Clinical Services

Surgical & Non-Surgical

ORTHOKERATOLOGY

Orthokeratology is a non-surgical process that reshapes the cornea by wearing rigid contact lenses while you sleep. When you awaken you can see clearly without glasses or the hassle of wearing contact lenses during the day. Unlike Laser Surgery, the therapy is non-invasive and reversible when treatment is ceased.

Orthokeratology enables active people to go about their daily work, recreation, and sports without any interference from glasses or contact lenses, and without the significant costs of invasive surgical correction.

Another remarkable aspect of orthokeratology is the evidence emerging that it slows by about 50% the progression of short-sightedness in young eyes. Orthokeratology has been shown to be a viable option for correcting vision as well as slowing the development of myopia in the future. This claim has been reinforced by results in many clinical studies, follow-up studies and retrospective reviews of cases.

MYOPIA MANAGEMENT

Myopia, commonly called short-sightedness (“sight set too short”) makes it difficult to see distant objects clearly. It is a very common condition. Myopia’s onset is typically in the mid-teens and less frequently later in the twenties. There is considerable debate about whether myopia is inherited or whether it is exacerbated by excessive close work.

The prevalence of myopia has increased significantly over the past few decades, especially in certain population groups of East Asia. As a result, considerable efforts and research has been conducted into how myopia occurs and how the progression of myopia can be halted or at least slowed. Current evidence supports a number of treatment methods for reducing the progression of myopia. There are currently three main treatment strategies to slow down the progression of myopia:

Options for managing myopia:

Recent studies such as the Atropine in the Treatment of Myopia (ATOM) project provide strong evidence to support the use of low concentration atropine eyedrops to retard the progression of myopia. Atropine is a prescription-only medication, the main effects of which are usual to dilate the pupil and relax the eye’s focusing (accommodation) system.

The most recent studies into atropine and myopia control show that atropine in low concentrations can significantly slow the progression of myopia without the usual side effects of pupil dilation and reduced functioning at near. It is believed that this effect is not due to the blocking of accommodation, but rather atropine’s effect on the receptors responsible for controlling the length of the eye.

Orthokeratology (“ortho-K”)

 Orthokeratology, also known as ortho-K, is a non-surgical process involving the wear of rigid contact lenses while sleeping. These lenses change the shape of the cornea, the clear tissue at the front of the eye. On awakening, distance vision is clear without the need to wear glasses or contact lenses during the day. The effect of wearing ortho-K lenses remains so long as the lenses are worn overnight, but the therapy is completely reversible.

Orthokeratology has increased in popularity over the past few decades, especially since a steady stream of evidence that indicates as well as correcting myopia in the short term, this therapy also slows the progression of myopia in the longer term.

Soft multifocal contact lenses

 Multifocal contact lenses are usually prescribed for patients with age-related decreased ability to focus on close objects. But recently they have also been used as another option to reduce the progression of myopia. Like orthokeratology, these lenses inadvertently blur the image that falls on the peripheral retina. This does nothing to compromise central vision and is not usually noticeable to the wearer, but also appears to slow the progression of myopia.

KERATOCONUS

Most people who are diagnosed with keratoconus have never even heard of it. They often assume the worst – that because it usually gets worse over time, therefore they will probably go blind. 

But … this is not the case if it is managed and treated properly from the start.

Keratoconus is a disease of the cornea, or front surface of your eye. The incidence in Australia is about 1 in 2,000 (so there are at least 10,000 Australians with the condition). It usually appears around puberty and progresses (gets worse) during your teens and twenties. 

During the progressive phase of the eye disease, your cornea becomes thinner and weaker and the surface becomes irregular or conical in shape. Your vision becomes more and more affected depending on the position and size of the conical shape.

What is forme fruste keratoconus?

 This is when the disease starts in your eye but then stops getting worse for some reason. This may happen before it even causes noticeable problems with your vision. It is a very mild form and not usually picked up unless you have tests for laser eye surgery.

Getting the right diagnosis

Your keratoconus may be worse in one eye than the other – sometimes much more so. This explains why a wrong diagnosis sometimes occurs. If your practitioner doesn’t see keratoconus often, they may explain the poor vision in one eye as amblyopia (or lazy eye). It is only when the vision in the other eye starts to deteriorate that they might look more closely and discover the real cause. 

We are aware of many patients that have been diagnosed later in life but originally have been mistaken as having a lazy eye. They have then been allowed to go through life with no binocular vision and all the associated issues that can occur.

Today this should never happen as we have at our disposal, highly sensitive measuring technology, but also an effective procedure called collagen cross-linking that can nip keratoconus in the bud. 

This makes it more important than ever to diagnose the keratoconus patient as early as possible. It is especially important if the patient is under the age of 25 years of age, when progression is most likely. 

Diagnosis of keratoconus is based on assessment of symptoms and on ocular signs. The definitive diagnosis is given by mapping the cornea by topography imaging. Corneal Topography is available on site at Central Coast Eyecare.

Once a diagnosis is made your optometrist will discuss options for management. In initial stages spectacle lenses may offer good vision, but as the condition progresses most patients with keratoconus will be fitted with rigid gas permeable (RGP) contact lenses. Advances in RGP contact lenses have made comfort and vision significantly better for patients with keratoconus.

If you have keratoconus that is shown to be progressive in nature, your optometrist may discuss a referral for corneal cross linking. Corneal Cross Linking is a specific treatment option undertaken by a specialised ophthalmologist. Central Coast Eyecare’s Optometrists work closely together with local ophthalmologists to offer patients the best outcome should a referral be indicated.

CO-MANAGEMENT OF EYE DISEASE

Co-management involves sharing your care between closely co-operating health practitioners.

Some systemic and ocular diseases and/or the medications used to treat these conditions may require you to be under the ongoing care of a medical specialist such as an ophthalmologist, rheumatologist or endocrinologist, as well as your general medical practitioner.

The most common co-management arrangements are those between us and ophthalmologists. In these circumstances we perform some of the ongoing work of regularly monitoring your condition and report back to your ophthalmologist. This is an area we have considerable experience in.

There are a number of benefits to co-management. From your point of view, we are often more accessible and it is frequently easier to make an appointment with us than your specialist. Your costs are also reduced. Co-management also frees up the ophthalmologist’s time so that they can be involved in procedures that fully utilise their skills.

Examples of conditions that we are frequently involved in co-managing with ophthalmologists and other health professionals include glaucoma, diabetic retinopathy, pre- and post-cataract or laser refractive surgery, and monitoring for side-effects of medications such as Plaquenil.

DRY EYE MANAGEMENT

Dry eye is a chronic condition affecting about one third of Australian adults and half of those aged over 50. Females are at greater risk of developing the condition.

Normally, a film of tears covers the surface of the eye to keep it moist, and meibomian glands in the eyelids secrete oils to slow evaporation of these tears. Dry eye results if there is an insufficient supply of tears or if the tears evaporate too quickly.

Meibomian gland dysfunction (MGD), where the glands don’t function properly either due to blockage or oil deficiency, is a leading cause of dry eye.

Sufferers have difficulty reading, using a computer, watching TV and driving. In its most severe form, dry eye can be accompanied by inflammation of the eye surface, sleep disturbances and depression. The detrimental effects (physical, emotional, financial) can be quite significant. If left untreated, some people may develop corneal ulcers, corneal scars and, rarely, even loss of vision.

Dry eye is commonly confused with other conditions, in particular allergies. It can be tricky to diagnose because symptoms vary, are subjective and can be described in many different ways (e.g. ‘feels gritty’ vs ‘feels like something in my eye’).

The condition can’t be cured, but available treatments aim to relieve symptoms and improve quality of life. The earlier dry eye is detected, and treatment started, the better.

Treatment may include the following measures to relieve symptoms and prevent complications:

DRIVING VISION ASSESSMENTS

For a person to continue to meet the Austroads (Roads and Maritime Services NSW) criteria for driving they must meet certain standards. At Central Coast Eyecare we keep up-to-date with the latest eligibility requirements to hold a licence to drive (both for car and commercial licences).

With our testing that is specific for driving, we can assess your level of capability to meet the requirements, and to discuss alternative strategies when the standards are not met. We are fully equipped with perimetry for visual field analysis and comprehensive measurement of binocular vision, visual acuity, colour vision and glare.