Losing your eyesight is something that many of us worry about. For most of us, it's a matter of being long or short sighted and glasses are an easy and effective solution. However, there are conditions which require more sophisticated treatment. Some of these problems are difficult to identify without expert help and so we rely on doctors and other medical professionals to help us determine what the problem is and what can be done to help.

There are a number of conditions which can affect the eyes and cause significant damage. Some of these conditions come on quickly and require urgent treatment. Others come on more slowly, providing more opportunities to treat them. However, if any of them are ignored or misunderstood for too long the consequences can be devastating.

Cataracts

Most of us consider cataracts to be something that affect older people and which can be easily treated. In large part this is right. The most common form of cataracts are age-related. However, there are lifestyle factors which can play a part: it is thought that smoking and excessive exposure to the sun can make a person more likely to develop them. People who are diabetic, have high blood pressure (hypertension) or are taking certain medications or suffer eye injuries are more prone to cataracts as well and so it is important that these people report any problems with their eyes promptly.

Some people are born with cataracts and these can have a variety of causes from infection or drugs (prescribed or non-prescribed) whilst in the womb or from a genetic problem inherited from a parent. If these aren't treated they can lead to permanent visual loss.

A cataract is a clouding in the lens of the eye. This restricts or prevents light getting through the eye. The cataract may only be slight but it can be complete, causing complete loss of vision in that eye. Usually, cataracts develop and progress slowly. They often affect both eyes but it is normal for one eye to be worse than the other.

Prevention

You can never remove all risk of developing cataracts. However, there are certain basic things which will help to improve your chances. Not smoking and protecting your eyes from UV radiation (e.g. by wearing sunglasses) can make a difference. If you are diabetic then ensuring that you control your condition as well as possible with lifestyle changes and medication where appropriate is really helpful. Having regular eye tests is important for everyone and such a test can help detect early changes in the eyes.

Symptoms

Principally this is blurred and cloudy vision for many people. It also becomes more difficult to see contrasts so that shadows, colours and contours can becomes hard to distinguish.

With age-related cataracts this comes on gradually and may not be noticed to begin with. If the cataracts are not age-related they may come on far more quickly and it is very important to seek prompt medical treatment in such circumstances.

Treatment

We all know how delicate our eyes are. For this reason, doctors are reluctant to operate until it is necessary. Early cataracts which aren't affecting the individual's sight don't generally require treatment and will be left until they become intrusive. If surgical treatment is necessary then it involves the removal of the affected lens and replacement with an artificial lens. Most people do very well after cataract surgery and it is usually done as a day procedure under local anaesthetic.

Glaucoma

This is a disease in which the optic nerve is damaged. It can permanently affect vision and can lead to blindness if it isn't treated. Usually it arises because there has been a build up of fluid within the eye, increasing the pressure in the eye. This, in turn, damages the optic nerve. Doctors will regularly talk about intraocular pressure (IOP) and if this is raised it is usually something which requires further investigation to ensure that the patient isn't at risk of glaucoma.

People do develop glaucoma without having raised intraocular pressure (IOP) and there are many, varied explanations for this. Certain ethnic groups seem to be more prone to certain types of glaucoma and women are more likely to develop glaucoma than men. There are some very unusual genetic factors which might be associated with glaucoma but the connection is not completely understood. Trauma or eye injury can lead to glaucoma as well, often long after the traumatic event. It is important that your full eye history is known by any expert examining your eyes so they can take proper account of things and reach the best, most informed decision possible.

There are two types of glaucoma: acute and chronic. Chronic glaucoma is more common. It comes on slowly and gradually, often showing no signs or symptoms until the damage is already done. Acute glaucoma, or closed angle glaucoma, usually comes on suddenly and can be very painful. This is more common in women than men.

As with cataracts, glaucoma is much more common as we age. Around one in ten people over the age of eighty are affected by glaucoma.

Diagnosis

In the UK, people over the age of 40 are recommended to have their eyes tested every two years to check for signs of glaucoma. Whenever you have an eye exam by an optician there are various tests which help to identify potential or actual glaucoma as well as looking at a host of other things. If you are identified as being 'at risk' of glaucoma then you are recommended to have a dilated eye exam at least once a year. It is important to have these regular check ups as problems like chronic glaucoma don't make themselves known before the damage is done. You won't know it's happening until it's too late in many cases so go and see your optician and have your eyes checked if you haven't done so in the last two years.

Treatment

Once the optic nerve has been damaged, this cannot be reversed. The emphasis, therefore, is on identifying the problem and stopping further damage being done. If the condition is detected early enough it can be stopped from progressing further or at least to slow any further deterioration very considerably.

If left untreated, glaucoma can lead to blindness. Eye drops and tablets might help to prevent fluid production in and around the eye and therefore reduce intraocular pressure (IOP). Ultimately, if these treatments aren't sufficient then laser or surgical treatment might be needed.

Detached Retina

This condition can affect anyone although, again, it is more common in older people. However, if there has been a trauma to the eye then it can occur regardless of age.

The retina is a layer of tissue at the back of the eye and it converts the light that comes through the eye into nerve signals, helping the brain to work out what you're looking at. The retina needs a constant supply of blood and without this the nerve signals begin to die and this can lead to permanent loss of vision.

Retinal detachment is very rare. Only about 1 in 10,000-20,000 people develop a new case each year.

If left untreated, total blindness can occur within just a few days.

Causes

The most common cause is that the retina becomes thinner and weaker with age and this means that it can tear away from its supporting network of blood vessels. Another cause is direct trauma although this is uncommon.

When tiny holes develop in the retina, these allow the fluid in the eye to pass through the retina and gather behind it, lifting it away from the network of blood vessels that feed it. These connections can break and the retina begins to detach. Previous eye surgery can make the retina more vulnerable.

Symptoms

The warning signs that the retina may be detaching include flashes of light which are very brief in the peripheral vision (i.e. not in the centre of the vision), a sudden dramatic increase in the number of floaters in the eye, a ring of floaters or hairs just to the side of the central vision and a slight feeling of heaviness in the eye. Most people with a detaching retina will not have all of these symptoms but will have some of them.

If the condition is not caught at this stage the symptoms are likely to progress to include a dense shadow starting at the side and moving across to the central vision, an obscuring of vision as if a curtain has been drawn across, straight lines appearing curved and loss of vision in the centre.

If someone starts experiencing any of the early signs they should contact their GP immediately or go to a hospital with an Ophthalmic A&E service. Retinal detachment can be stopped and the retina can be reattached but urgent treatment improves the outcome greatly.

Treatment

There are several ways of treating a detaching or detached retina. They all involve finding all the places where the retina has broken away, fixing them all and ensuring that the retina is firmly re-established. This is done with cryotherapy or laser treatment in some cases but more usually by surgical treatment. There are several surgical methods of fixing the retina back in place. An Ophthalmic Surgeon can advise which is the best method in any particular situation.

Surgery is usually very successful. Around 85% of cases are successfully treated with one operation and the rest may need a second operation but usually have a good outcome. After treatment, vision is gradually regained over a period of weeks although eyesight might not be as good as it was before.

What Can Go Wrong?

The most common problems relate to either a delay in diagnosing these problems or a complete failure to recognise and diagnose these conditions. Thompsons Solicitors are acting for a number of clients in such situations.

Testing showed raised intraocular pressure (IOP)

Thompsons Solicitors represented a client who went to his local opticians on two occasions approximately 5 months apart and saw two different optometrists on these visits. During both consultations the testing showed he had raised intraocular pressure (IOP) but neither appears to have appreciated the potential significance of this and referred him to hospital for further an Ophthalmic opinion. It transpired that he had glaucoma but this was not diagnosed until some time later. Had he been referred to hospital on either occasion his vision would have been maintained and further deterioration would almost certainly have been prevented.

As it was, our client was left unable to drive and dependent on significant care & assistance with all aspects of daily living. His vision had been seriously compromised because of the glaucoma and the damage which had been done to the optic nerve before the glaucoma was identified. Thompsons Solicitors began Court proceedings on behalf of our client in that case and were able to negotiate compensation before trial of £147,000. Nothing can replace our client's sight but this at least enabled him to be confident that he could afford to pay for the help and equipment he needed.

Glaucoma not identified

Another of Thompsons Solicitors clients had a long history of eye problems. She has suffered with multiple problems affecting both eyes for many years. She has had corneal grafts to both eyes and has had a corneal transplant to one of the eyes in the past. She has also had glaucoma in one eye before. Her eyes were deteriorating again and she was advised that she needed a corneal transplant in the other eye. The other eye had almost no vision left but it was felt that a transplant would help maintain the vision in the eye which still had a small amount of sight left. In the pre-operative period, which lasted several months, our client was experiencing pain which was different to the pain she had experienced before. She reported this on many occasions but it seems the doctors assumed that what she was reporting was normal for her condition, despite the fact that she had been in this situation for many years and knew what pain she had suffered in the past: they appear not to have listened to her. Eventually our client had the corneal transplant.

When she was examined post-surgery it was clear that her vision in that eye was almost completely gone. The Ophthalmic Surgeon made a brief check of her eye and asked how long she had suffered with glaucoma. This was the first she knew she had glaucoma in that eye. Her intraocular pressure (IOP) had never been taken in the run-up to this surgery despite her history of glaucoma affecting the other eye and the pain she had been reporting. Our client's vision is now almost completely gone and it is unlikely that she will recover. We understand that she is likely to deteriorate further because of the extent of the damage done to her optic nerve. Thompsons Solicitors have only recently received and reviewed this woman's medical records but are now approaching an expert Ophthalmic Surgeon to comment on the care & treatment she received and to find out what her chances would have been of having some good eyesight if the glaucoma had been identified sooner.

Experience a lot of floaters

Thompsons are also acting for a man who had recently had new glasses. Apart from being short-sighted he had no other history of problems with his eyes. He began to experience a lot of floaters over the course of a few short days and went to his optician, wondering if there was a link with the new glasses. The optician was busy with a customer when he arrived. Our client said he would wait but the shop manager asked if he could help. Our client described his problem to this man only to be told that floaters are normal and he shouldn't worry, they would soon disappear. He was also told that the optician was fully booked that day and wouldn't be able to see him but that he really didn't need to be seen. Our client was reassured by this and went away without seeing the optician.

The floaters did not disappear and two days later he woke up and was unable to see out of one of his eyes. He initially went to his local hospital who seemed unsure of the problem and suggested he come back the following day. When he did this there was still some uncertainty as to the nature of his problem but the doctor he saw mentioned that he could go to the A&E department at Moorfields Eye Hospital in London. As our client was in North London he did this and was immediately diagnosed with a detached retina. He has had surgery to reattach the retina and has regained some sight in that eye but it is a long, slow process and it is not yet clear how much sight will be regained. Thompsons are presently waiting for medical evidence on the nature and extent of the damage done to this man's eye and the steps which could and should have been taken to identify and treat the problem more quickly. We are determined to fight for his right to compensation for what he has suffered.

Further information can also be found on the following websites:

NHS Choices
www.nhs.uk

Royal National Institute for the Blind
www.rnib.org.uk

Action for Blind People
www.actionforblindpeople.org.uk

Vision Aid
www.visionaid.org