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RESEARCH & PUBLICATIONS Scroll Down 01. Eye. 2024. Hussain A, Baneke A. Comment on: "Effect of trabeculectomy on the rate of progression of visual field damage." Read All 03. Eye. 2022. Jayaram H, Baneke AJ, et al. Managing risk in the face of adversity: design and outcomes of rapid glaucoma assessment clinics during a pandemic recovery. Read All 05. Am J Ophthalmol. 2019. Alaghband P, Baneke AJ, Galvis E, Madekurozwa M, Chu B, Stanford M, Overby D, Lim KS. Aqueous Humor Dynamics in Uveitic Eyes. Read All 07. Cur Eye Res. 2016. Baneke AJ, Lim KS, Stanford M. T he pathogenesis of raised intraocular pressure in uveitis. Read All 09. Travel Med Infect Dis. 2012 Mar;10(2):92-6. Winner of the Travel Medicine and Infectious Disease “First Look – Student Research” Best accepted paper for 2012. Baneke A. Review: Targeting trachoma: Strategies to reduce the leading infectious cause of blindness. Read All 11. Journal of Paediatrics and Child Health. March 2014. Baneke A. The junior doctor, an untapped paediatric teaching resource? Read All 02. Eye. 2023. Nair A, Baneke A. Comment on: "Could the AREDS formula benefit patients with glaucoma?" Read All 04. Eye (Lond). 2019. Baneke AJ, Aubry J, Viswanathan AC, Plant GT. The role of intracranial pressure in glaucoma and therapeutic implications. Read All 06. Graefes Arch Clin Exp Ophthalmol. 2018. Baneke AJ, Williams KM, Mahroo OA, Mohamed M, Hammond CJ. A twin study of cilioretinal arteries, tilted discs, and situs inversus. Read All 08. Retin Cases Brief Rep. 2020. Baneke AJ, Vakros G, Sharma V, Wong SC. Bleb-related endophthalmitis after use of the invitrea injection guide. Read All 10. Br J Hosp Med (Lond). 2019. Radotra A, Baneke A, Paul B. Mydriasis secondary to use of glycopyrrolate cream. Read All

Patient information These pages are designed to provide evidence-based, straightforward guidance to help you understand your condition and the best treatment options available. Understanding Glaucoma What is Glaucoma? Understanding Intraocular Pressure Glaucoma risk factors "why me?" The different types of Glaucoma Living with Glaucoma Glaucoma Treatment Guide Eye drops and tablets A guide to surgical treatments Laser treatments Cataracts What are cataracts? A guide to cataract surgery A guide to lenses Laser after cataract surgery Other topics Dry eyes and blepharitis Age-Related Macular Degeneration Services in Essex

A Guide for Patients Dry eyes and blepharitis Dry eyes and blepharitis are both common conditions, which often occur together. Dry eye, also known as keratoconjunctivitis sicca, occurs when your eyes don't produce enough tears, or the tears they do produce aren't of the right quality. Blepharitis occurs due to inflammation of the eyelids, which is often associated with the growth of bacteria. Eyelids become red, and may have a crusty or sticky discharge, more noticeable in the mornings. Although uncomfortable, these conditions are not usually serious and there are things you can do to help. Management of dry eyes It is not uncommon for glaucoma patients to suffer with dry eyes. Symptoms include the feeling of dry, gritty eyes, increased redness, and increased watering. Some patients feel like there is something in their eyes and may experience episodes of blurring. Symptoms usually improve if the eyes are closed and if a preservative-free dry eye drop is applied. Unfortunately, dry eyes can be worsened by the use of eye drops to treat glaucoma. Some sensible advice to reduce the symptoms of dry eyes is set out below: Ensure you are well hydrated by increasing your intake of water and reducing your intake of drinks containing caffeine Reduce your heating, air conditioning and car fan settings Use wrap-around glasses if outside on a windy day, or when driving Stop or reduce contact lens wear Consider flaxseed oil or omega 3 supplement tablets Use a preservative free dry eye drop containing sodium hyaluronate or carmellose, 4-6 times per day (available over the counter) Use a preservative free gel for dry eyes containing carbomer or white soft paraffin, last thing at night before sleeping (available over the counter) Ask your ophthalmologist about switching to a preservative free glaucoma drop Ask your ophthalmologist to consider changing drops that are more likely to cause dry, uncomfortable eyes, such as Lumigan (bimatoprost) and Alphagan (brimonidine), to an alternative If using glaucoma drops, close your eyes after applying the drops and ensure you wipe any excess off your eyelids using a clean damp tissue. This will reduce eyelid irritation In severe cases, asking your ophthalmologist for a short course of steroid and antibiotic eye drops may help. Management of blepharitis Blepharitis is a condition causing inflammation of the eyelid margins. Though not infectious, it is associated with the growth of bacteria, and symptoms may be worsened by the use of glaucoma eye drops. Blepharitis can worsen symptoms of dry eyes. Patients with blepharitis may notice red, crusty or sticky eyelids on waking. Blepharitis is usually a long-standing condition and requires long term changes to manage. Sensible advice includes: Use a heated eye bag/eye mask (available online and from some opticians and pharmacies) 1-2 times a day before cleaning your eyelids Clean your eyelids every morning and evening with your eyes closed, using a clean flannel and warm tap water (this does not need to be boiled). Massage the lids towards the lid margins (the top eyelid down and the bottom eyelid up) Some people advocate using a gentle cleaner such as baby shampoo, or a pre-made wipe containing a cleaning agent, but the evidence is limited and it is probably better to use warm water alone If using glaucoma drops, close your eyes after applying the drops and ensure you wipe any excess off your eyelids using a clean damp tissue. This will reduce eyelid irritation Ask your ophthalmologist whether switching to a preservative free glaucoma drop would help Ask your ophthalmologist to consider changing drops that are more likely to cause dry, uncomfortable eyes, such as Lumigan (bimatoprost) and Alphagan (brimonidine), to an alternative Ask your ophthalmologist whether you would benefit from a course of oral antibiotics such as doxycycline or azithromycin In severe cases, asking your ophthalmologist for a short course of steroid and antibiotic eye drops may help. For a video explaining lid cleaning techniques in more detail please see below:

A Guide for Patients Understanding Glaucoma Risk Factors: "Why me?" If you’ve been diagnosed with glaucoma, you might be wondering, "Why me?". It's a common question. While certain causes like steroid use, trauma, or previous eye surgery are known, the reasons behind the most common type, primary open angle glaucoma, are not fully understood. However, we do know that glaucoma is a multifactorial disease, meaning there are various risk factors that can predispose someone to developing it. This page will help you understand these risk factors and how they may apply to you. The Bigger Picture Glaucoma is the leading cause of irreversible blindness worldwide. Read More Implications for Your Family Should they be tested? Read More Risk Factors What makes some people more likely to suffer from Glaucoma? Read More Diet and Lifestyle What you can do to improve your eye health. Read More Understanding the risk factors for glaucoma can help you take proactive steps in managing your eye health. Whether it’s monitoring your blood pressure, making healthy lifestyle choices, or ensuring regular eye tests, being aware of these risks is the first step in protecting your vision. If you have a family history of glaucoma or other risk factors, talk to your eye specialist about how you can best manage your eye health. The Bigger Picture Glaucoma is the leading cause of irreversible blindness worldwide. In the UK, about 2% of people over 40 have glaucoma, but it’s estimated that more than 50% of cases go undiagnosed. This means that for every person who knows they have glaucoma, there is likely another who has it but doesn’t know. In England alone, around 480,000 people have primary open angle glaucoma. The condition is more common in older adults, with 1 in 50 people over 40 and 1 in 10 people over 75 affected. What Are the Risk Factors for Glaucoma? Risk factors for glaucoma have been identified through years of observing people with the disease. These factors can be classified into two categories: modifiable and non-modifiable. Modifiable Risk Factors: These are risk factors you can change or control, such as managing high blood pressure. Non-Modifiable Risk Factors: These include things you cannot change, like your age or family history. Elevated Eye Pressure Most types of glaucoma are associated with high eye pressure. However, some people develop optic nerve damage from glaucoma even with normal eye pressure, a condition known as normal tension glaucoma. Currently, all glaucoma treatments focus on lowering eye pressure because it’s the only risk factor we fully understand and can manage effectively. High Blood Pressure The relationship between blood pressure and glaucoma is complex. Some studies suggest that high blood pressure can slightly increase eye pressure, while others indicate that low blood pressure, especially at night, might contribute to glaucoma. A sensible approach is to maintain blood pressure within a normal range and avoid extremes. If you’re on blood pressure-lowering medication, it’s important to inform your eye doctor, as adjustments to your medication might be necessary. Diet and Lifestyle While diet isn’t thought to have a significant impact on glaucoma, there’s some evidence that vitamin B3 (nicotinamide) might slow disease progression. It is found in red meat, poultry, fish, brown rice, nuts, seeds, legumes and bananas. However, there isn’t enough evidence yet for doctors to recommend it universally. Eating a healthy, varied diet and getting regular exercise are always good for overall health. Some studies suggest exercise and meditation are helpful for patients with glaucoma. Patients with pigment dispersion syndrome should avoid high-impact sports, as these can increase the risk of pressure spikes in the eyes; this does not apply to patients with other types of glaucoma. Other Risk Factors Age Glaucoma can affect people of all ages, but it’s most common in those in their 70s and 80s. As we age, the optic nerve gradually loses nerve cells, and glaucoma accelerates this process. The longer we live, the greater the risk of developing glaucoma. Ethnic Origin People of African or Caribbean descent are at higher risk of developing glaucoma, often at a younger age and with more severe disease. This risk increases significantly after age 40. Family History of Glaucoma Glaucoma, particularly primary open angle glaucoma and primary angle closure glaucoma, often runs in families. If you have a close relative with glaucoma, your risk of developing the disease is four to nine times higher than average. If you have been diagnosed with glaucoma your direct relatives should have regular eye tests, and are entitled to free NHS eye checks if they are aged 40 or older. Myopia (Short-Sightedness) Moderate to high short-sightedness increases the risk of developing certain types of glaucoma, especially pigmentary glaucoma and primary open angle glaucoma. Hypermetropia (Long-Sightedness) Long-sightedness can lead to primary angle closure glaucoma, as these eyes are often smaller, which can crowd the drainage system and lead to increased pressure. Implications for Your Family Glaucoma is often a painless condition that damages the outer edges of vision first, gradually working its way inwards. Because it progresses silently, many people don’t realise they have it until it’s advanced. Early detection through regular sight tests with an optician is crucial. While everyone should have an eye test every two years, those with a close relative (parent, sibling, or child) with glaucoma should be tested more frequently. In the UK, people over 40 with a first-degree relative who has glaucoma are eligible for free sight tests every two years. Bigger picture Risk factors Diet and lifestyle for family MORE ABOUT UNDERSTANDING GLAUCOMA AVAILABLE TREATMENTS CONTACT TO BOOK

A Guide for Patients Understanding Intraocular Pressure (IOP) Intraocular pressure (IOP) refers to the pressure inside your eye, which is essential for maintaining its shape and function. Just like the air inside a balloon keeps it inflated, the fluid inside your eye keeps it firm and healthy. However, when the pressure becomes too high, it can lead to conditions like glaucoma, which can damage your vision if left untreated. This section will explain what IOP is, how it works, and why it’s important to manage it properly. If you’ve been diagnosed with raised intraocular pressure or glaucoma, your eye specialist will work with you to manage and monitor it effectively. Treatments might include eye drops, laser therapy, or surgery to lower your pressure and prevent further damage to your vision. Regular check-ups and measurements of your eye pressure are important to ensure your treatment is working as intended. What is Intraocular Pressure (IOP) ? OP is the pressure created by the fluid in your eye. The eye is filled with two types of fluids: aqueous humour, which is found in the front part of the eye between the iris and the cornea, and a jelly-like substance called vitreous humour, located at the back between the lens and the retina. The aqueous humour is produced by the ciliary body, just behind the iris, and flows through the pupil into the front of the eye. From there, it drains out through the trabecular meshwork, located where the iris meets the cornea, in an area known as the drainage angle. The balance between the production and drainage of this fluid is what creates intraocular pressure. If the drainage is blocked or slowed, or too much fluid is produced, the pressure inside the eye increases. Imagine your eye as a sink: the tap (ciliary body) is constantly producing fluid, which fills the basin (anterior chamber) and drains out through the plughole (trabecular meshwork). If the drain is blocked, the water (or fluid) builds up, causing the pressure to rise. Glaucoma and Intraocular Pressure In open-angle glaucoma, the drainage system doesn’t work as efficiently as it should, causing the fluid to build up and increase the pressure inside the eye. Treatments for this include eye drops to reduce fluid production or help improve drainage, laser therapy, or surgery to create new drainage pathways. In angle-closure glaucoma, the drainage angle is blocked by the iris, which acts like a rubber stopper over the plughole. This blockage causes a sudden spike in pressure, which can be very painful and requires emergency treatment. This might involve medication to lower the pressure or a laser treatment (called a laser iridotomy) to create a small hole in the iris, allowing fluid to flow freely. How Do We Measure Intraocular Pressure? Eye pressure is measured using a special instrument that gently presses against the cornea to gauge how firm or soft the eye is, similar to testing the firmness of a balloon by pressing on it. The measurement is given in millimetres of mercury (mmHg), and this helps eye specialists assess whether your eye pressure is within a healthy range. What is a Normal Eye Pressure? Most people have an eye pressure that falls between 10 and 24 mmHg. However, what’s considered a “normal” pressure can vary from person to person. Some people with eye pressure below 21 mmHg may still develop glaucoma (normal-tension glaucoma), while others with pressures above 24 mmHg may not show any signs of the disease (ocular hypertension). According to the National Institute for Health and Care Excellence (NICE), if your eye pressure repeatedly measures 24 mmHg or higher, you should be referred to a hospital eye service for further investigation. However, some individuals with glaucoma can experience damage even with lower pressures, especially those with advanced disease. Factors That Influence Intraocular Pressure Intraocular pressure can fluctuate throughout the day due to various factors. These include: Body Position: Lying flat can increase your eye pressure compared to sitting upright, which is why night-time spikes in pressure may occur. Exercise and Activity: Physical activity, breathing, fluid intake, and even wearing a tight shirt collar can affect your eye pressure. Medications: Both systemic (whole body) and topical (eye drops) medications can influence your pressure. Caffeine: Drinking caffeinated beverages may cause temporary increases in eye pressure. For people with glaucoma, these fluctuations are particularly important to monitor, as spikes in pressure can contribute to further damage to the optic nerve.

A Guide for Patients Understanding Cataracts Cataracts are a common eye condition that can make your vision cloudy and blurry, much like looking through a foggy window. As we age, the proteins in our eye’s natural lens can start to change, leading to the formation of cataracts. If you’ve noticed your vision becoming less clear, particularly in low light or when driving at night, it might be due to cataracts. The good news is that cataract surgery is a highly successful procedure that can restore clear vision. What Exactly is a Cataract? A cataract happens when the normally clear lens inside your eye becomes cloudy. The word "cataract" actually comes from the Latin word for waterfall, "cataracta," because the cloudiness can resemble the appearance of water cascading down. Cataracts typically develop slowly over time, so you might not notice them at first. As they progress, you may find it harder to see clearly, especially in low light or when facing bright lights, such as headlights at night. Colours might appear duller, and you might struggle to distinguish contrasts as well as you used to. Most cataracts are simply a part of getting older, and they’re not usually linked to other diseases. However, certain factors can cause cataracts to develop earlier in life, such as diabetes, eye injuries, or the use of steroid eye drops. NHS CATARACT INFORMATION How is Cataract Surgery Performed? Cataract surgery is a procedure that involves removing the cloudy lens and replacing it with a clear artificial lens. The most common technique used today is called “phacoemulsification.” During the surgery, tiny incisions are made in the eye, and a small probe is used to break up the cloudy lens into smaller pieces. Once the cloudy lens is removed, it’s replaced with a clear plastic lens that is carefully chosen to focus light correctly onto your retina, restoring clear vision. More about cataract surgery More about different lenses

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< Back This is a Title 01 This is placeholder text. To change this content, double-click on the element and click Change Content. This is placeholder text. To change this content, double-click on the element and click Change Content. Want to view and manage all your collections? Click on the Content Manager button in the Add panel on the left. Here, you can make changes to your content, add new fields, create dynamic pages and more. You can create as many collections as you need. Your collection is already set up for you with fields and content. Add your own, or import content from a CSV file. Add fields for any type of content you want to display, such as rich text, images, videos and more. You can also collect and store information from your site visitors using input elements like custom forms and fields. Be sure to click Sync after making changes in a collection, so visitors can see your newest content on your live site. Preview your site to check that all your elements are displaying content from the right collection fields. Previous Next

< Back This is a Title 03 This is placeholder text. To change this content, double-click on the element and click Change Content. This is placeholder text. To change this content, double-click on the element and click Change Content. Want to view and manage all your collections? Click on the Content Manager button in the Add panel on the left. Here, you can make changes to your content, add new fields, create dynamic pages and more. You can create as many collections as you need. Your collection is already set up for you with fields and content. Add your own, or import content from a CSV file. Add fields for any type of content you want to display, such as rich text, images, videos and more. You can also collect and store information from your site visitors using input elements like custom forms and fields. Be sure to click Sync after making changes in a collection, so visitors can see your newest content on your live site. Preview your site to check that all your elements are displaying content from the right collection fields. Previous Next

< Back This is a Title 02 This is placeholder text. To change this content, double-click on the element and click Change Content. This is placeholder text. To change this content, double-click on the element and click Change Content. Want to view and manage all your collections? Click on the Content Manager button in the Add panel on the left. Here, you can make changes to your content, add new fields, create dynamic pages and more. You can create as many collections as you need. Your collection is already set up for you with fields and content. Add your own, or import content from a CSV file. Add fields for any type of content you want to display, such as rich text, images, videos and more. You can also collect and store information from your site visitors using input elements like custom forms and fields. Be sure to click Sync after making changes in a collection, so visitors can see your newest content on your live site. Preview your site to check that all your elements are displaying content from the right collection fields. Previous Next