New NICE glaucoma treatment guidelines

 New NICE glaucoma treatment guidelines

 

Glaucoma affects about 480 000 people in the UK. If left untreated it can lead to severe visual loss and blindness.

 

There are various treatments available to manage glaucoma and prevent visual loss. These treatments include a wide range of eye drops and surgical intervention. With the use of eye drops for the management of glaucoma it is of utmost importance that the drops be administered at the same time everyday to maintain a lower intra ocular pressure and prevent any pressure spike through the day.

 

The National Institute for Health and Care Excellence (NICE) has published updated guidelines for the treatment for newly diagnosed glaucoma cases. This includes the use of Selective Laser Therapy (SLT) for the management of Glaucoma and ocular hypertension. NICE guidelines recommend SLT as the first line of treatment for Open Angle Glaucoma.

 

SLT will make the management of glaucoma less complicated and more cost-effective. Patient compliance with eye drops will no longer be such a big factor in the management of the otherwise sight threatening disease.

 

There are only 27 UK Optometrist that are accredited to perform SLT for the treatment of Glaucoma. 26 of which qualified in December 2022. Andrew Matheson of Matheson Optometrists has been acredited in this line of treatment since 2019.

 

      Andrew Matheson performing SLT.

 

 

As yet accredited optometrists are only performing SLT in a hospital setting. Hopefully soon this procedure will be available in practice, which will make SLT available to many more people

At Matheson Optometrists we make use of state of the art equipment to ensure early diagnoses of glaucoma. It is advised that adult have a regular eye exam on a bi-annual basis and those with a family history of glaucoma be seen on an annual basis.

Andrew currently performs laser eye surgery at St Marys Treatment Centre in Portsmouth

 

Motorists urged to pick up the phone before getting behind the wheel after Dominic Cummings said he drove 30 miles to ‘test his eyesight’

PIXABAY/MIKESPHOTOS

Dominic Cummings explained that he drove 30 miles with his wife and young child to ‘test his eyesight’ after travelling from London to Durham.

Mr Cummings revealed that he had concerns COVID-19 had affected his eyesight, so drove to the town of Barnard Castle as a test run ahead of his journey back to London.

The AOP has emphasised that those concerned about whether their vision is safe for driving should call their optometrist before making a car journey.

Dr Peter Hampson, clinical director for the AOP, said: “We are seeing a rise in the number of people who have a disregard for how important good vision is for driving ability, and it is impacting the safety of the individuals who use our roads.

“Sight loss can often be gradual, and can go unnoticed, so if you’re a driver and have concerns about your vision, while routine sight tests are currently suspended due to the coronavirus pandemic, most practices are open for essential and urgent eye care and will be able to offer advice over the phone,” he said.

It is estimated that 2900 road casualties are caused each year as a result of poor vision.

The AOP runs an annual road safety campaign, Don’t Swerve a Sight Test, designed to encourage all drivers to think about their vision and driving.

In the wake of the senior adviser’s explanation for getting behind the wheel during lockdown, people took to social media to share their views.

BBC News (UK)

✔

 · May 25, 2020

"On the point about eyesight, I'm finding I have to wear spectacles for the first time in years... so I'm inclined to think that's very, very plausible"

PM Boris Johnson on Dominic Cumming's claim that he went for a drive to test his eyesighthttp://bbc.in/3de8Wwl 

Deacon Harle@Osborneharle

#Optometrists Have been working throughout this pandemic to provide urgent and essential #NHS eye care, especially for #keyworkers. We have #SteppedUpToSaveSight @CollegeOptomUK @The_AOP If your sight is affected do NOT drive

9

8:43 PM - May 25, 2020

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Optometrists, vision scientists and eye surgeons flocked to Twitter to point out that Mr Cummings would have been wiser to call an optometrist or attempt to read a clean number plate from a distance of 20 metres.

“If you suspect deterioration of sight, please don't drive to test how good it is,” a post from St Paul’s Eye Unit emphasised.

Barnard Castle as a Snellen chart

Fair play to whoever came up with this pic.twitter.com/0HGrVlJShN

77 million Europeans with AMD by 2050.

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in adults who are more than 50. A new study revealed that the condition might affect 77 million Europeans come 2050.

A team of researchers unveiled new information about the prevalence of AMD in the coming decades in the study, which was published in the British Journal of Ophthalmology. The new data may help the health care system to plan on allocating resources for patients and careful planning in the next decades.

The team came up with estimates through calculating information they pooled from 22 prevalence studies, which covered 55,323 people between the age of 60 and 81. The prevalence studies were those involving the existing disease, and the researchers also gathered information from four incidences (new cases) studies across Europe.

The findings of the study unveiled that the number of existing cases is expected to boost by 15 percent. On the other hand, the researchers project that the number of new cases will increase by up to 75 percent in the next three decades.

The team estimates that about one in four older adults in Europe will develop AMD, spanning from one in ten cases in those who are below 65 years old, to nearly 27 percent of those who are more than 75 years old.  The team also took into consideration the projections of those who will have advanced AMD, those who may experience irreversible blindness, and found that about 2.5 percent for all older ages combined.

Aside from the existing cases, the team also calculated for the new cases of advanced AMD. The team gathered information from 7,223 participants from four incidence studies. To calculate the annual rate of new cases of advanced AMD, they found that it was 1.4 new cases per 1,00 people more than 50 years old.

The annual new case of advanced AMD rate is 0.5 in 1,000 and 6.7 in 1,000 in those who are under their 70s, and those over 70s, respectively.

Overall, the figures helped the researchers estimate that in total, about 77 million people in Europe will develop AMD in the next three decades, compared to 67 million in 2015.

People who are more than 75 had the highest increase in case rates, increasing from 50 to 57.6 million, as much as 15 percent, in 2050. Those with advanced AMD is projected to also increase by as much as 20 percent, from 10 million to 12 million in 2050.

Lastly, the researchers noted that the new cases of advanced AMD would soar from 400,000 per year to a staggering 700,000 in the next 30 years. Germany had the highest number of cases.

The researchers emphasized that most of the studies they pooled were from Western Europe; the results of the study can’t be applicable to Eastern Europe countries. However, they propose conducting further studies to strengthen the findings of the study, involving other countries or even other continents in the world.

NEW Genius Platelet Rich Plasma PRP aids Corneal Repair

Initially we had Autologous Serum eye drops. These were manufactured from plasma extracted from a patients own blood. These are bottled after extraction and enhance corneal healing because of all the regenerative growth factors found in our blood plasma.

Now we have a evolution of this treatment – the Genius in-house platelet-rich plasma (PRP) extraction and centrifugal preparation system. 

The Genius system we saw at the recent 2019 Toyos Conference, is very slick, taking only 2 minutes to double spin/centrifuge the blood drawn. The whole process from drawing the blood to giving the patient 3 bottles of their own personalised eye drops takes 17 minutes. 

The Genius PRP system

A 30cc or 60cc sample of blood is usually taken from the patient’s non-dominant arm, typically from the Median Cubital Vein, the Median Cephalic Vein or the Cephalic Vein. These lie in the ante-cubital fossa which lies at the bend of the elbow at the front of the arm. Generally the Basillic Vein is avoided as it runs close to the Brachial Artery and the Ulna Nerve. The veins on the dorsal surface of the hand can be used, but require a higher level of expertise. 

PRP contains 7.8x the concentration of growth factors etc compared to whole blood or plasma and is analogous to a drip feed of amniotic membrane every day. We will be watching this space carefully as I have several patients whose eyes are too dry and sensitive to wear an amniotic membrane and bandage contact lens, even for a week or two. This could the answer for them. 

Most of the cross contamination of blood products issues do not apply as its autologous blood, the patient is only being given products made from their own blood. I expect we will see much more about this recent development in the near future.

Rolando Toyos explained at the conference that this drip feed of growth factors helped facilitate proper regrowth of corneal nerves and reduction in inflammation, often still present after corneal healing seems complete.

Don’t swerve a sight test

The AOP Don’t swerve a sight test campaign, which first launched 14 November 2017, is designed to encourage all drivers to have regular sight tests.

With an estimated 2900 road casualties caused by poor vision every year, we’re reminding motorists that a sight test, every two years, can help them stay safe and reduce the number of accidents on UK roads.

Please click the below links for more information

Driving and vision standards

Driving and vision

Testing vision on the road

A B See

Children don't know what's not normal. It's estimated more than 1 in 10 children have an undiagnosed visual problem which is affecting their learning and development. 

A sight test can help your child achieve their best. All children under the age of 16 int he UK are eligible for NHS funded eye examinations. They have also provisioned for vouchers to put towards glasses or contact lenses for under 16's. 

It is recommended taht children have a sight test with their local optometrist around the age of three. This allows any conditions which need monitoring or treating to be picked up early. After the first test, children should be seen every one to two years, depending on the optometrist's outcome. 

1 in 5 children in the UK are short-sighted

 (They can see things up close very well, but things in the distance are blurred; like the school board or teachers)

52% of parents believe every child has a full sight test at primary school, but this is not the case. 

74% of Optometrist in the last year, have seen children with vision problems which could have been treated more high success, had they been detected earlier. 

1 in 50 children will develop a lazy eye, also known as amblyopia. This becomes more difficult to treat as the child becomes older and is irreversable once past the age of 8.

Children don't need to have symptoms to be seen by an optometrist. 

Screen Time

Sunlight or white light is made up of red, orange, yellow, gren and blue light rays. Combined together, this spectrum of coloured light creats white light. 

Depending on where they lie in the spectrum, coloured light is either long wavelegnths with less energey, or short with higher energy. 

Blue light?

Blue light is high-energy visible light with much shorter wavelenghts, which is what is cause for concern. Blue light is naturally present in sunlight, but is also found in screens on our TVs, computers and phones. 

Damage?

Currently, there is no scientific evidence that blue light causes damage to the eyes. However, there is evidence suggesting that working at short distances, for example on a mobile device or reading a book for long periods can cause increased eye strain. 

Sleep?

Screen time close to bed time can cause poorer sleep quality, which means your chid's concentration levels throughout the next day are lower. This may be caused by the link between blue light and its suppression of melatonin the hormone which makes us feel sleepy. 

Nicotinamide hopes for damage in Glaucoma

Cardiff University has been granted funding, to research which dietary supplement of Nicotinamide, a form of Vitamin B3, can be used to help reduce and possibly prevent, retinal damage in Glaucoma.

Fight for Sight has helped fund this important research which could help pave the way for new types of glaucoma treatments. Currently treatment is centred around reducing eye pressure and come at a great cost both financially and in time, to the patient and the health service. 

As increased eye pressured is the main damaging driving force in glaucoma, the research will also test how effective Nicotinamide is in treating a wide range of eye pressure profiles.

There is currently a growing body of evidence which is shining a spotlight onto Nicotinamide and its protective role in preventing damage to retinal ganglion cells. (Retinal ganglion cell monitoring is now one of the latest ways to monitor and screen for glaucoma, it is also one of the earliest signs).

Cacicol corneal regenerative drops

CACICOL® is the first ophthalmologic matrix therapy agent which triggers REGENERATION of damaged tissues for ENHANCED HEALING.

 The Cacicol drop belongs to the regenerating agent family (or RGTA). These agents are key in corneal matrix repair therapy (or matrix repair). Cacicol helps to trigger the regeneration of damaged tissues for enhanced healing. It makes it possible to delay or even avoid more invasive surgical procedures. ItCacicol is intended for the management of chronic corneal wound healing, such as in dry eye, with persistent epithelial defects (where the surface layer of cells the epithelium is damaged) and persistent corneal dystrophies with associated pain. Cacicol is a regulated healthcare product which requires a medical prescription, to ensure it is best course of treatment  for each patient.Each box of contains 5 detachable and ready-to-use single-dose units and are preservative-free drops which are administered once or twice a week. CACICOL® acts as a scaffold. Its matrix structure permits the fixation and the protection of the components involved in the tissue regeneration process.

Halloween horror for one unlucky contact lens lady

A  woman was rushed to ER after store bought contact lenses were suctioned to her eyes.

To really complete an outfit, many people like to add special effect contact lenses to finish off their scary disguise.  Be it coloured eyes, cat eyes or even white eyes there are so many options available, over the counter.

Although these lenses can be bought in-store without a proper fitting, these seamlessly harmless lenses can be sight threatening. 

There are countless stories where these lenses have gone wrong, yet they still remain for sale both online and in store. A recent case in America say Gaye, a 20 year old party goer comes  close to being blind.

After wearing the lenses for a party, consulting an online video on how to insert them, Gaye struggled to remove them and fell asleep with them in situ. Later awaking to somewhat blurry vision and a strange sensation, she instilled eye drops hoping to diffuse the situation and went back to sleep. By midway through the next day, the sensation had become unbearable and Gaye feared she may be going blind. 

A trip in the ambulance to a&e, an ophthalmologist told Gaye she had scratches on the surface of her eyes, the term corneal abrasions. 

Dr Thomas Steinemann commented, “All contact lenses are medical devices and the lens has to fit the patient,” the professor of ophthalmology who treated Miss Gaye. “Even though you may not wear a correction (prescription), the lens still has to fit the outer surface of your eye, the cornea.”

Though they may look legitimate, as fashion lenses are not regulated as they are from an optometrist they could themselves have germs or be defective with chips or tears. A study in America found 48% of these lenses were contaminated.

All contact lens fitting sessions come with dos and dont’s, to help ensure the safe use of the lenses. Things like avoiding contact with water, to prevent serious infection and even wearing the lenses inside out.  


If you have any concerns with your eyes or lenses you have been using, please contact our practices for an appointment with our Optometrists. 

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

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.”

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.