 children over six years and affects the macula, the central part of the retina at the back of the eye. Stargardt disease is a progressive disease, and the gene responsible for causing this condition was discovered in 1997.

There is no treatment for the condition at present, but researchers are investigating several possible therapies.

 For further information, please visit the Stargardt’s Australia website at: http://www.stargardts-au.org 

Printed material about eye conditions

Printed material is available from many vision-related organisations and service providers, and many of these resources are available as electronic copies. A selection of printed information (brochures, flyers, fact sheets, booklets etc) available in 2009, is listed in the table below.

Printed Material	Organisation
Common Eye Conditions Common Eye Conditions	Optometrists Association of Australia
Cataract	Vision Australia, Queensland Eye Institute, Queensland Blind Association, Optometrists Association Australia, RANZCO, Queensland University of Technology
Diabetes and Diabetic Retinopathy (DR)	Diabetes Australia Queensland, Vision Australia, Queensland Eye Institute, Queensland Blind Association, Optometrists Associaition Australia,  Queensland University of Technology
Glaucoma Eye Q test Q and A about glaucoma What you should know about eye drops	Glaucoma Australia,  Vision Australia, RANZCO, Queensland Eye Institute, Optometrists Association Australia,  Queensland University of Technology Glaucoma Australia Glaucoma Australia Glaucoma Australia
Macular Degeneration (MD) What is MD? How is your macula? What can you do about MD? How is MD diagnosed? Treatment options for wet MD Amsler Grids	Macular Degeneration Foundation,Vision Australia, Queensland Eye Institute, Queensland Blind Association, Optometrists Associaition Australia, RANZCO, Queensland University of Technology, Retina Australia Macular Degeneration Foundation Macular Degeneration Foundation Macular Degeneration Foundation Macular Degeneration Foundation Macular Degeneration Foundation Macular Degeneration Foundation
Retinitis Pigmentosa (RP)	Retina Australia Queensland, Queensland Blind Association, Vision Australia
Refractive Error Hyperopia Myopia Presbyopia Amblyopia Astigmatism Myopia and Hyperopia	Optometrists Association Australia Optometrists Association Australia Optometrists Association Australia Optometrists Association Australia Optometrists Association Australia Queensland Blind Association
Other eye conditions Charles Bonnet Syndrome	Vision Australia
Colour vision Colour blindness Colour defective vision	Optometrists Association Australia Queensland Blind Associaition RANZCO
Conjunctivitis	Optometrists Association Australia
Convergence problems	Optometrists Association Australia
Cortical vision impairment	Vision Australia
Dry Eye	Optometrists Association Australia
Floaters and Spots Spots before your eyes	Optometrists Association Australia RANZCO
Keratoconus	Optometrists Association Australia, Vision Australia
Lazy Eye	Optometrists Association Australia
Lebers Congenital Amaurosis (LCA)	Vision Australia
Nystagmus	Vision Australia
Optic Atrophy	Vision Australia
Painful and irritated eyes Disturbed or impaired vision	RACGP RACGP
Stargardts Disease	Retina Australia, Vision Australia
Strabismus:Turned eyes in Children - understanding strabismus	Orthoptic Association Australia
Usher Syndrome	Retina Australia
Spectacles and Lenses Ready to wear reading glasses Caring for yur specs Multifocal lenses Bifocals Getting used to bifocals Spectacle supply scheme	RANZCO Optometrists Association Australia Optometrists Association Australia Optometrists Association Australia Optometrists Association Australia Queensland Government
Eye treatments Phakic introcular lenses and clear lens extraction  Medicare and optometry Pupil dilation Visual field exams Eye drops and ointments	RANZCO Optometrists Association Australia Optometrists Association Australia Optometrists Association Australia Optometrists Association Australia
Children Disturbed or impaired vision Eye problems	RACGP RACGP

The following links will take you directly to the information resources page for each agency, or contact agencies directly to request further details:
Diabetes Australia: http://www.diabetesaustralia.com.au/Resources/Information-Resources/Brochures--Booklets1/
Glaucoma Australia: 1800 500 880
Guide Dogs Queensland: http://www.guidedogsqld.com.au/page/Education/Guide_Dogs_Queensland_Low_Vision_Tips/ or 1800 810 122
Life Tec: http://www.lifetec.org.au/home/content.asp?pageID=205&main=205&sub=0
Macular Degeneration Foundation: http://www.mdfoundation.com.au/page17334.aspx or 1800 111 709
Optometrists Association of Australia: http://www.optometrists.asn.au/eyesvision
Orthoptic Association of Australia: email office@orthoptics.org.au
Paediatric Low Vision Clinic: http://education.qld.gov.au/studentservices/learning/disability/generalinfo/vision/
Queensland Eye Institute: http://www.qei.org.au/Eye-Disease-pg8865.html
Queensland Blind Association: http://www.qba.asn.au/graphic/framesD.htm
QBA directories: http://www.qba.asn.au/graphic/framesD.htm
Queensland University of Technology: http://www.hlth.qut.edu.au/opt/clinic/
Retina Australia Queensland: 1800 000 999
RACGP: http://www.racgp.org.au/familyhealth/Disturbed_or_impaired_vision_general
RANZCO: http://www.ranzco.edu/aboutus/faq
Vision Australia: http://www.visionaustralia.org.au/info.aspx?page=740

Many organisations provide educational resources FREE to health professionals.