Ophthalmology – Farrer Park Hospital
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What is Ophthalmology?
​Ophthalmology is the medical specialty dealing with the anatomy, functions and diseases of the eye. Ophthalmologists are trained to diagnose and treat all eye disorders and diseases, perform eye surgery and to prescribe and fit spectacles and contact lenses to correct vision problems of patients.

Dry Eyes
​In dry eye syndrome, the quantity or quality of tear is abnormal. This results in damage to the surface of the eye, eye irritation, foreign body sensation and blurring of vision. Age, hormonal changes, certain systemic conditions, certain systemic and eye medications, eye surgery, and eye conditions such as blepharitis, allergic eye diseases, disorders of the eyelids and loss of sensation of the eye surface can result in dry eyes.

Blepharitis is a chronic inflammatory condition of the eyelids due to excessive sebum secretion clogging the tiny oil glands located near the base of the eyelashes. Bacterial overgrowth can worsen the condition. This causes eye irritation and redness. It is not contagious. Excessive sebum secretion or skin conditions like acne rosacea can cause blepharitis.

A pterygium is a triangular fleshy growth on the white part of the eye. It may encroach onto the cornea, the clear covering of the eye, in advanced cases.Long-term exposure to ultraviolet light from the sun as well as dry and dusty environments are some causative factors.

Eye Infections
Eye infections are eye conditions caused by microbiological agents. They cause the eyes to become red and swollen.Eye infections  can be caused by exposure to viruses, bacteria, fungi or parasites. Contact lens wear, blepharitis, allergic eye conditions, trauma, or close contact with someone having viral conjunctivitis can cause infections.

Floaters and Flashes
Floaters are spots, cobwebs or squiggly lines that move around in your field of vision. They are more obvious against a white or bright background. Flashes are the perception of flashing lights or lightning streaks. They may be brought on by rapid eye movements.Floaters are usually due age-related degeneration of the jelly (vitreous gel) within the cavity of the eye. Other less common but potentially sight-threatening causes include bleeding into the vitreous gel, retinal tear, retinal detachment, infection and inflammation of the eye. Flashes are due to the vitreous gel pulling away from the retina and this causes the false perception of light.

Retinal Tears
Retinal tears are full-thickness breaks or holes in the retina, the light-sensitive layer lining the back of the eye.Retinal tears can occur when the jelly of the eye (vitreous gel) pulls away from the retina. Ageing, high myopia, eye surgery, eye trauma, eye infections and inflammations can cause the gel to separate from the retina, resulting in pulling on the retina and possibly tearing it.

Retinal Detachment
Retinal detachment occurs when the retina, the light-sensitive layer lining the inside back portion of the eye, separates from the eye wall.Retinal detachment usually develops due to retinal tears. Fluid from the vitreous gel enters through one or more tears and causes the retina to be separated from its underlying layers. Ageing, high myopia, eye surgery, eye trauma, eye infections and inflammations can cause the formation of retinal tears and retinal detachment. Retinal detachment may also develop due to uncontrolled diabetes affecting the eye and causing retinal scarring and pulling on the retina.

Epiretinal Membrane
An epiretinal membrane is the formation of a membrane over the most important part of the retina known as the macula. The macula is important for central vision. Epiretinal membranes can occur due to ageing changes, retinal tears, diabetes affecting the eye or retinal vessel occlusions.
Age-related Macular Dengeneration (AMD)
Age-related macular degeneration (AMD) is a condition which results in loss of central vision due to damage to the most important part of the retina known as the macula. The macula is important for central vision. AMD is a major cause of blindness in those aged 50 years and older worldwide. There are two forms of AMD: Dry and wet AMD. Ageing, smoking, excessive ultraviolet light exposure, a diet poor in fish and green leafy vegetables, obesity, uncontrolled hypertension and a positive family history are risk factors for developing AMD.
Diabetic Retinopathy
Diabetic retinopathy is an eye complication involving the retina in patients with long-standing or uncontrolled diabetes. Long-standing and uncontrolled diabetes can cause the retinal blood vessels to become leaky. This causes the retina to become swollen with fluid. Swelling of the central most important part of the retina known as the macula causes blurring of central vision. Diabetic retinopathy can range from mild, moderate and severe non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) where new abnormal blood vessels growth on the retina can lead to scarring, retinal detachment and severe vision loss. Proliferative diabetic retinopathy can also result in new abnormal blood vessels blocking the outflow of fluid from the eye to cause glaucoma and pain.  Uncontrolled hypertension, high serum cholesterol, kidney failure and smoking can also worsen diabetic retinopathy.
Glaucoma is a group of conditions where the nerve fibres of the eye nerve (optic nerve) become damaged, usually due to high eye pressures but in some cases even in the presence of apparently “normal” eye pressures (called low tension or normal tension glaucoma). This damage is irreversible and can lead to complete blindness in advanced cases.There are several different types of glaucoma. Primary open angle glaucoma accounts for the majority of cases.  Ageing, high myopia and a positive family history are risk factors for its development. Angle-closure glaucoma usually affects elderly Chinese women, especially those with high degrees of long-sightedness or hyperopia. Secondary glaucoma results from other eye conditions such as inflammation, uncontrolled diabetes, long term steroid use or eye trauma.
Cataracts are clouding of the normally clear lens of the eye. Ageing, eye trauma, eye surgery, eye infections and inflammation, long term medications such as steroids as well as systemic conditions such as eczema can lead to the formation of cataracts.

​In dry eyes, any underlying aggravating eye or systemic condition needs to be addressed. Artificial tears and ointments can help alleviate the symptoms of dry eyes. Topical cyclosporine can increase the production of tears. In severe cases, steroids and occlusion of the tear drainage system may be necessary. Reducing exposure to air-conditioning and wind, less contact lens wear and using a humidifier or moist chamber goggles are also helpful.

To treat Blepharitis, warm compresses of the eyelids, lid scrubs, topical antibiotic medications and artificial tears are helpful.  Mild topical steroids or systemic doxycycline therapy may also be necessary.

Early pterygium can be left alone and observed. The irritative symptoms can improve with the use of artificial tears. When the pterygium becomes cosmetically unacceptable or causes significant visual blurring, surgical removal is recommended. Surgery involves removing the fleshy growth and grafting an area of conjunctiva (translucent layer covering the white of the eye) over the excision site to reduce the risk of recurrence.

Treatment for eye infection is dependent on the cause of the infection. It usually involves topical medications but may sometimes include systemic therapy.

New floaters and flashes require a full eye and retinal examination to exclude serious and potentially blinding conditions which require urgent treatment. If they are a result of ageing with no retinal complication, usually no treatment is required and the floaters may become less noticeable over time. However, if the floaters are persistent and visually disturbing, laser vitreolysis can be considered.

Retinal tears are treated with laser to seal the break and prevent the retina from separating from the wall of the eye (retinal detachment).

Urgent surgery is usually required once retinal detachment occurs. In very early, limited retinal detachment, barrier laser photocoagulation may be performed but this is not suitable in every patient. Surgery may involve scleral buckling, vitrectomy, laser or freezing therapy. Success of surgery ranges from about 80 to 90 percent with the first operation. Additional surgeries may be necessary in some cases to reattach the retina successfully.

In mild, early cases, epiretinal membranes can be observed. When it results in significant distortion or blurred vision, the membrane can be peeled away with surgery (vitrectomy). Success of surgery in improving vision ranges from about 80 to 90 percent.

In dry AMD, modification of risk factors such as stopping smoking, reducing UV exposure by wearing UV protection sunglasses during outdoor activities, increasing the intake of fish and green leafy vegetables and exercise can be helpful. Nutritional antioxidant supplements may also reduce the risk of progression from dry to wet AMD. In wet AMD, the current gold standard of treatment is regular injections of anti-VEGF medications into the eye to keep the disease under control.

In Diabetic Retinopathy, Laser treatment (panretinal laser photocoagulation) is necessary in patients with severe NPDR or PDR. Serial injections of anti-VEGF medications into the eye has largely replaced focal laser as the first-line treatment for swelling of the retina or macula. When bleeding into the vitreous gel or retinal detachment has occurred, surgery is required.

Treatment depends on the type and severity of glaucoma. It involves the use of topical anti-glaucoma medications, laser treatment or glaucoma surgery.

In mild, early cases, cataracts can be observed. When they result in significant blurring of vision to affect activities of daily living or quality of life, surgery to extract the cataract and artificial lens implantation can be performed to restore vision. Different types of artificial lens implants are available and some can correct astigmatism and old-sightedness (presbyopia).

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