Post date: 
Sunday, 13 January 2019
Male patient before cataract surgery in hospital talking to smiling nurse

Professor Andrew Lotery outlines why registration rates for blindness are falling and exciting advances in eye health.

Macular degeneration

In terms of treatment of macular degeneration the outcomes have really improved because of the use of new types of drugs in the treatment of this condition.

By that I mean monitoring all antibodies that target a specific molecule in the back of the eye. We can now stabilise or even improve vision quite successfully in people with wet macular degeneration.

As a consequence of that, we’ve seen registration rates for blindness decreasing over the last few years, so I think that’s a mark that we’re actually making some progress.

That’s an innovation that actually started over 100 years ago when the notion of having a drug that could target a specific organ or tissue was first suggested and it it’s taken 100 years to develop the idea of monitoring all antibodies.

They’re now used in cancer therapies and rheumatology and one of the most successful used has been in the treatment of macular degeneration.

These are drugs that people might have heard of such as, Lucentis or Eylea. All very successful in treating wet macular degeneration.

Eye imaging

Another big innovation has been in imaging of the eye with a technology called optical coherence topography which allows us to take very accurate images of both the front and the back of the eye, the retina and see exquisite detail of the tissue which makes it much easier to make a diagnosis say of a retina problem. This technology is now widely used through the NHS and it’s changing how we manage patients.

The big challenge is of course lack of capacity, to see patients as quickly as we want. So with this new imaging technology, increasingly we’re developing what are called virtual clinics where patients have an image of their eyes taken but they don’t necessarily see a doctor on that visit because the imaging is so good that we can reliably look at the pictures and we can see a lot more patients.

Cataract surgery

Cataract surgery has got much better over my lifetime as an ophthalmologist. Previously it required stiches and a few days in hospital and a long recovery time. Now most cataract surgery is day case surgery, the operation takes 20 minutes in most cases and patients have a very fast recovery and don’t require any stitches because we can, with modern materials, put a new lens in the eye through an incision that’s maybe only 2mm in size. So the technology, better artificial lens for cataract surgery, better equipment to do cataract surgery has meant that the operations are faster and people heal quicker.

Genetic diseases

The other thing that has happened is our understanding of genetics of eye diseases. This has led to new ideas on how to treat macular degeneration. We know that faults in a pathway called the complement pathway in the body are to blame for people developing macular degeneration, so drugs targeting this pathway are now being developed.

We’re also starting to see gene therapy, replacing a faulty gene, being developed for eye diseases, this is still at a very early stage but the first licenced gene therapy treatment for any disease in the world was actually for an eye disease and that’s just been licenced in the United States for a rare form of inherited blindness called Leber’s congenital amaurosis and there’s now efforts to have this treatment brought to the UK.

This work started with clinicians and scientists working together to find the genes that caused this early onset form of blindness and after many years of research, it’s now become a licenced therapy that patients in the United States can get access to. It’s very new and will hopefully become available in the UK in the next couple of years.

Professor Andrew Lotery is Chairperson of the Royal College of Ophthalmologists Scientific Committee.

This article originally appeared in the Winter 2019 edition of Connect Magazine.