Nobody can deny that the practice of ophthalmology is highly effective. Many eye diseases can be cured or arrested, and it is possible to restore the sight fully from total blindness. Many of the commoner causes of blindness, especially in the third world, are treatable. The most important treatable cause of visual failure in the UK is cataract, and, of course, no patient should be allowed to go blind from this cause, although this does occasionally happen (Figure 8.1). Retinal detachment is less common than cataract but it provides a situation where the sight could be lost completely and then be fully restored. For the best results, surgery must be carried out as soon as possible, before the retina becomes degenerate, whereas delay before cataract surgery does not usually affect the outcome of the operation. Acute glaucoma is another instance where the sight could be lost but restored by prompt treatment. The treatment of chronic glaucoma has less impression on the patient because it is aimed at preventing visual deterioration, although in sight-saving terms it can be equally effective.
It is easy to overlook the value of antibiotics in saving sight. Before their introduction, many more eyes had to be removed following injury and infection. Systemic and locally applied steroids also play a sight-saving role in the management of temporal arteritis in the elderly and in the treatment of uveitis. In recent years, the treatment of diabetic retinopathy has been greatly advanced by the combined effect of laser coagulation and scrupulous control of diabetes. In the past, about one-half of patients with the proliferative type of retinopathy would be expected to go blind over five years and many of these were young people at the height of their
Figure 8.1. The family thought it was just old age.03
careers. The proper management of ocular trauma often has a great influence on the visual result, and the rare but dreaded complication of ocular perforating injuries - sympathetic ophthalmia - can now be treated effectively with systemic steroids. Amblyopia of disuse has already been mentioned; the treatment is undoubtedly effective in some cases but the results are disappointing if the diagnosis is made when the child is too old or when there is poor patient co-operation.
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