Saturday, 28 September 2019

Nice gives Luxturna the NHS go ahead.

The National Institute for Health and Care Excellence (NICE) has recommended the use of Luxturna (voretigene neparvovec) on the NHS, Novartis has announced.

Intravitreal injection (IVI) of a therapeutic substance is the most common procedure performed in ophthalmology. The diseases treated with this method include diabetic macular oedema (DMO), retinal vein occlusions (RVO), anti-vegf for the treatment of wet macular degeneration and gene therapy for choroideremia.

The treatment has been approved as an option for treating RPE65-mediated inherited retinal dystrophies in people with vision loss caused by inherited retinal dystrophy from confirmed biallelic RPE65 mutations, who have sufficient viable retinal cells

The drug is injected under the retina and carries a functioning RPE65 gene to act in place of the faulty one, and is recommended based on data from a Phase I clinical trial which found that the difference in mean change in binocular MLMT score between patients treated and the control group was 1.6.

It's estimated that 86 people would be eligible for treatment with voretigene neparvovec in England
The National Institute for Health and Care Excellence (NICE) has recommended Luxturna (voretigene neparvovec) for use in the NHS in England, making it the first available treatment for an inherited retinal dystrophy.

Voretigene neparvovec is the first licensed gene therapy for vision loss caused by RPE65-meidated inherited retinal dystrophy.

In the gene therapy, a healthy copy of the gene is injected directly into the eye so a working protein can be produced. Patients have to have some functioning retinal cells for it to work.
Research has shown that, in the short term that the drug improves vision and prevents the condition from getting worse. The draft recommendations are now out for consideration by the company, healthcare professionals and patient groups. If there are no appeals, NICE expects to publish its final guidance next month. The treatment would then become available from January 2020. The voretigene neparvovec evaluation at NICE has taken 20 weeks instead of the average of 38 weeks within the Highly Specialised Technologies programme.

This treatment is only for the treatment of Leber congenital amaurosis type 2 (LCA2) and severe early-onset RP caused by mutations in a specific gene called RPE65.
Researchers are hopeful this could pave the way for similar treatments for dry age-related macular degeneration (AMD) to be made available on the NHS. Evidence from clinical trials shows that, in the short term, voretigene neparvovec improves vision and prevents the condition from getting worse. There is no long-term clinical evidence, but the committee considered it is biologically plausible that the treatment effect is likely to continue for decades.

The list price of voretigene neparvovec is £613,410 per patient. This technology breached the Budget Impact Test, meaning it would have cost the NHS more than £20 million in one of the first three years after being introduced. However, the company has a commercial arrangement with NHS England making the treatment available to the NHS at a discount, the size of which is commercial in confidence.

This gene therapy is similar to that used for the treatment of Choroideremia

Saturday, 10 August 2019

AMD replication in Mice

UK researchers have replicated features of dry age-related macular degeneration (AMD) in mice.
Sight loss caused by damage to the central retina in age-related macular degeneration (AMD) represents the most common cause of irreversible blindness in developed societies. Scientists describe how the mice displayed characteristics of early stage geographic atrophy (withering away).  Early stages of geographic atrophy (GA) age-related macular degeneration is characterised by the demise of photoreceptors, which precedes the loss of underlying retinal pigment epithelial (RPE) cells. Sight-loss due to GA has no effective treatment; reflecting both the complexity of the disease and the lack of suitable animal models for testing potential therapies. To develop a mouse model with reproducible early GA-like features, retinas were exposed an 810 nm diode laser. The effects were assessed by colour fundus photography based on discolouration indicative of retinal atrophy. OCT scans from mice treated with the laser showed rapid development of a geographic atrophic region. An observed development of lesions in 63/80 animals, displayed an overall success rate of 80%.The researchers highlighted that a lack of dry AMD models has previously been one of the factors inhibiting the development of potential new therapies targeting the condition.

Dr Arjuna Ratnayaka, from the University of Southampton, said that the research was the result of multi -disciplinary work between scientists and clinicians over a seven-year period. “These mice could help us understand how AMD causes damage to the retina, which is desperately needed,” he said.“This is important, as it appears that prolonged injections of Vascular Endothelial Growth Factor inhibitors, which is used to manage wet AMD in patients, can sometimes result in a switch to the dry form.”

Saturday, 13 July 2019

Why driving with sunglasses on could land you a £2,500 fine

Did you know that driving with sunglasses on could actually land you a hefty £2,500 fine and nine points on your licence?

The Highway Code states that drivers must slow down or pull over if dazzled by bright sunlight and if you don't (and you're not wearing sunglasses to protect your eyes), you could be convicted of careless driving.

If caught, you may receive an on-the-spot fine of £100 and up to three penalty points on your licence, or you could go to court where the fine can be increased up to £2,500 and nine points.
However, as reported by The Plymouth Herald, you can actually be breaking laws while driving with sunglasses on too.
The reason for this is because sunglasses are divided into four categories based on the amount of light they filter out, with some being acceptable to wear while driving and others illegal.
Most sunglasses are category two - meaning that they filter between 18 and 43 per cent of light and are suitable for driving.
If you have category four sunglasses, which let less than eight per cent of light through, you're breaking the law.
Please see this handy guide below to help you work out which category of sunglasses are most suitable for your needs.

Do E-Cigarettes vaporise the health risks associated with smoking?

Everyone is aware of the dangers of both active and passive smoking and the recent smoking in public places regulations highlight this awareness. E-cigarettes are claimed by Public Health England(PHE) to be 95% less harmful than conventional cigarettes, largely because they do not subject the user or people nearby to tar and carbon monoxide. This is not endorsed by the National Institute of Clinical Excellence(NICE) as a smoking cessation device. Some respiratory specialists are concerned that Vaping “risks a further epidemic of lung disease for today’s children”.

The nicotine is vaporised with a mix of polypropylene glycol and glycerine and often other flavourings. The vape material can cause adverse changes in the lining of the lungs which can lead to Chronic Obstructive Pulmonary Disease(COPD) and may be associated with heart disease (myocardial infarction). Vapes that contain nicotine salts rather than free based nicotine are less volatile and as such more of the nicotine reaches deeper into the lungs.

As vaping has only been round for a relatively short time, we do not know all its adverse effects. We do know that the chemicals in the vapour such as formaldehyde are toxic to the ocular surface and can cause irritation and dry eye. This can apply to passive vaping as well as direct use.

The nicotine itself can affect the eye especially in diabetics, by speeding up diabetic retinopathy and diabetic macular oedema. By reducing the retinal blood flow nicotine can contribute to the early development of Macular Degeneration (AMD). Eye Care Practitioners need to be alert for signs of these conditions in Vape users.

Friday, 10 May 2019

Transitions Contact lenses arriving in the UK!

The clever contact lens that knows light, these contact lenses change colour in the sun. They automatically turn a darker shade of grey, giving you increased comfort, better vision and reduced glare all without sunglasses.
Seamlessly adapting to changing light levels in our day to day, they provide more effortless sight with less squinting, all day. The new technology reduces the impact of the eye’s exposure to light both indoors and outdoors. The Oasys is a 2 weekly replacement lens, which currently covers a wide range of prescriptions (-12.00D to +8.00D). 
The lens offers a blue light filter, blocks harmful UV and gives improved adaptation when moving from indoor to bright outdoor sunlight. 
After more than a decade of in-depth research and clinical trials, the lens which provides more than benefits to clear vision, is set to arrive in the UK later this year. Acuvue Oasys with Transitions Light Intelligent Technology is already available in America and Canada, creating quite the buzz.

Tuesday, 9 April 2019

Research offers new approach on glaucoma treatment.

A new trail compares drops and laser-based treatment could have a huge impact on how we manage the disease.
A milestone study has opened up new possibilities for managing the disease. 80% of patients respond as well as they would to the eye drop PGA and if the laser treatment wears off over time it can be repeated. It takes 10 minutes in an outpatient setting, using a YAG laser and side effects are most uncommon.
Research from Moorfields Eye Hospital and UCL Institute of Ophthalmology showed using SLT, selective laser trabeculoplasty on newly diagnosed patients was more successful and cost effective, than the current method of drops. SLT has become an established treatment for glaucoma but due to the lack in evidence and perception of the laser, has not yet been widely adopted.

The studies main question was ‘Should SLT be used first line?’ The answer was a resounding yes. SLT is safe and more effective as a first line, with drops later as needed. 93% of patients met their pressure target at 3 years, with 72% not requiring any drops at all.

The LiGHT trail, one of the biggest of its kind assigned one of the two treatments to each patient; either the traditional eye drops or the quick, painless laser which disrupts the blockage. SLT was first introduced in 1995 and become a recognised replacement for argon laser trabeculoplasty (ALT). Though both are effective and safe SLT is safer and more repeatable

‘Eyes of patients in the SLT group were within target intraocular pressure at more visits by 93% than those in the eye drops group at 91%, with glaucoma surgery to lower intraocular pressure required in none versus 11 patients,’ in a report funded by the National Institute for Health Research.
SLT has now been recommended as the first-line of treatment for open angle glaucoma and ocular hypertension. 600,000 people in the UK are living with glaucoma and with an aging population, Glaucoma Research Foundation have said it expects rates of the disease to increase in the coming decades. 
Researches await the NHS to clinically endorse the laser as first-line which could be life-changing for glaucoma patients. Currently the eye drops work to lower pressure in the eye by increasing the fluid outflow and reducing the amount of aqueous the eye produces. Laser treatment becomes an option if the drops prove ineffective. 
According to the NHS, ‘you may need to try several types (of eye drops) before you find the one that works best for you. Sometimes you may need to use more than one type at a time.’ Consider the amount of time required both on the patients’ side and the prescribing medic, glaucoma can be a time consuming and costly disease. Requiring regular check-ups to monitor pressure and for those who are ineligible for free prescriptions, a financial burden too. 
Trabeculoplasty is used most often to treat open-angle glaucoma. A laser beam is used to place a small hole in the iris (the coloured part of the eye) which allows the aqueous to drain more freely within the eye so the iris doesn’t plug up the trabecular meshwork.  
This new form of treatment would reduce outpatient visits, if not eliminate them all together. Reducing the pressure on the hospital eye services and set to save the NHS up to £1.5m a year in direct treatment costs for newly diagnosed patients.  

These results could fundamentally change how glaucoma is treated worldwide. 

Wednesday, 3 April 2019

It is Glaucoma Week

It is Glaucoma Week, a disease that remains one of the biggest causes of irreversible blindness globally. There is huge publicity in a bid to attract people to have regular eye examinations and optic nerve checks, especially first degree relatives, FDR.

FRDs are at 10 times the risk of developing glaucoma. If these relatives acted and had regular glaucoma checks, it's likely to save a great deal of sight. Glaucoma is a group of diseases, causing progressive damage to vision. What is surprising for  most patients, is that it does so without any prior warning or symptoms until much later in the disease process. While treatment here is effective against further progress, so arresting the disease, there is no reverse to the damage done. Early diagnosis is key for preserving vision.

The World Glaucoma Associated aims to eliminate glaucoma blindness through awareness and examination.