Here is a short list of the most frequent causes for which a patient will seek advice from an ophthalmologist; however this list is not exhaustive, as it is impossible to describe all the affections of the eye in a few words.
Some systemic diseases may affect the eye, and the GP will then ask you to see an “eye doctor”. This short list is supposed to help you to understand some commonly encountered eye problems.
1. The most frequent one: blurred vision, because there is myopia, hyperopia, or astigmatism, the images can be blurred: the vision has to be corrected by glasses, contact lenses, or refractive surgery.
If the eye is too long, or if the cornea and the crystalline lens do not focus the images properly, the rays of light will be focused in front of the retina. This means that a myope will see properly at close range, but that the distance vision will not be sharp.
In western countries, more or less 30% of the population are myopes.
Myopia should remain stable between 20 and 40 years of age, but can vary with pregnancy, computer work, systemic diseases.
If the eye is too short, or if the cornea and lens are not strong enough, the light rays will be focused behind the retina.
This means that a farsighted person will see the objects they are closer to.
It is possible to compensate for mild hyperopia before the age of 40, but hyperopia becomes more and more troublesome with age.
If the cornea is too steep or too flattened on a meridian, it will look like a rugby ball and the light rays will be focused at different distances from the retina, disturbing the vision at any distance.
This is astigmatism; it can be associated with myopia or hyperopia.
2. Another cause is presbyopia: after 45 years, many individuals need reading glasses.
Presbyopia is a lack of accommodation, and therefore of focus. It appears progressively towards 40-45 years and becomes more and more troublesome: the reading of small texts is more difficult, particularly when there is little light, the close objects become a little vague. The only solution is to put on reading glasses.
Farsighted patients are hindered faster than nearsighted or emmetropic (those who do not wear glasses).
For spectacle wearers, it will be necessary to consider bifocals, or multifocals, or progressive lenses to solve the problem.
In some cases, depending on the age, it may be possible to operate to solve the problem: a bifocal or multifocal implant can correct the view from far and near, or even the intermediate view.
This procedure is similar to a cataract procedure, and can only be performed after a complete examination of the eye during a consultation, where the advantages and disadvantages of this technique will be explained on a case by case basis.
3. Elderly people can have a blurred vision because of a cataract: the lens is opaque; this phenomenon starts slowly and affects both eyes, not always at the same time; they need cataract surgery (the lens will be removed and an artificial lens will be implanted) to improve their visual performances.
4. Another disease of the eye is called glaucoma: the pressure inside the eye is too high; it has nothing to do with blood pressure, can vary from one eye to another, and happen after 40 years to some patients. The mechanism is the following one: the liquid inside the eye is produced and must be eliminated; if the production raises, and or the elimination or filtration diminishes, the pressure will raise, because the eye is a solid organ, non-expandable. This can severely damage the eyesight and must be treated by special eyedrops, laser surgery, or conventional surgery.
5. Diabetes: diabetic patients need to be followed carefully, as this illness can affect the retina and impair vision: some diabetics patients can present retinal hemorrhages, to treat by the laser, in order to stop or to reduce the loss of visual acuity. The eye can be checked once a year or more by a special exam, called fluoangiography to detect subclinical or clinical lesions, to be treated by the laser.
6. Another cause of visual loss is macular degeneration. The macula is the centre of the vision on the retina, the point with the highest sensibility, useful to read, take a picture, aim at something, etc. With age, a decrease in macular performance can appear, because of vascular problems, hypertension, cholesterol level above normal, UV exposure, etc.
Patients often complain about seeing distorted images, or seeing parts of words or text in reading. In some cases, a real central dot exists, where the view is disturbed, fuzzy. This is called a central scotoma. Consultation is urgently needed: the character of the macular lesion or the type of macular degeneration (dry or wet) will be determined and treatment initiated.
Complementary examinations (Fluoangiography and OCT or Optical Coherence Tomography) will allow you to follow the evolution over time.
In some forms, the treatment will consist of laser application or repeated injections of a new and very expensive (but reimbursed) product that improves visual acuity. However, repeated checks are essential because relapses are very frequent.
A simple test is the Amsler Test: look eye-by-eye at a grid, wearing the reading glasses and checking for lines that are distorted or straight. If the lines are distorted, consult.
7. Red eyes can have different origins: conjunctivitis (infection), allergy, trauma, UV exposure, foreign body if one-sided, dry eyes, etc. Once again, early and appropriate treatment must solve the problem.
10. Lazy eye (amblyopia) and strabismus: very often associated in the childhood; because the child does not see properly for any reason, the eye does not fix anymore, and becomes lazy and can deviate: it is called strabismus and must be treated like amblyopia, the quickest possible, to allow the normal development of the eye, before the age of 6 or 7 years.
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