Ensues a moment of unadulterated awkwardness as I wait for them to twig and say that of course that’s not going to affect their own eye care. I end up talking to my patients about glaucoma on a very regular basis because it’s really quite interesting – if you don’t have it yourself.
Glaucoma is a proper pain in the neck to provide care for. Firstly, usually it doesn’t give any symptoms until it’s too late. Secondly it’s common, particularly in those in the more mature bracket. Thirdly, there is no one medical test that gives accurate results regarding whether you do or don’t have it. Finally, it actually isn’t one disease – it’s a family of eye diseases…how very confusing. This is why half of all glaucoma that exists in our world is undiagnosed.
What is so troubling about all this is that it is a permanently blinding eye condition, for which there is great treatment available, if only you knew to access it. I have heard it referred to as ‘the thief in the night,’ stealing people’s vision without anyone ever knowing. One of our local glaucoma specialists describes it as suddenly someone switches off the lights…for good.
Generally speaking glaucoma can be described as a condition where the optic nerve (the cable that takes the information from the eye to the brain) becomes damaged. This is usually in response to high eye pressure but not always. The particular pattern in which the nerve becomes damaged usually results in a loss of peripheral vision first, the ironic thing being that our brain fills in our peripheral vision with what it already knows to be there – hence we don’t notice a problem.
In my opinion the best way to make sure you don’t have it is surprise surprise…regular eye examinations from someone like me. In seriousness, regular comprehensive eye examinations from the same well-trained optometrist, is a great way to ensure it’s picked up at its earliest point so you can enjoy the fullest functionality of your cabling, whilst we are still above ground to enjoy it.
The optometrist can weight all the results from all the relevant tests over the years and combine them with your known risk factors to give a pretty good sensitivity and specificity. We have an unusually high proportion of glaucomatous patients in our practice because we tend to attract people with ‘unusual’ eyes…we think this has made us pretty good at picking it up as well as helping the specialists monitor it for progression over the years. As an optometrist, but more importantly as a patient who is at an increased risk of developing glaucoma, I can’t see why you wouldn’t.
For more information or to book an appointment, call Ann or Ali on 02890 323 341 or e-mail them at firstname.lastname@example.org .
Andrew Petticrew, Optometrist.
What is Keratoconus anyway?
I could write for about three days on what keratoconus is and how it affects people but in short, it is a condition which affects the cornea (the clear structure that lies over the pupil and iris). The cornea acts as the most powerful lens in the eye and consequently, the optical quality of this structure is crucial for good vision.
It is helpful to point out that the normal cornea is utterly incredible to begin with. It is the only living structure in the entire human body that is completely optically clear, the only structure in the entire human body which breaths for itself (from the air around us), and is the most sensitive structure in the entire human body with over 11,000 nerve endings per square millimetre.
I describe the cornea as being like steel reinforced concrete – it has a matrix gel (the concrete) and it has collagen fibres running through it (the steel reinforcement). It is the astounding regularity of the collagen fibres which gives the cornea its amazing optical clarity which is essential for visual function. Anything that causes these collagen fibres to become irregularly arranged causes the cornea to become cloudy. Just one example of this is the very clever pump which regulates the amount of water in the gel to maintain this regularity – to be honest, I find it incredible that it ever works to begin with!
Keratoconus is a condition where the collagen doesn’t work properly and the shape of the cornea becomes irregular resulting in reduced vision.
Do I have keratoconus?
Well, as it turns out, that’s a very good question. Keratoconus has a wide variety of different severities and presentations. There are a lot of people who are asymptomatic – they don’t have any problems at all and without specialist tests, neither they nor their optometrist would ever know.
The first tell-tale sign is often that the irregularity causes a prescription for glasses which changes more rapidly than usual or in an unusual way. But prescriptions for glasses often do this so in itself this doesn’t tell us what we need to know. The diagnosis can really only be made with analysis of the curvatures and thickness of the cornea using a number of specialist instruments and even then, there will be certain incidences where we miss it. There is a not very straightforward family link with keratoconus so if a family member has it, it is worth investigating.
What can be done for keratoconus?
Firstly it can be monitored – often it is not particularly progressive, so we do nothing more than watch it to see if it changes and talk to the patient about how they can manage symptoms and risk factors. Often the irregularity means that glasses do not give good vision and contact lenses are required.
There is a standing joke that the contact lenses we work so hard to design and fit aren’t really doing the work – it’s the tear lens created behind the contact lens, filling in the irregularity in the front surface of the cornea that corrects people’s vision. Designing the back surface of the lens is pretty tricky though – the keratoconic eye is a very very complex shape and all of them are different. And if I get it wrong, it can cause permanent scarring. To give you an idea, the lens which looks like a little clear bit of plastic less than a centimetre across, the back surface is designed, using over twenty different parameters, each of them accurate to five hundredths of a millimetre.
In order to get the very best performance possible, we use one of the widest ranges of contact lens manufacturers, types, materials and designs available anywhere in the UK – and there’s a reason for that. We have found the task isn’t easy and there is a lot to gain. Remember, many of our keratoconic patients can’t really see with glasses so contact lenses which give reliable crisp vision and all day comfort are very helpful.
Thankfully, there are loads of really innovative products and techniques available – and we are always scouring the journals for more. We use standard and specialist RGPs, piggy back with a range of different soft lenses, specialist soft lenses, corneosclerals and sclerals – we find that this gives us the best chance of getting a really good result for you.
More importantly, we stay hugely motivated to find the very best optical products for you. Regularly I find myself asking patients, “Yes, they are good, but are they good enough?” The question here is really whether the patient would like to put the time in to investigate other avenues. I joke that what we lack in skill, we make up for with pure tenacity!
Finally, we put it together with an aftercare package which enables you to pay monthly for everything we do. The aftercare means you can be sure you are looking after your eyes properly and investing in good eye health. Occasionally, the cornea becomes so irregular and thin that the care of a specialist is helpful, so we try to keep really good links with the local specialists who are at the top of the game .
If you would like to book a no-obligation appointment with us to discuss your keratoconus, give Ann/Ali a call on 02890 323 341 to book an appointment.
Local optometrist, Frank Petticrew, has this month been awarded the prestigious Herschel Medal in recognition of his outstanding original contributions to contact lens design and fitting – the first time an optometrist anywhere in Ireland has been given this accolade.
Frank Petticrew, who has practised in Belfast for over 50 years, was overwhelmed by the award commenting: “It’s traditionally a highly guarded secret to whom the medal would be awarded and I was totally taken by surprise. I’m delighted to have the good wishes from so many friends in the contact lens world, right across the spectrum of contact lens designers, manufacturers, scientists, educators and especially clinicians.”
Frank is the third generation of the Petticrew family to work in eye care, his father and grandfather being opticians and jewellers in their practice on Bow Street, Lisburn which was established in 1887. He is succeeded in Petticrew Optometrists by his youngest son Andrew who now fits specialist contact lenses in the family practice in Belfast.
Andrew commented: “When dad started to fit contact lenses, they were a really new technology and there was a lot still to learn. I think one of his greatest contributions was in the field of photography in contact lenses. Nobody really new how to do it and my dad did some fantastic work which enabled contact lens technologies to be developed and optometrists to be better trained.”
Throughout his career, Frank has fitted a huge range of different types of specialist contact lenses both in private practice and in the Royal Victoria Hospital in Belfast. Many of the contact lenses are used for people whose eyes are diseased or scarred. This means that a custom designed lens is necessary to be able to have any vision at all. He has also done some brilliant work fitting artificial eyes for people who have been disfigured in the troubles.
Frank has held a huge variety of different positions throughout his career including Past President of the Northern Ireland Optometric Society; an accolade he shares with his son. He has lectured all over the world including our very own University of Ulster, has been expert witness in many legal cases and has been awarded honorary membership of the Association of Optometrists.
Frank continued, “I have been fortunate to serve the people of Northern Ireland and have been lucky in my choice of specialism. I have enjoyed the work immensely and my patients have appeared very grateful for any help I have been able to give.”
“For many patients, contact lenses have completely transformed their lives, by improving the appearance of an unsightly eye or enabling them clear, undistorted vision where glasses couldn’t help. It has been my privilege to have the opportunity to help these patients work, bring up a family and lead a relatively normal day to day life.”
Andrew commented, “I couldn’t be more proud of my dad – he is an innovator and an excellent optometrist. The recurrent thought amongst our patients continues to be that he is a ‘true gentleman.’”
We think what what do here at Petticrew Optometrists is brilliant but the bit that we feel make the most difference to our patients is the eye examination. To show how determined we are to be better, we mystery shopped ten different optometrists practices, big and small, cheap and expensive, and had a full eye examination in all of them. It is with this knowlege we can say that we give the most comprehensive eye examination of all of them…and by a country mile.
If you want to know a bit more, why not have a look at:
Your sight is a very precious thing, book an appointment today by e-mail with Ann or Ali at email@example.com or telephone us on 02890 323 341.
Andrew Petticrew BSc(Hons) MCOptom.