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#SeeTheMusic and More – Cataracts, are they clouding your performance?

Cataracts and the performing arts professional

Being the UK’s only performing arts eye care specialists and the only optician registered with the British Association For Performing Arts Medicine (BAPAM), we understand first-hand how eye disorders can negatively impact a career. 

Artists such as musicians, dancers, singers, presenters and technicians including camera operators, sound engineers and Audio-visual technicians, are just some of the performing arts professionals we have assisted to see the music.

At some point in our lives, most of us will have vision problems. The majority of these problems are caused by refractive errors, which means they’re problems with the way the eyes focus light, rather than an eye disease or disorder. However, there are some eye disorders and diseases that many of us could experience. This blog series highlights the common eye conditions that many performing arts professionals encounter. 

Here is our list of the 5 most common eye disorders and diseases:

  • Cataracts

    are a widely occurring eye problem and usually affect people over the age of 65. Most have a visually impairing cataract in one or both eyes. Cataracts are usually seen as the formation of a dense, cloudy area in the lens of the eye. When this happens, light is simply unable to pass through to the retina and the victim is unable to clearly see objects in front of them.

  • Dry eye disease

    is a common condition that occurs when your tears aren’t able to provide adequate lubrication for your eyes. Some people may experience subtle, but constant, eye irritation to significant inflammation and even scarring of the front surface of the eye. 

In different parts of the world, dry eye syndrome affects anywhere from 5% to 50% of the population. Contact lens wearers are particularly susceptible to the condition. The condition is also common in the elderly.

  • Glaucoma

    causes damage to the eye’s optic nerve.  In most cases, this is due to fluid buildup and increased internal pressure. This interferes with the transmission of images from the optic nerve to the brain. If the buildup of pressure continues without treatment, it may lead to permanent loss of vision. 

Glaucoma progresses relatively quickly and can cause blindness within a few years. The most common symptoms of glaucoma include tunnel vision, peripheral vision loss, blurry eyes, halos around the eyes, and redness of the eyes.

  • Macular degeneration (AMD)

    is a condition affecting the central part of your view. It typically affects people in their 50s and 60s. The condition does not cause total blindness. Nevertheless, it can make everyday tasks difficult, such as reading and recognising faces.

Your vision may deteriorate without treatment. AMD can develop slowly over several years (“dry AMD”) or rapidly over a few weeks or months (“wet AMD”).

The exact cause of AMD is unknown. The risk factors include smoking, high blood pressure, being overweight, and having a family history of AMD.

  • Retinal Detachment

    is precisely what it sounds like. It is the detachment of the retina from its place within the eye. There may be small tears in the retina before the whole retina is detached. If it is left untreated, complete vision loss can occur in the affected eye. It sounds painful, but people rarely feel any pain during retinal detachment.

There are various warning signs that a retinal detachment may occur. These include blurred vision, a sudden appearance of light flashes, and a curtain-like shadow in one’s field of vision.

Cataracts: An overview…

Cataracts are the result of the crystalline lens, developing cloudy patches. The crystalline lens is an important part of the eye’s anatomy that allows the eye to focus on objects at varying distances. It is located behind the iris and in front of the vitreous body.

These patches tend to grow larger over time, causing blurry, misty vision and eventually blindness.

Our lenses are generally clear when we’re young, allowing us to see through them. As we age they start to become frosted or yellow, like dirty bathroom windows, often severely limiting vision.

It is common for both eyes to be affected by cataracts. That said, they may not necessarily develop at the same time or be the same type of cataract in each eye. They’re more common in older adults and can impact daily activities such as driving. Cataracts can also affect young children and babies.

Seeking medical advice

Consult an optician if any of these symptoms occur:

  • Blurred or misty vision
  • Lights seem too bright or glaring 
  • You have trouble seeing in low light
  • Night driving is difficult
  • Colours appear faded
  • If you wear glasses, you may feel your lenses need constant cleaning, or that your lens coating isn’t working.

Although most cataracts aren’t painful and won’t irritate your eyes, if they’re in an advanced stage or you suffer from another eye disorder, they may cause discomfort.

Performing Arts Professionals and Cataracts

Q: Can Cataracts Affect My Performance?

A:  Cataracts can affect sight-reading and your ability to perform if your vision is affected as a result.  The crystalline lens is similar to the camera lens. Through it, light is focused on the retina for processing as vision. Cataracts form when Collagen, the most abundant protein in the body, builds up on the lens, clouding vision.

As cataracts progress, you may encounter issues with limited vision.  You may have difficulty seeing music on the stand, the accidentals, dynamics or even key signatures. For dancers, dance notation may appear blurred or for production staff problems viewing computer screens may become evident.  As cataracts progress, they can affect more aspects of your day-to-day and performing life if left unchecked.

We find that musicians tend to feel the effects of cataracts sooner than most general practice clients. This is because cataracts cause problems with sight-reading and depending on the type of cataract can appear as blurred patches or discoloured areas across the music manuscript. 

There are 31 types of cataracts, but the 3 main types of age-related cataracts are nuclear sclerotic, posterior subcapsular and cortical. Because they’re grouped by where they form, they present slightly different symptoms, develop at different speeds, and have different causes. They can all cause progressive vision loss, which means the vision gets worse over time.

Nuclear sclerotic cataract

Nuclear sclerosis is the most commonly occurring type of cataract. ‘Nuclear’ refers to it from the nucleus of the lens, while ‘sclerosis’ refers to hardened body tissue. 

Symptoms

It is difficult to focus when you have nuclear sclerosis. As your sight deteriorates, you might experience a temporary improvement in your close-up vision. As your cataract progresses, your vision will deteriorate again. Objects at a distance will appear blurry and colours will appear faded as the lens yellows further.

Cortical cataract

‘Cortical’ refers to the outer layer of something, which describes this cataract as being on the outer edge of the lens,– the opposite of a nuclear sclerotic cataract. A cortical cataract develops spoke-like lines that lead to the centre of the lens, scattering light as it enters the eye.

Symptoms

Your vision may be blurred or you may see blurry lines. You can also experience problems with glare from the sun and artificial lighting, as well as driving at night. Cortical cataracts may develop fairly quickly, with symptoms becoming more apparent within months rather than years.

Posterior subcapsular cataract

They form at the back of the lens – i.e., posterior – in the capsule where the lens sits (subcapsular). Cataracts in this area can produce more disproportionate symptoms for their size because the light is more focused towards the back of the lens. Diabetes or extreme short-sightedness place you at greater risk for a subcapsular cataract. Additionally, if you are exposed to radiation or use steroids, you may develop a cataract of this type.

Symptoms

Under certain conditions, a subcapsular cataract can cause difficulty seeing in bright light and can produce glare or halos around lights at night – so it can be particularly problematic when on stage or when dealing with stage lighting. You may have blurry vision and be unable to read.  Subcapsular cataracts tend to develop faster than both nuclear sclerotic and cortical cataracts.

Performers visual demands

Performers are required to use one or more of the following skills:

  • Rapid changes in focus. Changing focus between objects at different distances rapidly and accurately is vision focusing. A musician, for instance, needs to read the music on the stand, look at the conductor and other members of the ensemble all at different distances clearly and accurately. This can be affected by cataracts as they cause the lens to become stiff, affecting the lenses flexibility and the ability to change focus quickly.
  • Vision fixation: The ability to read sheet music, regardless of how fast its tempo. This also can be affected by cataracts as they cause blurring, glare and patchy vision.
  • Peripheral vision: The ability to see and observe out of the corner of your eye when looking at a fixed object such as sheet music on the stand. In an orchestra, a player must be able to see both their stand partner or another member of their section even when they may be unable to alter their head position due to their instrument.  This can be severely compromised by cortical cataracts that begin on the outside edge of the lens (the peripheral). Cortical spokes, or white streaks or wedge-shaped opacities, progress inward on the lens, impairing vision and obstructing light reflection. 
  • Focusing regulation: The ability to retain eye coordination during high-speed activities or while under high physiological pressure.

The above demands can place a lot of pressure on the performer, especially when their vision isn’t up to par. 

Effective treatment of age-related cataracts

For a while, new glasses and brighter reading lights can ease the symptoms of cataracts. 

However, cataracts do get worse over time, so you’ll eventually need surgery to remove and replace the affected lens.

The only proven treatment for cataracts is surgery. During cataract surgery, an artificial lens replaces the cloudy one inside the eye. The procedure is highly effective at improving vision, but it can take between two and six weeks for vision to be fully restored.

Generally, cataract surgery takes 30 to 45 minutes. It is usually done as a day surgery under local anaesthesia, and you can usually go home the same day. 

Monofocal lenses are offered by the NHS, which have a single point of focus. In other words, the lens will be fixed either for near vision or distance vision, but not both.

If you opt to have your surgery privately, both multifocal and accommodating lenses are available to you, which allow you to focus on both near and distant objects.

Unless you have opted for multifocal or accommodating lenses most people will need to wear glasses for some tasks, like reading, using computers or reading music.

If you have cataracts in both eyes, surgery is done 6 to 12 weeks apart to allow the recovery of one eye at a time.

In Summary

Cataract treatment is beneficial to both performers and amateurs. However, they do have limitations and will not stop the ageing process. We recommend that you continue with regular eye examinations after your surgery, Either every two years or 12 months, as recommended by your optometrists. As performers ourselves our unique perspective enables us to offer balanced, impartial advice on all aspects of cataract treatment.

Our optical specialists understand the demands of professional musicians and performing arts professionals. Working in collaboration with our dispensing opticians and optometrists, we are able to assist musicians. It is surprising how many musicians are unaware of the many solutions available to them. 

With the precision of our performing arts eye exams, the expertise of our optometrists and dispensing opticians using cutting edge diagnostic equipment and dispensing procedures our unique approach can help to resolve hyperopic performing arts practitioners’ vision problems.

Contact: To find out more about Allegro Optical, the musicians’ opticians go to; https://allegrooptical.co.uk/services/musicians-optical-services/

Categories
Music

#SeeTheMusic and More – Presbyopia and performing arts professionals

Presbyopia and the performing arts professional

In our unique position as the UK’s only eye care specialists working with performing arts professionals, we are well aware of how eye disorders and refractive errors can negatively impact careers. As BAPAM registered practitioners we are using this series of blogs to highlight and explain many common eye conditions that performers face. The performing arts professionals that we have helped include musicians and presenters, dancers and camera operators, sound technicians and singers.

The four most common types of refractive error are:

  • Myopia or Short-sightedness. Myopia results from light focusing just short of the retina due to the cornea or the eyeball being too long.
  • Hyperopia or Long-sightedness. Generally, hyperopia is a result of the eyeball being too short from front to back, or of problems with the shape of the cornea (the top clear layer of the eye) or lens (the part of the eye that helps the eye to focus).
  • Presbyopia or Old Sight. Presbyopia is caused by a hardening of the eyes crystalline lens, which occurs with ageing. As our lenses become less flexible, they can no longer change shape to focus on close-up images.
  • Astigmatism, or rugby ball-shaped eyes. Astigmatism causes blurred distance and near vision due to a curvature abnormality in the eye. A person with astigmatism either has an irregular corneal surface or a lens inside the eye that has mismatched curves. 

In the UK, 61 percent of people have vision problems that require corrective action. Just over 10 percent of people regularly wear contact lenses, and more than half wear glasses. However, not all vision problems are caused by refractive error. In spite of the name, presbyopia is not caused by refractive error, but rather by the hardening of the crystalline lens of the eye as we age. The lenses become less flexible as they age, so they cannot focus on close-up objects.

There are several symptoms associated with presbyopia, including blurry vision, headaches, and difficulty focusing on objects up close. Vision continues to deteriorate as we age. 

Presbyopia and the musician

Presbyopia affects performing arts professionals slowly over time and may present some with career-limiting consequences A performer with presbyopia has difficulty seeing objects that are close to them clearly, from around the age of 50 this includes the music on the stand. Often objects at a distance remain relatively clear unless the presbyopia is combined with another eye condition or refractive error.  The numerous working distances present a variety of challenges to the performer. The need to see the music on the stand is often the biggest issue. Even so, seeing the conductor, the audience, the soloist, and other sections of the ensemble clearly can pose a challenge. 

What causes presbyopia?

As we age, the lens of our eyes becomes less flexible and we have difficulty focusing on close-up objects. Imagine the eye as a camera. Whether an object is near or far, the lens of the camera can autofocus on it. Our eyes work in a similar way. The iris works with our corneas to focus light. Our curved corneas bend light, and then a tiny circular muscle encircling our crystalline lenses contract or relax, causing a change of focus. The muscle relaxes if the object is far away. When something is close, the muscle contracts, allowing us to focus on nearby items such as a book, computer screen, mobile phone or sheet music. However, as we age, our eyes continue to grow and add layers of cells to the lens – a bit like an onion! As a result, the lens becomes thicker and less flexible. Nearby objects are blurred as a result.

#SeeTheMusic and more

The visual demands of performing artists and those who work in production are extremely diverse. Thus, presbyopia can pose some serious challenges. Musicians and presenters must contend with music on the stand or an autocue for the presenter. In the production control room, the production team views multiple screens on a wall of video monitors. The team typically reviews scripts, running orders, production notes and often musical scores as well. Focusing at multiple distances can be challenging in a fast-paced environment such as this.

Musicians and performers often ask us, as performing arts eye care specialists, “What makes their eyes so unique?” Performers’ vision or their eyes aren’t particularly exceptional, but the way they use them is. Artists share many characteristics with athletes when it comes to the many visual demands they are subjected to.

The vision skills required for all sports, both competitive and non-competitive, differ depending on the sport. The same is true for most performers, whether they are professionals or amateurs, what instrument they play and the ensemble they play in. Their role as a performing arts professional presents different challenges, from sound technicians, camera operators, production staff and lighting engineers, they all have multiple viewing distances and visual demands.

Allegro Optical has developed detailed assessments of vision skills for artists and performers of all ages using advanced diagnostic equipment and investigative techniques.

Most performing arts professionals need one or more of the following skills:

  • Vision focusing:

    A capability to change focus quickly and precisely between objects of different distances. Musicians must be able to read the music on the stand, look at their conductor, and see other sections of the ensemble clearly and accurately from different distances.

  • Vision fixation:

    Music reading skills, particularly at a fast tempo and regardless of how fast the music moves.

  • Peripheral vision:

    Observing an object out of the corner of your eye, such as a sheet of music on a stand or a bank of flat or curved screens in a production room. Even when a player is unable to alter their head position due to their instrument, they must still be able to see both their stand partner or another member of their section.

  • Focusing regulation:

    Maintaining eye coordination during high-speed activities or when under high physiological pressure.

Effective treatment of Presbyopia

Spectacles

Presbyopia presents unique challenges for first-time spectacle wearers, such as a reduction in depth of focus when wearing reading glasses. Spectacles used solely to correct presbyopia (reading glasses) have a number of disadvantages, including an enlarged image size or magnification, peripheral distortions, and a reduced field of vision.

All of these present performance-limiting challenges to the performer. As Michael Downes, Director of Music St Andrew’s University said “Things had become more challenging very quickly – until I was 47 or 48 I didn’t have any problems at all, but then they rapidly became severe. The ‘tipping point’ was an April 2019 concert – I realised that unless I did something about it I would no longer be able to carry on doing my job to a satisfactory standard.

Without the help given me by Allegro Optical, I think I would be continuing to have very severe difficulties.”  

Many performing arts professionals turn to varifocals, bifocals or “office” lenses to resolve their vision problems, however all of these lenses present the musician with problems. Even the very best individual designs and “tailor made” varifocal lenses provide a narrow field of clear vision. 

Occupational, “Office” or computer lenses provide a wider field of view, but the depth of field is often limited to 2-4 metres.

Bifocal lenses do offer a limited solution in that the bottom of the lens will magnify the music on the stand and the upper part of the lens provides a clear view of the conductor, however, the wearer does experience two different image sizes. This is known as image jump and it can present problems to some wearers.

Contact lenses

Some performers prefer to use contact lenses, particularly if they find using glasses inconvenient or unattractive.

The lightweight and near-invisible properties of contact lenses make them appealing to performers, but a presbyopic correction can sometimes be less satisfactory if not worn before.  Presbyopic contact lens wearers often complain that they can’t see as well in contact lenses and that their distance vision is compromised.  In addition to a long-wear period and a dry, warm and often dusty environment, wearing contact lenses on stage can also exacerbate dry eyes. Most contact lens wearers experience dry eye symptoms toward the end of the day. Unfortunately, the majority of musicians perform in the evening, so this often coincides with their performances. For musicians, especially those who work as freelancers or session musicians, dry eyes can lead to blurred patches of vision that make sight-reading difficult.

Laser eye surgery

Laser eye surgery is often considered as a way around having to use glasses and contact lenses, we would add a word of caution here for performing arts professionals. We see many clients who come to us a few years after having undergone laser surgery. Most complain that while they can still see well in the distance and for reading, their music reading distance is deteriorating, especially if they have opted for a monovision correction. When performers ask us about laser surgery we usually recommend lens replacement surgery. 

Lens implant surgery

Lens implants are a viable and long-term treatment for presbyopia. A small incision is made in the cornea to implant an artificial multifocal lens into your eye to focus light more clearly onto the retina for all distances.

Also known as Refractive lens exchange (RLE) is an operation similar to cataract surgery in which the natural lens is removed and replaced with an artificial one.

The procedure is typically done under local anaesthesia, and you can normally go home the same day. The procedure is usually done separately for each eye.

In Summary

Both performers and amateurs find many of the optical corrections discussed above to be a viable solution to the problems posed by presbyopia. Some however find the plethora of solutions available on the high street to be far from ideal. 

As performers ourselves our unique perspective enables us to offer balanced, impartial advice, it also allows us to create unique lens designs and optical solutions to correct the vision disturbance presented by presbyopia. 

Our optical specialists understand the demands of professional musicians and performing arts professionals. Working in collaboration with our dispensing opticians and optometrists, we are able to assist musicians. It is surprising how many musicians are unaware of the many solutions available to them. 

With the precision of our performing arts eye exams, the expertise of our optometrists and dispensing opticians and their access to cutting edge diagnostic equipment and dispensing procedures our unique approach can help to resolve hyperopic performing arts practitioners vision problems.

Contact: To find out more about Allegro Optical, the musicians’ opticians go to; https://allegrooptical.co.uk/services/musicians-optical-services/