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Tuesday, 20 November 2018

Seeing Success in Gene Therapy Trial! Choroideremia


Gene Therapy Success!
A trial for choroideramia gene therapy has been reported. 14 patients at Oxford Eye Hospital received injections of a virus containing the missing gene, into the eye.

Significant improvements to vision were found across the group of patients. 12 maintained or even gained vision, which remained for up to five years. Of the untreated eyes, only 35% sustained vision.

"I was going into the operating theatre and having my eye injected with a virus that was used to insert the correct DNA into my cells so that the missing protein was produced. After the operation, I had my month one test. When I was doing the usual eye chart test, I had a lightbulb moment. I realised that I was about to go on reading past a point I had not reached in a decade.

I read the equivalent of four lines on the eye chart more than I could before. I was sitting there reading and I had tears just streaming down my face with this massive grin" - Joe Pepper, a Surrey teacher on receiving gene therapy.

This research will hopefully pave the way to future breakthroughs, for other eye diseases including macular degeneration.






Choroideremia is a condition that causes progressive loss of vision. Mainly affecting males, the first symptom is usually night blindness. Patients often feel their vision is not as good in low lighting, often starting from early childhood.

The visual problems are a result of loss of the cells that pick up light and also the choroid blood complex surrounding,this is also known as atrophy. As the condition progresses, visual field loss can follow, narrowing to leave tunnel vision. Fine detail or acuity can also be lost over time.Generally vision can decrease over time, but the severity each person experiences can vary.

Cause
Choroideramia is caused by mutated genes, specifically the CHM gene. CHM gives instructions and attaches to other molecules called Rab proteins inside cells. A mutation causes a cascade of events which mean the Rab proteins can not reach or attach to the correct area (organelles inside the cells), cells then die off prematurely.

Inheritance
An X-linked recessive pattern. The X-chromosome, one of the two sex chromosomes, are found as pairs in females XX and XY in males. So males only require one copy of the mutated gene to cause the condition, while females need two mutated copies. Women with just one copy are called carriers, they generally will not have symptoms of choroideremia but may show small areas of cell loss during a thorough eye examination. Though these changes may affect vision, but later on in life.





Statistics
It's estimated that choroideremia affects 1 in 50,000 to 100,000 people. It has been noted that they condition may go underdiagnosed because it shares similarities with many of eye disorders.
Of all causes of blindness, choroideremia accounts for 4%.

Read more at www.matheson-optometrists.com/choroideremia.html

Monday, 29 October 2018

Don’t Flush It!!...... .....Recycle It!!

Don’t Flush It!!......



                                                                                                   .....Recycle It!!

For most people it is much better for their eyes if they replace their contact lenses frequently, often on a daily basis is best. Doing so produces plastic waste both from the contact lenses and the blister packs and cardboard packaging they come in.

 Recent research indicates that possibly 20% of contact lens wearers dispose of their used contact lenses by flushing them down the toilet or sink. There are 5 million contact lens wearers in the UK.

Fragmentation of contact lenses into microplastics (particles less than 5mm in size) within a wastewater treatment plant can occur that can then result in microplastics pollution of our rivers and oceans. UK rivers have some of the highest concentrations in the world. In fact the river Tame at Denton in Greater Manchester has the world’s worst recorded micro-plastic pollution, according to a study in march 2018 at University of Manchester. It recordedover half a million – 517,000 particles – per square metre, more than some of the worst rivers in the Far East.



The problem is due to the fact that the plastics do not degrade, merely breaking down into smaller and smaller pieces over time. Microplastics have been shown to have a negative effect on the health of some forms of sealife, even sometimes causing death.

Because bottom feeding sealife which injest these microplastic particles form part of the food chain it is likely that these particles will affect birds and animals higher in the food chain, possibly humans too.

The flotsam in the pacific ocean, nick-named the great Pacific Garbage Patch has been estimated to be 3x the size of france. 



People think of contact lenses as being too small to cause much of a problem. This is NOT the case. Because so many people are flushing them directly into the water system, they pose a real threat. We must do something about this NOW.

Conventional recycling facilities typically cannot handle contactlenses and their blister packs.

Until now the best advice has been to put your contact lens waste apart from the cardboard packaging into the normal domestic waste bin. 

In this area it will be incinerated at high tempreture producing only carbon dioxide and water. This is less than ideal as it still contributes to raising the levels of greenhouse gases, but at least it produces valuable electricity for the national grid and does not contaminate the atmosphere or oceans.

There is a new scheme now underway at certain forward thinking optometry practices such as the Matheson Optometrists group with several branches in Hampshire, where there are special contact lens collection boxes. People can put there used contact lenses and blister packs into these boxes and they will be sent to specialist recycling centres just for this type of material. This is something we can all do to make a difference by lowering the microplastic polution of our oceans and global warming.





Matheson Optometrists also recycle people’s old spectacles that are no longer required. The are measured and serviced and catalogued and taken with their optometrists to places such as the deprived areas of Eastern Europe and Africa.
                                                            Pic of purple recycling box
Purple collection boxes are available at all Matheson Optometrists practices for this purpose. Childrens spectacles are especially needed for these charitable trips to africa                                                           






 IMG_4858.jpg

Make a difference now, recycle your spex and contact lenses, help the environment and those less fortunate than you in undeveloped countries.

Why not visit the matheson-optometrists.com youtube video channel to find out more about these ventures?

Sunday, 30 September 2018

Police Road Side Checks


Seeing correctly while driving is crucial to road safety. It's true that most of us can see while we drive, but are we really seeing everything we need to?

Of course there are the legal requirements to meet, but having sharp vision gives us more time to react to hazards in the road. Police are stopping drivers and conducting road side eye examinations. If your unable to read a licence plate at 20 meters  your licence could be immediately revoked.

Large objects such as cars and road signs may be visible, but this isn't always a true representation of your vision. Having an up to date prescription and protection from glare can improve your vision.

The current UK driving laws only require vision to be tested once. It is then up to the driver personally to notify the DVLA if their vision becomes too poor to keep driving. With this new testing taking place across Hampshire, Thames Valley and West Midlands police the data found will give huge insight into visual standards nationally.

We sometimes forgot that our insurance providers will not hold the agreement if your vision is not meeting the requirement.

It has been great to see so many proactive patients coming to check their vision, book in to see one of our optometrists today.

Friday, 28 September 2018

Increase of contact lens related sight threatening eye infection



UCL, University College London alongside Moorfields Eye Hospital led  a study of infection in contact lens wearers. Since 2011, the researchers found three times as many incidences of Acanthamoeba keratitis in South-East England. A rare but preventable cause of blindness.

When contact lens users are aware of the risks involved in poor lens hygiene, they often adopt the correct habits and infection is unlikely. The increased cases illustrates the need for awareness.

Findings published in the British Journal of Ophthalmology, saw reusable contact lens wearers were at the highest risk. This group are more likely to have used ineffective lens solution, have water contaminate their lenses and admitted to poor lens hygiene.



What is Acanthamoeba keratitis (AK)?

  • An eye disease affecting the cornea, the front surface of the eye. 
  • It becomes inflamed and painful due to the infection. 
  • The Acanthamoeba bug forms cysts during infection. 
  • It is not only contact lens wearers that can be infected, but wearers pose a higher risk due to contamination of lens cases. 



What are the statistics?

  • It can affect 2.5 in every 100,000 contact lens wearers.
  • 25% of people with AK need corneal transplants to treat the disease or restore vision. 
  • A quarter of affected patients become severe cases, loosing up to 75% of their vision or going blind all together. 
  • Since 2000 - 2003 where incidences were 8-10 in a year, it's now noted that we treat between 36-65 cases annually.

What increases the risk?

  • Researchers found that people were three times more likely to contract AK, if they had poor contact lens hygiene. 
  • Those who did not consistently wash and dry their hands as part of their lens routine. 
  • Also, in people who wore their contact lenses swimming or in hot tubs, while showering or face washing.



Where is Acanthamoeba found?

  • The Acanthamoeba bacteria is actually found in the UK more commonly than in other countries. 
  • Water contamination is the main concern for the UK, as Acanthamoeba is found in higher levels in domestic water supplies, as opposed to mains water. 
  • As well as hot and cold water, it can also be found in soil.



How can I prevent an AK infection?

  • Always follow your Optometrists advice on good lens hygiene and best practice.
  • Wash and completely dry your hands before handling your lenses. 
  • Avoid wearing your lenses swimming, when washing your face or showering/bathing. 
  • Consider switching to a daily disposable lens, you can ask your optometrist to check your suitability and which lens type would be best for you. As the lens is replaced each day, there is no feeding ground for bacteria to grow over time and each lens is clean and fresh.


References:

Wednesday, 26 September 2018

A Four-tunate Passing


We were so happy to be in the right place at the right time.

At our Fourmarks practice, Mrs H had been walking past when she decided to test her eyes with the Amsler grid in the window. What she found both surprised and frightened her, but we were able to see her the same day and diagnose the cause.

This is Mrs H's account of the day.


"How fortunate it was that I walked past Matheson Optometrists' window in Four Marks!
I looked at the Amsler grid displayed in the window and discovered that the central vision of my right eye appeared black and misty and the straight lines had become wavy. I closed my right eye and peered at the grid with my left eye. No mist, no black circle, and no wavy lines. That discovery, in my right eye, made me very nervous and worried. I made an appointment immediately to see one of the optometrist.  I saw Mr Andrew Matheson, who gave my eyes a thorough examination and, with the up-to- the-minute technology available at the practice, he was able to diagnose wet-eye macular degeneration. On hearing this, I was rather frightened, but with Mr Matheson’s calm, kindly reassurance and his immediate proactive response, I was able to go to an eye consultant and receive the necessary injection of Avastin in my effected eye.
The sooner this injection is given, the better the prognosis.  Having this injection so quickly, has meant I have a much higher chance of arresting the macular degeneration and saving my eyesight.  It is vital to get to see a ophthalmologist within a couple of weeks of the symptoms starting. Under the NHS the aim is to be seen, and if required, treated within two weeks of the symptoms starting .How lucky I am to have looked into the Matheson Optometrists' window!
A big THANK YOU to Matheson Optometrist's at Four Marks."

Since the diagnosis, Mrs H has had injections at the local Hospital Eye Service and is under good care. Following treatment, Mrs H has added:

"Good news! Having had my second injection at Southampton Hospital Eye Unit, there is an excellent chance of either stopping the vision loss or of improving it. Early diagnosis is vital."



An Amsler grid which can be used at home to check your vision, for signs of macular degeneration. 

Instructions for using the Amsler grid

Test your vision with adequate lighting.
Wear your reading glasses or look through the reading portion of your bifocals (if you normally read with spectacles)
With Progressive or Varifocal lenses you may notice some form of distortion. Distortions may occur as a result of the lens design and not your eyes. If you have a cause for concern please consult an eye care professional.

1. Hold the Amsler grid at normal reading distance (about 35cm).
2. Cover one eye at a time with the palm of your hand.
3. Stare at the centre dot of the chart at all times.
4. Do not let your eye drift from the centre dot.

You can find more about Amsler grids on our website, by clicking HERE.

Saturday, 22 September 2018

A High Court decision could save the NHS ‘millions’

The right to offer patients a choice to use the cheap, effective drug Avastin to treat wet age-related macular degeneration, has been a long time coming. More than a decade ago, doctors realised Avastin, a drug licensed for cancer, might also work to treat eye conditions when used "off-label". This is a term used when a drug has a licence to treat something else. 

Publicly-funded clinical trials across the world - including one done and paid for by the NHS - have shown Avastin does give just as good results when it is split into the tiny doses needed to inject into the back of the eye. At the heart of the issue is the fact that the company that owns the rights to Avastin, Roche, has never sought a licence to market it for eye conditions - only some types of cancer. 




The licensed drugs for wet AMD in the UK are Lucentis (marketed by Novartis) and Eylea (marketed by Bayer). To complicate matters, Lucentis is derived from the same molecule as Avastin. Roche holds the intellectual property rights for both - Novartis licenses it from them. 

Back in 2007, Tory MP George Young said that publicly-funded trials would "provide good evidence that would allow regulators such as NICE to recommend the use of Avastin over Lucentis and save the NHS a considerable amount of money".Indeed, one health economist has estimated for the BBC that if the NHS had made the switch to Avastin a decade ago, it could have saved between £2-3bn.Bayer and Novartis, who both market drugs for the treatment for wet AMD (Eylea and Lucentis, respectively), challenged the lawfulness of the policy adopted by the CCGs.

The policy stated that Avastin would be offered to patients with wet AMD ‘as the preferred treatment option’ because of the price difference between Avastin and the other two medicines. 

Avastin costs £28 per injection, while Eylea costs £816 per injection and Lucentis costs £551 per injection. 

Bayer and Novartis claimed that the supply of Avastin to treat wet AMD was unlawful under EU law because it does not have authorisation for ophthalmic use. They also argued that the use of the drug for ophthalmic purposes undermined patients’ rights of access to treatments recommended by the National Institute for Health and Care Excellence (NICE). 

Speaking on behalf of the CCGs, CCG chief officer in South Tyneside, Dr David Hambleton, said they were delighted to be able to offer Avastin as an alternative treatment to patients.  “The drug is undeniably, equally effective, and much less expensive, and the money this will save – in excess of £13.5 million per year for the 12 CCGs involved in this litigation alone, and hundreds of millions of pounds across the country – can be ploughed straight back into delivering the very best care possible to our patients,” Dr Hambleton said. 

Avastin is used across Europe and the US for treating wet AMD, and international clinical trials have indicated that it is safe and clinically effective. Bayer and Novartis expressed their disappointment with the decision, and said it encourages the use of a medicine that is not licensed purely for financial reasons. Both companies are considering an appeal of the decision. 



A statement from Novartis said: “This is a bad day for patients, doctors and the NHS.  This ruling threatens to jeopardise a world-leading system that has protected patients for many years by ensuring medicines have been tested rigorously and carefully scrutinised for delivering value.”

Bayer stated: “The ruling prioritises the cost of medication over doctors’ clinical judgement and expertise, as well as over the regulatory assessment of a medicine’s quality, efficacy and safety.”

In response to the decision, optometrist and clinical director at the AOP, Dr Peter Hampson, said that the cost savings Avastin can bring was welcome news for anyone concerned about eye health. “With an ageing population it’s essential that the treatment of wet AMD has a sustainable future. This ruling could potentially save millions of pounds, allowing for increased funding in areas of care that are currently in desperate need of investment,” he explained.

Helen Lee, policy and campaigns manager for the Royal National Institute of Blind People (RNIB), welcomed the clarity provided by the decision, but recognised that patients might be concerned about what this means for their treatment. “It is critical each patient has the opportunity to have a full discussion with their clinician to give consent prior to switching or embarking on treatment. We know that some patients are permanently losing vision due to delayed and cancelled eye care appointments as services are struggling to cope with demand, so all savings generated by providing Avastin rather than licensed anti-VEGF drugs must be invested in eye care services.”

In January, new guidance was issued by NICE, highlighting Avastin’s clinical effectiveness and safety for treating wet AMD, which promoted the General Medical Council to state that its use would not raise fitness to practice concerns. 

Tuesday, 18 September 2018

What is OCT? And do you need it?

A retinal scan using OCT, with a fluid pocket (the black circles within the layers of coloured sensory retina).


OCT, the newest technology to sweep the optical industry. Without any invasive techniques or instruments, a simple scan done alongside your routine eye exam could potentially save your sight.

What does it show?
When our optometrists examine your eyes, they look into them through the pupil. Sometimes, if a patient has small pupils they are dilated, to give a wider view inside. Looking directly onto the retina, your eye health is assessed to look for changes that are or could affect your vision.

With the OCT, we are able to see a cross section through your eye. As if coming through from the side, the scan shows any leakage from blood vessels, haemorrhages. Debris building up in the macular, your area for central vision, reading and recognising faces, also known as age-related macular degeneration. The scan gives an objective measurement of structures in the eye, giving us a 3D model.

Normal Anterior Chamber angle. The top curve is the cornea, which is the front of the eye. The bottom bumpy curve, is the iris, the coloured part of your eye. 

A narrow anterior chamber angle, which could be at risk of closing. 

Newer attachments have allowed imaging of the front of the eye too. Viewing the angle made between the iris and cornea, allows assessment for Glaucoma. The corner of this angle is likened to a drain plug, where fluid created in the eye is drained away. There are some natural iris variations, which look open when viewed from the front, but with scanning can show exactly how wide and open the drainage is. 


How does it work?
It uses scanning lasers, with high depth resolution and high speed acquisition. In a similar way as ultrasound, lots of individual sections are combined to create a 3D image. The OCT sends a optical signal, similar to a light source, into the eye and measures the time taken for the reflection to return. Different structures in the eye, reflect the signal at different lengths.

A technician will position you onto the chin and forehead rest, with your eye comfortably aligned, different scans will be taken. The process takes around 10 minutes to complete. An optometrist will review your scans and relay the results to you.

Both images were captured using an OCT, the left image is how the practitioner sees the eye, when looking through. The image on the right, shows this same area as a cross section. 

Why is it important?
Often changes can happen within the eye, that we are not aware of. The OCT can measure structures that are translucent or lying beneath the surface of the retina. Before we can see and you can feel the changes, the scan will be able to detect them. Using this information, our Optometrists can advice you on the best way to proceed. In the case of AMD, taking a specific formulation of supplements can help to slow down the degenerative process. Though this only has an affect in the early stages of the condition. So the earlier we are able to detect changes, the sooner we can manage them.

So, do I need one?
It is always a good idea to have at least baseline readings that can be compared to at subsequent visits. If there happen to be any changes or new occurrences  that need referencing. OCT scans are recommended for all our patients over 60. The frequency of scanning year after year, is dependent on any monitoring that is required. For some patients, ever other year is sufficient, others will need more regular check ups.

You can find more information on OCTs on our website. We also have an informational leaflet with a home monitoring Amsler grid at our clinics. All of our practices have the Zeiss Cirrus HD-OCTs, call us to arrange an your OCT scan.