Anglia Community Eye Service

Tel. 01945 466222

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Our Services

Conditions we treat

At ACES we can treat the majority of all eye problems without the need for patients to attend hospital. Only a small minority of patients need to go to hospital. The following is a small selection of the common eye conditions we treat:

  • Cataract
  • Glaucoma / Surgical Trabeculectomy
  • Blepharitis
  • Flashes & Floaters
  • Watery Eye
  • Choroidal Neavus

Conditions we do not treat

  • Diplopia / Double Vision
  • Retinal Detachment
  • Diabetic Screening
  • Children (Under 18)
  • Patients requiring a general anaesthetic
Mr. Jakeman Surgery

Condition Descriptions

Select one of the conditions below to view a description of the condition, and of the treatment.

Cataract Description

A cataract is a clouding of the lens inside the eye which leads to a decrease in vision. It is the most common cause of blindness and is conventionally treated with surgery. Visual loss occurs because opacification of the lens obstructs light from passing through the eye to the retina at the back of the eye.

It is most commonly due to ageing, but there are many other causes, such as trauma, other eye conditions, and drugs. Over time, yellow-brown pigment is deposited in the lens and this, together with disruption of the lens fibers, reduces the transmission of light and leads to visual problems.

Those with cataracts often experience difficulty in appreciating colors and changes in contrast, driving, reading, recognizing faces, and coping with glare from bright lights.

Cataract in human eye

Cataract Treatment

Cataract removal can be performed at any stage and no longer requires ripening of the lens. General anaesthetic, that is, being put to sleep, is not required, and surgery is performed as a day case procedure under local anasthetic. About 9 out of 10 patients can achieve vision of 6/12 or better with glasses after surgery.

Phacoemulsification is the most up-to-date method of removing cataracts today, and is the method used by ACES. This procedure uses ultrasonic energy to emulsify the cataract lens. Phacoemulsification typically comprises several steps:

  • Anaesthetic - The eye is numbed with either an infusion of anaesthetic around the eye or using simple eye drops.
  • Corneal Incision - Two cuts are made through the clear cornea to allow insertion of instruments into the eye.
  • Capsulorhexis - A needle or small pair of forceps is used to create a circular hole in the capsule (or bag) in which the lens sits.
  • Phacoemulsification - A handheld probe is used to break up and emulsify the lens into liquid using the energy of ultrasound waves. The resulting 'emulsion' is sucked away.
  • Irrigation and Aspiration - The cortex which is the soft outer layer of the cataract is aspirated or sucked away. Fluid removed is continually replaced with a special salt solution to prevent collapse of the structure of the anterior chamber (the front part of the eye).
  • Lens insertion - A plastic foldable lens is inserted into the capsular bag that used to contain the natural lens. Antibiotic is injected into the eye to reduce the risk of infection. The final step is to inject salt water into the corneal wounds to cause the area to swell and seal the incision.
Cataract surgery

For further information, please read our Cataract Leaflet »

Glaucoma Description

Glaucoma is a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness. Glaucoma normally occurs when the fluid pressure inside the eye rises. There are several different types of glaucoma, but all treatments involve trying to lower the pressure inside the eye to a safer level. The safer level is simply the pressure at which further damage to the nerve is halted or slowed to an acceptable level.

Acute angle closure glaucoma

Glaucoma Treatment

There are a number of ways to reduce eye pressure. For the majority of patients using regular eye drops will achieve this. In a few patients, either because they cannot tolerate their drops, or the pressure needs to be reduced further, either laser treatment or an operation may be recommended.

The most common operation is called a Trabeculectomy. This operation was first performed 40 years ago in Cambridge. Occasionally the operation can be combined with cataract surgery but usually it is performed alone.

Glaucoma surgery

Blepharitis Description

Blepharitis is a condition characterised by chronic inflammation of the eyelid. The severity and time course of blepharitis can vary. Onset can be acute, resolving without treatment within 2–4 weeks (this can be greatly reduced with lid hygiene), but more generally is a long standing, intermittent inflammation varying in severity.

Signs and symptoms that are associated with the chronic inflammation include:

  • Redness of the eyelids
  • Flaking of skin on the lids
  • Crusting at the lid margins, generally worse on waking
  • Infection of the eyelash follicle/sebaceous gland (hordeolum)
  • Red eye
  • Debris in the tear film, seen under magnification (improved contrast with use of fluorescein drops)
  • Gritty sensation of the eye or foreign-body sensation
  • Eye itching

The lids may become red and may have ulcerative, non-healing areas which may actually bleed. Blepharitis does not tend to cause problems with the patient's vision, but due to a poor tear film, one may experience intermittent blurred vision.

Blepharitis Treatment

Unfortunately, complete eradication of all symptoms is often not possible, but improvement of symptoms is usually possible. The single most important treatment principle is a daily routine of lid margin hygiene to remove crusts and toxic products from the lid margins. This can be achieved by daily scrubs using a cotton wool bud and dilute baby shampoo or bicarbonate of soda. The frequency of lid scrubs can be varied as the symptoms are brought under control. Warm compresses can be particularly helpful in patients who have an associated thick and sticky tear film.

Antibiotics can be helpful in an acute worsening of blepharitis, but are usually not helpful and not prescribed. Frequent instillation of artificial tears can be very helpful in eliminating symptoms of soreness and irritation.

Flashes & Floaters Description

Floaters are deposits of various size, shape, consistency, refractive index, and motility within the eye’s vitreous humour, which is the gel filling most of the back of the eye. In the young eye, the vitreous humour is transparent, but as one ages, imperfections gradually develop. The common type of floater, which is present in most people’s eyes, is due to degenerative changes of the vitreous humour.

The perception of floaters is known as myodesopsia. They are also called Muscae volitantes (Latin: "flying flies"), or mouches volantes (from the French).

Floaters are visible because of the shadows they cast on the retina or refraction of the light that passes through them, and can appear alone or together with several others in one’s visual field. They may appear as spots, threads, or fragments of cobwebs, which float slowly before the observer’s eyes. Since these objects exist within the eye itself, they are not optical illusions.

Floaters

Flashes & Floaters Treatment

There are no medications (including eye drops) that can correct for this vitreous deterioration. It is possible to perform an operation to remove the vitreous, but this is not without complications, and surgery is rarely justified. Floaters are caused by the normal ageing process of the eye, and will become less obvious as the brain learns to ignore them. Looking up/down and left/right will cause the floaters to move within the direct field of vision as the vitreous humour swirls around due to the sudden movement.

Age-Related Macular Degeneration Description

Macular degeneration, often age-related macular degeneration (AMD or ARMD), is a medical condition that usually affects older adults and results in a loss of vision in the centre of the visual field (the macula) because of damage to the retina. It occurs in "dry" and "wet" forms. It is the most common cause of blindness and poor vision in East Anglia. Macular degeneration can make it difficult or impossible to read or recognise faces, although enough peripheral vision remains to allow other activities of daily life.

Although some macular dystrophies affecting younger individuals are sometimes referred to as macular degeneration, the term generally refers to age-related macular degeneration (AMD or ARMD).

There are two kinds of AMD.

Dry AMD

Dry AMD develops when the cells (retinal pigment epithelium - RPE) under the macula become damaged as a result of a build-up of waste products. These clump together, and can be seen by the ophthalmologist when examining the retina as small pale areas called drusen. This is the more common of the two forms of AMD accounting for around 8 out of 10 cases. It progresses slower than wet macular degeneration over years. Every year out of 12 people with dry AMD, one will go on to develop wet AMD.

Greens

Wet AMD

Wet AMD develops when abnormal, new blood vessels form underneath the macula (sub-retinal neovascular membranes). These fragile blood vessels leak fluid and blood which leads to scarring and poor sight.

Wet AMD is more serious and without treatment, vision can deteriorate within days.

Prevention of Macular Degeneration

There is currently no specific treatment for dry macular degeneration, but evidence is slowly accumulating to suggest that stopping smoking, eating foods containing a high concentration of certain nutrients and anti-oxidants, such as broccoli, kale, and red and yellow peppers, will prevent deterioration. Alternatively, nutrient supplements such as I-caps, macushield, or ocuvite tablets are obtainable from the chemist, health food shop or your optician may prove to be helpful.

If your ACES ophthalmologist has told you that you have fairly advanced dry AMD or have wet macular degeneration in the other eye there is good evidence from large trials that these tablets will reduce your chances of losing sight. If 100 people with this level of AMD took supplements for 5 years then 14 of them would have been prevented from losing vision (Age Related Eye Disease Studies 1-2 (AREDS)).

Unfortunately, most areas do not allow your GP to prescribe these tablets and you will have to buy them yourself.

Which kinds of macular degeneration can be treated?

Some kinds of wet AMD can be treated in the early stages. This involves receiving injections of a drug such as Lucentis into the eye. This works by causing the abnormal new blood vessels under the retina to shrink. Monthly injections are needed over months and often several years. About one in every three patients notice an improvement in vision, whilst the condition can be stabilised in over half of those affected. Unfortunately some patients continue to lose vision in spite of treatment.

How do you know if someone has macular degeneration?

If your sight is blurring you should see your GP or optician and consider asking to see a specialist such as ACES. The most important early symptoms to look for are distortion or blurring occurring over a few weeks.

How might I help a friend or relative with poor sight?

Make sure they do not become isolated. Give them a visit, a ring or an excursion. If they seem depressed, this may well be treatable by their GP.

Check that they have seen an ophthalmologist such as ACES so that all modern treatments have been considered and they have the benefits that poor sight registration gives.

Have they tried low visual aids such as magnifiers? These can usually be prescribed by ACES or other eye services so there is no need for the expense of buying them.

Ask advice from your local macular society or association for the blind.

Read more about macular degeneration: NHS Choices Website »

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Created by Neon Fish

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