When presenting to our staff for your appointment, new patients will be asked to complete a patient registration form that remains within your history.

If you have attended Melbourne Eye Specialists before, we do ask that you inform us of any changes to your personal details such as a change of address, Medicare details, contact phone number or if you have become entitled to any Centrelink benefits since your last visit.

If you required a new letter of referral for your consultation, please offer this to our staff when you present for your appointment.

As we age, the complex structures of the lids that allow them to sit gently opposed to the surface of the eye and blink easily without abrading the surface eye can become damaged or dysfunctional. As the lid loosens, the lid might turn out, an ectropion, or roll over and inwards, an entropion.

Loosening of the lower eyelid can contribute to watering of the eye – if the lid turns out then the puncta, the drain plug, may not be in contact with the tear film anymore.

Many of the lower lid problems are amenable to relatively surgical solutions, such as tightening of the lid, either at the nose end or at the temple side.

The upper lid most common problem suffered from is ptosis, or dropping of the lid, which most often is due to stretching of the muscle that holds the upper lid in place. Stretching may require the lid muscle to be tightened, a process which can either occur through the skin or through the under surface of the lid.

Ocular coherence tomography (OCT) has been an extraordinary advance in both retinal disease and glaucoma management. Current OCTs, such as the NIDEK that we use, have resolutions down to one micron and tell change in structures at the back of the eye, sometimes with great accuracy. There is still some variation between tests, but the advantage of the NIDEK is it takes three complete data sets and so it is much less prone to single point errors.

The OCT is used for retinal disease, such as diabetic retinopathy or macular degeneration, but also to check for structural changes in glaucoma, serial OCT is a very valuable way to tell change in glaucoma. We use the OCT for assessing structural changes in glaucoma.

It certainly may, but in a very unpredictable manner. Some patients have a disease which comes and goes in short-lived episodes (“flare ups”). Others have a chronic disease which is active for many months or years. In both instances, the disease may “run its course” eventually, and become inactive, not requiring any more treatment. The challenge is to protect the eyes from the effects of uveitis and to minimise the damage caused until the disease becomes inactive.

Cataract surgery is generally useful in glaucoma, in fact it can form part of the strategy to controlling the disease. Cataract surgery rarely makes glaucoma worse but it depends on how much control is exerted over the glaucoma before the cataract surgery. Mostly cataract surgery is a good thing for glaucoma and should make the glaucoma a bit easier to control.

Injury to the eye can cause a number of enduring complications but glaucoma is a common one. This most often happens after blunt injury to the eye, such as occurs after a tennis ball or a blow to the eye. In this instance the pressure may rise initially then settle only to rise again later, sometimes much later. After blunt injury a risk management strategy around developing glaucoma needs to be implemented lifelong. This does not need to be too onerous and will often involve optometry.

Traumatic glaucoma often eggs exist in an eye that is otherwise injured and reconstruction of the front part of the eye is often involved in managing the glaucoma. This involves surgery to the cornea or iris and sometimes the replacement of the lens, either artificial or original which may need to be sutured in place.

We will work with retinal doctors and corneal doctors with complex trauma cases to restore and/or preserve vision, and to create a comfortable and cosmetic eye.

Sometimes there is a role for plain photographs of the optic nerve or some structure at the back of the eye, and we use a Kowa non-mydriatic camera, whose capacity for clarity, even through an undilated pupil, is unrivalled. Simultaneous stereo photographs allow us to give a three-dimensional rendition, particularly of the optic nerve head, that which is affected in glaucoma.

Although we do not routinely take serial photographs, we often take photographs at the beginning of a course of treatment, which allows us to follow against these photographs with time.

After your orthoptic assessment, you will see your ophthalmologist who will address your problems, provide a diagnosis when appropriate and advise treatment for managing your ocular condition.

Prior to seeing the doctor, patients will usually see one of our university-trained orthoptists who will perform preliminary testing to assist with history diagnosis, treatment and ongoing management.

The orthoptists conduct assessments of your vision and glasses requirements. They may also perform other tests that cover cataract measurement assessment, glaucoma diagnosis (including automated perimetry, and fundus photographs) and retinal assessment (including photos and angiograms). The orthoptist may give you drops to dilate your pupils, which means there may be a degree of blurred vision afterwards.

In addition, the orthoptist may provide the ophthalmologist with a range of test results, assist with exercises to recover visual functions, aid the diagnosis and management of eye movement disorders and allow prescriptions of glasses to relieve symptoms and/or restore function.

These commonly accompany each other. Floaters are things that appear in the vision and may range from small, dot-like things, to larger translucent objects, to quite dense cobwebs, and even to the point where the vision is quite obscured.

Floaters are opacities in the vitreous, in the jelly in the back part of the eye, and usually indicate that the vitreous has changed in character and structure, as it does so, sometimes with inflammation, but often just with age.

Flashes occur when the retina is distorted. The vitreous (the jelly in the back of the eye) attaches to the retina and as the vitreous changes with age it can pull on the retina, producing a flash of light. These are most often in the dark when the eye is moved. The flash is brief, but often quite bright, in the far periphery.

New onset of floaters and flashes of light do require review and this should occur on a semi-urgent basis.

Intraocular lenses are implanted within the shell of the original cataract. This shell is called the capsule and the capsule is living tissue, which over time may become thicker and less transparent. Adding layers of cells to this produces an opacification in the posterior capsule, which we laser away in the office. This is sometimes called the ‘after cataract’, but it is a common problem, occurring in somewhere between 10-25% of patients who undertake cataract surgery. It can be anywhere from three months to five years, but we recently lasered a capsule whose cataract operation was 25 years ago. Laser capsulotomy is a simple, safe procedure, which is done on site, is painless, and is never needed to be done again.

Mostly infections around the eye are in the eyelid or in the tear sac to the nose side. Infections in the eyelid can be quite significant and can even involve the tissue around the eye, so called the orbit. Diffuse infections are called cellulitis and can be a significant risk. Anything that is a swelling in the upper or lower lid, which seems to be expanding rapidly, needs to be attended to as a matter or urgency.

After your orthoptic assessment, you will see your ophthalmologist who will address your problems, provide a diagnosis when appropriate and advise treatment for managing your ocular condition.

We are capable of taking high resolution video and still images off the slit lamp of structures on the surface and within the eye. This can be particularly useful to follow evolving lesions and to be able to review changes, particularly where they are longstanding.

Glaucoma can occur in infants and childhood, and sometimes congenital conditions can manifest as glaucoma in early adult hood. These are usually where some part of the front of the eye is mis-formed creating an obstruction to fluid outflow and elevated pressure. If these are in a child or baby we will manage this in concert with a paediatric ophthalmologist, but if the child is older or a young adult that will not be necessary.

These conditions are complex and vary significantly from patient to patient. Good treatments are available but more often will require surgery to control pressure.

If a review appointment is requested by your doctor this will be arranged for you by our staff. Surgery bookings can be arranged with our theatre bookings department on the day of your consultation. Our staff can best answer any questions about fees or payments when you visit.

Our administration staff do their best to simplify payment processes for patients. We are registered with Medicare Online Claiming, which allows us to send your account to Medicare, saving you the time and hassle of going to a Medicare office.

Payment on the day is appreciated. If you have registered your bank account details with Medicare, and you have paid in full on the day, Medicare will automatically deposit the rebate amount into your account within 2-3 working days. Alternatively, Medicare can send you a cheque in the post.

We accept cash, cheque, money order, Eftpos, Visa and Mastercard.

No, however Medicare pays 85% of the schedule fee.

At Melbourne Eye Specialists and Melbourne Glaucoma Specialists we treat Glaucoma through:

Medication

Laser

Minimally Invasive Glaucoma Surgery (MIGS)

Trabeculectomy

Revision Trabeculectomy

Non-penetrating Glaucoma Surgery

Deep Sclerectomy

Canaloplasty

Viscocanalostomy

Glaucoma Drainage Devices (GDDs)

Molteno Implants

Baerveldt Implant

Cycle-Diode Laser

If a review appointment is requested by your doctor this will be arranged for you by our staff. Surgery bookings can be arranged with our theatre bookings department on the day of your consultation. Our staff can best answer any questions about fees or payments when you visit.

Our administration staff do their best to simplify payment processes for patients. We are registered with Medicare Online Claiming, which allows us to send your account to Medicare, saving you the time and hassle of going to a Medicare office.

Payment on the day is appreciated. If you have registered your bank account details with Medicare, and you have paid in full on the day, Medicare will automatically deposit the rebate amount into your account within 2-3 working days. Alternatively, Medicare can send you a cheque in the post.

We accept cash, cheque, money order, Eftpos, Visa and Mastercard.

No, however Medicare pays 85% of the schedule fee.

Lasers have a large role to play in ophthalmology as the clarity of the front of the eye allows laser light to enter the eye. There are many different types of laser, both in ophthalmology and in glaucoma, so one person’s experience of laser may well be quite different from another.

Laser Peripheral Iridotomy

• Performed for angle closure mechanism, or where the iris maybe occluding/has a risk of occlusion of, the angle. This is angle closure, and laser iridotomy is tremendous at reducing the risk. Laser iridotomy does not change the focus or appearance of the eye and is invisible to the patient. Although it does markedly reduce the risk in patients who have risk of angle closure.

Selective Laser Trabeculoplasty

• Selective Laser Trabeculoplasty (SLT), can be done in our rooms, causes minimal discomfort, and can be very effective in lowering intraocular pressure without drops.

Other lasers include:

• Cyclodiode laser, which is done in a hospital. This reduces the amount of fluid production in the eye and can decrease the intraocular pressure that way; and

• Iridoplasty, which can change the form of the iris, particularly if the iris is becoming entrapped in the angle in spite of peripheral iridotomy.

Melbourne Eye Specialists is not a Bulk Billing practice. Fees are dependant on the clinician you see and whether or not you have a procedure, investigation or test performed on the day. Discount rates are offered to pensioners and health care cardholders.

There is a chance you may have drops put in your eyes to dilate your pupils. These drops can blur your near vision for up to 3 hours at most although this can vary with each individual. We would therefore recommend you don’t drive during this period. If you have any concerns or are unable to arrange alternative transport, please let our staff know prior to your appointment so we can inform your doctor.

MIGS is a recent term which covers a variety of new devices: the classic MIGS devices are "trans-trabecular" - in other words the traverse the trabecular meshwork and seek to reinstate aqueous flow into the original canal (of Schlemm). The two available in Australia are the iStent and the Hydrus and they operate in a similar manner.

The XEN implant is more akin to standard filtration operations (such as the trabeculectomy and non-penetrating glaucoma surgery). The implant improves the reliability and speeds the recovery from the procedure and is becoming an attractive alternative to the larger glaucoma operations. (Assoc Prof Coote chairs the advisory committee for XEN through Allergan).

Melbourne Eye Specialists is not a Bulk Billing practice. Fees are dependant on the clinician you see and whether or not you have a procedure, investigation or test performed on the day. Discount rates are offered to pensioners and health care cardholders.

Trabeculectomy remains the mainstay of glaucoma surgery. Trabeculectomy was so named for the removal of the trabecular meshwork, although the major way trabeculectomy works is by filtration of fluid from the inside of the eye into the tissue around the eye. This is all performed underneath the upper lid, and this procedure has evolved markedly over the last 40 years. It is done in a hospital, usually under local anesthetic usually and as a day case. It involves making a small hole in the wall of the eye, which is covered then by a partial thickness flap. Resistance to fluid flow is achieved by releasable stitches, the area is soaked in an anti-inflammatory material and then the tissue closed in a watertight fashion. Trabeculectomy has different variations and some of these are valuable at improving outcome or decreasing complications in particular types of eyes. Trabeculectomy is an imperfect operation, but it is dramatically better than it used to be and it is employed when it is unsafe to allow the eye to continue with medical treatment only for the glaucoma. It is rare for the glaucoma operation to fail early, but it can, and then may well need further intervention by the surgeon.

There is a chance you may have drops put in your eyes to dilate your pupils. These drops can blur your near vision for up to 3 hours at most although this can vary with each individual. We would therefore recommend you don’t drive during this period. If you have any concerns or are unable to arrange alternative transport, please let our staff know prior to your appointment so we can inform your doctor.

Yes, this type of laser is available.

One of the big advances in glaucoma surgery over the last 20 years has been the increasing success of fixing the problems that arise in glaucoma surgery. In general these will be where the glaucoma operation fails to lower the pressure satisfactorily, where the pressure is too low, or where the operation produced an unintended side effect. All of these issues are resolved by revision of the trabeculectomy, which involves a number of different types of operations, which are performed less commonly but now with much greater success. Revision trabeculectomy is a subspecialty area and can be very successful in quickly resolving problems that develop.

A/Prof Michael Coote has written and talked extensively on revision trabeculectomy and is considered a world expert in this area. Revision trabeculectomy may not be the appropriate solution where a previous operation has failed, but its role and success has expanded markedly and it has offered, for a great number of patients, a simple and effective solution to their problems.

Yes, this type of laser is available.

Non-penetrating glaucoma surgery is a newer advance in the history of glaucoma filtration surgery. As the name suggests, it differs from standard trabeculectomy by not completely entering the eye. The intent is to make the eye wall more porous and lower the pressure at a more regulated, gentle way, reduce the postoperative complications as well as the number of postoperative visits.

Non-penetrating glaucoma surgery has come a long way since its first iterations and has now a significant role to play. It is not for everyone and is not likely to completely supplant trabeculectomy. It does, however, have a role to play; it may be better for some patients facing glaucoma surgery. Please ask one of our doctors if you are appropriate for non-penetrating glaucoma surgery.

Parking:

Metre parking is available along Victoria Parade, Nicholson St and Brunswick Street.

There are also paid car parks located next to the Eye and Ear Hospital, or next to St Vincent’s Private Hospital on Fitzroy Street.

Train:

Parliment station is located approx. 350 m from our practice. Upon leaving the station, take the Lonsdale/Nicholson Street exit and travel up Victoria Parade from Nicholson Street.

Tram:

The closest tram stop to our practice is St Vincent's plaza. There are four tram routes which stop here, the 11, 12, 30 and 109.

Parking:

Metre parking is available along Victoria Parade, Nicholson St and Brunswick Street.

There are also paid car parks located next to the Eye and Ear Hospital, or next to St Vincent’s Private Hospital on Fitzroy Street.

Train:

Parliment station is located approx. 350 m from our practice. Upon leaving the station, take the Lonsdale/Nicholson Street exit and travel up Victoria Parade from Nicholson Street.

Tram:

The closest tram stop to our practice is St Vincent's plaza. There are four tram routes which stop here, the 11, 12, 30 and 109.

No. We can take measurements for your intraocular lenses and organise a surgery date suitable for you, but the procedure will be scheduled for another date to be performed in hospital.

Deep sclerectomy is a version of non-penetrating glaucoma surgery. In this, the sclera is excised underneath the flap in order to make a porous chamber and allow fluid to exit the eye in a more controlled way. It does offer some advantages as well as some disadvantages and, as usual, the question of whether it is appropriate for you will be answered in consultation with your doctor. Non-penetrating glaucoma surgery and deep sclerostomy are two procedures that are only offered through Melbourne Eye Specialists.

A post-operative review time will be set relating to your procedure. The review may be the following day, within a week or even in a few weeks. You will be advised after your surgery about your post-operative appointment details.

Canaloplasty is an elegant technique, which involves opening of Schlemm’s canal. Schlemm’s canal is the main collecting duct for aqueous; dilating this and allowing higher levels of flow out of the eye without opening directly into the front of the eye offers advantages. Canaloplasty is evolving and it may have a role in certain types of glaucoma.

Melbourne Eye Specialists offers canaloplasty to its patients, but the decision about whether or not it is right for you, needs to made in consultation with a treating ophthalmologist.

Viscocanalostomy is an opening of Schlemm’s canal using a viscous substance, usually Helon, often used ta the time of cataract surgery. Viscous material is injected into Schlemm’s canal to dilate it, but nothing is left in place and is usually combined with deep sclerectomy or non-penetrating glaucoma surgery.

Its role in the treatment of your glaucoma needs to be discussed with your treating ophthalmologist. Melbourne Eye Specialists offers viscocanalostomy in context of deep sclerectomy and non-penetrating glaucoma surgery.

Generally the eye patch can be removed later the same evening or early the next day, however your doctor will advise you of all post-operative eye care.

Glaucoma drainage devices is an umbrella term used to describe two main tube and plate devices, which have been available to patients for many years. These two are the Molteno implant and the Baerveldt implant. Both implants are structurally quite similar and involve the insertion of a very fine tube into the front part of the eye, allowing fluid, aqueous, to drain to a plate, which is placed around the outside of the eye but underneath the tissue, up underneath the upper lid.The use of glaucoma drainage devices has, in the past, been restricted to more complicated situations, but the role of these devices is getting revisited and refined as new research emerges.Melbourne Eye Specialists offers both a Molteno and Baerveldt implant for patients, but, as usual, the choice will be in consultation with your ophthalmologist..

No, as you will have had an anaesthetic, you will need someone to drive/escort you home.

We recommend you allow approximately 4-6 hours from the time of your admission till the time you leave the hospital. However, your Doctor will give you a more acurate time frame.

Prof Tony Molteno, who designed the Molteno implant, did so whilst living and working in South Africa. Many years ago he emigrated to the south island of New Zealand where these implants are still made. The Molteno implant has gone through a number of revisions and the Molteno 3 implant, the one we now use, is a refined and highly tested device, which is used in a variety of circumstances, often where other forms of glaucoma surgery are less likely to be effective.

George Baerveldt designed this implant in the early 1980s and many of these implants have been used around the world. It is not structurally dissimilar to a Molteno implant and indeed both Baerveldt and Molteno both originate from South Africa where glaucoma in the black community has traditionally been very difficult to manage and no doubt stimulated this work. The Baerveldt implant is implanted in a very similar way to the Molteno implant and the choice between the two, the Molteno and the Baerveldt, is often not a critical one.

Melbourne Eye Specialists offers both Molteno and Baerveldt implants for their patients, and the choice and process will be discussed with your ophthalmologist.

Our operative facilities are at St. Vincent’s Private Hospital, an exceptional private hospital and exceptional day surgery facility, V.P.S.C and the Eye & Ear Hospital which is associated with our branch practice.

Cataract surgery is generally useful in glaucoma, in fact it can form part of the strategy to controlling the disease. Cataract surgery rarely makes glaucoma worse but it depends on how much control is exerted over the glaucoma before the cataract surgery. Mostly cataract surgery is a good thing for glaucoma and should make the glaucoma a bit easier to control.

Cyclodiode laser is a method of reducing aqueous production in the eye. It is a laser that is done under a local anaesthetic and relatively high-powered laser is passed across the wall of the eye in order to reduce the production of aqueous. Cyclodiode laser is usually performed where other treatment options have also been employed. It is most often used as an adjunct, but can be used as a primary treatment in uncommon circumstances. Cyclodiode laser is only offered through the Royal Victorian Eye and Ear Hospital, but all three of our glaucoma doctors have appointments at the Eye an Ear Hospital and can perform cyclodiode laser on Melbourne Eye Specialists patients in that facility.