Making a Move

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Making a Move

• Vision component
• Developed by Vision 2020 Australias Vision
  Initiative program funded by Victorian Department
  of Health

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Overview

• Eye health in Australia
• Preventing sight loss
• Anatomy of the eye
• Common eye conditions
• The relationship between falls and eyesight
• Whos who in eye care and where to get help

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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.

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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.

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Blindness and vision impairment in Australia
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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.

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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.

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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.

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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.

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The anatomy of the eye
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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.

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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.

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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.

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Age-related Macular Degeneration
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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.

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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.

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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.

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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.

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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

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Cataract
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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.

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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.

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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.

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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.

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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.

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Diabetic retinopathy
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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.

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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.

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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.

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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.

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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.

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Glaucoma
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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.

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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.

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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.

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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.

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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

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Refractive error
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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.

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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.

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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.

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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.

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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.

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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.

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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 persons vision
  please ensure that you refer on to the correct
  services see whos who section.

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Whos who in the eye care sector

• The following slides provide a brief introduction
  to whos 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

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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

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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 .
• Victorias 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.o
  rg.au

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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

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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

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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.d
  ocs/VESdir.pdf

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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 visit
• www.ranzco.edu

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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 [phone]
• www.eyeandear.org.au

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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

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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 lifes journey.
• No referral needed - enquiries from individuals,
  family members and health professionals are all
  welcome.
• Specialised services are available including,
  childrens mobility, acquired brain injury
  mobility, orientation mobility, occupational
  therapy, and guide dog mobility.
• For more information on guide dogs visit
• www.guidedogsvictoria.com.au

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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
  visitwww.visionaustralia.org.au
• Telephone 1300 VISION (1300 847 466)

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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

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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.

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Thank you

• For more information please contact
• Robyn Wallace
• Vision 2020 Australia
• [phone]
• rwallace_at_vision2020australia.org.au
• Or visit www.visioninitiative.org.au