Making a Move

Vision componentDeveloped by Vision 2020 Australia’s Vision Initiative program funded by Victorian Department of Health

Overview

• Eye health in Australia

• Preventing sight loss

• Anatomy of the eye

• Common eye conditions

• The relationship between falls and eyesight

• Who’s who in eye care and where to get help

Eye health in Australia

• More than 500,000 Australians have vision loss.

• Prevalence of eye disease predicted to double over

the next ten years.

• 75 per cent of vision loss is preventable or

treatable.

• Vision loss increases threefold with each decade

over 40 years.

Eye health in Australia

• Eighty per cent of vision loss is caused by five

conditions (listed alphabetically):• Age-related Macular Degeneration (AMD)• cataract• diabetic retinopathy• glaucoma• under-corrected and uncorrected refractive error.

Blindness and vision impairment in Australia

Preventing sight loss - what you can do

• Encourage your clients to have an eye examination

especially if: • there is a family history of eye disease• the client is over the age of 40• the client has diabetes• the client has noticed a change in their vision.

• Early detection and treatment is essential.

• Medicare covers most of the costs associated with

visiting an optometrist or ophthalmologist.

Preventing sight loss - what you can do

• Talk to your clients about their vision.

• Vision loss may be an underlying cause for another

condition.

• Conduct a visual acuity test or refer to an

appropriate health professional.

• If you are concerned about a clients vision discuss

this with the treating general practitioner or eye

health professional.

Preventing sight loss

• People with vision impairment are at a greater risk

of suffering from secondary conditions:• falls• depression• early special accommodation• increased risk of hip fracture• increased early mortality• social isolation.

Preventing sight loss

• Advise your clients to:• QUIT smoking• protect their eyes from injury• protect their eyes from ultraviolet light by:

• wearing a hat• wearing appropriate sunglasses

• maintain good general health.

The anatomy of the eye

Function of the eye

• Light enters the eye through the cornea, which

refracts the widely diverging rays of light and bends

them through the pupil.

• The iris limits how much light enters the eye by

expanding or contracting the pupil.

Function of the eye

• The eye functions like a camera.

• The light enters the eye then is focused through the lens.

• The lens can changes shape depending on the distance of the object from the eye to, “fine-tunes” the focus.

• The light then travels through the vitreous to the retina.

• The photosensitive retina is stimulated and converts the image into an electrical signal, which is sent through the optic nerve to the visual cortex of the brain.

• The brain analyses the information and interprets the signals as an image.

Common eye conditions

• 80 per cent of vision impairment and

blindness is caused by five conditions (listed

alphabetically):

• Age-related Macular Degeneration – 10 per cent

• cataract - 14 per cent• diabetic retinopathy - 2 per cent• glaucoma - 3 per cent• under-corrected or uncorrected refractive

error - 62 per cent.

Age-related Macular Degeneration

Age-related Macular Degeneration (AMD)

• A chronic degenerative condition that affects the

central vision. Progression is likely.

• Ten per cent of the people with macular

degeneration have the “wet” form which may

respond to treatment.

• The majority of people have the “dry” form of

macular degeneration.

• Two out of three people will be affected by AMD in

their lifetime.

Prevalence and risk factors of AMD

• Ageing is the greatest risk factor with prevalence of

AMD trebling with each decade over 40 years.

• AMD is present in thirteen per cent of people

between the ages of 70-75.

• It is the leading cause of disease related to vision

impairment in Australia.

• Smoking increases the risk of developing AMD.

• Family history is also risk factor - genes have been

identified and linked with AMD.

Functional implications of AMD

• Loss of central vision which results in:• having difficulty distinguishing people's faces.• having difficulty with close work.• perceiving straight lines as distorted or curved.• being unable to differentiate between the

footpath and road.• having difficulty identifying the edge of steps if

there is no colour contrast.• being unable to determine traffic light changes.• having difficulty reading, with blurred words

and letters running together.

Prevention of AMD

• Early detection of AMD is crucial - some forms of the disease may be arrested with early treatment by an ophthalmologist.

• Regular eye examinations are the key to early detection of disease before vision loss occurs.

• If your client notices any change in the quality of their vision, advise them to talk to their GP to arrange an appropriate referral to an eye health professional.

• Advise your clients to QUIT smoking.

Treatment of AMD

• Treatment options are improving with new technology such as Lucentis.

• When new vessels grow under the retina, surgery may be an option.

• Laser surgery can reduce vision loss if caught early and aims to prevent further vision loss.

• Often however, lost vision cannot be recovered - early detection and treatment is the key.

• For more information on AMD visit

www.mdfoundation.com.au

Cataract

Cataract

• A Cataract is a clouding of the lens inside the eye,

light cannot be focused properly as it enters the

eye.

• Thirty one per cent of the population over the age

of 55 has cataract.

• Everyone will develop cataract and half will need

cataract surgery if they live long enough.

• The rate of cataract surgery doubles with each

decade of life.

Prevalence and risk factors of cataracts

• Cataracts are a leading cause of vision

impairment in Australia.

• Increasing age is the most significant risk factor

for developing a cataract.

• Other risk factors include:• diabetes• corticosteroid use • trauma • smoking• sun exposure.

Functional implications of cataracts

• Clouding of the lens results in:• blurred vision• reduced contrast• having difficulty judging depth• seeing a halo or double vision around lights at night• seeing images as if through a veil• being particularly sensitive to glare and light• having dulled colour vision.

Prevention of cataracts

• Advise your clients to:

• QUIT smoking• protect their eyes from ultraviolet light by:

• wearing a hat• wearing appropriate sunglasses

• protect their eyes from injury by wearing:• protective work wear• protective sports wear.

Treatment of cataracts

• Regular eye examinations and updated glasses

may delay the need for surgical treatment.

• Surgery:• Initial consultation is required to measure the eye

for the correct replacement lens.• Usually in and out of hospital on same day.• No general anaesthetic is required (in most

cases).• The lens inside the eye is removed, except for the

back capsule.• a new intraocular lens (IOL) is inserted.

Diabetic retinopathy

Diabetic retinopathy

• This disease is a complication of diabetes.

• It affects the small blood vessels of the retina.

• Blood vessels begin to leak and bleed inside the

eye.

Prevalence and risk factors of diabetic retinopathy

• It is estimated that three per cent of the population aged over 55 years have diabetic retinopathy.

• Twenty two per cent of people with known Type 2 diabetes have some form of retinopathy related to their diabetes.

• Within 15 years of being diagnosed with diabetes, almost three out of four diabetics will have diabetic retinopathy.

• People who have had diabetes for many years, have diabetic kidney disease or have Type 1 diabetes have a greater risk of developing diabetic retinopathy.

• Diabetic retinopathy is the primary vision threatening condition for Aboriginal and Torres Strait Islander people.

Functional implications of diabetic retinopathy

• Changes to the retina results in:• having difficulty with fine details e.g. when

reading or watching television• experiencing visual fluctuations from hour to

hour or day to day• seeing images as rippled e.g. straight lines

appear bent• experiencing blurred, hazy or double vision• losing some patches in the field of vision• having difficulty focusing.

Prevention of diabetic retinopathy

• Early diagnosis and treatment can prevent severe vision

loss.

• Your clients should get their eyes examined at least every

two years (or as directed by their eye care professional) if

they have diabetes.

• A diabetic eye examination should always include pupil

dilation.

• In addition to regular eye examinations, important factors to

reduce the risk of developing diabetic retinopathy include

good management of blood sugar, blood pressure,

cholesterol levels.

Treatment of diabetic retinopathy

• Early detection and treatment is essential.

• Up to 98 per cent of severe vision loss can be

prevented with early detection and prompt laser

treatment.

• Laser treatment to the retina can slow the

progress of diabetic retinopathy in some cases.

Glaucoma

Glaucoma

• Glaucoma is a disease that affects the optic nerve

at the back of the eye.

• Relieving pressure on the nerve reduces

progression of the disease.

• Early detection and treatment can slow the vision

loss.

Prevalence and risk factors of glaucoma

• People over the age of 40 are more likely to develop

glaucoma than younger people.

• Almost three per cent of the Australian population

over 55 years are affected.

• Glaucoma can run in families, people with a blood

relative diagnosed with glaucoma should regularly

visit their eye health professional.

• People with extreme refractive error, people with

previous eye injuries and people who have taken

corticosteroids are at greater risk of developing

glaucoma.

Functional implications of glaucoma

• Optic nerve damage results in: • a gradual loss of peripheral vision• having difficulty adjusting to lighting changes e.g.

between indoors and outdoors• experiencing occasional blurred vision• seeing haloes around lights• being particularly sensitive to glare and light• having difficulty identifying the edge of steps• being unable to differentiate between the footpath

and road• tripping over or bumping into objects.

Prevention of glaucoma

• Regular eye examinations to ensure early

detection and treatment are the only way to

control glaucoma and prevent vision loss.

• Fifty per cent of people with glaucoma are

unaware that they have the condition.

Treatment of Glaucoma

• Lost vision can not be recovered.

• Treatments to prevent further loss are

available but early detection is the key.

• Early glaucoma is often asymptomatic which

is why examinations are critical.

• Glaucoma is managed by medication, laser

and surgery.

• For more information on glaucoma visit

www.glaucoma.org.au

Refractive error

Prevalence and risk factors of refractive error

• All age groups can be affected by refractive

error.

• People over the age of 40 should have regular

eye examinations to eliminate refractive error as

a cause of vision impairment.

• Family history of refractive error is a risk factor.

Functional implications of refractive error

• Functional implications depend on the type and severity of

refractive error.

• Long-sightedness (hyperopia or hypermetropia) results in

difficulty seeing near objects.

• Short-sightedness (myopia) results in difficulty seeing

distant objects.

• Astigmatism results in blurred vision at all distances.

• Presbyopia (focus difficulty after the age of 40) rresults in

difficulty seeing near objects.

Treatment of refractive error

• Refractive error is often treatable with:• glasses• contact lenses

• laser eye surgery

• Low vision aids assist people maximise vision

where other treatments no longer improve

vision.

Glasses and falls - prevention

• New glasses can take a while to get used to. People

may feel unsteady at first. Advise clients to wear

them in safe familiar environments (indoors at first).

• Slowly build up wearing time.

• Bifocals and Multifocals may cause distortion and

blur when looking down.

• Remind clients to move their head more when

looking down to look through the correct part of the

lens.

• Advise clients to take care going up and down stairs

and gutters.

Glasses and preventing falls

• Transition (photochromatic)lenses change colour in

the sun. These lenses take time to fade when

indoors.

• Advise clients to take the glasses off for a few

minutes when they go indoors, or sit on a chair

inside near the door for a few minutes while they

become clear again.

• If clients have persistent problems advise them to

discuss this with their optometrist.

The relationship between falls and eyesight

• Vision disorders account for approximately three

per cent of the burden of disease.

• People with a vision impairment have: • twice as many falls • three times the risk of depression • the risk of hip fractures increased by eight fold.

Vision assessment - how to reduce the risk

• The Vision Assessment tool has been developed by

the Vision Initiative to be used at the beginning of

the Making a Move program.

• It has been designed to identify participants whose

eyesight may increase the risk of falling.

• It will trigger a referral to an eye health

professional as needed.

• If you have concerns about a person’s vision please

ensure that you refer on to the correct services –

see who’s who section.

Who’s who in the eye care sector

• The following slides provide a brief introduction to who’s

who in the eye care sector, the services they offer and

how to access them.

• More information is also available on the

Vision Initiative website.

www.visioninitiative.org.au

Vision 2020 Australia

• National peak body for the vision care and eye health sector.

• Represents close to 60 members and associate organisations.

• Provides a platform for collaboration across the eye health and

vision are sector.

• Part of VISION2020: The Right to Sight a global initiative of the

World Health Organisation.

www.vision2020australia.org.au

The Vision Initiative

• A program aimed at raising awareness of eye

health and vision care to the general community

and to health care professionals.

• Funded by the Victorian Department of Health .

• Victoria’s public health response to the National

Framework for Action to Promote Eye Health and

Prevent Avoidable Blindness and Vision Loss.

• For more information visit

www.visioninitiative.org.au

Optometrist

• An optometrist in a primary eye care provider.

• Medicare provides a full rebate on most optometry

consultations.

• Patients do not need a referral to see an optometrist.

• Little or no waiting period for appointments.

• Will fast-track referrals to ophthalmologists if necessary.

• Many have therapeutic endorsement allowing optometrists

to prescribe certain topical eye medications.

• To locate your nearest optometrist, please visit

www.optometrists.asn.au

Australian College of Optometry

• The Victorian Eyecare Service (VES) is coordinated by the

Australian College of Optometry.

• It provides low cost eye care and glasses for people:• on low incomes• with Pension Concession Cards or Health Care

Cards.

• Interpreters are available upon request.

• For more information visit www.aco.org.au

Australian College of Optometry

• Glasses start from around $33.50 for single vision

reading or distance glasses and $47.00 for bifocals.

• Metropolitan locations:

Carlton, Broadmeadows, East Preston, Braybrook,

Frankston, Doveton, Victorian Aboriginal Health Service,

Outreach (aged care, SRS, disability).

• Participating VES private practitioners in country areas

are listed at: www.vco.org.au/vco.docs/VESdir.pdf

Ophthalmologist

• Ophthalmologist are secondary eye health providers.

• Qualified medical doctors often known as eye surgeons or eye specialists.

• Provide diagnosis, surgical and medical treatment of eye disease.

• Referral from a GP, medical specialist or optometrist is required in order to obtain the Medicare rebate.

• Waiting time for appointments can vary according to the condition (if urgent, a GP, optometrist or specialty ophthalmologist can bring this forward).

• For more information on ophthalmologists visitwww.ranzco.edu

Royal Victorian Eye and Ear Hospital

• Victoria wide teaching, training and research health

service.

• Specialising in eye, ear, nose and throat (ENT) medicine.

• Accident and Emergency is open 24 hours, seven days a

week - no referral is needed.

• Referrals are required to be seen in the outpatients clinics.

• Contact details:

Crn Victoria Parade and Gisborne Street

East Melbourne

Phone 9929 8666

www.eyeandear.org.au

Low vision services

• Approximately 180,000 Australians have a vision

impairment that can not be corrected by glasses.

• The number of people who are blind or vision impaired is

expected to increase to approximately 800,000 by 2024.

• Low vision services assist people when glasses and

medical treatment are no longer satisfactory.

• They help people to maintain their independence.

• Low vision services are usually free.

• For more information on low vision services visit

www.visioninitiative.org.au

Guide Dogs Victoria

• Guide Dogs Victoria provide services to Victorians who

are blind or vision impaired, enhancing their safety,

independence and quality of life at every stage of

life’s journey.

• No referral needed - enquiries from individuals, family

members and health professionals are all welcome.

• Specialised services are available including, children’s

mobility, acquired brain injury mobility, orientation &

mobility, occupational therapy, and guide dog

mobility.

• For more information on guide dogs visit

www.guidedogsvictoria.com.au

Vision Australia

• Vision Australia offers a wide range of services to

assist people who are vision impaired across their

life span.

• Clients can be referred by a health professional or

they can self refer.

• To assist health professionals in referring clients,

Vision Australia has a referral form on their website.

• For further information on Vision Australia visit

www.visionaustralia.org.au

Telephone: 1300 VISION (1300 847 466)

Support groups

Vision loss support organistaion provide support and information for people

living

with vision impairment and blindness.

• Blind Citizens Australia 1800 033 066

www.bca.org.au

• Glaucoma Australia 1800 500 880

www.glaucoma.org.au

• Keratoconus Australia 0409 664 811

www.kerataconus.asn.au

• Macular Degeneration Foundation 1800 111 709

www.mdfoundation.com.au

• Retina Australia 1800 999 870

www.retinaaustralia.com.au

Acknowledgement

Vision 2020 Australia would like to thank:

• Genevieve Napper Australian College of Optometry

• Kellie Michel Royal Victorian Eye and Ear Hospital

• Kent Snibson Optometrists Association Australia

• Nicholas Brislane The Royal Australian and New Zealand College

of Ophthalmologists.

• Nikki Robbins Vision Australia

• Sandie Mackevivius Vision Australia

• Fiona Scoullar Vision 2020 Australia

• Robyn Wallace Vision 2020 Australia.

Thank you

For more information please contact:

Robyn Wallace

Vision 2020 Australia

(03) 9656 2020

rwallace@vision2020australia.org.au

Or visit www.visioninitiative.org.au