Heart and Soul

“Normally about the size of your fist (unless you’re Donald Trump)”

To say our bodies are complicated is somewhat of an understatement. The number of processes each one carries out every second is staggering. From managing all the thoughts racing through your brain, digesting last night’s dinner, pumping oxygen into the blood from the outside world and contracting a select group of muscles just to stop you from falling over, it is in perpetual activity even if it doesn’t always seem like it. The organs of the body take on all these different roles, each one vital to the workings of all the others.

For now, however, I will focus on one of the most vital of all our organs – the heart. For obvious reasons, it is pretty useful. With every beat, it pumps blood into the arteries taking with it all the vital components of the blood into your tissues and all the other organs of the body as well. Indeed so vital is its role that it is little wonder it has adopted an almost spiritual role. We’re often told to follow our hearts – though this makes little sense in literal terms – and apparently that’s where home is as well. Part of the reason the Aztecs most commonly extracted people’s hearts as a form of sacrifice was their belief that it was the seat of the individual, more so than the brain, a belief shared by classical philosophers such as Aristotle.

In reality, the only bearing it has on our thinking and individuality is in its relationship with the brain – without the heart, the brain would be nothing. Normally about the size of your fist (unless you’re Donald Trump), it is made up mostly of muscle and comprises four chambers. Two of these called the atria and these sit atop the two larger ventricles, which do most of the pumping. The right atrium and ventricle take returning blood from the veins of the body and send it straight out to the lungs to be resupplied with oxygen. From there, the blood returns to the left atrium and then left ventricle, where it is given a final push into the body to do all of its good work. Generally it takes around 20 seconds for blood to circulate round the body before it gets back to the right atrium again.   

To prevent back flow, there are several valves and, as these close, they cause the characteristic sound of your heart beating that we can listen to more closely using a stethoscope. Often we can pick up whether there is a bit of turbulence in the system if the valves are not functioning properly – ie a heart murmur.

If all is well, your heart will beat regularly and the signal for this comes from within the heart itself, from a collection of cells in the atria (called the sino-atrial node). Electrical impulses originate from here and spread like a circuit through the heart tissue, making the muscles contract in time with each other. In a lifetime, you can expect your heart to beat around 3 billion times, or 115,000 times a day. When the tissue that conducts these electrical impulses throughout the heart muscle is damaged, this can sometimes result in funny rhythms, or arrhythmias, of which there is a spectrum varying from serious to not so serious. Ultimately, the beating of the heart is governed ‘in house’ and though signals from the brain can stimulate it to speed up and slow down, the rhythm originates from the heart itself which is why, if a heart is removed from the body, it will continue to beat on its own for a little while.

Inevitably with such an important role, when things go wrong, we tend to know about it. In the past, infectious disease tended to be the leading cause of death but, since the middle of the last century, heart disease rose considerably, overtaking infectious disease (certainly in the developed world) as the biggest killer. However, due to plenty of research and advances in healthcare, in the last 15 years death rates from heart disease and stroke have reduced by about 50%. It is still the leading cause of death in males between the ages of 50 -79 years old and, though more common in men, heart disease is something we should all, including women, be thinking about.

Heart disease is a term thrown around a lot but what is it exactly? It falls into a broader category of cardiovascular disease which encompasses things like stroke as well. Essentially the main issue for any cardiovascular disease is the process in which arteries become blocked resulting in loss of blood flow to the areas these arteries supply. When the area that blocked arteries supply is heart muscle, we call this ischaemic heart disease. (Most strokes occur when blood supply is blocked to a part of the brain).

When an artery supplying heart muscle (coronary artery) is partially blocked, the heart needs to work harder as one exerts oneself. If the supply cannot meet the demand, this gives rise to chest pain which resolves when rested. This is angina.

When a coronary artery becomes blocked and blood supply is cut off completely, this results in chest pain not relieved by rest (often accompanied by nausea, shortness of breath, sweating and a feeling of impending doom), and areas of heart muscle can die. This is a heart attack, also known as a myocardial infarction. (myo = muscle, cardia = heart)

Following damage or weakening of the heart muscle (sometimes due to valve problems), the heart sometimes beats less powerfully than before and can result in reduced cardiac output that doesn’t meet the normal demands of the body. This can result in fluid build-up in the legs and reduced exercise tolerance and is known as heart failure.

The process that blocks the arteries is known as atherosclerosis which is essentially a build-up of fatty material that circulates inside your blood vessels. Over time, this atheroma gradually accumulates, like a natural dam in a stream, and restricts the blood flow, often without any symptoms until the last minute. Like many things there is no one cause for this but rather a group of risk factors that are commonly preached about by healthcare professionals but that are worth repeating here.

Smoking (stop it!)

Inadequate physical activity

Poor diet

Obesity

High blood pressure (the higher the blood pressure in the blood vessels, the harder the heart has to pump to push the blood around, inducing extra strain that can damage heart muscle over a period of time, not to mention increasing the chance of blood vessels blocking)

High cholesterol

All of these are things that can be managed and optimised and are extremely important to consider, particularly if you have a family history of heart disease. If you are concerned about any of the above, it is always best to come and have a chat with your GP to talk about the best ways to reduce your risk of heart disease. Having a healthy heart doesn’t need to be more complicated than addressing the above factors and prevention is always better than the cure.

Dark Pines

One of the most enjoyable novels I have read for a while. Perfectly paced, interesting characters and a genuinely good story. Also interesting, having just read a book on hearing loss, that the main character has to wear hearing aids. I didn’t plan that!

Love the author, Will Dean’s, bio as well… Having settled in rural Sweden, “he built a wooden house in a boggy clearing at the centre of a vast elk forest, and it’s from this base that he compulsively reads and writes.”

Good man.

Dry January: Probably a good idea

‘Billionaire Vodka’ is filtered through ice and then some Nordic birch charcoal before being passed through sand made from crushed diamonds and gems.

I saw a programme on television a while back (I think Chris Packham was involved) in which there was a gentleman who, seemingly unprovoked, would quite regularly lose co-ordination, become disorientated and somewhat ‘lary’. Despite his protestations, his wife began to suspect that he was sneaking off to the pub at every available opportunity without telling her. Understandably this placed rather a strain on their relationship until finally it transpired that he was innocent after all. It turns out he was suffering from something called Auto-brewery Syndrome.

This thankfully rare condition is thought to occur when there is an overgrowth of yeasts in the intestines that produce a natural fermenting process in the gut, resulting in high alcohol levels that make the sufferer quite literally drunk without having consumed any alcohol.

Fermentation (the science of which is known as zymology for the purposes of pub quiz trivia) is key to producing alcohol and there is evidence to show that we, as a species, have been using it to make alcoholic drinks for thousands of years, as far back as 7000 BC. In the middle ages we were brewing beer as an everyday drink, often protecting against various water-borne diseases. It was also quite handy for sailors to take along with them on long voyages. Essentially, alcohol – specifically in alcoholic drinks ethyl alcohol or ethanol – is produced when yeasts and bacteria break down natural sugars found in fruits and grains in the absence of oxygen. Lactic acid that causes cramp in muscles during exercise is formed through a similar process.

Of course, as much as we like it, drinking the stuff does not always result in the best of outcomes. Some research has estimated that, at any one time, up to 0.7% of the world’s population (equivalent to around 50 million people) are drunk. Unfortunately in the UK in 2016 7,327 people died from alcohol specific causes and around 40% of all violent crime involves alcohol in some way. It accounts for more than a million hospital admissions each year.

As you can imagine, this creates rather a strain on the health service as well as on a person’s general health. When we drink alcohol, it creates a numbing effect on the brain, resulting from inhibition of certain neurotransmitters. Most likely it is this sensation that has us coming back for more each time. While in the moment it could be described as pleasant, it has some far more negative effects.

Your body reacts to ethanol as a toxin and this causes a reduction in insulin effectiveness in the long term if we drink a lot. Conversely, in the hours after drinking lots of ethanol, there will be an upturn in insulin production, lowering our blood sugar and causing tiredness and fatigue. As it is broken down, it produces acetaldehyde, which is heavily implicated in hangovers. It is also something which has been implicated in ethanol’s role in causing cancer, in this case by damaging DNA.

There are seven proven types of cancer (probably more yet to be proved) in which alcohol has a causative role: bowel, breast (possibly due to increased oestrogen levels), laryngeal, pharyngeal, mouth, oesophageal and liver. The liver becomes more and more damaged with persistent alcohol use and the scarring produced from this (cirrhosis) can cause irreparable and unpleasant consequences which may ultimately be fatal.

If that is not enough, excessive alcohol will drive up blood pressure and predispose a drinker to diabetes, all of which increase the risks of heart attacks and strokes. Alcoholic drinks account for around 11% of the UK population’s sugar intake further compounding this risk. It will inevitably cause weight gain and likely some tooth decay along the way.

Sleep can be greatly affected by alcohol. While many people drink as an aid to sleep, although that initial numbing effect may help them drift off, the sleep achieved will be restless and inefficient. Time spent in REM (rapid eye movement) sleep will be increased, resulting in less time spent in deep and restful slumber. This only causes fatigue and makes things worse rather than better. 

What then, is a ‘safe’ level of alcohol? The chief medical officer’s official recommendation is that we do not exceed 14 units of alcohol each week (one unit is 10ml of alcohol). This is a reduction from the old recommendations and represents roughly 6 pints of beer, or 6 glasses of average strength wine.
Often people underestimate how many units there are in their drinks – it is more than you might think!

If you do drink 14 units a week, spreading them out is the way to go rather than all at one time. If you are drinking any more than this, you are really not doing your health any favours, not to mention your bank account. Incidentally, the most expensive vodka in the world will set you back a cool 3.7 million dollars. ‘Billionaire Vodka’ is filtered through ice and then some Nordic birch charcoal before being passed through sand made from crushed diamonds and gems. Served in a diamond encrusted crystal bottle, it is some fairly serious stuff. While not all alcohol is priced that high, it does highlight the glamour that often surrounds it. Therein lies much of its danger.

Dependence on alcohol can creep up on you and, if unchecked, can quite literally kill you. It is thought that only 6% of alcohol dependant people will access treatment every year, so if you are unsure it is worth coming to see your GP or accessing any of the online resources listed at the bottom of this article.

You may have heard every now and again about the benefits of alcohol. In the past, before the advent of anaesthesia, surgeons would ply their patients with alcohol before procedures and physicians would recommend a ‘hot toddy’ to stave off a cold. In fact, while giving an initial boost (due to the effects of alcohol on the mind) a dash of whisky in your hot drink probably only serves to slow down the natural process of fighting off the infection.

Certainly there have been studies reported in the papers about regular red wine being good for your heart. The truth is, certainly in my mind, that there is simply not enough evidence to back this up. While some studies have shown benefits, the context in which they have been carried out is far from conclusive. Things like red wine do contain ingredients known as flavonoids, thought to be rich in anti-oxidants which, among other things prevent clotting disorders. However, current evidence only points towards an overall benefit in a very small amount of alcohol (5 units a week) for women over 55 years old. Before you all go rushing down to the pub, remember that is a mere 5 units a week!

So I would recommend that the next time you feel a spot of cenosillicaphobia coming on – a pathological fear of an empty glass – consider filling it with something other than alcohol instead. I’m not saying we should stop drinking altogether but moderation is the overwhelming key. And if there are any generous billionaires out there, I would much prefer a nice house or three rather than a bottle of vodka. Thanks. 

Churchill’s Ministry of Ungentlemanly Warfare

Giles Milton paints an heroic picture of the incredible operations and missions carried out during WWII. An interesting read just after the Codemaker’s War as it deals with a lot of the same organisations from a very different angle.

 

The Dreaded Headache

“…there have been discoveries of skulls dating back to Neolithic times (between 10,200 BC and 2000 BC) drilled into and partially removed in what is thought to have been an early attempt at treatment”

I was speaking to a friend recently who claimed that he had never had a headache. On further enquiry, it appeared he simply had no concept of what one might feel like, even the dreaded hangover headache.  Now I don’t have any statistics on this, but I suspect that this situation is very rare. Let’s face it, most of us get headaches and, unfortunately, there are lots of things that can lead to one.

Throughout history people have suffered and there have been discoveries of skulls dating back to Neolithic times (between 10,200 BC and 2000 BC) drilled into and partially removed in what is thought to have been an early attempt at treatment. Drastic though that may seem, some have shown signs of bone growth around these holes, suggesting the patients survived this process. Altogether more civilised were the ancient Greeks and Romans who tried either peppermint tea or rubbing raw potato into their heads.

Overwhelmingly the most common cause is the tension headache and most of us will have experienced one of these. They occur due to muscular tension that can develop from the shoulders and neck or from around the muscles of the forehead if, for instance, one’s posture in front of the computer is not optimised. They can also develop through stress or if the eyes have been straining to read a screen for too long. It’s always worth popping to your optician to get your eyes tested if you feel you are straining a lot, especially if you’re getting headaches.

Although tension headache is most common, it is perhaps over-diagnosed at the expense of another common cause of headache – the migraine. Thought to have a global prevalence of 14.7%, it is estimated that the UK population loses 25 million work or school days from the condition each year. That equates to roughly £2.25 billion loss to the economy and produces a £150 million cost to the NHS through prescriptions and GP appointments.

Migraines are typically one sided (although not always), hence the derivation of their name from the Greek word ‘hemikrania’ meaning ‘half the skull’. Despite their impact and prevalence, the process behind what causes them is still unknown. Rather than relating to blood vessels in the brain constricting and then dilating as once thought, it is now suspected to be more related to particular neurological systems. There is ongoing research into various facets of this, including particular gene associations (there is a definite hereditary element to migraines), specific brain regions activated in the earliest stages and the roles of various neuropeptides. It’s all pretty complex stuff.

One third of migraines will start with an aura (a visual phenomenon a little like the image below although it can differ from person to person) and may progress to a throbbing ache, typically lasting for between 4 to 72 hours. Women are more prone than men, and tend to suffer more often during or just before their periods.

Just one way you might visualize an aura

If you have a migraine, it is best treated as early as possible with paracetamol or ibuprofen. If these don’t work, regular sufferers may benefit from trying one of the triptan medications available on prescription. Once established however, a migraine can be debilitating and so lying down in a dark room and resting is often the best course of action.

It’s worth considering that there can be certain triggers. Coffee, chocolate, sugar-free food sweetened with aspartame or sucralose and any foods containing tyramine such as citrus fruits, bananas, processed meats, onions and nuts are all potential offending items.

What of other causes of headaches? I mentioned hangovers earlier and these must be up there alongside tension and migraine headaches in terms of prevalence. Essentially, when we drink lots of alcohol, our bodies dehydrate and this reduces our circulating volume of blood. This causes a shrinkage of the brain that then pulls upon the membranes holding it in place, thus causing an ‘ache’. Like the migraine however, the full process is not wholly understood and there is a theory that suggests a significant contributing factor may be the build-up in the brain, in place of glucose, of a chemical known as acetaldehyde (which is a breakdown product of alcohol).  Either way, the best way to avoid it is obviously to limit alcohol intake and, if you are going to drink a lot, ensure you drink plenty of water before bed and in between alcoholic drinks.

There are several more severe and mercifully less common headaches worth mentioning.

Trigeminal neuralgia (the trigeminal nerve is a major nerve that supplies various areas of the head and neck; neuralgia is ‘nerve pain’) is characterised by short episodes of sharp, intense, electric shock pain in the eyes, nose, scalp, forehead, jaw or even lips. Even the slightest touch can trigger it, including a light breeze, and it can be life-changing for sufferers of severe forms.

Similarly, cluster headaches can be so severe that they are sometimes referred to as the suicide headache. The pain from these is often described as a penetrating and excruciating pain around the eye and can last anything from 15 to 180 minutes. Some have labelled it the worst pain a human can experience. If you are suffering from these, the chances are you won’t need prompting to come and see a doctor.

If you suddenly experience a sudden severe (often described as thunderclap) headache, one that you might describe as the worst headache you have ever had (assuming you have never had a cluster headache!) or as if you have been hit on the back of the head, it might be a sign of a different cause – a subarachnoid haemorrhage (subarachnoid means below the outer layer of the brain, haemorrhage = bleed). This can be accompanied by sensitivity to light and neck stiffness, much like those suffering from meningitis. This needs a trip to A&E to get tested.

More subtly, but still serious, is a headache that manifests in tenderness over your scalp. If you have pain when you press over your temples (typically, in contrast, rubbing here with a tension headache helps) then it may represent an inflammation of the blood vessels in the scalp known as temporal or giant cell arteritis. This is a rheumatological condition and may require blood tests and maybe even biopsy of the offending areas. It can also cause blurred vision so if you think this is happening (typically you will be a woman around your 70th year) then it is worth coming to see us.

Finally, if you are waking up every morning with a headache over the course of several weeks, this is probably something you should also get checked out. It could well be tension, a stiff neck or blocked sinuses but this pattern can sometimes point towards pressure within the brain itself caused by a tumour. No harm in coming to get it checked by us.

Far from wanting to worry you, the chances are that, if you have a headache, it is caused by tension or a migraine. So my advice is similar to what it would be for many other health conditions. Maintain a healthy and balanced diet, with plenty of exercise, and ensure you drink enough water through the day. Get your eyes checked regularly and make sure you consider your posture both at work and at home on the sofa. Manage stress (as much as that is possible!) and if you are worried that the headache has any worrying features, feel free to come and see your GP. As for hangover headaches though, I’m afraid you’re on your own. “

Exercise

“Fit and fat is better than being unfit and thin.”

Forget pills, staying active is the best medication.
After-all, when it comes to being healthy, there is almost nothing else that comes near it in terms of its effectiveness.

There is a quote from a health promotion consultant called Dr Nick Cavill that seems to pop up more and more regularly these days – ‘If exercise were a pill, it would be one of the most cost effective drugs ever invented.’ When you look at the statistics, it is difficult to disagree.

There is strong evidence to suggest that exercise reduces the risk of the following conditions by the following percentages…

Coronary artery disease and stroke – 35%
Type 2 Diabetes – 50%
Colon cancer – 50%
Breast cancer – 20%
Osteoarthritis – 83%
Depression – 30%
Dementia – 30%
Hip fractures – 68%
Falls in older adults – 30%

These are not insignificant numbers as I’m sure you will appreciate. Exercise really is good stuff and also helps with self esteem, sleep quality and energy levels.
The government’s aim is for everyone to be doing around 150 minutes of moderate aerobic exercise each week. Moderate exercise is something that essentially causes you to breath faster, increase your heart rate and feel warmer – a good way to gauge it is if you are breathing too heavily to sing the words to a song. Examples might be going for a brisk walk or hike or playing a game of volley ball. Only half of us in the UK are reaching that target. It doesn’t take too much of an imagination to consider the effect it would have of all of us matching this target on the mortality rates for all of the conditions above.

It goes deeper than this though. We are a species that evolved as hunter gatherers, constantly on the move, but in world with televisions and remote controls, motorised vehicles, and robots that do your hoovering for you, it comes as no surprise that we are suffering from the effects of a sedentary lifestyle. As such, even if we are reaching our exercise targets, if we spend the rest of the time sitting or lying down (and the average person in the UK sits for 7 hours a day, 10 hours if you’re over 65 years old) then those benefits are lost or at least have less impact on the risk of adverse health conditions.

It is therefore key for us to move about every now and again even if we’re not exercising. The recommendation is that every half an hour, we should get up and move about for 2-3 minutes. Practically I know sometimes it may seem difficult but actually when you think about it, is it really? Sometimes only the smallest things need adjusting to achieve this, whether it be an agreement with your boss to get up and walk around the office once in a while or maybe even (as horrifying as this sounds) keeping the remote in the shed at the bottom of the garden. Essentially we’ve all got a bit lazy and our bodies are experiencing the consequences.

For those thinking, ‘well my knee hurts too much for me to do any exercise’, or ‘the local volley ball court is too far away,’ I’m afraid that’s no excuse. Remember, moderate aerobic exercise is anything that gets you breathing and increases your heart rate, so if your knee hurts, do some swimming or even some armchair aerobics, likewise if you can’t get to your local sports centre easily, go for a brisk walk down the road or around the garden for 30 minutes every day. There is a mode of exercise for almost everyone.

Why does exercise and activity help you may ask? Recently, research has revealed quite in depth benefits that we were previously unaware of. Much of this has to do with the anti-inflammatory effects of activity. At the cellular level, our bodies are in constant turnover. Each cell in our body has something called a mitochondria which is essentially a mini power plant. It is here that we produce energy to be used in various processes throughout the body. Each mitochondria will build up a charge and if we are not using energy, they stay charged. The longer they do, bits of charge will gradually escape in the form of ‘free radicals’. These free radicals are bad news and contribute to cell and mitochondrial damage, aiding the ageing process and generally making us less healthy. It is thought that this process causes microscopic inflammation throughout the body.

Activity and exercise helps by utilising this energy and preventing release of free radicals but also produces anti-inflammatory substances from muscle that help to mediate the inflammation at a cellular level. That is not to mention its effect in increasing insulin sensitivity of cells, reducing risk of conditions like diabetes, along with strengthening heart muscle to reduce average heart rates and contributing to lower blood pressure and cholesterol.

There is a lot of focus these days on weight loss when it comes to exercise. This is quite a damaging concept and is reinforced by many commercial diet plans and courses. Although it is important to maintain a good weight and avoid obesity, weight loss is not the be all and end all. There are two types of fat. Subcutaneous fat (sub – beneath; cutaneous – skin) is the stuff that pads out our waist lines and is the most visible. However, arguably far more important is the fat that surrounds our organs like the liver and the heart. This is called visceral fat (viscera meant ‘internal’ in latin) and build-up of this visceral fat has significant implications for our general health. Even if our exercise seems to be doing nothing to our subcutaneous fat, it will be having far greater effects on our visceral fat and this is very important. Therefore we mustn’t measure the success of our exercise or indeed any form of activity with weight loss. Fit and fat is better than being unfit and thin.

The Eye

“…fingerprints have approximately 40 individual features but the average iris has 256.”

What do the following celebrities all have in common? Christopher Walken, Dan Akroyd, Simon Pegg and Jane Seymour. It takes only a quick glance at the title of this article to ascertain that it must be something to do with their eyes. Well done though if you said that they all have ‘Heterochromia’, which means that each of their eyes are different colours. Regardless of whether or not one’s eyes have this rather exotic trait, these clever and intricately complex little organs tend to be a focal point and, at an individual level, one of our most vivid and emotive defining features.

They are thought to have evolved initially in single celled organisms that held light sensitive proteins. Over many millions of years, the process of ‘seeing’ became a reality through a mind-boggling transition into the eyes that we see today. Across the animal kingdom, there are many different types of eye and, as is the outcome of all evolution, the creatures they serve benefit in different ways depending on the environments in which they live.

Geckos can see colour 350 times better than us, bees have 5 eyes, most spiders have 8 and worms merely have a collective of light sensitive receptor cells. Not all eyes are structurally the same. For example, some vertebrates, including cats, have an extra layer of tissue behind the retina (the layer of cells that collects and processes light) called the tapetum lucidum. This reflects any light that has got through first time round and reflects it back into the retina again, giving rise to excellent night vision – very handy for catching unsuspecting mice. It also results in the eye-shine we see when some type of mammal is lurking in the bushes and served as inspiration for the ‘cats’eyes’ we see on our roads.

We humans must make do without these handy features and we are limited to just the two eyes. This is better than one though, as it gives us a perception of depth. To enable us to see, we must collect the light from around us and process it. Light bounces off everything (almost) and if we look towards something the light from this will hit our eyes. This light travels first through the cornea and second through the pupils (the holes made by the retractable fibres that make up the iris (the part that gives our eyes their colour). Here it hits the lens, a rounded clear organ that alters in size as we focus differently. This allows it to redirect light from different distances onto the back of the eye where the retina sits, so that it doesn’t produce a blurry picture. At the retina, the light is converted by different types of cells into nerve signals and the information is then taken via the optic nerve to the brain where it is further compiled into what we understand as ‘sight’. Interestingingly, because of the way in which the light is focused on the retina, the unprocessed image is upside down and back to front, so the brain must flip these back the right way round.

As doctors, the eyes are a useful thing to check when examining a patient because they can tell us a lot about a person’s health. Shining lights into the eyes causes the pupils to constrict and faults here can point to certain neurological conditions as can double vision and loss of visual fields. Looking at the back of the eye, we can sometimes tell if there is raised pressure in the fluid surrounding the brain, and at the front, there are characteristic appearances in or around the eyes of people who might have thyroid problems or high cholesterol. In babies, it is important to check for something called the red reflex, the normal red-orange colour of the eye when light is shone. Asymmetry here or a white reflection can sometimes point to something called retinoblastoma which is a type of cancer.

The most common eye examination one might receive is the visual acuity check. Using the Snellen charts, reading the letters on rows of ever decreasing size, we challenge ourselves to get to the very bottom level. The phrase ‘20/20 vision’ is often talked about, which essentially means we can see something at 20 metres that the average person would see at 20 metres. Outside the USA, we use 6 metres as a scale and if you wanted really exceptional vision, you would aim for something more along the lines of 6/7 (in other words you could see something from 7 metres that the average person would only be able to read at 6 metres).

If our vision isn’t quite up to scratch, we might need a correction and this is where glasses and contact lenses come in. Depending on which survey you read, between 69% and 77% of people in the UK wear glasses or contact lenses – so many that it is isn’t surprising that they have become somewhat of a fashion accessory!

More seriously, there are currently approximately 2 million people in the UK living with a level of sight loss that has a significant impact on their daily life. There are around 350,000 people registered as blind or partially sighted alone.

There are a plethora of conditions that can cause such sight loss.

  • In the UK, age-related macular degeneration is a major cause (a deterioration of the macula, a part of the retina, due either to the formation of deposits on the retina or to fluid build-up underneath the macula).
  • Diabetes is a big cause of sight impairment as well – it causes progressive damage to the blood vessels at the back of the eye and is known as diabetic retinopathy.
  • Glaucoma is a build-up of pressure in the fluid within the eye. Your optician will check your pressures by puffing air at the eye using a machine. As long as it is well controlled and monitored it can be treated with certain medicated drops.
  • Cataracts are a gradual clouding of the lens. When vision is too severely affected, surgery is an option to correct this.
  • Retinal detachment is an emergency and characteristically involves a sudden curtain of vision loss falling over one eye. It may be preceded by flashing lights and a sudden increase of floaters and needs an immediate trip to eye casualty.

Incidentally, floaters are small bits of debris that float in the eye and move around with a slight lag as the direction of gaze changes – these are common, and, except as mentioned above, are not normally something to worry about, though they can be very annoying. Unfortunately they are essentially untreatable.

As GPs, we often see a handful of more common and less serious conditions that could have been dealt with first by a pharmacist or managed at home. Red and gunky eyes most often represent conjunctivitis, while red swollen eyelids (blepharitis) or a cyst or stye over the lid can be treated with hot compresses, and a watering eye can be your body compensating for a dry eye, so try some lubricating drops. Most eye conditions do not need antibiotic treatment.

If your eye is painful however or if you are not quite sure, this must be reviewed, especially if it is red as well. There will be a local eye casualty (if you’re in the UK) that patients can call if they are unable to get to their GP. This may be where your GP refers you if they feel it needs more in-depth specialist review.

The following recommendations can help to keep your eyes healthy:

  • Don’t smoke – Unsurprisingly this causes all sorts of problems including macular degeneration and cataracts.
  • Make sure you wear sunglasses – it protects against harmful UV rays and makes you look awesome.
  • Get regular optician checks – apparently around 10% of the adult UK population have never had an eye check. Problems are not always immediately evident and so it’s best to get checked every two years at the very least, more frequently if you’re over 40.
  • Eat the right things – generally anything with lots of omega 3 fatty acids and vitamin A (also known as retinol which helps with night vision!) Examples would be oily fish, kale, spinach, peppers, oranges, broccoli and eggs.

So overall, eyes are pretty marvellous things and, more than that, they are deeply personal. One only has to look at the rising use of retinal scanning to realise just how individual they are -fingerprints have approximately 40 individual features but the average iris has 256. We only have two of them, so we must take the best care of them possible.