Opticians, Contact Lens Practitioners
and Hearing Aid Audiologists

Why have an eye examination?

An eye examination or sight test is not just about getting glasses but rather a vital health check for your eyes and can detect problems with your general health as well, such as high blood pressure. Various eye conditions if detected early can be prevented from developing further and causing serious sight loss or blindness.

What is involved in an eye examination?

Eye examinations usually last for about half an hour.

Prior to the eye examination, a vision screening is performed to give the Optometrist (the person who tests/examines your eyes) a baseline about your vision and eye health. This can include:

• Autorefractor: this is an instrument which gives the Optometrist an indication of your optical prescription. It involves you placing your chin on a rest and looking at a target, usually a balloon, which moves in and out of focus while it measures your vision.
• Tonometer: This is an instrument which measures the pressure in your eyes and can detect conditions such as Glaucoma. You will be asked to look into the instrument and a small puff of air will be presented to your eye giving a reading of the pressure.
• Fundus Photography: This is a newer instrument which provides a permanent picture of the back of your eye. This is helpful to monitor the health of your eyes and to identify or monitor early eye disease such as diabetes. You will be asked to look in to the instrument and just like a normal camera you will see a flash of light as the photograph is taken.
• Visual Field Testing: This instrument checks your peripheral vision for any missing areas which could indicate a problem with your eyes. You will be asked to look at a screen on which you will be asked to say when you see tiny lights flash up in front of you.

The results form these tests will be explained to you by the Optometrist during the eye examination.

During the eye examination the optometrist will initially ask you some questions such as:

• When was your last test?
• Do you feel there are any problems with your vision / eyes?
• Do you currently wear glasses and if so what do you use them for?
• How is your general health?
• Are you taking any medication?
• Are there any family health or eye conditions?

The examination will entail a number of tests being performed to give your final optical prescription and if glasses are required, or not, and to see if your eyes are healthy.

Some of the tests that may be used include:

• Retinoscopy
  This is usually one of the first tests performed. It gives an indication of your optical prescription and is performed by the Optometrist shining a light into your eyes while they change lenses in front of them.
• Cover test
  This is where you look at a distant letter (or near) or spot and the optometrist alternatively covers your eyes to check for any eye turns (squints).
• Motility tests
  This is where the Optometrist will ask you to follow a light to check that the muscles controlling your eye movements are working correctly.
• Refraction “the Sight test”
  This is where you will be asked to read letters on a distant chart and asked which of two lenses makes the letters clearer. This “fine-tunes” the result from the Autorefractor or retinoscopy to determine your final prescription. The optometrist will also assess your ability to read small print and see if any corrective glasses are required.
• Checking the health of your eyes
  The Optometrist will use either and Ophthalmoscope or Slit-lamp microscope to have a close look at the outer and internal structures of your eyes. From this examination the Optometrist can detect if your eyes are healthy or if your have any eye condition’s such as Cataracts, Macular degeneration, Diabetic eye disease and Glaucoma.
  
  Occasionally, if you have small pupils or the Optometrist needs to check something specific in your eyes they will use dilating drops to make your pupils bigger to allow a through examination. These drops do make your vision blurry for a few hours and it is advisable to wear sunglasses and not to drive until the effects have worn off.
• Other tests which may be performed are:
  • Amsler test – A test of the health of your macula and detects early changes due to macula degeneration
  • Colour Vision testing – this as its name suggests looks to see if you have a colour vision problem which could be mild or more severe and may limit certain occupations or hobbies that can be undertaken.
  • Stereo tests – These tests check how the eyes work as a pair and assess your depth perception.
  • Dry eye tests – These tests look at how your tears function and assess if any dry eye drops or punctum plugs are required.

How much does an eye examination cost ?

The cost of a private eye examination is: £20

If you are in our Contact Lens Scheme then you receive a free eye examination

NHS Eye examinations are free if you fall in to one of the categories below:

• Are Aged 60 years or over
• Are under 16, or under 19 if in full time education
• If you or your partner receive income support, working families tax credit, income based job seekers allowance, Pension credit guaranteed credit
• You are named on a valid NHS tax credit exemption certificate or HC2
• You have Diabetes or Glaucoma
• You are 40 years or over and have a close relative with Glaucoma
• Hospital Ophthalmologist says you are at risk of Glaucoma
• You are registered blind or partially sighted
• You have a complex optical prescription

If you are a VDU user then most companies will offer schemes (Eyecare, Duncan & Todd) where you will receive a free eye examination and a voucher towards your glasses.

EYE CONDITIONS

The eye

• Cataracts

  This is a clouding of the lens of your eye. The lens is used to focus an image of what you are looking at on to the back of your eye, but in the case of cataracts the clouding causes the image to be blurred affecting your vision. Generally most people over the age of 60 years experience a degree of cataract causing blurred vision, glare from lights such as car headlights or the sun, and faded colour vision. People under 60 years can also develop cataracts, although this is not as common, due to diseases such as Diabetes, certain long-term medications or trauma.

  Initially the blurred vision caused by cataracts can be rectified using glasses, or a change in your prescription. As they get worse you may need to be referred to an Ophthalmologist to be considered for surgery to remove the cataracts. This surgery is mostly done as a day-case under local anaesthetic taking approximately 25 minutes and is a successful operation in almost 99% of cases.

• Glaucoma

  Glaucoma is a condition in which the optic nerve is damaged, usually due to raised pressure in the eye resulting in reduced peripheral vision. It usually affects 2% of the population over the age of 40 years and has an increased risk (4x) in people of African-Caribbean origin or those with diabetes. There are also cases in younger adults and children although these are much less common.

  There are 4 main types of Glaucoma:

  • Chronic (slow onset) Glaucoma – this is the most common form of Glaucoma and is where either too much fluid (aqueous) is produced or the drainage of the fluid is impaired resulting in increased pressure and loss of nerve fibres and peripheral field loss.
  • Acute (sudden onset) Glaucoma – This is where there is a sudden reduction / blockage of the fluid drainage from the eye resulting in a very high pressure and severe red painful eye needing immediate treatment to stop permanent damage to the eye.
  • Secondary Glaucoma – This is Glaucoma caused by another disease such as Diabetes affecting the eye pressure.
  • Developmental Glaucoma – This is Glaucoma resulting from a malformation of the eye as it developed and is seen in babies.

  The NHS will pay for eye examinations of people over 40 years of age with a parent, child or sibling with Glaucoma. The tests which will be performed include examination of the optic nerve head using an Ophthalmoscope or Slit lamp microscope, a measurement of the eye’s pressure, and assessment of the peripheral visual fields.

• Diabetic Retinopathy

  Diabetic retinopathy is one of the most common causes of blindness in the UK. Retinopathy means damage to the tiny blood vessels (capillaries) that nourish the retina, the tissues in the back of the eye that deal with light. Damage to these vessels causes blood leakage (haemorrhage), which may be small and confined to the retina or may extend forward into the jelly that fills the main cavity of the eye (the vitreous gel). This can seriously affect your vision.

  Another feature of diabetic retinopathy is that new, fragile blood vessels grow on the surface of the retina, particularly around the head of the optic nerve (the optic disc). These new vessels bleed easily.

  The diabetic retinopathy can occur as a result of all types of diabetes and if left untreated can lead to blindness.

  It is important to have regular routine eye examinations because if new blood vessel formations are detected early, they can be treated effectively. Any new blood vessels can be dispersed by applying multiple laser burns to the retina.

• Macula Degeneration

  

  Macular degeneration is a painless eye condition that causes you gradually to lose your central vision (the ability to see what is directly in front of you). You use your central vision during activities such as reading, writing and driving.

  Macular degeneration occurs when the part of your eye that is responsible for central vision (the macula) is unable to function as effectively as it used to.

  Macular degeneration doesn't affect your peripheral vision (your outer / side vision), so the condition won't make you completely blind.

  Types of macular degeneration

  There are two types of macular degeneration, dry and wet.

  Dry macular degeneration affects your eyes gradually. Although there is no treatment for dry macular degeneration, there are ways you can learn to cope with it.

  Wet macular degeneration is more serious than dry macular degeneration, and can develop very quickly. It requires treatment as soon as possible.

  Who is affected by macular degeneration?

  Macular degeneration most commonly affects people over 50 years of age. Macular degeneration in older people is referred to as age-related macular degeneration.

  Approximately 2% of people over 50 years of age have age-related macular degeneration. In people over 65 years of age, the number rises sharply to 80%, with about 20% of those over 85 years of age having the condition. In fact, in older people, age-related macular degeneration is the most common cause of visual impairment.

  Macular degeneration is more common in women than in men, although the reasons for this are not fully understood.

  In rare cases, young people can also be affected. This is usually caused by a genetic condition.

• Flashes and Floaters

  The vitreous (Jelly) in the eye has tiny particles in it which are seen at some time as floaters in your vision. With age these floaters can become more noticeable and can appear like a spider’s web. If you notice a sudden appearance or increase in floaters then an appointment should be made as soon as possible.

  Flashes of light can also be seen by some people these may be if you stand up suddenly or you may see zig-zag patterns, usually in your side vision which can indicate visual migrane.

  However, if flashes and floaters are seen at the same time , or you see a dark lace over an area of your vision then this could be due to a small tear in the retina at the back of your eye and requires URGENT attention as if left could result in a detachment causing serious and possibly permanent visual loss.

• Retinal Detachments

  Many retinal detachments happen as a result of a tear or hole developing in the retina. This often occurs when the retina becomes thin, particularly among those who are short-sighted.

  Retinal detachment can also be brought on by other health conditions such as diabetes, surgery for cataracts, and occasionally after a serious blow to the eye.

  The signs of a hole or detachment are usually flashes and floaters or a veil/shadow across your vision. If these signs are noticed then urgent attention is required to confirm a tear / detachment and refer for treatment to repair it.

• Uveitis / Iritis

  

  Uveitis is the general name given to an inflammation of part of the uveal tract of the eye. The uveal tract is a group of connected structures inside the eye, made up of the iris (coloured part of the eye), the ciliary body (ring of muscle behind the iris) and the choroid (layer of tissue that supports the retina).

  There are different types of uveitis, depending on which part of the eye is affected:

  • Anterior uveitis: inflammation of the iris (iritis) is the most common type of uveitis, accounting for 75% of cases.
  • Intermediate uveitis: this affects the area behind the ciliary body, as well as the retina and the most forward edge of the retina.
  • Posterior uveitis: this affects the area at the back of the eye, the choroids and the retina.
  • Panuveitis uveitis: the entire uveal tract is affected.

  Uveitis can be acute and short-lived or chronic and recurrent. Uveitis is a serious condition. If it isn't treated a person's eyesight can be seriously damaged.

• Conjunctivitis

  

  The white part of your eye and the inner surfaces of your eyelids are covered by a transparent membrane (thin layer of cells) known as the conjunctiva. If the conjunctiva becomes inflamed, you have a condition called conjunctivitis.

  There are three types of conjunctivitis: irritant, infective and allergic. Each type of conjunctivitis is caused by different factors.

• Irritant conjunctivitis

  Irritant conjunctivitis occurs when an irritant such as chlorine or an eyelash gets into your eyes. This can make your eyes sore, and if you rub them it can make the soreness even worse. Avoiding the irritant and not rubbing your eyes will help.

  Infective conjunctivitis

  Infective conjunctivitis can be caused by a virus, bacteria or, in rare cases, by a sexually transmitted infection such as chlamydia or gonorrhoea. The most common symptoms include reddening and watering of the eyes. You may also notice a sticky coating on your eyelashes, particularly when you first wake in the morning, which can make your eyes feel like they're stuck together. Infective conjunctivitis is a very common condition and is responsible for 35% of all eye-related problems recorded. It is most common in children and the elderly.

  Infective conjunctivitis rarely requires any treatment because the infection will normally heal by itself, usually within one or two weeks. For some people a general antibiotic will be prescribed for bacterial infections.

  Allergic conjunctivitis

  Allergic conjunctivitis is a common condition and is responsible for 15% of all eye-related problems recorded. It occurs when your eye comes into contact with an 'allergen'. An allergen is a substance that makes your body's immune system react abnormally, causing irritation and inflammation in the eye. This is known as an allergic reaction. Common examples of allergens include pollen, dust mites and animal fur.

  There are a number of types of allergic conjunctivitis. The two most common types are outlined below.

  Seasonal allergic conjunctivitis (Hayfever) is the most common type of conjunctivitis cases. Symptoms recur at the same time each year and are most commonly triggered by pollen.

  Perennial allergic conjunctivitis symptoms occur all year round and are usually present when you wake in the morning. The symptoms can be caused by a variety of allergens, such dust mites or animal fur.

• Squint (Strabismus)

  A squint, also known as strabismus, is a condition where eyes are misaligned because of an incorrect balance of the muscles that control them. One eye can turn inwards (Esotropia), outwards (Exotropia) or upwards (Hyper or Hypotropia), while the other eye looks forward. Squints can be constant or intermittent (only apparent at certain times, for example when tired).

  The cause, severity and direction of a squint varies from person to person. It's usually spotted in childhood, sometimes within weeks of a baby being born, and affects 5-8% of children (one or two in every 30).

  How does a squint affect vision?

  This depends on the type of squint and the age of your child.

  In a young child a squint can lead to the development of a lazy eye. To avoid double vision, the brain ignores the signals from the eye with a squint, and only ‘sees’ images from the normal eye. As the squinting eye is not being used, it will eventually become ‘lazy’.

  In an older child, a squint may give double vision but not produce a lazy eye. This is because their vision will be fully developed.

  Occasionally, children may experience headaches or blurred vision while their squint is being controlled.

  If the vision in the squinting eye is poor, a child may have to wear a patch over the other eye to encourage the vision to develop.

  Can adults develop a squint?

  Squints that have been corrected as a child can sometimes reappear in adulthood.

  It's unusual to develop a squint as an adult, but if you do it may result in double vision because, having been trained to collect images from both eyes, the adult brain is much less able to suppress the image from the weaker eye.

  If a new squint develops in an adult, you always need a thorough investigation to find the cause.

Looking after your eyes

Why ?

Surveys show that people fear losing their sight more than any other sense. Yet those of us with good vision often find it so hard to imagine life without it that we tend to take it for granted. The mere fact that around 120 people every day lose their sight through injury or disease in the UK alone means that we should be anything but complacent when it comes to looking after our sight. Here are some ways that can help you:

Eyes & Safety

DIY causes thousands of eye related injuries a year.

Injuries are often caused by flying objects such as wood chips or shards of metal and a good defence against these is a pair of safety goggles. Goggles aren’t expensive but they should conform to European Standard BS EN 166. If you’re welding, wear a full-face mask and goggles with the British Standard number BS 1542.

Workplace

Every year, thousands of workplace eye accidents are reported to the Health and Safety Executive, and some of these involve loss of sight.

No matter where you work, your employer should inform you of any safety issues and procedures. This isn’t just in your interests, it’s also in your employers’ - the minimum compensation payout for the loss of sight in one eye is around the £100,000 mark! Some jobs require you to wear protective equipment such as goggles which your employer should provide. Make sure you wear them!

Eyes & Sun

Our ability to see depends entirely on light, yet certain kinds of light can actually be bad for our eyes. One kind of light - ultraviolet (UV) radiation - appears to contribute to a variety of disorders, including cataracts, cornea damage and, perhaps most importantly, age-related macular degeneration (AMD). One study has shown that spending five or more hours outside every day in the summertime during your teens and early adult years could increase your risk of AMD by as much as 50 per cent, which goes to show that it’s never too early to start looking after your sight! Below you’ll find out what UV is, what it does and how to stay safe in the sun.

UV

Ultraviolet radiation is a kind of invisible light whose most common source is the sun. There are three types of UV - UV-A, UV-B and UV-C. Here on Earth, UV-C rays don’t pose any threat, as they are absorbed by the upper atmosphere and so don’t reach us. Most of the UV that reaches down here on the Earth’s surface is UV-A. This can penetrate deep into the eye, causing damage inside it. It also causes the skin to tan, and is thought to contribute to ageing of the skin and skin cancer.

Most UV-B is also absorbed before it can reach us, but some does penetrate the atmosphere, and it is even more harmful than UV-A. It too can cause sunburn and skin cancer, and is absorbed in the eye by the cornea and lens, causing damage to these structures.

When it’s strongest

Because of its association with sunburn, it’s tempting to think of UV as only being present on sunny days. It is true that it tends to be at its strongest when the sun is shining brightly, but it is actually present all the time during daylight hours and can do damage even when it’s cloudy!

You’re at greatest risk of over-exposure to UV:

• Between the hours of 10am and 2pm
• During the warmer months of spring and summer
• When you’re on or near water, sand, snow or any other highly reflective surfaces. For example, you can easily absorb a lot of harmful UV when you’re under a sun umbrella, if you’re surrounded by white sand and water
• At high altitudes
• The closer to the equator you are
• When you're taking certain prescription drugs that increase your sensitivity to UV

How to avoid damage

The best way to avoid damage to the eyes from UV is to stay out of the sun altogether, but failing that, wearing a hat with a brim or a peaked cap could shield you from as much as 50 per cent of the sun’s UV. It is also important to wear a pair of good-quality sunglasses, or Transitions lenses as they can block up to 100 per cent of UV radiation.

Sunglasses

These are some simple guidelines to follow when you buy your next pair of sunglasses.

If they don’t carry the CE marking, don’t buy them! Although it’s illegal to sell non-UV-protective sunglasses, trading standards officers still find them on sale. Yet wearing them could be worse than not wearing any at all. Normally, the eye protects itself from bright light by constricting the pupil and closing the eyelids, but when sunglasses are worn, the pupil doesn’t constrict and, if the glasses are very dark, the pupil may dilate. This allows more harmful UV into the eye when the sunglasses are not UV protective.

Your sunglasses should block out 75-90 per cent of visible light and 99-100 per cent of UV rays.

Wraparound sunglasses prevent light - and UV - from getting behind your sunglasses and into your eyes.

Shades come in lots of different colours, but the best colours of lenses for protecting your eyes are brown, amber, green or grey.

Check that the lenses don’t have any distortions or scratches.

Shatterproof plastic lenses, such as polycarbonate, are much safer, especially if you’re buying sunglasses for a child.

Light-coloured eyes - blue, grey or green eyes - need more protection. Children’s eyes are more vulnerable than adults’, so it’s vital that those responsible for children make sure they wear sunglasses too. If you’re buying them for yourself, why not buy your child a pair too?

Eyes & Computer Screens – Computer Vision Syndrome (CVS)

Computer Vision Syndrone (CVS) is a collection of symptoms, or Asthenopia, such as headaches, blurred vision, neck pain, fatigue, eye strain, dry, irritated eyes, and difficulty refocusing the eyes. These symptoms can be further aggravated by improper lighting conditions (ie. bright overhead lighting or glare) or air moving past the eyes (e.g. overhead vents, direct air from a fan). CVS has not been proven to cause any permanent damage to the eye.

CVS is caused by decreased blinking reflex while working long hours focusing on computer screens. The normal blink rate in human eyes is 16–20 per minute. Studies have shown that the blink rate decreases to as low as 6–8 blinks/minute for persons working on the computer screen. This leads to dry eyes. Also, the near focusing effort required for such long hours puts strain on ciliary muscles of the eye. This induces symptoms of asthenopia and leads to a feeling of tiredness in the eyes after long hours of work. Some patients present with inability to properly focus on near objects after a short duration. This can be seen in people aged around 30–40 years of age, leading to a decrease in the accommodative focusing mechanisms of the eye. This can be a setting for early presbyopia (poor near vision due to ageing).

Dry eye is a major symptom that is targeted in the therapy of CVS. The use of artificial-tear solutions or punctum plugs can reduce the effects of dry eye in CVS.

Proper rest to the eye and its muscles is recommended to relieve the associated eye strain. Various catch-phrases have been used to spread awareness about giving rest to the eyes while working on computers. A routinely recommended approach is to consciously blink the eyes every now and then (this helps replenish the tear film) and to look out the window to a distant object or to the sky—doing so provides rest to the ciliary muscles. One of the catch phrases is the "20-20-20 rule": every 20 minutes, focus the eyes on an object 20 feet (6 meters) away for 20 seconds. This basically gives a convenient distance and timeframe for a person to follow the advice from the ophthalmologist. Otherwise, the patient is advised to close his/her eyes (which has a similar effect) for 20 seconds, at least every half hour.

Decreased focusing capability is helped by wearing a small plus-powered pair of glasses or using special non-fatigue lenses. Wearing these eyeglasses helps such patients regain their ability to focus on near objects.

Children’s eyes

It is important to teach children about looking after their sight, as it is the one sense we take for granted. Good eye sight is crucial for a child’s development and is important so that they can learn at school and interact with other people.

If a child has had a problem with their eyes from an early age they will think that their sight is normal. They will have nothing to compare their sight to, so if they are struggling to see things in the distance or cannot see colours appropriately, they may not complain. Encourage your child to communicate any problems such as headaches or the need to sit at the front of the class. If you notice that they rub their eyes a lot or always sit close to the TV, or have difficulty concentrating on their homework, then there could be a problem with their sight. Also look out for any signs of a squint which is an indication of a weaker eye and you should book an eye examination.

Teach your child about taking breaks from activities which require concentration. Ensure they take a rest from doing their homework, using the computer or reading. Although it has not been proven that using computers or doing other close work activities for a long period of time can cause sight problems, they can lead to tired or sore eyes.