Harley Street Ophthalmology

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Ophthalmology literally means the study of eyes, and it focuses on both medical and surgical eye problems and diseases. A Harley Street ophthalmologist also covers some of the typical duties of an optomotrist in prescribing glasses if necessary to ensure the treatment is as complete as possible.

Diagnosis

Although the patient will often have a good idea of the problem with his or her eye, diagnoses are still undertaken in Harley Street ophthalmology clinics to pinpoint the exact issue and allow for more accurate treatment. These are arranged in consultation with the surgeon and use such advanced technology as OCT (optical coherence technology) which is effective in diagnosing retinal disease and glaucoma.


Paediatric ophthalmology

Paediatric ophthalmology is treatment aimed at children. A specialist Harley Street ophthalmologist will perform any appropriate ophthalmological operations with the child’s safety in mind. As a child is typically less resilient than an adult, it is the role of the ophthalmologist to make the operations as comfortable and pain-free as possible, offering all the possible anaesthetics. In some cases an alternative to the full adult operation must be administered and this will be explained to the parent and child in an informative consultation.

Squint

Squint (also known as strabismus) is a problem that can affect both adults and children; in children it is dealt with by paediatric ophthalmology. Squint involves a lack of alignment of the eyes which can have a number of ramifications, including poor depth perception. It can be caused either by the brain’s having difficulty in co-ordinating the eyes or by a problem with any of the muscles controlling the eyes. There is a range of variations of the condition, including paralytic strabismus; the diagnosis is used to distinguish the particular problem. Four main treatments are available at Harley Street for squint. Firstly spectacles may be prescribed to solve the problem. A number of squint variations can be dealt with by use of eye drops, and occlusion, a technique that involves temporarily patching one eye to make the other more functional, can also be offered. If none of these are suitable to the patient’s needs, and if the patient is eligible, surgery is another option, usually on the muscles responsible for the condition.

Cataract surgery

Typically a condition associated with old age (senile cataract) but also capable of manifesting in an individual of any age, a cataract is a clouding of the natural lens in the eye resulting in a lack of clarity of vision. Some causes include trauma or diabetes but often just age can lead to cataracts forming. A cataract is not a growth or skin over the lens but actually the lens itself. Untreated, a cataract can become a Morgagnian cataract which can cause extreme inflammation, and it can further develop into glaucoma. The basic aim of cataract surgery is to remove the cataract and replace it with a functional artificial lens. There are two main methods of cataract surgery: phaco (phacoemulsification) and ECCE (extracapsular cataract extraction). Both are performed by keyhole surgery and are done under anaesthetic. In phacoemulsification part of the capsule containing the lens is surgically removed. Then a probe is inserted which vibrates at an ultrasonic frequency and breaks down the cataract into pieces which can then be removed. The artificial lens can then be implanted and if necessary the incisions are sealed with stitches. This is generally the more common method, but in certain cases, such as harder cataracts, ECCE is used. The procedure involves a larger incision and the lens is surgically removed before being replaced. This requires more stitching but may be necessary if the surgeon reads this from the diagnosis. Although Harley Street surgeons offer a guidance on a range of replacement lenses, it is usually up to the patient to decide his or her preference.

Glaucoma

Glaucoma refers to a range of diseases in which the optic nerve is permanently and irreversibly damaged, typically as a result of raised pressure in the eye. If it remains untreated then the patient can become blind. There are two main types of glaucoma; closed angle, which is sudden and painful, and open angle, which is protracted and may not be conspicuous until already quite underway. Harley Street surgeons are able to stop the progression of the disease and prevent any further damage to the optic nerve. Due to the severity of the condition multiple diagnoses are given to the patient in order to allow for the best possible treatment. There a number of potential treatments for glaucoma which the surgeon will outline to the patient in order to make the optimum choice. One method of regulation is the daily application of eye drops which can halt the progression of the disease. If surgery is preferred, treatment by micropulse diode laser is an advanced method that leaves no scarring. As glaucoma involves a blocked fluid flow, laser treatment burns a part of the base of the iris to increase fluid output, combating the disease. Typically this is only an effective treatment for open-angle glaucoma. It also allows for re-treatment if deemed necessary by the surgeon. The most prevalent of surgical procedures in Harley Street ophthalmology clinics is trabeculectomy. This is a minimally invasive operation that uses microtube implants to reduce eye pressure and halt the progress of glaucoma.

Macular disease

Macular disease, or macular degeneration, is characterised by a loss in vision at the centre of the visual field in older people. It is caused by damage to the retina. Symptoms can include haemorrhages in the eye and distorted vision. There are again a number of treatments, most of which are aimed at preventing further degeneration. One of the more common involves injections which control abnormal blood vessel growth responsible for the condition; if this is a viable option a Harley Street surgeon will offer it. Similarly a laser can be used to destroy these blood cells, but this does result in a permanent blind spot. Photodynamic treatment is another option: in this a drug known as Visudyne is injected into the bloodstream and is absorbed the blood vessels. Next, a cold laser is shone on the retina for about a minute which activates the drug and destroys the vessels.

Risks

The risks of squint surgery are generally negligible. They can include perforation of the sclera (outer coating of the eye) and this can result in infection; this is however exceedingly rare. If surgery on the muscles is not completely successful then the muscle can become ‘lost’, causing numerous difficulties. The quality of Harley Street surgeons makes these risks even less probable. Typically the risks of glaucoma surgery are the possibilities of recurrence of pressure or damage. The operations are not generally risky but may need to be repeated numerous times in order to achieve a longer-lasting success. Again, the advantage of Harley Street treatment is that the first operation is usually very successful, and the risk of recurrence is low. Macular disease treatment is generally aimed at preventing further damage rather than encouraging the restoration of sight. At Harley Street there are experimental methods available but these do come with risks and these will be explained to the patient if he or she wishes to undertake them.

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