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The North Balwyn Eye Clinic and Laser Centre offers a complete range of eye-care services. All the doctors are medically trained eye specialists who have undergone at least 5 years training after completing their medical degree (6 Years). The following services are offered: (Click to see more)
Different sorts of cataracts can produce different symptoms. Glare sensitivity and blur are most common. Sometimes the cataract can cause the spectacle prescription to continually change, necessitating regular updates of your glasses. It is no longer true that the cataract needs to be "ripe" before it can be removed. As soon as symptoms start to interfere with your enjoyment of life, an opinion should be sought to determine if removal of the cataract is likely to be of benefit. Surgery is required to remove cataracts. Usually patients go into hospital on the morning of the surgery and are able to be taken home a few hours after surgery.
Phacoemulsification is used to remove the old lens ie it is broken into small pieces and sucked out of the eye (like a vacuum cleaner!). Virtually all patients have an artificial lens (intraocular lens or IOL) inserted during the surgery to replace the one being removed. Modern technology allows these lenses to be folded in half before insertion, so the incision in the eye is often less than 4mm. This micro-surgery allows quicker recovery after the surgery and greater safety during the healing process. Usually no sutures are required, and patients can see again as soon as the eye pads are removed. Glaucoma is known as the silent blinder. Glaucoma involves an increase in the fluid inside the eye to a point that pressure damages the optic nerve. It is most likely to occur after the age of 40, and the commonest type of glaucoma has no symptoms at all until the late stages of the disease when it is very difficult to stop the progression of damage to the optic nerve. If discovered and treated early, in most cases damage can be minimized and vision preserved. Testing for glaucoma is simple and painless. Mostly, treatment is by eye drops. In some types of glaucoma laser surgery can be of benefit and in advanced or difficult cases, surgery may be required.
It is very important that everyone over the age of 40 has regular eye checks to screen for this disease, and if there is a family history of glaucoma then this is even more important. Fluorescein (Retinal) Angiography
Diabetes is becoming more common. It can produce many problems in the body, but the most feared one is blindness. *** It has been estimated that if all diabetics had regular eye checks and appropriate treatment, then the incidence of diabetic blindness could be reduced by 98%.***
The North Balwyn Eye Clinic and Laser Centre offers fluorescein angiography on site.
If laser treatment is required, this is also offered on site. Dr Mark McCombe is a retinal surgeon who specialises in diabetic retinopathy. He was involved in the production of treatment guidelines for diabetics published by the NH & MRC in 1997.
The macula is that part of the retina (the "film" in the camera) we use when we're looking directly at something. It is our "central" vision. It may degenerate with age. Sometimes this can be mild, sometimes it can result in the loss of the ability to read. It almost never results in total blindness. Some types of macular degeneration can haemorrhage, with the sudden loss of central vision. If detected early, before bleeding has actually occurred, it may be possible to treat the leaking blood vessel. Impending haemorrhage can sometimes give symptoms of distortion. All people over the age of sixty should have regular checks for macular degeneration, particularly if there is a family history of it. Laser Surgery - Excimer, YAG & Argon
Laser refractive surgery, LASIK and PRK, are available at the Melbourne Excimer Laser group adjacent to the Royal Victorian Eye and Ear hospital. All pre and post laser treatment is delivered at North Balwyn.
During the early 1980's researchers etching computer chips found that the 'cold' light from the excimer laser created no thermal damage and left a very clean margin. This meant it could have refractive surgery applications as well. Ultraviolet light and high energy pulses lasting only a billionth of a second can be used to disrupt the molecular bonds between the corneal cells with an accuracy up to 0.25 microns. (Note: a human hair is about 30 microns in diameter) This means the excimer laser pulses can predicably and accurately alter the shape of the front surface of the eye, the cornea. For example: eyes that are too greatly curved (myopic or shortsighted) can be accurately "shaved" to make them less curved, and thus vision can be corrected.
Dr Workman is a fully accredited by the Civil Aviation Safety Authority as a Designated Aviation Ophthalmologist. This means that he can certify all aircrew and air traffic controllers for aviation purposes. Please advise the receptionist when making an appointment if CASA certification is required. Plastic
surgery around the eye requires special expertise. Problems with
the tear drainage system or the eyelids turning in or out can usually
be fixed surgically. Often a simple procedure is all that is required
to prevent chronic irritation from ingrowing eyelashes or other
lid problems.
If you would like a second opinion about any aspect of your eye care, please feel free to make an appointment. You may be assured of complete confidentiality.
Dr Workman is frequently asked to give an opinion on matters before the Medical Board or the subject of a court action or WorkCare claim.
Children, especially very young children, require extra special
care. If you are concerned about any aspect of your child's eyes
or vision then it is important you receive expert advice, as some
problems need to be treated at an early age to ensure the child
develops their maximum visual potential.
If the human visual system is thought of as a video camera connected to a computer, it is easier to understand how this can happen. During the first eight years or so of life, the visual system is still developing. For this to happen properly, the camera needs to send clear images to the computer. Once the system is developed and the child is older than eight, it is secure and stable. However if the camera doesn't send clear pictures to the computer, the computer may never develop the ability to "see" clearly. Once the age of eight is passed, this will never happen. If only one of the two cameras is blurred, the child may not obviously have poor vision. That is why it is important to have every child's eyes tested at about the time they start school. If the computer has developed the ability to "see" clearly (with the aid of spectacles), and the system is stable, it may be possible for the child to stop wearing glasses. The "camera" will be defocused, but the computer remains stable and the "camera" can always be refocused later. Make sure you understand all the implications of this before taking action. These comprehensive eye examinations screen for all eye diseases. All aspects of vision correction are evaluated and advice can be given on any conditions or concerns, including: When the eye is unable to focus on distant objects, but can see up close, it is said to be myopic or shortsighted. This usually becomes apparent early in the second decade of life and may progress until about the age of twenty.
Most spectacle lenses these days are plastic. Whilst they are more prone to scratching than glass, they are lighter, resist impact better and are less likely to shatter.
Laser surgery can be very effective for low to moderate levels of myopia. It is a surgical procedure and should not be embarked upon until all the implications of that are fully understood. (See section on Laser Surgery)
Long sightedness (Hypermetropia/Hyperopia) Hypermetropia means that some of the eye's focussing system needs to be activated just to see clearly in the distance. In the normal eye, the focussing system would be at rest for this. The closer the object being looked at, the more focussing power is needed.
Spectacles and contact lenses can be used as with myopia. Laser surgery is less effective but may be of use in lower degrees of hypermetropia.
Presbyopia From the day we are born, our ability to focus up close starts to diminish. This is because the lens inside the eye that changes shape to keep light from what we are looking at focussed, gradually loses its agility. By about the mid forties, we are unable to maintain comfortable focus up close and we then require "reading" glasses. They are only for use up close and so make the distance blurred. Some people are concerned that wearing reading glasses will weaken the eyes. Because the process is continuous, our need for reading glasses will increase whether we wear them or not and whether we like it or not!
If you need both distance and reading glasses it may be convenient to combine them into bifocals or multifocals. It is even possible to have bifocal contact lenses.
Our doctors are registered with the Department of Veterans Affairs and can provide ophthalmic services to veterans.
Dr Mark McCombe has a Fellowship in diseases of the retina and vitreous. See diabetic and macular degeneration sections. Disclaimer
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A cataract is an opacity or mistiness in the lens within the eye. The lens is located immediately behind the iris or coloured part of the eye and it helps to focus light on the retina at the back of the eye. The lens should be transparent (like clean glass) but if a cataract forms it loses transparency and interferes with the passage of light through that lens (imagine looking through a dirty windscreen at sunset).
Cataracts often form slowly and visual changes may not be noticed. Once it is removed the change can be dramatically better.
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Just as a cardiac angiogram can show the doctor the state of the arteries and veins around the heart, so does a fluorescein angiogram show the state of the arteries and veins at the back of the eye. The only difference is that X-Rays are not required. It is possible to use a modified camera to take photos. A special dye is injected into a vein in the arm. A series of photographs are taken over a period of a few minutes, and the doctor can interpret these. The skin may be tinged yellow for a day or so and the urine also, but this shouldn't cause any difficulties.
All diabetics need their eyes checked at least every two years. Your doctor will be able to tell you if more frequent checks are required for your eyes. Adult onset diabetics need their eyes checked on diagnosis, but juvenile onset diabetics don't need their eyes checked until two years after diagnosis.
Most laser surgery is available on site at the North Balwyn Eye Clinic and Laser Centre. YAG laser surgery may be required after cataract surgery or in some types of glaucoma. Argon laser surgery may be necessary for diabetic retinopathy, blocked veins in the retina or retinal tears, and also in some types of glaucoma.
Both of these are available on site.
Excimer laser refractive surgery has come a long way since it was first introduced into Australia in 1991. The procedure of choice is now LASIK. This a safe and effective procedure, but like all operations has risks and complications, and because it is a non-essential procedure these should be particularly well understood. Refractive surgery will not help everyone who wears spectacles.
We offer a no- obligation consultation where Dr Workman can explain if this procedure is suitable and what it could achieve. We fully inform patients and advise many that it will be of no benefit to them. Those who have benefited from this procedure have been amongst the happiest of our patients.
North Balwyn Eye Clinic and Laser Centre also has a minor operating procedures room. Equipped with an operating microscope, it is very convenient for small procedures, eg. removal of cysts on the eyelids, and is a safe alternative that may save you hundreds of dollars in theatre fees at hospitals. We have a sterilizer and are aware of the Australian Standards association requirements. Wherever possible we use disposable instruments, and minum eye drops. 
Different people use the term "lazy eye" differently. Some mean that the eye is turned (strabismus). Some mean that the vision never develops properly (amblyopia).
Spectacles and contact lenses have been used for many years to correct myopia.
There have been great advances in contact lens technology and now it is common to be able to wear almost any type of soft contact lens as a disposable lens. These can be disposed of anywhere from a day to a month. Safety is also improved although commitment to good contact lens care is still important.
Young people, with plenty of focussing power in reserve, often don't need any help for their hypermetropia. Older people will often need help for near objects, such as reading, and later on will need help with distant objects also. Young children with hypermetropia may develop a squint or turned eye as a result of using their focussing system to overcome the blur, and this is why the doctor may prescribe glasses for a child with a turned eye.
The front surface of the eye is shaped like a sphere. That is, it looks like part of the surface of a basketball or the back of a soup spoon. In astigmatism, the surface of the eye is warped and out of round. It looks more like the surface of a football or the back of a dessert spoon. Sometimes it can even be quite irregular. Regular astigmatism can be corrected with spectacles or contact lenses and, if appropriate, with laser. Irregular astigmatism can only be corrected with hard contact lenses.
Astigmatism can be associated with myopia and hypermetropia.
The glasses do not weaken our eyes
long sighted people will need reading glasses earlier than normal sighted people who will need them earlier than shortsighted people. Some shortsighted people can always read without their glasses because their prescription happens to coincide with what their reading prescription should be!
