Consultant Q&A

    22 November 2014

    Q I have a real problem with floaters in my eyes. They appear to have got worse in recent years. Is there any point in going to the doctor about them? Is there any treatment?
    A Floaters are a common symptom caused by normal ageing changes in the clear jelly that fills the eye in front of the retina. As we age, the transparent structure of the supporting scaffold starts to condense, causing shadows that can be seen as they move across the retina. Eventually the structure collapses, causing a separation of the back face of the jelly from the retina. This normal ageing process is of no danger, but can cause irritating sensations of moving flies or seaweed-like shadows apparently floating in the visual field. For most people these sensations gradually diminish as we get used to them. On occasions, such as in bright light, they become bothersome. In certain rare circumstances, if truly unbearable, or for certain professions such as racing drivers, treatment can be offered. For instance, an outpatient, day-case procedure, YAG laser vitreolysis, can reduce the floaters and shift the larger ones out of the visual axis. Urgent examination by an optometrist or ophthalmologist is required if there is a sudden change in the floaters, if there are flashing lights or if an opaque shadow falls over part of the vision. In these rare cases the symptoms are suggestive of a retinal tear that could lead to detachment of the retina. Diabetics and people who are short-sighted should also be examined if they suddenly develop floaters. If the floaters gradually worsen, then a routine ophthalmological opinion is worthwhile.
    Q My husband woke up one morning a few weeks ago with a patch of what looked like blood in the white part of his eye. What causes this to happen and is it dangerous?
    A Bright red patches on the white of the eye look alarming but are in fact not dangerous. These little haemorrhages under the outer conjunctival coat will resolve spontaneously over a couple of weeks. A routine check of blood pressure by the GP is advisable, and if on a blood-thinning drug, such as warfarin or aspirin, a check-up on the dose is recommended. Rubbing the area can lead to recurrences, as can forced sneezing or coughing.
    Q Is it true that it’s best to wait for as long as possible for a cataract operation? If so, why?
    A It is advisable to have cataract surgery when you are bothered by the vision. Modern cataract surgery with small incisions and optically superb lens implants is safe and effective in relieving the symptoms of poor vision in cataract patients, and is performed as a day case under drops with minimal disturbance to the daily routine. Decades ago patients were advised to wait ‘until the cataract was ripe’. This was because the incidence of serious complications was relatively high and only a few patients were offered lens implants to rehabilitate the vision after surgery. Modern advances have put those dark days firmly behind, and indeed waiting for cataract surgery is of no benefit and can make the operation more difficult.
    Q I have very itchy, dry eyes, especially when I wake up in the morning. Is there anything I can do about this?
    A Drying of the eyes is a common problem that is more prevalent in mature females and the elderly. It can be worse in the morning and symptoms can be relieved by a variety of over-the-counter drops. Try to avoid dehydrating oneself in the evening by not drinking caffeinated drinks or alcohol and perhaps have a glass of water before going to bed. If the itching persists, think about the possibility of allergies and buy a new pillow. House dust mites collect in unbelievable quantities in old bed linen. A significant proportion of the allergic population react to these proteins causing itching eyes.
    Q Is laser eye surgery considered safe? I’ve heard some scare stories about people being unable to drive at night after their operation.
    A Laser eye surgery to correct refractive error is a safe convenient alternative to wearing glasses or contact lenses. As always, you need to seek professional advice from the experts. People with large pupils and other optical problems of the eye are indeed at risk of night vision problems. However, laser centres will spend a lot of time evaluating your eyes with several highly technical optical measuring devices. If you are at high risk of developing post-operative problems, you will be advised not to have the procedure. Do your research — find the centres that offer good pre-operative investigations and counselling and who provide personally tailored after care with emergency cover if needed. Check the surgeon is a laser specialist and not just part-time. These are your eyes, the cheapest deal is not necessarily going to be the best.