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#SeeTheMusic and More – Glaucoma, the silent thief of sight

Eye conditions and the performing arts professional

Being the only performing arts eye care specialist in the UK as well as the only optician registered with BAPAM , we fully understand how issues with the eyes can negatively affect a performer’s career.

Musicians, dancers, singers, presenters, camera operators, sound engineers, and video technicians have all benefited from our assistance.

We all may experience vision problems at some point in our lives. Most of these problems are caused by refractive errors, which affect the way the eyes focus light, rather than an underlying condition or illness. Nevertheless, eye conditions affect many people. The purpose of this blog series is to examine common eye disorders experienced by performing arts professionals.

Glaucoma – What exactly is it?

The term “glaucoma” refers to a group of diseases that affect the optic nerve, which connects the retina to the brain, resulting in a loss of peripheral vision. Primary open-angle glaucoma (POAG) is the most common form of glaucoma.

Of the multiple types of glaucoma, the two main types are open-angle and angle-closure glaucoma.

Variants of open-angle and angle-closure glaucoma include:

  • Secondary Glaucoma.
  • Pigmentary Glaucoma.
  • Pseudoexfoliative Glaucoma.
  • Traumatic Glaucoma.
  • Neovascular Glaucoma.
  • IridoCorneal Endothelial Syndrome (ICE)
  • Uveitic Glaucoma.

As glaucoma is asymptomatic, but causes irreversible vision loss, it has been referred to as the “silent thief of sight.”. According to the World Health Organisation, it’s a leading cause of irreversible blindness (World Health Organisation, 2010). (Bunce et al., 2010) cites it as the second most common cause of visual impairment registration in England and Wales. Glaucoma is an umbrella term for a large group of disorders with a wide variety of clinical and pathological characteristics. The common characteristics are: 

  • Optic nerve damage
  • Visual field loss

The disease is a silent progressive disease and, if detected and treated early, is preventable and can lead to significant visual impairment or blindness. Diagnosis is crucial, and adherence to treatment is essential to prevent vision loss.

Glaucoma accounts for the majority of the workload (1 million visits per year) in  UK eye clinics. About 2% of people over 40  years of age and nearly 10% of people over  75 have primary (chronic) open-angle glaucoma (POAG). Only about half are diagnosed (National Institute for Health and Care Excellence, 2009). The social and economic burden of glaucoma-related vision loss and  workload is likely to increase due to longer life expectancy (Coleman and Miglior, 2008; Burr et al., 2007). Because glaucoma patients may  have no symptoms until they have lost their vision, then the loss of vision is irreversible. Once vision loss is apparent, 90% of the fibres of the optic nerve  may be irreparably damaged (NICE, 2009). Treatment slows progression by lowering intraocular pressure (IOP).

Consequences of glaucoma for the performer

Damage to nerve cells in the retina leads to damage to the visual field. Peripheral fields are usually damaged first. Loss of peripheral vision may go unnoticed until it reaches a significant level, due to the small role that peripheral vision plays in the overlapping vision of our eyes and in perceiving what most people can see. Deterioration usually progresses slowly over the years, although some types of secondary open-angle glaucoma can progress faster.

Performers, particularly musicians who play larger instruments such as pianos, organs and large percussion use their peripheral vision more than most. As a result the symptoms of peripheral vision loss may well be detected sooner. 

Some instrumentalists however may be at an increased risk of the condition. Recent studies suggest that musicians playing high-impedance wind instruments may be susceptible to glaucoma. This could be because the Valsalva manoeuvre is generated when blowing into a high impedance wind instrument. The Valsalva manoeuvre has been reported to cause high intraocular pressure (IOP). 

High and low resistance wind musicians experience a temporary increase in intraocular pressure while playing their instrument. The magnitude of the IOP increase is greater for high resistance players than for low resistance players. High-resistance wind musicians have a lower incidence of visual field loss than other musicians but IOPS are significantly higher, which is associated with lifetime playing time. The cumulative effects of long-term intermittent elevated IOP while playing high-resistance wind instruments could cause cell damage and possibly lead to an increased risk of developing glaucoma.

How do we check to see if you are at risk of glaucoma?

Tonometry

Our optometrists perform a number of different tests to look for glaucoma. We use a device called a tonometer to measure the pressure inside your eye. Our optometrist will put a small amount of anaesthetic and dye into the front of your eye. They will then shine a light into your eye and then use a tonometer to measure the pressure in your eye. Some optometrists use a different instrument that uses a puff of air called a non contact tonometer which does not touch the eye to check the pressure.

A visual field test determines whether any portions of vision are missing. It’s possible that you’ll be shown a series of light dots and asked to press a button to indicate which ones you saw. Some little dots may appear at the periphery of your vision (peripheral vision), which is generally the first area of glaucoma to be impacted. If you can’t see the spots you may be at risk of glaucoma.

Evaluation of the optic nerve 

Because the optic nerve, which connects your eye to your brain, can be damaged in glaucoma, an examination may be performed to determine its health.

Slit Lamp Exam

Eye Drops will be used to dilate your pupils for the test. Your eyes are then examined using a slit lamp (a microscope with a bright light) Slit-lamp examination of the optic nerve magnifies the view with hand-held lenses, allowing for greater control over the examination. This technique produces a stereoscopic, inverted image of the optic nerve.

Optical coherence tomography (OCT) tests create a topographical map of the optic nerve by taking cross-section pictures of the retina with non-invasive light waves. The thickness of the nerve fibre layer, which is the portion of the optic nerve most vulnerable to eye pressure elevation, is measured by an OCT test.

Referral to a specialist

If signs of glaucoma are detected during any of the tests, you will be referred to an ophthalmologist for further investigation. If you do have glaucoma the ophthalmologist will confirm your diagnosis and find out:

  • how far the condition has progressed
  • how much damage has been done to your eyes
  • what may have caused the condition

The ophthalmologist will be able to advise on treatment. 

In some cases, your ophthalmologist will continue to treat you. But for less serious types of glaucoma, you may be referred back to the opticians.

Treatment

There are a few courses of action to treat glaucoma, including eye drops, laser treatment and surgery. The best treatment for you will depend upon your condition.

Eye Drops

Treatment can’t reverse any vision loss but it starts with eye drops. These can help reduce IOP by improving drainage from your eye or by reducing how much fluid your eye makes. Depending  how low your eye pressure should be, more than one type of the eyedrops may be recommended.

Laser Treatment

Laser treatment might be suggested in the event that eye drops don’t work.

This is where a high-energy light is focused on part of your eye to stop or reduce fluid build up.

Sorts of laser treatment include:

laser trabeculoplasty

a laser is used to open up the vessels inside the eye,  to allow more fluid  to empty out and reduce the tension inside

cyclodiode laser treatment

a laser is utilised to remove a small amount of eye tissue that delivers the fluid, which can then decrease pressure in the eye

laser iridotomy

a laser is used to make openings in the iris to permit liquid to escape from your eye.

Surgery

In situations where eyedrops or laser treatments haven’t been successful surgery may be offered.

The most well-known sort of a medical procedure for glaucoma is called trabeculectomy. It includes removing part of the eye’s drainage mechanisms to permit more liquid to escape without any problem.

There are other glaucoma surgical options, including:

trabeculotomy — similar to a trabeculectomy, other than a tiny segment of the eye-drainage vessels are removed using an electric current.

A segment of the white outer covering of the eyeball (the sclera) is removed to allow fluid to drain more easily from the eye.

Deep sclerectomy — the drainage channels in the eye are enlarged, sometimes with the insertion of a small device.

trabecular stent bypass – a small catheter is inserted into your eye to improve fluid outflow.

Conclusion

Patients with chronic conditions, such as glaucoma, should work with their optometrist and other eye care professionals. Preventing irreversible and severe vision loss necessitates early detection and screening.

Getting regular eye exams is now the easiest approach to avoid major glaucoma damage.

Most people can keep their vision with early identification and meticulous, lifetime treatment. In general, a glaucoma check should be performed:

  • under age 40, every two years
  • from age 40 to age 64, every 12 months
  • after age 65, every six to 12 months

A screening should be done every year or two in those with high risk factors after 35. In addition to people of African descent and people with diabetes, those with a family history of glaucoma and wind instrumentalists have an elevated risk of getting glaucoma. If you have a parent or sibling with glaucoma, you are at higher risk.

Benefits of Exercise

A moderate exercise program is beneficial to your overall health, and studies have shown that moderate exercise, such as jogging or walking, three or more times a week, can lower IOP.

You can only reap the benefits of exercise for as long as you continue to exercise; this is why moderate exercise on a regular basis is recommended. The practice of yoga can be beneficial, but it’s important to avoid inverting positions, such as headstands and shoulder stands, as these can increase IOP.

If you have any questions or concerns regarding an exercise program, you should speak with your doctor.

Keep Your Eyes Protected

While participating in sports or doing home improvement projects, it is important to wear protective eyewear.

Protecting your eyes from injury is another way to prevent glaucoma. Traumatic glaucoma and secondary glaucoma are both caused by injury to the eyes.

The best defence against glaucoma and other eye diseases is a regular comprehensive eye exam.

In Summary

The optometrists at Allegro Optical have the technology, facilities, including our fantastic 3D OCT eye scanners, and experience to determine if your eye flashers are serious. Early detection and treatment are critical for preserving your vision, eye health, and performing arts career.

As the UK’s only specialist Performing Arts eye care provider we understand more than most just how much dry eye conditions can impact a performer’s career and everyday life. 

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 performing arts practitioners’ vision problems. 

If you are suffering from any of the symptoms mentioned above or have any of the symptoms described then please speak to one of our staff.  To book an appointment or find out more about our exclusive dry eye programme, Call us today and speak to a member of our team. 

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 -Floaters and Flashes, what are they and should you worry?

Eye conditions and the performing arts professional

Because we are the only performing arts eye care specialist in the UK and the only optician registered with BAPAM, we understand how eye conditions can negatively impact a performer’s career.

Performing arts professionals, such as musicians, dancers, singers, presenters, camera operators, sound engineers, and video technicians, have all benefited from our assistance to see the music.

We are all likely to encounter vision problems at some point in our lives. Most of these problems are caused by refractive errors, which affect the way the eyes focus light, rather than a condition or illness affecting the eye. Even so, many of us could be affected by eye conditions. In this series of blogs, we examine common eye conditions experienced by performing arts professionals.

Floaters – What are they?

In today’s blog we are looking at two common vision complaints, Floaters. When performing on stage under bright lights, floaters and flashes can be especially bothersome. Many of our clients comment that they see floaters, but what exactly is a floater? 

A “floater” is a small spot in your vision that is caused by tiny particles of collagen or protein that form in the jelly-like substance in the centre of the eye. When the jelly-like substance in the eyeball (known as the vitreous gel) changes, shrinks, or becomes more liquid, it causes eye flashes and floaters. The optometrist may sometimes refer to this as posterior vitreous detachment, and it is a regular occurrence as we become older (PVD).

When we see a floater, we are actually seeing the shadow cast on the retina, not the floater itself. As the vitreous diminishes, the gel-like substance becomes stringy, casting shadows on the retina and causing floaters to appear in our field of vision. The retina is a thin layer located at the back of the eye. This layer converts light energy into electrical signals, which are then transmitted to your brain and processed to produce the images we see (our vision).

Floaters come in a variety of shapes and sizes: some are light, others are dark, some are chunky, and still others are stringy. When we try to look at them directly, they appear to dart away from our field of vision. Floaters are more visible when viewed against a bright plain background and on their own are rarely something to worry about. Floaters are much more common than flashes. 

Floaters are common and, in most cases, pose little risk to our vision or eyesight. They usually do not require treatment, but they might occasionally be a symptom of retinal detachment, which is a more serious problem that necessitates medical attention. When the vitreous, which is shrinking, drags on the retina, drawing it away from the back of the eye and effectively tearing it, retinal detachment occurs. Because retinal detachment can permanently damage your vision, it is best to have your eyes checked as soon as possible rather than ignoring the problem and risking vision impairment.

Blurred vision, pain in your eye, a sudden increase in floaters or flashes, the sudden appearance of floaters or flashes, a decline in your central vision, or shading of vision are all signs of a more serious problem.

Why the flashes?

Flashing lights or lightning streaks may appear when the vitreous gel in our eyes pulls on the retina. After being hit in the eye or on the head, many people describe this sensation as seeing “stars.” These light flashes can happen on and off for weeks or months.

Eye flashes appear in our field of vision as dots or pinpricks of light. They come in a variety of shapes and sizes, some of which are wavy, others jagged, and still others which resemble shooting stars.

It is common to see brief flashes of light, and in many cases, there is no cause for alarm. We recommend that anyone experiencing frequent, persistent, or increasing occurrences of eye flashers see an optometrist as soon as possible.

Flashes can occur as a result of the following conditions:

  • Ageing – Causes the vitreous to shrink or change, resulting in flashes of light. The likelihood of seeing light flashes increases with age.
  • Pressure on the retina – Rubbing your eyes too hard or being struck in the eye can cause the vitreous to bump the retina, resulting in eye flashers.
  • Migraine – A migraine can cause vision problems. As part of a migraine, you may experience glinting lights, dots, sparkles, and flashes of light.

Is it a Serious Issue to Have Eye Flashes?

Given how important our vision is to us, it’s natural for us to wonder if our vision is in danger when we see a flash of light in our eye. While many cases of eye flashes are considered normal, they can also be the result of a serious retinal condition.

Tear or Detachment of the Retina

In rare cases, the vitreous can pull the retina so hard that it tears, causing it to peel from its position at the back of the eye. Flashers can be caused by a torn or detached retina.

The sudden onset of new eye flashers, persistent flashers, a floater shower, and flashes of light accompanied by blurry vision are all indications that an optometrist should be seen as soon as possible. To avoid blindness or partial vision loss, retinal surgery or other interventions may be required.

In Summary

The optometrists at Allegro Optical have the technology, facilities, including our fantastic 3D OCT eye scanners, and experience to determine if your eye flashers are serious. Early detection and treatment are critical for preserving your vision, eye health, and performing arts career.

As the UK’s only specialist Performing Arts eye care provider we understand more than most just how much dry eye conditions can impact a performer’s career and everyday life. 

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 performing arts practitioners’ vision problems. 

If you are suffering from any of the symptoms mentioned above or have any of the symptoms described then please speak to one of our staff.  To book an appointment or find out more about our exclusive dry eye programme, Call us today and speak to a member of our team. 

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 – Dry eye, it’s a blinking nuisance

Dry eye disorders 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.

Almost all of us will experience vision problems at some point in our lives. Refractive errors are responsible for most of these problems, which means they affect the way the eyes focus light, rather than an eye disease or disorder. Nonetheless, many of us could be affected by eye disorders or diseases. In this blog series, we examine common eye conditions experienced by performing arts professionals. 

Here are the five 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.

Dry Eye Disease: An overview

It will never be possible to completely cure Dry Eye, however, we can easily manage and its symptoms are treated and alleviated with a tailored treatment program.

What is Dry Eye?

Dry eyes are caused by either not producing enough tears or tears that are of poor quality or that evaporate far too quickly.  Tears are normally made to keep the surface of the eye moist and lubricated, so a lack of tears or a reduction in the quality can result in gritty, burning sensations in the eyes and also cause vision problems.

Symptoms of Dry Eye

The symptoms of Dry Eye may include:

  • Dryness
  • Burning, stinging or itching
  • Gritty feeling
  • Irritation from wind or smoke
  • Blurred or smeared vision
  • Tired eyes
  • Red eyes
  • Excessive watering
  • Photophobia (sensitivity to light)
  • Contact lens discomfort

Causes of Dry Eye?

  • Ageing
  • Allergies
  • Blepharitis (inflammation of the eyelids)
  • Dry environment and pollution
  • Computer use
  • Visual concentration,
  • Contact Lens wear
  • Hormonal changes, especially in women e.g. menopause
  • Dry Eye may also be symptomatic of general health problems or disease e.g. people with arthritis are more prone to Dry Eye (Sjogren’s Syndrome = arthritis + dry eye + dry mouth)
  • LASIK surgery
  • Preservatives
  • Certain types of medication – your optometrist or GP can advise you of any known links between medicine and Dry Eye.

Performing Arts Professionals and Dry Eye  Disorders

After a rehearsal or a concert, do your eyes become tired and irritated? After playing and reading the music for a while, does it start to look blurry? These are symptoms of dry eye. Having spoken to our clients and measuring their blink rate we have found that about  1/3 of them suffer from varying degrees of dry eye symptoms.

The bright stage lights and dry air found in most rehearsal rooms and orchestra pits, along with the almost constant staring at sheet music adds to the risk of developing dry eyes. Fortunately, there are simple steps you can take to ease its symptoms.

In most cases, dry eyes occur when your eyes do not make enough tears to keep them moist and to wash away dust. Environmental factors also contribute to dry eyes. Performing Arts and media production environments may contribute dry eyes.

Am I at risk of Dry Eyes?

Almost everyone suffers from dry eyes at least once or twice due to allergies, low humidity, or windy weather. Dry eyes are more likely to affect people with certain health conditions, such as autoimmune diseases.

Dry eyes may be caused by an underlying health condition such as diabetes, rheumatoid arthritis, or rosacea.

A dry eye disorder occurs when tear production is too little or when tears evaporate too quickly. In either case, there is not enough fluid in the tears. When tears are insufficient, the surface of the eye can become dry. The tears will also become saltier. This leads to inflammation, discomfort and blurred vision.

As a result of chronic dry eye disease, ocular tissues can become damaged and in severe cases, scarring can appear on the cornea, the clear dome of tissue that covers the front part of the eye. When the damage is severe, it can cause blurry vision or even blindness. It is not uncommon for dry eye disease to affect a person’s quality of life significantly. The effect of chronic, mild or moderate dry eye disease on quality of life can be as significant as breaking a hip due to pain and physical limitations, according to one study in the United Kingdom.

How to look after your dry eyes

The optician will probably start your dry eye care with advice to reduce environmental dryness and shake up your daily routine. The first line of care recommendations might include these tips:

  • Avoid air blowing in or across your eyes: Air conditioners and heaters contribute to dry eye disease. Point fans away from your eyes when inside or driving. In windy weather, wear protective eyewear such as sunglasses. Try using an eye mask or humidifier if you have a heater or fan running during the night while you sleep. Ceiling fans are notorious for drying out your eyes!
  • Blink more often or take an eye break: Our blink rate is lower when we read, play a piece of sheet music, look at a computer screen, or use our smartphones. When performing tasks that require more visual concentration, blink more often or close your eyes for a few minutes periodically.
  • Use artificial tears: Lubrication plays an important role in the treatment of dry eye disease. Preservative-free artificial tears are recommended. Essentially, this is due to the fact that preservatives used to stop bacteria from growing over time can damage the surface of the eye, causing further irritation and redness. A wide variety of pharmacies and supermarkets sell artificial tears that are free of preservatives. Infections can be prevented by purchasing individual vials. The key to artificial tear use is preventing the eyes from feeling dry in the first place, not after they begin to feel dry.
  • Try an eye gel or ointment: Longer-lasting lubrication might be provided by these thicker tears. Because the thickness can blur your vision for 15 minutes or more, you might consider putting them in before bed. If you don’t close your eyes completely during sleep, using gel overnight helps protect your eyes.
  • Use a warm compress:  Warm face cloths and eye masks can help clear blocked oil glands. Apply them for five to ten minutes twice a day. It can be relaxing to do this regularly to maintain your eye health.
  • Lid scrubs: It is important to keep the eyelid area clean in order to help keep the glands healthy. Several pharmacies and supermarkets sell lid scrubs that can be used to remove debris. You should scrub your lids every day and use warm compresses to increase oil production and keep your glands healthy. 

Advanced dry eye therapies

If self-care therapies don’t effectively treat your symptoms, your optician or optometrist might suggest more advanced, nonsurgical treatments, such as:

  • Medication adjustment: There are certain drugs that can worsen dry eye symptoms, including antihistamines, antidepressants, birth control pills, and blood pressure medications. Talk to your GP or pharmacist to find an alternative. Be sure to discuss all medications you are taking with your doctor and continue taking them as prescribed until your doctor recommends a change.
  • Prescription eye drops: Prescription eye drops help increase tear production and reduce inflammation in the eyes if the over-the-counter artificial tears aren’t enough. Ask your GP about a prescription for Hylo Forte if you have a persistent problem
  • Nonsteroidal anti-inflammatory drugs (NSAIDS): The discomfort caused by dry eyes can be relieved with over-the-counter NSAIDs.
  • Steroid eye drops: It is possible to need steroid eye drops for short periods of time when dry eye disease triggers inflammation. Due to potential side effects, these drops should only be used for a short period of time in order to reduce inflammation.

What if none of that works?

For cases of severe dry eyes we can refer to specialists who may recommend one of the following therapies;

  • Specialty contact lenses: The surface of the eye can be protected by certain types of contact lenses. They ensure that the cornea remains hydrated and promote healing. Contact lenses called scleral lenses can be helpful for patients with severe dry eye disease.
  • Eyelid thermal pulsation technology: It may be possible to receive an out-patient procedure if you suffer from meibomian gland dysfunction. A device is placed over the eyelids and heat is applied to soften the hardened oil-like substance. In addition, pulsed pressure is used to open and express the clogged glands. The glands can produce healthy oils once the hardened substance has been removed from the glands, preventing tears from evaporating. This procedure takes about 12 minutes.
  • Intense pulsed light (IPL) therapy: This procedure can be performed as an outpatient procedure for patients with rosacea and meibomian gland dysfunction. The small blood vessels that supply the glands in the eyelids can be treated using a cool laser. Consequently, the inflammation of the eyelids and ocular surface is reduced and healthy lipids that prevent tear evaporation are produced.

In Summary

As the UK’s only specialist Performing Arts eye care provider we understand more than most just how much dry eye conditions can impact a performer’s career and everyday life. 

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 performing arts practitioners’ vision problems. To help in the treatment of dry eye we have developed a Dry Eye Treatment Programme. This is a management program consisting of:

  • Initial 30 minute consultation with a dry eye specialist Optometrist, followed by reviews within the first 3 month period as necessary
  • Up to 3 appointments with an Optometrist and/or Dispensing Optician throughout the year
  • Preferential discounts of products to manage your condition
  • All this for just £4.99 per month
  • Treatment may consist of:
  • Ocular lubricants
  • Heat treatment
  • Lid massage
  • Lid hygiene
  • Supplements

If you are suffering from any of the conditions mentioned above or have any of the symptoms described then please speak to one of our staff.  To book an appointment or find out more about our exclusive dry eye programme, Call us today and speak to a member of our team. 

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 – 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/

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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/