Making a Move

2. Making a Move Vision component Developed by Vision 2020 Australia’s Vision Initiative program funded by Victorian Department of Health

3. 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

4. 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.

5. 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.

6. Blindness and vision impairment in Australia

7. 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.

8. 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.

9. 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.

10. 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.

11. The anatomy of the eye

12. 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.

13. 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.

14. 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.

15. Age-related Macular Degeneration

16. 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.

17. 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.

18. 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.

19. 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.

20. 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

21. Cataract

22. 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.

23. 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.

24. 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.

25. 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.

26. 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.

27. Diabetic retinopathy

28. 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.

29. 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.

30. 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.

31. 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.

32. 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.

33. Glaucoma

34. 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.

35. 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.

36. 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.

37. 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.

38. 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

39. Refractive error

40. 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.

41. 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.

42. 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.

43. 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.

44. 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.

45. 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.

46. 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.

47. 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

48. 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

49. 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

50. 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