Healthy Eyes AMD Supplement

Dry macula degeneration has 2 subtypes, drusen based and atrophy based. In drusenoid macula degeneration there is a gradual build up of waste products in the retina, formed during the process of seeing. Just underneath the photo-receptors is the retinal pigment epithelium, the drusen deposits here disrupt the normal regular spacing of the photo-receptors and distort our central vision.

There is a gene therapy research trial being undertaken in Oxford on dry AMD, which although is in the early stages is proving promising. The degenerating process and build up of waste product is normally slow and currently the only proven way to attempt to slow down progression is to take an antioxidant vitamin/mineral supplement, such as Healthy Eyes.

Healthy Eyes are a chewable supplement containing Lutein and Zeaxanthin which is perfect for those suffering or wishing to lessen their chances of developing age related Macula degeneration.

The chews are formed from natural fruit pectin ( a gelling agent extracted from citrus fruits), giving it a pleasant and fruity taste. There are no artificial colourings or flavourings and are gelatin and gluten free. To suit most modern diets, they also contain no milk, wheat, eggs or nuts and have no artificial sweeteners.

These waste products building up in the retina are now being picked up earlier than before, with OCT scanning and Autofluorescence Photography. Matheson Optometrists are working with retinal camera developers in building a system for this. When Lipofusin (considered an aging or 'wear-and-tear' pigment) in the retina is illuminated with a specific wavelength of visible light, it fluoresces, or glows.

Surgeons perform first gene therapy procedure aimed at stopping AMD-related blindness

The first gene therapy procedure, aimed at stopping age-related macula degeneration (AMD) has just been completed by researchers.

Robert MacLaren FRCOphth a professor of ophthalmology at the University of Oxford undertook the operation at the John Radcliffe Hospital, also in Oxford.

Professor MacLaren ran the first gene therapy clinical trials from Oxford for rarer causes of blindness, Choroideremia and retinitis pigmentosa. Professor MacLaren ran the first gene therapy clinical trials from Oxford for rarer causes of blindness, Choroideremia and retinitis pigmentosa.

The patient, Janet Osborne an 80-year-old woman from Oxford, has geographic atrophy (GA) which is associated with progressed dry AMD. It causes blurring in the central part of vision, for Janet in her left eye.

The procedure involves detaching the retina, injecting a virus-containing solution, beneath. Contained in the virus is the modified DNA sequence which infects the retinal pigment epithelium cells and corrects the genetic defect which causes AMD, reports Oxford University Hospital.

"We're harnessing the power of the virus, a naturally occurring organism, to deliver the DNA into the patient's cells. When the virus opens up inside the retinal cell it releases the DNA of the gene we have cloned, and the cell starts making a protein that we think can modify the disease, correcting the imbalance of the inflammation caused by the complement system." MacLaren stated at the release.

"It is an interesting application and approach to this very common cause of vision loss," Allen C. Ho, MD, the Director of the Retina Research Program at Wills Eye Hospital and OSN Retina/Vitreous Board Member noted.

The operation was the first phase of the 1/2 FOCUS trial, which is accessing the biological activity of the treatment, developed by Gyroscope Therapeutics.

"What's unique about this particular clinical trial is that they are trying gene therapy surgically delivered to the subretinal space to try to modify the disease process," Ho said. While other clinical trials are testing injection therapies to treat dry AMD and geographic atrophy, there are no proven treatments currently.

Ho added, "Using gene therapy for this form of the disease to modify disease progression is interesting and exciting science, but not proven yet."

OCT scan of dry AMD.

OCT Scan of wet AMD.

UK biotech Gyroscope Therapeutics could have a mass market product on its hands if its new gene therapy for one of the most common form of blindness proves effective.

It is estimated that 196 million people globally will have the disease in 2020, while 11m will suffer significant vision loss. The company dosed the first patient with their one-off targeted injection, in hopes to prevent any further photoreceptor degeneration in the retina. In the UK already 600,000 people are affected by AMD.

Targeting the naturally occurring molecule which is responsible for activating MAC, a cell-killing factor named the membrane attack complex which in dry AMD seems to have gone rogue. MAC damages healthy retinal cells as well as unhealthy cells. The injection acts to block the molecule from attacking, this injection being the first of the companies' therapies to progress into clinic.

The initial trial will check the safety of the procedure and provide evidence that it can slow down degeneration. If early signs are positive, the therapy testing will be expanded to include patients with less advanced AMD. 

" A genetically defined treatment administered early on to preserve vision in patients who would otherwise lose their sight would be a tremendous breakthrough and certainly something I hope to see int he near future," said MacLaren. 

These pioneering advances in medicine follow on from the clinical trials for the treatment of choroideramia which has recently been successful.

Gene therapy treatments could prove useful for other conditions

Currently under trial are

Professor MacLaren said: 'This is a rapidly evolving field. Given that we understand a lot more now about the manufacture of the treatment, and the effects of the virus when doing gene therapy at the back of the eye, as well as all the other gene therapy programmes being developed at the moment, I would hope that we’ll see a treatment for people with dry AMD within the next few years.'

For further reading please see

http://www.retina-specialist.com/article/gene-therapy-the-new-frontier-for-inherited-retinal-disease

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. 

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.

UV and you

 

With the recent wave of summer sun, brings an increase of UV. Come rain or shine, we are always susceptible to the harm of UV rays. In the summer months however, exposure is at its peak! Fight for Sight, an eye research charity found only 1 in 2 of us are wearing UV blocking sunglasses. 

Here are 5 tips to reduce UV damage:

Darker lenses don't necessarily mean better protection! Sunglasses aren't equal in their ability to block UV. So a tint can be purely cosmetic with or without blocking UV well.

Tip: Look for CE marks to ensure your lenses meet the European standard for UV protection. 

It's a common misconception that we don't need protection on cloudy days. This may be true for wearing a tint,as it may not be as bright. UV however can penetrate through the clouds, so is still present, even when the sun isn't shining.

Tip: Day to day spectacle lenses can now be glazed to completely block out the sun's UV, therefore preventing long term damage. So now, clear lenses can give full coverage, all year long.

Have blue eyes? It's true that people with blue or lighter coloured eyes are more at risk of UV damage. Which in turn increases the risk of AMD. This is because lighter coloured eyes contain less melanin, a naturally occurring protective pigment.

Tip: Become familiar with the risk factors that contribute to AMD (Read more about AMD here). 

Sand and water are highly reflective, so they increase the UV levels in the surrounding area. If you're visiting the beach or planning a holiday, be sure to have protective sunglasses ready. 

Tip: Polarised lenses are extremely effective at blocking out glare, giving clear, undisturbed vision even on the sunniest of days. 

Our most vulnerable time, is up to the age of 5. After this our lens becomes more adapted to blocking out UV; so we better protect our retina (the camera film like layer, at the back of the eye). Damage done at this age can contribute to the development of cataracts later on in life.

Tip: Making sure your children have the appropriate sun protection, will help to reduce the cumulative effects of UV damage early on. 

If you are frequently exposed to UV, whether walking the dog or vacationing in warmer climates, you should protect your eyes. Be sure your sunglasses provide good vision, a high level of protection and enjoy the summer!

Matheson Optometrists stock a large range of optical quality sunglasses that give excellent protection against UV light giving you safer more comfortable vision in strong sunlight.We can provide plano sunglasses or have them made to your prescription. Prescription sunglasses are available at Matheson Optometrists from £59.95, including frames, lightweight tinted plastics lenses and UV 400 treatment.