Low Vision

Low Vision

As an optometrist my main aim in our job is to protect clear vision. We do this not only by providing spectacles and contact lenses but by detecting preventable vision loss by eye disease. Unfortunately sometimes, regardless of early detection, these eye diseases lead to low vision.

Low vision is vision loss that can no longer be correct to a reasonable level with spectacles or contact lenses. Common conditions which lead to low vision are cataracts, age related macula degeneration, glaucoma as well as various other conditions.

"Sight loss affects people of all ages. As we get older we are increasingly likely to experience sight loss." (Access Economics, 2009)
In the UK: 

• 1 in 5 people aged 75 and over are living with sight loss
• 1 in 2 people aged 90 and over are living with sight loss
• 63 per cent of people with sight loss are female, 37 per cent are male.
• Estimated two million people in UK living with sight loss.

• "The number of people in the UK with sight loss is set to increase dramatically. It is predicted that by 2050 the number of people with sight loss in the UK will double to nearly four million" (Access Economics, 2009) 

Without additional help using low vision aids people can struggle to read post, medicine bottles, watch TV and cook. Part of the low vision assessment is providing aids to help with such tasks but another key part is helpful tips on how to make the tasks easier.

The Community Low Vision Service

If you still have problems seeing clearly even with up to date spectacles you may have Low Vision. A low vision assessment can help to identify any problems you have and to suggest how to best utilise your vision. The most common example of this is using a magnifier to make small print bigger but there are other low vision aids and advice available.

The service is free of charge and the Low Vision aids are loaned to you for as long as they are useful. Normal spectacles may be needed to get the most out of your Low Vision aid but these are not provided on the scheme.

Accessing the Scheme

The Scheme is available for all patients registered to a GP in the North Tees or the South Tees area. To enter the scheme you will need to have had an up to date sight test in the last year. Your current optician or ophthalmologist will be able to tell you if you meet the requirements (6/18 or less in BE or N9 or less in BE) and they will be able to provide you with a referral into the scheme. In the North Tees area we can see any age category but in the South Tees area the scheme is limited to over 60s.

If your last sight test was longer than a year ago another sight test would be required with your optician before entering the scheme. If you do not have an opticians in the area we will happily do a sight test for you. Most patients can claim a NHS sight test but there may be a charge for certain patients.

You should bring the following to any low vision assessment:

• your most recent spectacles
• any magnifiers or low vision aids you have (even if you’re not using them)
• The referral letter from your own optometrist
• anything that can help assess your visual tasks at home, e.g. crosswords, books, newspapers etc.

OPTICAL MAGNIFIERS - available on the NHS

• Stand Magnifiers
• Hand Magnifiers
• Pocket Magnifiers
• Spectacle Mounted Magnifiers

Other BASIC AIDS - these can be purchased from the RNIB

• Typoscopes
• Reading Stands
• Coloured Chopping Boards
• Level Indicators
• Talking Watches
• Large Print Books
• Audiobooks

LIGHTING

Good lighting can have a massive impact on the ability to read, especially to someone with Low Vision. They are also very good for intricate hobbies such as model making and crafts.

We can provide a high powered LED lamp for £70.00 which has a touch sensitive dimming feature.

ELECTRONIC MAGNIFIERS

Unfortunately Electronic magnifiers are not available to NHS Low Vision patients. However, they can achieve up to 12x without distortion whilst still being able to be carried in a large pocket. These often give much better quality of vision than higher powered optical magnifiers that are provided by the NHS and are worth the extra investment.

ESCHENBACH Smartlux Digital - £500

Optelec Compact+HD - £390 

Mr Iain Mellis is a qualified Optometrists with a Professional Certificate in Low Vision, registered to do the NHS low vision scheme at both Mellis Eyecare practices.

If you would like to book in for a Low Vision Assessment please call:

Thornaby 01642 751048 North Ormesby 01642 225671

Or book online at:

www.melliseyecare.co.uk

A Guide to Occupational Lenses

 What are occupational lenses? 

Unfortunately our eyes weren't designed to read for any length of time and this gets increasingly difficult as we get older. After the age of 40 nearly everyone will need reading glasses. However, if we still want to function normally and read, use a computer,  whilst being able to peer up and see distance objects like clocks and people's faces, then we need a more advanced lens type. Varifocals were often used for this but they were designed before the internet age. They are great for driving or walking around shopping but as they have little intermediate correction they are not very good for computer use. Therefore, for today's digital world lens manufacturers have come up with "Occupational" or "Indoor" Lenses.

Occupational lenses are a type of varifocal lens that are designed to suit a specific task, such as working at a computer in an office environment.

Normal Reading Glasses

Traditional reading glasses are clear at our normal reading distance of approximately 40cm. However, in today's modern world we often have to read at arms length or further due to phones, tablets and computer screens. With a normal varifocal lens there are three useful parts in the lens, these being the distance part, the intermediate part and the near part, found in the top, middle and bottom of the lens respectively. Typically a normal varifocal lens is set up to favour distance vision and near vision, and the intermediate part of the lens is quite small. This can be a disadvantage for anyone who spends a lot of time at a computer screen as it restricts the position from which a screen can be viewed clearly, and means that the wearer must keep their head in one place.

To overcome this difficulty, the occupational lens, also known as an indoor lens and as a degressive lens, increases the size of the near and intermediate parts of the lens. To do this it usually sacrifices some or all of the distance prescription.

Add Power 60

The Hoya Add Power 60 is a degressive lens that sacrifices all of the distance prescription in order to get the best possible vision in the near portion of the lens out to a distance of sixty centimetres, which is a typical computer screen distance. This lens is ideal for a job that requires a lot of reading and computer screen work, but little else.

Tact 200

The Hoya Tact 200 and Tact 400, also sacrifice the full distance prescription to maximize the near and intermediate parts of the lens, but in this case they allow clear vision out to 2m and 4m respectively. The Tact 200 would be ideal for someone working at a computer in a smaller office area, and the Tact 400 might be used by someone working at a computer in a larger, open office.

 Great for wearing indoors 

Great for reading music

For those people who want the advantage of a degressive lens, but without completely sacrificing the distance part of the prescription, Hoya supply the Workstyle range in 200 and 400 versions. These are lenses that maximize the near portion of the lens and the intermediate portion of the lens out to either 2m or 4m, like the Tact lenses, but which also retain a small portion of the lens for the full distance prescription. This offers an excellent solution to the requirements of office work, but because the distance portion of the lens is smaller than the intermediate and near portion, these lenses should not be used for driving. However, many people find them great for hobbies such as reading music or sports such as golf and shooting.

Contact Lenses

Contact Lenses

Contact Lenses offer different people different things. Some people wear CLs for cosmetic purposes, while others wear CLs as they give them the freedom to pursue sports like rugby and football or other outdoor activities. In some professions spectacles can be a hindrance and contact lenses can overcome this. In certain instances CLs can also give better vision than glasses.

As technology advances newer sophisticated materials are expanding the choice of lenses and the type of people who are suitable for contact lens wear. To find out if there is a type of contact lens suitable for you, please ask an optician. If you have asked previously and were told you were unsuitable this may no longer be the case so why not ask again?

What are contact lenses?

Contact lenses are small but powerful lenses that rest on the cornea of the eye and correct any refractive error the wearer my have. There are two main types of CLs:

• Hard: Rigid Gas Permeable
• Soft: Hydrogels & Silicone Hydrogels

Soft Hydrogel	Soft Silicone Hydrogel	RGP
Completely cover the cornea and do not move with the blink (good for sports). Comfortable from the start but not for sleeping in. Require careful cleaning and are more fragile than RGPs and can tear. Made from a plastic derived from HEMA Come in various water contents and are supplied on frequent replacement (disposable) schemes. Soft material requires special ‘toric’ design to correct astigmatism. Can be tinted to change or enhance the colour of your eyes. Can be changed monthly, fortnightly or daily.	Very much like standard hydrogels but contain silicon. Higher oxygen therefore eyes are healthier. Less complications in daily wear. Can sleep in the lenses (some lenses can be worn for an entire month if required). Can be changed daily, weekly, fortnightly, monthly. As far as health and comfort these should be the lenses of first choice for all Patients.	Smaller than size of cornea and move with blink (not good for some sports). lnitially uncomfortable to wear but eventually can be worn all day. Easy to keep clean and are durable but can flex and break if mishandled. Come in various permeabilities (dk, which is how much oxygen is transmitted) and designs. Replaced annually on our direct debit scheme Rigid material can correct  mild to moderate astigmatism (up to 2.00 DC) using ‘simple’ designs. Do not change the colour of the eyes.

Rigid Gas Permeable (RGP) Lenses

They are hard lenses partially made from silicon. Unlike old designs of hard lenses RGPs allow oxygen to travel through the lens allowing the eye to ‘breathe.’ Traditionally they have provided better vision, fewer complications and a longer lifetime when compared to soft lenses.

However, they do not provide the initial comfort of a soft lens and wearing times have to be gradually increased until you are wearing them most of the time.

Soft Hydrogel Lenses

These are lenses made from ‘HEMA’ or similar plastics which hold water within the lens substance. The amount of water can make up to 90% of the lens and this gives the lens its comfort when on the eye. Soft hydrogels can either be:

• daily disposable (after wearing the lens for a day it is thrown away).
• monthly disposable (after wearing the lens it is cleaned and stored in solution but after either two, three or four weeks the lens is again thrown away). These are inferior lenses and as such we no longer offer them to new clients.

Silicone Hydrogel Lenses

Hydrogels made with silicon allow greater transmission of oxygen through the lens. This means that the eye will look and feel fresher at the end of the day when compared to normal hydrogels. There are fewer complications with silicone hydrogels and some have been CE marked so you can sleep in the lenses. However, we do not recommend extended wear lenses due to the increased risk of infection.

Silicone hydrogels for extended wear are stiffer than traditional hydrogels so tended to be slightly less comfortable but as newer more advanced designs are introduced they are becoming more and more comfortable in comparison.  If you have ever been told to stop wearing CLs due to complications caused by lack of oxygen, these lenses could give you another option.

I have astigmatism? Can I still wear CLs?

Astigmatism is when the eye focuses light in two different planes, instead of focusing light to a sharp point. This often happens when the front of the eye, the cornea, is not spherical (like a football) but is shaped elliptically (like a rugby ball).

Spherical: The rays of light in all meridians are focused at the same point.

Astigmatism: Rays of light 90 degrees to each other are focused at two different points. This can’t be corrected by a simple spherical design of soft CL. It needs a more complicated toric CL that will correct both meridians of blur.

I need spectacles for reading. Can I still wear CLs?

People aged 40 and over start to lose the ability to focus at near, a term named presbyopia and when this happens they normally need bifocals, varifocals or separate reading glasses.

People often think they have to wear specs to correct this but both soft and hard lenses can correct for presbyopia. So if you are having problems reading, ask your optician about MULTIFOCAL CLs. You don’t have to be a current wearer of contact lenses to try these.



I like the sound of CLs. What happens now?

Everyone who wants CLs needs to have a Fitting Assessment and this is charged as a separate fee for new CL wearers.

This covers the professional time measuring the parameters of the eye and the time taken to teach insertion, removal and general handling of the lenses.

If it is found that you are not suitable for CLs an Assessment Fee will still need to be paid.

Once you and the Optician are confident in your handling you will be given a trial pair of lenses to try for two weeks.

You will then be asked to come back in wearing the lenses (ideally for about four hours) and to bring your spectacles to the appointment.

The Optician will test the fit of the CLs and the vision with the lenses in. He will also check that the health of the eye is not affected by the lenses.

The Optician may have to alter the prescription based on his finding and ask you to return after trying some different lenses.

If everything is ok and both you and the Optician are happy with the CLs, depending on your type of wearing scheme, you can take your lenses and solutions home.

We will then ask you to return for regular aftercares to make sure that no problems arise.

These are normally every six months and will coincide with picking up your next six months supply.

Recommended on Complete Eyecare

Mellis Eyecare Complete is our direct debit scheme

Mellis Eyecare Complete includes the following:

• An eye examination routinely every year (or more often if required)
• A contact lens check every 6 months.
• A FREE pair of spectacles worth £60.00 every year you are on the scheme
• 20% off branded spectacle lenses & frames

Direct debit covers cost of lenses already collected. Any outstanding debt would have to be paid on cancellation. If you fail to collect the lenses whilst continuing to pay your direct debit you will not be entitled to a refund as any lenses ordered are specific to your prescription and cannot be returned to the manufacturer.

Dailies  (30 pairs)

First Month purchased in advance then direct debit fee goes towards future supply

Lens Type	Manufacturer	TOTAL / Month	Lenses/Month	Fees / Month
MyDAY	Coopervision	£ 40.40	£ 30.40	£ 10.00	Soft	Daily
Proclear 1 Day	Coopervision	£ 25.80	£ 15.80	£ 10.00	Soft	Daily
Proclear 1 Day Multifocal	Coopervision	£ 44.60	£ 34.60	£ 10.00	Soft	Daily
Biomedics 1 Day Extra Toric	Coopervision	£ 43.40	£ 33.40	£ 10.00	Soft	Daily
Clariti 1 Day	Sauflon	£ 38.60	£ 28.60	£ 10.00	Soft	Daily
Clariti 1 Day Multifocal	Sauflon	£ 45.80	£ 35.80	£ 10.00	Soft	Daily
Clariti 1 Day Toric	Sauflon	£ 43.40	£ 33.40	£ 10.00	Soft	Daily

Monthlies.  (1 pair per month)

First 3 Months purchased in advance then direct debit fee goes towards future supply

Lens Type	Manufacturer	TOTAL / Month	Lenses/Month	Fees / Month
Biofinity	Coopervision	£ 17.35	£ 7.35	£ 10.00	Soft	Monthly
Biofinity Torics	Coopervision	£ 19.57	£ 9.57	£ 10.00	Soft	Monthly
Biofinity XR	Coopervision	£ 18.95	£ 8.95	£ 10.00	Soft	Monthly
Biofinity Multifocal.	Coopervision	£ 23.61	£ 13.61	£ 10.00	Soft	Monthly

Rigid Gas Permeables

Lens Type	Manufacturer	Initial Fee	TOTAL / Month	Lenses /Month	Fees / Month
GP Torics.	Thomson	£ 150.90	£ 22.58	£ 12.58	£ 10.00	RGP	Yearly
Maxim Varifocal.	Thomson	£ 190.90	£ 25.91	£ 15.91	£ 10.00	RGP	Yearly
Optimum Comfort 65	Thomson	£ 90.00	£ 17.50	£ 6.08	£ 10.00	RGP	Yearly

If you would like to book in for a contact lens fitting please give us a call:

Thornaby 01642 751048 North Ormesby 01642 225671

Or book online at:

www.melliseyecare.co.uk