Chalazia are cysts in the substance of the lid caused by a blockage in the meibomian gland. In the upper lid there are around 20 of these and in the lower there are around 24. They are corkscrew-shaped glands that exit on the lid margin and are filled with a cheesy, oily material, which is not particularly liquid at skin temperature. Obstruction to these glands unfortunately causes a backup and the material then ruptures out of the gland and into the tissue around into, producing an intense inflammation, which then gradually walls off, producing a pellet-sized cyst.

There are three strategies for dealing with chalazia.

The first is watch and wait and allow them to gradually go. This can take some months and if they are in an obvious position, it may not be reasonable to wait.

The second is to inject them with steroid, which, although does not get rid of the actual underlying lump, reduces the inflammation markedly and will often make the problem much less obvious.

The third option is to incise and curette the lump, to remove the cheesy sort of material and allow it to settle down. Even this does not get rid of some of the residual shell, which takes even a few weeks to resolve. This is the quickest way to resolution but does require a small procedure on the lid.

Often it is suggested that patients perform heat and compress when they get a cyst. Heat and compress is where the eyelid is heated up and the meibomian glands massaged towards the lid margin (down from above, and up from below). The value of this is to reduce the amount of trapped meibomian secretion within the glands, but it is not helpful once a cyst has formed.

Car/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:

Parliament 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 that stop here - the 11, 12, 30 and 109.

If your appointment finishes after 6 pm, due to safety reasons, St Vincent's security will have changed the accessability of the Healy Wing. After 6 pm you can only exit from Building C. This can be achieved either from the main stairs, which are normally closed during business hours, or through the back and into the courtyard for mobility ramps.

In order to provide you with a suitable date and time, where possible we recommend that you phone 6-8 weeks in advance to make your appointment.

For all enquiries and appointments at Melbourne Eye Specialists, please call the appropriate number below;

Fitzroy – Ph: 9417 1055 Fax: 9417 5952

We appreciate that your time is valuable and we try not to keep you waiting. Each patient consultation is unique and can involve more extensive testing or treatment than others. An initial consultation is a perfect example. We recommend you allow 1-2 hours for your visit. Any emergencies will be attended to immediately which may impact on your waiting time. Also, you are very welcome to telephone before you arrive to check how appointments are progressing.

Veteran’s Affairs Gold Card holders are entitled to transport to and from appointments, which our administration staff are happy to organise. Please inform our staff when you book your appointment if you require this service at least 24 hours prior to your appointment.

This is the most common cause of central visual loss in almost every country on earth. It is, as the name suggests, related to increasing age. In addition to getting older, there are some genetics and possibly some lifestyle factors. Although there have been some studies that show there is a nutritional component to macular degeneration, it is not so easy to see a compelling difference between supplementation and no supplementation in people with good diets.

It is noted though that macular degeneration is worse in those people who smoke, and for this as well as many other reasons, smoking should be avoided.

Macular degeneration broadly falls into two categories: “wet” and “dry”. Actually the wet version is a complication of the dry form and although there is treatment available for the wet form, the dry continues to progress. The current treatment for wet macular degeneration is injections of in the back of the eye of medications that turn off new blood vessel growth. Currently there are three agents used – Avastin, Lucentis, and Eylea – and they are all effective at reducing new vessel growth, which is the nature of wet macular degeneration. Unfortunately the injections do not usually last much longer than six weeks, although it is not always needed that injections are required every six weeks or so.

Injections for macular degeneration can be done in the office and not more uncomfortable than a standard injection anywhere else.

Primary Open Angle Glaucoma, Angle Closure Glaucoma, Pseudo-Exfoliation glaucoma (PXF), Pigment Dispersion Glaucoma, Inflammation and Steroid Induced Glaucoma, Traumatic Glaucoma, Congenital and Anterior Segment Dygenesis

Other Glaucomas:

Irido-Corneal Endothelium syndrome (ICE), and Aniridia, Epithelial Ingrowth, glaucoma associated with corneal disease or surgery, and glaucoma associated with emulsified silicon oil are all examples of rare diseases that are managed frequently in our group.

Iritis or anterior uveitis

Inflammation of the front compartment of the eye, namely the iris and ciliary body. This is usually characterised by the presence of inflammatory cells in the anterior chamber of the eye. These cells are visible to the ophthalmologist examining a patient through a slit lamp (the microscope used to examine patients’ eyes)

Posterior uveitis

Inflammation in the back part of the eye, namely in the vitreous gel, the retina and/or the choroid. Depending on the exact part of the posterior part of the eye involved, other terms used may include retinitis, choroiditis, pars planitis, intermediate uveitis, retinal vasculitis.

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Pan uveitis

This is a term used to describe inflammation of both the front and the back parts of the eyes, including the optic nerve in some cases.

Corneal infections occur sometimes when the eye has been injured, or has sutures in it, or has a disease, and sometimes because the eye has been exposed to unusual organisms. Contact lens wear is something that produces an increase risk of infection in the cornea and patients who wear contact lenses need to be aware that they need to seek help rapidly should their eye become sore or red.

Corneal infections, for the most part, can be treated quite well with topical antibiotics. Antibiotics in the form of drops can get high concentrations in the cornea, can be effective at treating most infections, although there are still some particularly difficult infections, including fungal infections and acanthamoeba, which are difficult for medicines to heal.

The main problem with cornea infections is the scarring and damage that occurs, and hence the distortion and loss of quality of vision.

Cortical Cataract Cataracts are an opacity in the lens in the eye, more in the surface.

Nuclear Cataract

Cataracts are an opacity in the lens in the eye, more in the centre.

In truth, most cataracts are an amalgam of different types. Rarer types of cataract include posterior subcapsular cataracts, anterior subcapsular cataracts, posterior polar cataracts, embryotic cataracts, Christmas tree cataracts, and the rare Morganian cataracts, when they become very advanced.

Intraocular pressure (IOP) is a key piece of information in both the diagnosis and management of glaucoma. Intraocular pressure is not something that can be felt, unless it is extremely high, and needs to be measured to tell what it is.

IOP is always measured indirectly and through the cornea. There are a number of different techniques for doing so, but the most common one that we use is the Goldmann Applanation Tonometer. These are calibrated devices that are used on slit lamps in the office, and represent the “gold standard” for measuring pressure.

We also have a handheld device, known as the Perkins tonometer, as well as a Rebound tonometer, known as the “ICare”.

We also have a home tonometer system (a version of the ICare) which we use on certain patients with very variable intraocular pressures.

In special circumstances, we will use the Pascal dynamic contour tonometer, which can be useful with coexisting corneal disease.

All four methods of measuring IOP are available in our offices.

All intraocular pressure measurements are a one point in time and need to be considered in the overall scheme and risk. Intraocular pressure measurements are quite variable in the individual and across populations, so a pressure may be fine for one person and not for another.

Treatment in glaucoma is aimed at lowering the intraocular pressure, and thus lowering the stress on the nerve at the back of the eye.

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.

Blepharitis is a catchall term to describe inflammation of the margin of the lid. It is an unusually common condition as the margin of the lid is a particularly delicate and sensitive area.

Blepharitis often produces stinging or burning eyes, and can reduce the vision a little bit as it reduces the integrity of the tear film and the surface of the eye.

Blepharitis can be associated with skin conditions, including rosacea and dermatitis, but it can exist on its own as well.

We recognise two basic types of blepharitis. One is an anterior blepharitis, which produces a scaly sort of material in and around the eyelashes. This is best treated with some form of detergent material to gently remove the scaling material, which can form on the tear film and make the eyes uncomfortable. We would recommend products such as Lid Care or SteriLid as over-the-counter products that work well for this.

Posterior blepharitis is related to obstruction to meibomian glands and is better treated with heat and compress, and sometimes some antibiotic ointment. Heat and compress is required to be correctly applied. Heat is usually in the form of a face washer or a heat pack, allowing the lid to become really quite warm. The reason or this is to make the meibomian glands more liquid and allow their discharge to the surface to be more effective. Massage needs to occur aimed at discharging these glands across the full length of the lid to the lid margin. Generally starting around the centre and moving towards the lid margin with the fingertip is a good way to improve the drainage of these glands.

Over the past 20 years we have performed over 30,000 cataract operations. Cataract surgery has evolved and now cataract operations can be done safely, even in complicated and unusual circumstances. New intraocular lenses improve the visual outcomes for our patients, and we have a history of considered adoption of new innovations. We wish to provide the best care to our patients, which is tailored to them and has evidence of effectiveness.

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Cataract surgery is a remarkably evolved form of surgery. It started many hundreds of years ago as a very imprecise and damaging process, intended basically to dislodge the lens. Later iterations involved the wholesale removal of the lens, leaving the sufferer with very thick glasses. After about 1980 the use of the intraocular lens to replace the cataract became commonplace and the use of very thick glasses post-cataract became a rarity. In the early 1990s small incision cataract surgery developed and has been evolving ever since. Small incision cataract surgery involves no sutures and the use of a foldable lens, which sits in the space where the original cataract was. It is not sewn in or stitched or glued in, and it is gradually “shrink-wrapped” by the capsule of the original cataract such as the lens becomes very stable and does not require replacement.

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In recent times there has been a new laser developed for doing part of a cataract operation. This is often called Femto II or laser assisted cataract surgery. Although it is a very elegant procedure, there is no data currently to suggest that it offers any benefit to patients. All the studies so far fail to prove non-inferiority; in other words, at this stage it is not possible to prove that it is better than the current highly evolved cataract surgery, in fact it is not possible to prove that it is not inferior.

Although very impressed with the technology, Melbourne Eye Specialists does not perform Femto II laser for our cataract patients as at the present time - its cost and complication profile prohibits it from something that we would want done on ourselves or we would offer to our nearest and dearest.

Diabetic retinopathy means changes in the retina secondary to diabetes. Diabetes causes problems with blood vessels, partly due to sugar making some of the layers of blood vessels more brittle. Microvasculopathy, or blood vessel disease in small blood vessels, occurs in the retina, the kidneys and in the feet.

Diabetic retinopathy is a significant cause of visual loss and occurs over time. Diabetic retinopathy is more common the higher the HbA1c is (the longer term sugar control index), the length of time of diabetes, how high the blood pressure is, and how high the cholesterol is. Diabetic retinopathy can get worse in pregnancy.

There are a lot of treatment strategies for diabetic retinopathy, but they are much better instigated as a prophylactic rather than waiting for the vision to decline. Vision loss from diabetic retinopathy is hard to recover from – much better to prevent it.

The treatment options for diabetic retinopathy include laser, injections of steroids and anti-vascular endothelial growth factors, and sometimes surgery.

Fuch’s endothelial dystrophy is one of the corneal dystrophies, but the most common one, and produces a change to the endothelium, or the under surface layer, usually starting in the centre of the cornea. The effect mostly for the patients is a scattering of light and haloes or stars around lights at night, but it can progress to being more significant visual loss and eventually to thickening of the cornea, where it is not possible to get clear vision.

Fuch’s endothelial dystrophy is relatively common, but mostly fairly mild. It has an inheritance and there is no treatment available for it, apart from resolving the problem with the cornea once it becomes damaged. Resolution comes in the form a corneal graft – either all of the cornea (penetrating keratoplasty) or only the endothelial layer (Endothelial transplantation).

Fuch’s endothelial dystrophy can get worse with glaucoma and may be worse after cataract surgery and injury to the eye.

In order to provide you with a suitable date and time, where possible we recommend that you phone 6-8 weeks in advance to make your appointment.

For all enquiries and appointments at Melbourne Eye Specialists, please call the appropriate number below;

Fitzroy – Ph: 9417 1055 Fax: 9417 5952

We appreciate that your time is valuable and we try not to keep you waiting. Each patient consultation is unique and can involve more extensive testing or treatment than others. An initial consultation is a perfect example. We recommend you allow 1-2 hours for your visit. Any emergencies will be attended to immediately which may impact on your waiting time. Also, you are very welcome to telephone before you arrive to check how appointments are progressing.

Veteran’s Affairs Gold Card holders are entitled to transport to and from appointments, which our administration staff are happy to organise. Please inform our staff when you book your appointment if you require this service at least 24 hours prior to your appointment.

Central corneal thickness, or CCT, is a piece of information sometimes used to help calibrate intraocular pressure measurements. As intraocular pressure measurements are taken through the cornea, a thickened cornea can sometimes cause over-reading, and a thin cornea under-reading of intraocular pressures.

There are various different calibration charts, none of which have great utility, but we do take note of central corneal thickness when we are establishing risk.

It is measured in two ways: one is a contact system using ultrasound, and the other is a non-contact system using the swept-scan anterior segment OCT (Casia), which has now become the standard. Both are available in our offices.

Yes, you need a current referral from your local doctor or from an optometrist. Generally referrals are valid from 9-12 months from a General Practitioner and Optometrist and 3 months from a Specialist.

It is your responsibility to ensure your referral is current for your appointment. Please ask our staff to check this for you if you are unsure.

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.

This is numerically the most common form of the disease covered by the umbrella term of ‘Glaucoma’. It is usually a disease of people over the age of 60, but certainly can occur before this. Around half of people have a family history of glaucoma with this disease and a number of causative genes have been identified. One of us (Michael Coote) was involved in the discovery of the first gene in glaucoma, GLC1 a, in 1996 when he was working in the USA. This gene causes an early onset disease, often in the 20s 30s and 40s and is strongly inherited.

Classically the eye pressure rises and then there are identifiable changes to the Optic Nerve. Later there is the development of visual field defects (loss of vision in the mid and far-periphery) which are often not noted by the patient. Primary open angle glaucoma usually progresses at a reasonably predictable rate and is amenable to drops, laser, or surgery as required.

Occasionally glaucoma will manifest to the patient with loss of clarity and a noticeable change in vision. All forms of glaucoma visual loss are (essentially) not recoverable – loss of vision is always permanent when caused by glaucoma, so prevention is the key.

There is a discernible version of Primary Open Angle Glaucoma known as Low Tension Glaucoma or Normal Tension Glaucoma (LTG or NTG). In in LTG or NTG the eye pressure does not reach statistically abnormal levels, although it is usually above average (taken as 15 mmHg). This is not to say that eye pressure is not important in the development of visual loss in LTG and NTG, it certainly is, but that the eye pressure does not start off statistically elevated. Although there are genetic and racial predisposition (particularly Japanese) and some demographic risk (thin, tall, athletic postmenopausal women with low blood pressure) NTG and LTG can occur in many different human demographics.

Particular care must be taken in treating the LTG/NTG version of glaucoma as there is a tendency to over treat. Whilst there is no doubt there are progressive forms of glaucoma starting with low pressures, there are a great number of patients who have eyes and tests that look like LTG and NTG but do not benefit from treatment. They may need enduring ‘risk management’ to identify change should it occur, but they may not benefit from any form of intervention or treatment.

Proven progressive LTG/NTG may well need surgical intervention due to the difficulty of lowering pressure with nonsurgical means when the starting pressure is relatively low.

The medical approach to diagnosing these problems includes several levels:

1. The specialist examines the patient and defines the extent and severity of the eye problem. 2. An attempt is then made to find a cause and look for other health problems which may underlie the eye problem. 3. A decision whether treatment is required, and what treatment to use.

Typically, patients with ocular inflammation undergo a clinical assessment (describing their symptoms and answering relevant medical history questions). This is followed by examination of the eyes and, when relevant, a general medical physical examination. In many, but not all cases, further workup is required including laboratory and imaging tests. The need for such tests is determined by the specialist based on his/her clinical impression.

After conducting a medical assessment and laboratory workup, the specialist may arrive at one of the following conclusions:

1. The condition is limited to the eye and is the result of a specific, treatable problem (for instance, an infection with toxoplasma or a herpes virus) 2. The condition is limited to the eye and is the result of an immune disorder of an unknown cause (for instance, vasculitis of the retina) 3. The condition is part of a systemic problem (involving other organs than the eye), and is the result of a specific, treatable problem (for instance an infection with tuberculosis or the herpes virus) 4. The condition is part of a systemic immune disorder of unknown cause (for instance sarcoidosis, ankylosing spondylitis, Behcet’s disease). While many of these conditions have specific medical names, there is no clear understanding why they occur, and they are treated using similar general principles and similar drugs. However, given their potential effect on other organs, there is often a need for a team of doctors to be involved, most commonly an ophthalmologist and a rheumatologist.

Practically speaking, in many patients who have inflammatory eye diseases such as uveitis or scleritis no cause is found for the problem. In others, the disease is characteristic and has a medical name (for instance, sarcoidosis) and may involve other parts of the body, but there is no understanding why it occurred and what caused it.

Yes, you need a current referral from your local doctor or from an optometrist. Generally referrals are valid from 9-12 months from a General Practitioner and Optometrist and 3 months from a Specialist.

It is your responsibility to ensure your referral is current for your appointment. Please ask our staff to check this for you if you are unsure.

Tears in the retina can occur because of a normal event known as “posterior vitreous detachment”. The vitreous generally fills the cavity in the back of the eye, but tends to shrink and detach from its back surface, that which is next to the retina, with age. Shrinking and detachment of the vitreous is normal, but can cause the development of floaters and on occasion flashes of light in the periphery.

The sudden onset of floaters and flashes are things that should be checked out and they can be associated with a tear in the retina. A tear in the retina is unusual but much more important than the “posterior vitreous detachment”.

A tear in the retina where it is relatively new without extension can be relatively easily treated with either laser or cryotherapy.

More extensive detachment of the retina will require more complicated procedures. Retinal detachment surgery has improved dramatically, but it is still preferable not to have one.

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.

Intraocular lenses have evolved significantly over the years. Current intraocular lenses are foldable devices, which have a high level of both stability and refractive capacity. They come in a great range of sizes and powers, and now include the capacity to reverse even high levels of astigmatism. Some intraocular lenses have two areas of focus in them. Although on the face of this, this sounds like a good idea, there are some down sides to this process and these lenses still occupy less than 1% of the market for intraocular lenses. The main reason is that the process of creating two places of focus reduces the contrast in both of them and produces some difficulties, particularly at night. It is reasonable to assume as we age that the value of these lenses will reduce for the patient and that some of the problems associated will increase. Melbourne Eye Specialists does offer these lenses, but the choice of them will be made in consultation with the treating ophthalmologist.

A watery eye is due to an imbalance between the amount of tear production and the amount of tear outflow.

Tear production is by the lacrimal gland, which is up in the upper outer part of the area where the eye is, and underneath the upper lid. Tear outflow occurs on the nose side and down into the nose.

We make more tears at certain times, such as when the eye is irritated or wind is blowing or emotional crying, and if we make enough tears it will overflow even a normal drainage system. However it is much easier to overflow a drainage system that is partially or completely blocked. At rest most tears are evaporated, so even a completely obstructed tear outflow system may not water and it may be only under stress that it does so.

A key differentiation though is to establish whether or not the problem is mostly irritation and increased tear production, or obstruction and decreased tear outflow.

Outflow can be tested and sometimes improved with nasolacrimal duct lavage, or so-called sac “washout”. This is a procedure done in the office and can help tears traverse down the outflow a little bit better, or at least identify where and if there is an obstruction.

Corneal transplants are the oldest and most common organ transplants but are unusual as we do not match the donor to the recipient. In other forms of transplant great care is taken in matching the donor to the recipient to reduce the chances of rejection. This is not helpful for corneal transplantation.

Corneal transplants, because they have no blood supply, are much less prone to rejection and there has not been any strong evidence to show that matching the blood type (or other immune markers) has any value in improving the outcome of corneal transplants.

Corneal transplants are performed in the operating theatre, under local anaesthetic usually, and they involve the removal of the existing cornea, or at least the central part of it, and replacement with a donor cornea. A donor cornea can now be stored for up to a month in a particular transport medium and donor corneas are now usually in good health and can bed in quite nicely to the recipient.

Corneal transplants require sutures to hold them in place and those sutures will often stay in place around twelve months from the operation.

It is rare to get substantially better vision within 6 months after a corneal transplant, although it does depend on how poor the vision is to start with. Often the visual recovery is quite prolonged, so it is important to consider the recovery period in the surgical planning for a corneal graft.

An A-scan is a complicated set of measurements done to establish the curvature, position of objects in the globe, as well as the length of the eye. These are all combined together into a formula, which can predict what intraocular lens power is used at the time of surgery to improve the outcome of cataract surgery in terms of glasses.

A-scans have improved dramatically over the years and we use a Haag-Streit scanner, which has multiple corneal points and a laser-based scan, and has excellent accuracy and consistency.

Astigmatism is further investigated using swept-scan anterior segment OCT (Casia) to establish the extent of corneal astigmatism, and this is added to calculations. Astigmatic intraocular lenses are a great advance and can improve unaided vision post-cataract. We use astigmatic lenses where there is a reasonable chance that they will offer better vision postoperatively.

Please allow up to 2 hours for your appointment. It may take a little longer if your doctor organises tests or treatments for you on the day of your visit.

This is a very broad question and the answer depends on the type of uveitis, and the cause, if known. Each patient has different problems and needs, and the treatment is decided on based on the individual circumstances.

Treatment may include:

* Local anti inflammatory treatment to the eye/s in the form of eye drops. * Local anti inflammatory treatment to the eye/s in the form of injections to the vicinity of the eye or to the eye. * Oral medications, including corticosteroids (cortisone type drugs) antibiotics, antiviral tablets, and/or drugs which suppress the immune system. * Local medical and surgical treatment of possible eye complications of uveitis, such as cataract, glaucoma or epiretinal membrane.

This is a very common cause of glaucoma and in certain populations is more is the most common form. It is a partly inherited condition, but also is associated with getting older and developing cataract (or the precursor of an enlarged lens). Angle closure glaucoma can, uncommonly, present suddenly with pain and loss of vision in the eye. We call this acute angle closure glaucoma and this requires urgent treatment.

Angle closure glaucoma has a deliberately more preventative strategy as the underlying problem is more mechanical. Laser Iridotomy (see under treatment) is usually performed well ahead of any event to reduce the chances of a sudden angle closure event. Cataract surgery becomes an important part in the management of angle closure, more so than any other form of glaucoma.

Angle closure can be treated with drops and other medications, and laser and classical glaucoma surgery is effective.

PXF glaucoma is common and can manifest in the 40s and 50s, but is much more common as we age. Mercifully this is a disease which is usually quite asymmetric, being much worse in one eye than the other. Unfortunately it is a form of glaucoma that can produce significant loss of vision in the affected eye and can be difficult to control. Although the predisposition to PXF has a genetic component, it is less obviously inherited, and the severity of the disease is quite variable.

PXF glaucoma will often need surgery and this will often include cataract surgery if it has not been performed. Glaucoma surgery does have a higher rate of failing in PXF and there is a tendency to adjust surgical strategies to take this into account. We have pioneered new ways to make management of this disease safer, especially in the elderly.

Long-term problems with PX F glaucoma include a dislocation of the intraocular lens, classically described 10 years after the original cataract operation. This does happen only in small minority of patients with PX F, but it is very rare in other people. Dislocation of the intraocular lens can be fixed with surgery – and this is an operation we have extensive experience in.

Please allow up to 2 hours for your appointment. It may take a little longer if your doctor organises tests or treatments for you on the day of your visit.

The front part of the eye, known as the anterior segment, has many structures in it, but often is the cause of concern and problems.

The cornea, the very front surface, can become opaque or scarred, and significant alterations in curvature, such as astigmatism, can be very destructive to vision. Corneal ectasias, such as keratoconus, are resolved easily now with swept-scan anterior segment OCT (Casia).

Going deeper into the front of the eye, angle closure is a condition where the iris opposes the trabecular meshwork and obstructs outflow. Angle closure is a common form of glaucoma and can be mostly prevented with YAG laser iridotomy. In order to establish and manage risk, anterior segment OCT is a valuable device.

The development of peripheral anterior synechiae (PAS), or the results of trauma, such as cyclodialysis clefts, can be picked up with swept-scan anterior segment OCT

* A current letter of referral from a General Practitioner, Optometrist or Specialist * Medicare Card * Pension or Health Care Card * If you wear distance or reading glasses, please bring these with you. * Sunglasses to minimise the sensitivity to glare that may occur from the dilating drops or laser procedures.

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

Conjunctivitis literally means inflammation of the conjunctiva, which is the lining underneath the lid and around the edge of the eye. Conjunctivitis can be infective or non-infective, and out of the infective ones, it can be viral or bacterial.

Conjunctivitis produces a red eye and a change in the tear film often to make it sticky or thick, and usually affects the quality of the vision and makes the eye uncomfortable.

Bad conjunctivitis can be very disabling and mild conjunctivitis just annoying.

Children get conjunctivitis in the epidemic proportions, but most of the causes there are viral and are often not viruses that cause conjunctivitis in adults.

There are forms of conjunctivitis that are particularly nasty and affect the front surface of the eye, called keratoconjunctivitis, and these are quite infective.

A relatively common cause of conjunctivitis is Herpes virus (HSV 1 – like the cold sore) and can affect the conjunctiva and sometimes the lid margin, particularly in the first infection.

Conjunctivitis is often treated with Chlorsig drops, but Chlorsig drops are of limited value and often it is better for us to identify the underlying cause and apply other more effective antibiotic or more specific treatment to the underlying cause.

Sometimes conjunctivitis does not have a clear cause and we will apply supportive treatment and sometimes some anti-inflammatories.

Glaucoma and cataract run hand in hand. Cataracts can cause, or certainly worsen, glaucoma, and the removal of the cataract can make glaucoma substantially better. Cataract surgery when performed before glaucoma surgery can often be quite effective at lowering intraocular pressure, although not always, but when performed after cataract surgery can often raise the pressure. The timing of cataract surgery in glaucoma is a significant one, and any decisions around intervention for cataract will need to be considered in the context of glaucoma. These decisions will be made in consultation with your treating ophthalmologist.

This is one of the most commonly asked questions, and the answer is far from satisfying. It would be fair to say that, for most of these conditions, there is no understanding of the reason they occur at a given time to a given person. There is therefore not a lot one can do to reduce the chance of a recurrent disease. Changing your diet, exercise patterns, environment, stress levels etc are not known to make a difference.

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.

Cataract commonly occurs in the context of penetrating or blunt trauma to the eye. It may occur quite quickly or may develop over time, but the main concern is that the cataract surgery at this stage is more difficult technically and involves a high level of complication. In addition it may not be possible to place an intraocular lens in the same place or support it in the way that it normally is, and certain steps need to be taken to reduce the risk associated with this. The management of trauma is particular interest of A/Pr Michael Coote and the management of cataract in trauma, including the use of specially made anti-glare lens (Morcher lenses) is a particular interest.

The swept can anterior segment OC gives objective and precise measurements of the structures of the front of the eye. This is particularly useful in angle closure glaucoma, or where there is a risk of this disease. Clinical assessment of the front of the eye has been quite subjective, and the assessment of risk glaucoma developing possibly more so.

Significant risk of angle closure suggests that intervention (laser or cataract surgery or both) may be useful - less risk may just need monitoring. We are not great at predicting what risks the individual eye runs, and hence who needs what. But these new 3D scanners have very significantly improved the data and made the process much more objective.

Pigment Dispersion Glaucoma presents with a wide range of severity, with the worst affected people developing significant glaucoma in their 20s. Pressures can fluctuate quite markedly including to symptomatic level where patients will notice intermittent blurring of vision related to high pressures. This can happen spontaneously or after exercise.

Pigment Dispersion Glaucoma is due to iris pigment flaking off and depositing in the drain plug, the trabecular mesh work, and causing gradual obstruction. By blocking the outflow from the eye the pressure increases and causes damage to the nerve. Pigment Dispersion Glaucoma treatment is more centred around laser than in most other forms of glaucoma. Selective Laser Trabeculoplasty (SLT) is an important form of treatment in many forms of glaucoma, but particularly so in Pigment Dispersion.

Dry eye is a term that covers a multitude of problems on the surface of the eye. Many of these are better termed tear film instability rather than truly dry eye, but they all have symptoms in common, which are discomfort and loss of clarity of vision. Both the discomfort and loss of clarity are intermittent, and often related to tiredness and weather.

There are a number of lubricants available on the market and they have different thicknesses and components. In general there are thin, quite watery lubricants, which get gradually thicker and still water-based, until they become a gel. Finally we add oil-based lubricants if the problems is somewhat intractable. Oil-based ointments work better overnight and certainly work better if the lid is involved.

Some lubricants seem to suit some people and not others, and often a trial of a number of them is required to find the one that suits you the best.

In the vast majority of cases, the answer is NO. Uveitis may inflict considerable damage on the eye/s and may rarely cause blindness. However, if diagnosed correctly and treated in a timely manner, many of its blinding complications can be avoided or treated and controlled. There is an ever increasing arsenal of drugs and techniques to battle complications of uveitis, such as macular oedema, cataract or glaucoma.

Like with any disease, there is a range of severity, and most patients with uveitis do not have a severe, vision threatening condition. Similarly, in a very small minority of patients, the condition is very severe and even aggressive therapy cannot prevent severe loss of vision. Luckily, most patients at this day and age manage to lead a normal lifestyle, work, study and drive, despite suffering from uveitis and similar conditions.

We recommend you allow approximately 4-6 hours from the time of your admission till the time you leave the hospital.

* A current letter of referral from a General Practitioner, Optometrist or Specialist * Medicare Card * Pension or Health Care Card * If you wear distance or reading glasses, please bring these with you. * Sunglasses to minimise the sensitivity to glare that may occur from the dilating drops or laser procedures.

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.

Most of the risks associated with cataract surgery fall well below 5% and mostly well below 1% for people undertaking cataract surgery, who are otherwise reasonably well, with eyes that do not have significant other pathology, and in the hands of experienced surgeons. There are, however, eyes that have much higher levels of risk associated with other disease in the eye, including glaucoma and trauma and uveitis, and these eyes need particular care in managing them as they have a much higher risk profile than standard. High risk cataract surgery is a particular interest of A/Pr Michael Coote, who has managed a very significant number of these over 20 years with good result.

There are many different sub-types of inflammation in the eye – each with a different underlying cause and often with different treatments. Inflammation can wax and wane and over many years and many eyes with long term and repeated inflammation can develop problems with pressure. Sometime inflammation will present with high eye pressure, such as the Possner-Schlossman syndrome.

Treatment of uveitis and steroid induced glaucoma is a process very much dependent upon the underlying diagnosis and the speed of progression. This is more complex and nuanced, and depends on a great number of factors individual to the patient.

The management of glaucoma associated with inflammation or steroid use is effective. Broadly the treatment of inflammation needs to take precedence and be satisfactory to control inflammation and stop damage to the eye from it. If the treatment contributes to glaucoma then this is frustrating but it is the correct outcome. Under-treated or untreated inflammation is substantially more damaging to the eye that the treatment or the secondary glaucoma, and the glaucoma can be treated once it’s recognised.

We will usually manage uveitis glaucoma in concert with a uveitis doctor.

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.

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.