Age-related macular degeneration (AMD) is a common eye condition that affects the macula, the central part of the retina responsible for detailed vision. It mainly affects older people and can cause blurred, distorted or lost central vision.

AMD can make everyday activities such as reading, driving, watching television and recognising faces more difficult.

Types of AMD

There are two main types of age-related macular degeneration: dry AMD and wet AMD.

Dry AMD is the most common form and usually progresses gradually. In advanced cases, it can cause significant loss of central vision.

Wet AMD occurs when abnormal blood vessels develop beneath the retina and leak fluid or blood. It can cause a rapid deterioration in vision and, without treatment, may result in permanent central vision loss.

People with dry AMD can develop wet AMD, so regular eye examinations and monitoring are important.

Stages of AMD

AMD is generally classified as:

• Early AMD: Usually causes no noticeable symptoms.
• Intermediate AMD: May cause blurred or distorted central vision, with changes visible on retinal examination and imaging.
• Late AMD: Causes more significant central vision loss and may occur as advanced dry AMD or wet AMD.

Treatment of AMD

There is currently no treatment to reverse established dry AMD. However, specific vitamin and mineral supplements may help reduce the risk of progression to advanced AMD in some patients.

Wet AMD can be treated with anti-VEGF injections, which reduce abnormal blood vessel growth and leakage. These treatments can stabilise vision and may improve vision in some patients.

Anti-VEGF medicines include ranibizumab (Lucentis), aflibercept (Eylea) and, in certain circumstances, bevacizumab (Avastin). Treatment is given by injecting the medicine directly into the eye using a very fine needle.

Treatment usually involves a series of injections, with the interval between injections adjusted according to the individual patient’s response. Some patients require ongoing treatment for several years.

In the UK, NHS treatment eligibility is guided by NICE (National Institute for Health and Care Excellence) recommendations and local treatment pathways.

Expert AMD Assessment and Treatment

Early diagnosis and regular monitoring are important in managing age-related macular degeneration. If you have noticed new distortion, blurred central vision or a sudden change in your vision, an ophthalmic assessment should be arranged promptly.

Diabetic retinopathy is a complication of diabetes caused by high blood sugar levels damaging the small blood vessels in the retina, the light-sensitive tissue at the back of the eye. If diabetic retinopathy is not detected and treated appropriately, it can lead to permanent sight loss and blindness.

How Can Diabetic Retinopathy Cause Visual Loss?

Diabetic retinopathy can affect vision in several ways:

• Macular oedema: Leakage of fluid causes swelling in the macula, the central part of the retina responsible for detailed vision.
• Neovascularisation: Abnormal new blood vessels grow on the surface of the retina. These fragile vessels can bleed into the eye and cause sudden visual loss.
• Macular ischaemia: Reduced blood supply to the macula can damage the retinal tissue and affect central vision.

Symptoms of Diabetic Retinopathy

Diabetic retinopathy often causes no symptoms in its early stages. This is why regular diabetic eye screening is essential, even when your vision appears normal.

As the condition progresses, symptoms may include:

• Gradual deterioration or blurring of vision
• Sudden loss of vision
• Floaters or dark spots in your vision
• Distorted or patchy vision

Eye pain and redness are not typical symptoms of diabetic retinopathy but may occur with other eye conditions or complications and should be assessed promptly.

Treatment for Diabetic Retinopathy

Treatment depends on the type and severity of diabetic retinopathy and may include:

• Eye injections: Anti-VEGF medicines can reduce swelling and abnormal blood vessel growth. Steroid injections or implants may also be considered in some patients.
• Laser treatment: Laser can be used to treat leaking blood vessels or areas of abnormal blood vessel growth.
• Eye surgery: Vitrectomy surgery may be required for complications such as persistent vitreous haemorrhage or retinal detachment.

Good control of blood sugar, blood pressure and cholesterol, together with regular diabetic eye screening, can help reduce the risk of developing or progressing diabetic retinopathy.

Expert Diabetic Retinopathy Care

Early detection and appropriate treatment can help protect your vision. If you have diabetes, attending your recommended diabetic eye screening and ophthalmology appointments is an important part of maintaining your eye health.

Cataracts Surgery

This leaflet explains what you need to know about cataract surgery. It is adapted from information provided by the Royal College of Ophthalmologists.

What is a cataract?

A cataract is clouding of the natural lens inside the eye. The lens sits behind the iris, the coloured part of the eye, and normally helps focus light onto the retina.

As we get older, the lens naturally becomes less flexible, making it more difficult to focus on near objects. This is a normal ageing process and is not the same as having a cataract.

A cataract develops when changes occur within the lens, causing it to become cloudy rather than clear. This prevents light from passing through the lens normally and can result in blurred, misty or reduced vision.

Cataracts can affect one or both eyes. They are treated by removing the cloudy natural lens and replacing it with an artificial lens implant.

Before cataract surgery

Before your operation, you will have a pre-operative assessment. Your eye will be examined and carefully measured to determine the appropriate strength of the artificial lens implant.

It is important to tell your ophthalmologist if you have previously had any eye surgery, including laser eye surgery to reduce your dependence on glasses.

Your general health will also be assessed to ensure that you are suitable for surgery.

What happens during cataract surgery?

Cataract surgery involves removing the cloudy natural lens and replacing it with an artificial intraocular lens (IOL).

Most cataract surgery is performed using a technique called phacoemulsification. The cataract is broken into small pieces using ultrasound and gently removed from the eye.

The operation is usually performed under local anaesthetic, so you will be awake but should not feel pain. The anaesthetic may be given as eye drops, an injection around the eye, or a combination of both.

Cataract surgery is normally performed as a day-case procedure, so you can usually return home on the same day.

You may be at the hospital for several hours to allow time for preparation, surgery and recovery.

During the operation

Your pupil will be dilated and the eye and surrounding area will be cleaned carefully to reduce the risk of infection. A sterile covering will be placed over your face, leaving the operated eye exposed.

The surgeon makes very small openings in the cornea to allow fine instruments to enter the eye. The front of the lens capsule is opened and the cloudy lens is removed using phacoemulsification and gentle suction.

The natural lens capsule is left in place to support the artificial lens implant. The new lens is inserted into the capsule, where it unfolds and remains securely positioned.

You may see lights, movement or shadows during the procedure, but you should not be able to see detailed images of the operation.

After surgery, your eye may be covered with a dressing or shield. You will receive instructions about your eye drops before going home.

Recovering from cataract surgery

Your eye may feel mildly sore or uncomfortable as the anaesthetic wears off. Simple painkillers such as paracetamol are usually sufficient if required.

Your eye may appear red or bloodshot, and some bruising can occur. This is usually temporary and improves over the following days.

You will be prescribed eye drops, usually including an antibiotic and an anti-inflammatory or steroid drop. It is important to use the drops exactly as instructed and complete the prescribed course.

It is normal to experience:

• Grittiness or mild irritation
• Watering
• Blurred vision
• Redness or bloodshot appearance
• Increased sensitivity to light
• Temporary changes in vision

Most people recover quickly and can return to many normal activities within a few days, although the eye may continue to settle for several weeks.

What will my vision be like after surgery?

In an uncomplicated operation, vision usually becomes clearer as the cataract is removed. Some people notice an improvement immediately, while for others it may take several days.

A standard monofocal lens implant is generally designed to provide clear vision at one main distance, usually distance vision. You may still need glasses for reading and other close-up activities.

Some patients may also require distance glasses to fine-tune their vision after surgery.

The aim of standard cataract surgery is to improve the quality of your vision, rather than necessarily eliminate the need for glasses.

Intraocular Lens Options

There are several types of intraocular lens (IOL) available for cataract surgery. The most appropriate option depends on your eyes, visual requirements and lifestyle.

• Standard Monofocal Lens – A high-quality lens designed to provide excellent vision at one main distance, usually distance vision. Reading glasses will generally still be required for near tasks. These lenses do not incur extra cost for NHS and private patients, equally.

• Premium Lenses

• Extended Depth of Focus (EDOF) Lens – Designed to provide a broader range of clear vision, particularly for distance and intermediate vision. EDOF lenses can be particularly useful for activities such as using computers and laptops, viewing dashboards and other intermediate-distance tasks. They may also provide useful near vision for larger print, although reading glasses may still be required for small print and detailed near work.
• Multifocal Lens – Designed to provide useful vision at several distances, including distance and near, and can reduce dependence on glasses for many everyday activities. However, glasses may still occasionally be required, and some patients may experience visual effects such as glare or halos. Multifocal lenses are premium lens options and may involve an additional cost, depending on your healthcare provider or insurance policy.
• Toric Lens – Specifically designed to correct astigmatism as well as the focusing power of the eye. Toric lenses can provide excellent vision at a selected distance while reducing the need for glasses to correct astigmatism. They are premium lens options and may involve an additional cost, depending on your healthcare provider or insurance policy.

Although these lenses can reduce the need for glasses, they cannot guarantee complete independence from glasses and may have specific visual effects such as glare or halos. They are generally available privately and involve an additional cost.

Before selecting your premium lens, we need to discuss your visual requirements and lifestyle to select to most appropriate one that can meet your expectations. Your ophthalmologist

If both eyes require surgery, the timing of the second operation will be discussed with you. If you have a strong glasses prescription, you may experience temporary imbalance between your eyes after the first operation.

What are the risks of cataract surgery?

Cataract surgery is a very common and generally safe procedure, but, like any operation, it carries some risks.

Most patients have an uncomplicated recovery. Possible complications include:

• Posterior capsule opacification (clouding behind the lens implant)
• Inflammation
• Macular oedema
• Corneal swelling
• Retinal detachment
• Infection
• Bleeding
• Raised eye pressure
• Damage to the iris or other structures of the eye
• A tear or break in the lens capsule
• Retained lens fragments
• Movement or incorrect positioning of the lens implant
• Glare or halos
• Continued need for glasses
• Rarely, significant or permanent loss of vision

Posterior capsule opacification

One of the more common longer-term effects after cataract surgery is posterior capsule opacification (PCO). This occurs when the membrane behind the artificial lens becomes cloudy, causing vision to become blurred again.

PCO can occur months or years after surgery and is usually treated effectively with a simple YAG laser capsulotomy.

If a complication occurs, appropriate treatment will be offered to protect your vision wherever possible.

Activities after cataract surgery

Most people can gradually return to their normal activities within a few days. However, during the early healing period you should:

• Avoid rubbing or pressing on the eye
• Avoid strenuous exercise and heavy lifting
• Avoid eye make-up until advised that it is safe
• Take care in dusty or windy environments
• Avoid getting dirty or soapy water directly into the eye

You should avoid swimming during the early recovery period because of the risk of infection.

Contact sports and activities where the eye could be struck should also be avoided until your ophthalmologist confirms that it is safe to resume them.

Your ophthalmologist will advise you at your follow-up appointment when you can safely return to your normal activities.

Driving

Whether you can drive after cataract surgery depends on your vision, the condition of your other eye and any other eye conditions you may have.

You should not drive until you are satisfied that your vision is adequate and you have been advised that it is safe to do so. If you have a significant difference in prescription between your eyes following surgery, this may temporarily affect your ability to drive.

If you are unsure, discuss driving with your ophthalmologist at your follow-up appointment.

When should I seek urgent advice?

Contact your ophthalmologist or eye department urgently if you experience:

• A significant or sudden deterioration in vision
• Increasing or severe eye pain
• Increasing redness or swelling
• New flashes or a sudden increase in floaters
• A curtain or shadow appearing across your vision
• Significant discharge from the eye

These symptoms can occasionally indicate a complication requiring prompt assessment.

Questions and further information

Cataract surgery is a highly successful procedure, and most patients recover without significant problems. Your ophthalmologist will discuss the benefits, risks and expected outcomes of surgery with you and answer any questions before the operation.

If you have any concerns before or after your cataract surgery, please contact your ophthalmology team.

Glaucoma is a group of eye conditions that damage the optic nerve, which connects the eye to the brain. Glaucoma can lead to permanent loss of vision and, if left untreated, may eventually cause blindness.

Raised eye pressure (intraocular pressure) is an important risk factor, although glaucoma can also develop when eye pressure is within the normal range. The strength and susceptibility of the optic nerve vary between individuals.

Types of Glaucoma

The main types of glaucoma include:

• Primary open-angle glaucoma (POAG): The most common type, which usually develops slowly over many years.
• Angle-closure glaucoma: Occurs when the drainage angle of the eye becomes blocked. Acute angle-closure glaucoma can develop suddenly and requires urgent treatment.
• Secondary glaucoma: Develops as a result of another eye condition, injury, inflammation or certain medications.
• Developmental glaucoma: A rare form that develops in babies and young children.

Symptoms of Glaucoma

Glaucoma often has no symptoms in its early stages. Vision loss usually begins gradually at the edges of the visual field, so many people do not realise they have glaucoma until significant damage has occurred.

If untreated, glaucoma can cause progressive and permanent loss of vision.

Acute angle-closure glaucoma is different and can cause sudden symptoms, including:

• Severe eye pain
• Red eye
• Blurred vision
• Headache
• Halos around lights
• Nausea or vomiting

Acute angle-closure glaucoma is an eye emergency and requires immediate medical attention.

Treatment for Glaucoma

Glaucoma treatment aims to prevent or slow further damage to the optic nerve. Treatment may include:

• Eye drops: Medicines that lower eye pressure.
• Laser treatment: Procedures such as selective laser trabeculoplasty (SLT) can improve drainage of fluid from the eye.
• Glaucoma surgery: Surgery may be recommended when eye drops or laser treatment are insufficient to control eye pressure.

Regular eye examinations are important because early detection and treatment can help protect your vision.

Expert Glaucoma Assessment and Treatment

If you are concerned about glaucoma, an ophthalmic assessment can check your eye pressure, optic nerves and visual fields and determine whether further monitoring or treatment is required.

Accurate diagnosis is an important part of effective eye care. A range of specialised eye tests and imaging techniques can be used to assess the retina, optic nerve and other structures of the eye.

OCT Scan

Optical coherence tomography (OCT) is a non-invasive imaging test that uses light waves to produce detailed, cross-sectional images of the retina and optic nerve.

OCT scans can help diagnose and monitor conditions including glaucoma, age-related macular degeneration (AMD), diabetic eye disease and other retinal conditions. They can also help guide treatment and monitor how well a condition is responding.

Fundus Photography

Fundus photography uses a specialised camera to take detailed photographs of the inside of the eye, including the retina and optic nerve.

These images can help identify and monitor changes caused by conditions such as diabetic retinopathy, glaucoma and retinal disease.

Visual Field Test

A visual field test measures your peripheral and central vision. It can detect areas of missing or reduced vision that may not be noticeable in everyday life.

Visual field testing is commonly used to diagnose and monitor glaucoma and can also help assess visual problems associated with retinal disease, stroke and other neurological conditions.

Gonioscopy

Gonioscopy is an examination of the drainage angle of the eye using a specialised contact lens.

It is particularly useful in the assessment of glaucoma, helping to determine whether the drainage angle is open or closed and assisting in identifying the type of glaucoma present. This information can help guide the most appropriate treatment.

The results of the recent left eye laser procedure appear to have been as satisfactory as with the previous eye. Much of the improvement was apparent to me shortly after leaving the hospital. My thanks to Mr Entabi for his skill and careful attention; it has been my pleasure to deal both with him and his secretary.

I hope my next consultant will be as kind as you and Mr Entabi have been, but you will be a hard act to follow. Thank you

This note is to formally thank you for the kind and very valuable assistance offered towards my surgery for cataract removal with my choice of a multifocal lens implant. I am very satisfied with the overall outcome. I also wish to extend my appreciation and thanks to yourself, all the team and staff who supported with professionalism in all the service and surgery aftercare. Thank again for your support towards this marvellous job.