Conditions we treat

Cataracts

Cataracts occur when the lens, a small transparent disc inside your eye, becomes less transparent and more misty. Over time, this causes blurry or misty vision and can eventually lead to reduced sight until they are treated. Cataracts are common in older people and are a normal part of the ageing process of the eye. When we are young, our lenses are usually clear and transparent, allowing us to see through them. As we get older, they start to become cloudy and can limit our vision.

Sometimes, children can be born with cataracts or develop them in the first few years of life. However, most cataracts occur after the age of 50. Childhood cataracts require specialist assessment by our paediatric ophthalmology team.

In most cases, cataracts continue to develop slowly and surgery to remove the cataract may be needed to restore sight. Cataracts do not normally damage the eye in other ways.

Our services

We carry out cataract surgery in our day case department at the West of England Eye Unit Wonford, at Axminster Hospital and at the Nightingale Hospital Exeter. We do approximately 4,500 of these operations every year.

Our eye surgeons will replace the cloudy lens inside your eye with a clear artificial one.

It's the most common operation performed in the UK, with a high success rate in improving eyesight.

 

Treatment for cataracts

You can find out more about the treatment for cataracts on the NHS website. 

Post-cataract laser

During cataract surgery the lens inside the eye is removed, but most of the bag in which it is naturally held (known as the capsule) is left behind to hold the plastic lens implant that is put in. Sometimes the back surface of the capsule goes cloudy (posterior capsule opacification, PCO).

This is common, occurring in up to half all patients who undergo cataract surgery. It typically occurs within five years of surgery but can occur at any time. Sometimes the front of the capsule can shrink around the hole created in it at the time of cataract surgery (anterior capsule phimosis). These conditions cause blurry vision or glare, a bit like having a cataract again.

Luckily, the treatment is straightforward – laser can be used to make a hole in the capsule again. This is done in the eye outpatients department.

Typically your high street optometrist (optician) will identify this problem and refer directly to the laser service.

 

Our services

We carry out cataract surgery in our day case department at the West of England Eye Unit Wonford, at Axminster Hospital and at the Nightingale Hospital Exeter.

 

Treatment for cataracts

You can find out more about the treatment for cataracts on the NHS website. 

Adult Strabismus (Squint) / Ocular Motility

This service is for patients who have strabismus (squint, a turn in the eye) or a problem with their eye movements (motility). This can lead to double vision (diplopia), or the appearance (cosmesis) of a strabismus may be a source of anxiety.

Our specialists work closely with the orthoptic department to diagnose the underlying cause and offer treatment to correct double vision and, where appropriate, surgically straighten the eyes.

If you are referred to one of these clinics, you will usually see an orthoptist first. Orthoptists are specialists in measuring eye movements and strabismus (squint).

Once detailed measurements have been taken, you may see one of our specialist ophthalmologists who will assess your medical history, the results from the orthoptic examination, and may examine your eyes using the microscope to get more information.

Further tests, such as pupil reactions, visual fields (a measure of your peripheral or “side” vision) or blood tests may be required to determine the cause of eye movement problems.

Eye movement (motility) problems have a variety of causes, and we will usually refer to other specialists or your GP to manage the underlying issue. Some examples include trauma, thyroid eye disease, diabetes, high blood pressure, and stroke.

Longstanding strabismus (squint) does not usually need so many investigations. Many squints are present from a young age. This kind of squint may be corrected by surgery to move the muscles, but this is not appropriate in all cases, so the ophthalmologist (eye doctor) will discuss your options on a case-by-case basis.

General eye problems

The team in this service - sometimes also known as primary care - treats general eye problems.

If your symptoms or signs don’t fit neatly into one of our other sub-specialised services, you can be seen in the general clinic. These clinics are an opportunity for our specialists to make a full assessment of your eye problem(s) and decide on the best treatment for you.

Sometimes a referral to another sub-specialist clinic will be required, once the team in the general clinic has made a diagnosis.

 

Medical retina (including macular degeneration and diabetic eye disease)

This service deals with conditions affecting the photographic film at the back of the eye, called the retina and the central part of the retina (which gives detailed vision) called the macula.

These conditions might need treatment using eye drops, medications, injections, or laser.

We look after patients suffering from a range of retinal disorders, including:

  • Diabetic retinopathy and maculopathy, also known as diabetic eye disease
  • Uveitis, a form of eye inflammation
  • Macular degeneration, a condition which causes distorted, blurred or loss of vision
  • Inherited retinal dystrophies, a group of rare eye disorders
  • Retinal vascular conditions, a group of conditions affecting the blood flow to the retina

 

Treatment for Medical retina (including macular degeneration and diabetic eye disease)

You can find out more about the treatment on the NHS website. 

Glaucoma

Glaucoma is a common eye condition where the optic nerve, which connects the eye to the brain, becomes damaged. It's usually caused by fluid building up in the front part of the eye, which increases pressure inside the eye.

Glaucoma can lead to loss of vision if it's not diagnosed and treated early. It can affect people of all ages, but is most common in adults in their 70s and 80s.

We have a specialist glaucoma department in the West of England Eye Unit, where we diagnose and treat this condition.

Treatment for Glaucoma

You can find out more about the treatment on the NHS website. 

Cornea

The cornea is the transparent window at the front of the eye, and is responsible for two thirds of the focusing power of the eye. It must remain clear, smooth, and regular to provide good vision.

It can be affected by a wide range of conditions with a variety of causes.

The corneal service provides assessment and treatment for acute (short-term) and chronic (long-term) conditions affecting the cornea.

  • Infection, including those caused by the use of contact lenses
  • Corneal ulcer
  • Injury
  • Inherited and acquired corneal dystrophies
  • Corneal ectasia, such as keratoconus
  • Severe dry eye
  • Care of corneal grafts
  • Recurrent Corneal Erosion Syndrome (RCES)
  • Pterygium

Ocular Prosthetics

We run a dedicated ocular prosthetics service. Artificial eyes can be provided to people who have had their eye removed (enucleated or eviscerated) which is very rare, or to people who have damaged eyes, small eyes, or other eye-related conditions. 

Find out more by visiting our dedicated website. 

Surgical retina

This service deals with conditions affecting the photographic film at the back of the eye called the retina and the jelly within the eye called the vitreous.

This service focuses on specific conditions which may need surgical intervention. 

We look after patients suffering from a range of retinal disorders, including:

  • Retinal detachments, tears, or holes
  • Epiretinal membrane (ERM)
  • Vitreomacular traction (VMT)
  • Macular hole
  • Vitreous haemorrhage

Oculoplastics

Oculoplastics is a type of surgery carried out on the eye lids, sockets or eye ball, as well as some areas of the face. Oculoplastic surgeons are trained eye doctors (ophthalmologists) who specialise in this type of treatment.

Our surgeons perform surgery on the eye lid and facial plastic surgery. This includes removal of eyelid cysts, tumours, and reconstruction, repair of eyelids that have turned inwards or outwards (entropion or ectropion), drooping eyelids (ptosis correction) and eyelid reshaping (blepharoplasty).

We also treats blocked tear ducts with a variety of methods.

Minor operations may be carried out in our minor ops room by a specialist practitioner.

Paediatrics

Children typically have a slightly different range of eye problems to adults. They also require a unique approach to examining their eyes.

Our paediatric ophthalmologists specialise in examining, diagnosing and treating eye problems in children.

They aim to make each examination pleasant and welcoming for your child.

Optometry

Optometry involves examining the eyes to check for eye disease before providing treatment. Sometimes that treatment includes glasses, contact lenses, or magnifiers.

Optometrists (sometimes known as opticians) are eye-care professionals who train at university to examine the eyes.

All the specialist optometrists in the eye unit support consultant ophthalmologists (eye doctors) in macular/medical retina, cornea and glaucoma clinics. They also work independently in eye injection follow- up clinics and perform some laser treatments. Our dispensing optician provides a full glasses service for children coming to the eye hospital.

Core Optometry services include:

  • Glasses tests for adults with complicated eye problems
  • Complicated contact lenses (when sight cannot be improved with glasses) e.g. Keratoconus, corneal distortion, very high prescriptions, and scarred eyes
  • Adult and children low vision assessments (magnifiers and other aids)
  • Children’s glasses tests and checking the back of the eye as part of the “Children’s Rapid Access Clinic”, ophthalmology children’s clinic, and the Orthoptic screening programme
  • Specialist children’s contact lens fitting
  • Specialist glasses dispensing for children
  • Special school clinics at WESC foundation and other centres
  • DVLA Goldmann visual field testing
  • Arranging and managing  hospital placements for Pre-registration Optometrists and visiting undergraduates from the University of Plymouth Optometry School

Extended role services include:

  • Macula and Medical Retina clinic: working with the consultant ophthalmologist to examine patients referred by their local optician. We help to diagnose their eye problem and arrange treatment if required, as well as monitor patients who are having treatment
  • Cornea clinic: working alongside the consultant ophthalmologist to monitor patients who might need or have had a corneal graft, treat corneal infection, and diagnose corneal conditions
  • Ectasia monitoring clinic: assessing patients with keratoconus and similar eye conditions to detect any progression in the disease and to refer for treatment with corneal cross linking if appropriate
  • Glaucoma clinic: managing patients with unstable glaucoma to consider further treatment with eye drops, laser, or surgery.
  • Laser clinic: performing laser to clear debris off the back of the implant after cataract surgery or improve drainage from the eye in patients with glaucoma.

Facial Dystonia

Facial dystonia is a common condition in which there are involuntary spasms and sustained contractions of the muscles often affecting the eyelids.

Treatment with botulinum toxin injections underneath the skin of the eyelids and/or brows is usually very effective.

Dedicated facial dystonia treatment clinics are delivered regularly by a consultant ophthalmologist or specially-trained orthoptist.

Certification of Visual Impairment

Certificate of visual impairment (CVI) registration is the registration of patients deemed to be sight-impaired or severely sight-impaired. Registration takes place on the recommendation of your consultant ophthalmologist with guidance from other team members and following discussion with the patient.

Our Northern services are run by John Wade and Nicky Searle, both Rehabilitation Officers for the Visually Impaired.

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Last updated: November 15, 2022