Vision Matters - Q3 - Sep 2018 by Mediaplanet UK&IE

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IN THIS ISSUE

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Spotlight on how sight loss is impacting the whole community from young to old P4

How artificial intelligence is enabling more efficient diagnosis of eye conditions P6

How drivers are a surprising risk group being impacted by glaucoma P6

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Your eyesight might not be as ‘fine’ as you think

David Cartwright Chairman, National Eye Health Week

Our sight is precious. You only have to close your eyes for a moment to appreciate just how important your vision and eye health is. And, for 83% people across the UK, sight is the sense we treasure most.

et, in Britain today, a million people are living with avoidable sight loss and experts predict, this number could rise by another 40% by the year 2030. David Cartwright, Chair of Eye Health UK highlights some of the steps we should all be taking to help reverse this worrying trend. Follow us

Essential eye checks Failing to have regular eye tests, once every two years (unless advised otherwise by your optometrist), is probably the biggest threat to eye health. Almost 14 million Brits (13.8) don’t have regular tests, despite them being essential health checks. According to research carried out for National Eye Health Week (24 – 30 September), 41% of those who don’t go for regular eye checks say they don’t bother because they know their eyes are fine. But, good eyesight does not mean all is well. Gradual deterioration due to poor eye health can go unnoticed until there is a significant problem and sight has MediaplanetUK

been irrecoverably lost. Not only can an eye test detect eye conditions, such as glaucoma, years before you notice a change in your vision, they can also uncover signs of general health problems including diabetes, high blood pressure, early signs of heart disease and even brain tumours. Eye tests take around 30 mins and are often free National Eye Health Week seeks to change this by raising awareness of the need to take care of your eyes and make eye tests as much a part of your healthcare regime as having a dental check-up. @MediaplanetUK

A routine test takes around 30 minutes and for millions of us it’s absolutely free – paid for either by the NHS or your employer. Treating minor eye conditions Your optometrist is also best placed for timely diagnosis and treatment of minor eye conditions. A new service currently being introduced in some areas, will see accredited opticians offering NHS appointments for conditions like conjunctivitis or dry eye. Getting outdoors could be good for your eyes Lifestyle choices pose another big @MediaplanetUK

threat to the nation’s eye health. Your diet, weight, activity levels and alcohol consumption can all affect your eye health. Protecting your eyes from the sun’s UV rays and not smoking can also help keep your eyes and vision healthy. There is emerging evidence that spending more than two hours a day outdoors can reduce the risk of myopia, even if there is a family history of the condition.

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A 360° look on sight loss An insight into ageing Eye diseases don’t always cause obvious symptoms. An eye test by an optician doesn’t just check to see whether you need glasses – it’s also an important check on the health of your eyes.

ision loss among older people is a major healthcare problem. Approximately one person in three has some form of vision-reducing eye disease by the age of 65. Most people find that, as they age, close-up vision blurs, tear ducts function less well, and eyes can get dry and inflamed. Cataracts may

make your sight cloudy and hazy and cause changes to the lens in your eye. Keeping our eyes healthy is important as untreated vision problems can make day-to-day life harder. Vision problems can lead to higher risk of falls, loss of confidence, which can affect going out, our confidence, our wellbeing, reading and following instructions, which could have serious consequences i.e misreading prescriptions and taking the wrong medications. Eye diseases don’t always cause obvious symptoms and regular eye tests (every two years or more often in some cases) are key to

maintaining eye health as we age. Opticians can detect small changes at an early stage, usually before we have noticed any changes. Opticians will recognise and advise treatment and follow up for common, age-related conditions such as macular degeneration, glaucoma, cataract and diabetic eye screening. Anyone over 60 is entitled to a free eye test.

Approximately one person in three has some form of visionreducing eye disease by the age of 65

Lesley Carter Senior Health Influencing Manager, Age UK

We can't correct our vision without professional help, and there's no quickand-easy fix for eyesight problems, but here are tips to keep your eyes healthy: • Get regular eye tests.

• Stop smoking. Smoking is harmful to the eyes – research has shown that smoking increases the risk of age-related macular degeneration, glaucoma and cataracts. Cigarette smoke irritates the eyes and will worsen dry eyes.

• Wear sunglasses to protect your eyes from the sun. • Eat healthily, particularly plenty of fruit and vegetables, which have specific nutrients that are important for eye health.

Read more at ageuk.org.uk/information-advice/health-wellbeing/conditions-illnesses/eye-health/

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Spotlight on diabetes Daniel Howarth Head of Care, Diabetes UK

Your retinal screening appointment can identify problems with your sight before you’ve even noticed they’re there. Spotting problems early can quite literally save your sight.

osing your sight due to serious complications with your eyes – diabetic retinopathy – can have a huge impact on your life; it could affect your career, your family life and your independence. Early signs of diabetic retinopathy are very hard to spot. Often it’s once the damage has become serious that

a person with retinopathy will realise something is wrong. But if eye complications do start to develop, they can nearly always be treated to avoid long-term problems – as long as they’re spotted and diagnosed in time. That’s why going to your eye screening appointments is so vital. Everyone with diabetes should receive regular appointments for an eye screen; the frequency of these appointments depends on your type of diabetes, and the results of your previous screen. At your appointment you may receive drops that dilate your pupils, and a photograph will be taken of your

retinas. A specialist called a retinal grader, alongside an ophthalmologist, will then assess these photographs and grade them depending on the condition of blood vessels and of your macular (the seeing part of your retina).

The results – or grades – that you get will inform what happens next.

Keep an eye out for your child’s vision Dr Susan Blakeney Clinical Adviser, College of Optometrists

ew research indicates that myopia is more than twice as prevalent among children in the UK now than 50 years ago. We review early warning signs that may indicate a problem. ‘‘Preschool children don’t know what everyone else can see, so they won’t always complain if they can’t see something. We recommend that all children have vision screening at school. If this is not available, or you have any concerns about your child’s

eyes then take them to an optometrist. This will be paid for by the NHS. This is particularly important if there is a family history of childhood eye problems or needing to wear glasses from a young age. You’d be surprised how many parents don’t bring children in to see us even when they know there’s a family history. Children don’t need to be able to read or even speak, as we can see if there is anything wrong by simply shining a light into their eyes. They’re never too young.’

The most important thing to remember is that the earlier problems are spotted, the earlier treatment can start, and the best chance you’ll have for a positive outcome.

The earlier any problems are picked up, the sooner they can be treated

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Glaucoma, “the silent thief of sight” Professor Stephen Vernon Vice-President, Royal College of Ophthalmologists It can develop imperceptibly over the course of years, even leading to blindness if undetected. We look at the value of regular eye checks and who should be particularly aware. What should we look out for and who is most at risk? “Everyone over 40 should have an eye check at least every two years,” stresses Vernon. “Glaucoma’s called the silent thief of sight because it has no symptoms until it’s very severe. Those who have a sibling with diagnosed glaucoma, and those of Afro-Caribbean extraction should be particularly careful because they are more prone.” And he’d add a surprise third group – drivers. “I’ve had a number of patients, typically males who’ve always bought reading glasses off the shelf and turn up for their first eye check at 65 or 70 with visual symptoms; they can read the eye-test board perfectly well but they’ve actually lost a lot of side vision and have advanced glaucoma. At their first consultation I have to advise them that they have to stop driving immediately and inform the DVLA .” Current and future treatments Most cases of chronic glaucoma can be treated with eye drops, which usually cause no, or very minor side effects but have to be used for life. Next lines of treatment are laser treatment and surgery, which are both increasingly successful and safe. Vernon says procedures called MIGS – minimally invasive glaucoma surgery – are also becoming more popular for early-stage glaucoma. In the coming decades, he sees exciting developments in gene therapy: “Glaucoma is related to many genes; it would be a lot easier to identify and treat if it were a one-gene disease. If we can find out which affected gene a patient has and replace local cells to keep the eye pressure down, that could solve the problem.” One of the main issues with glaucoma is detection and monitoring. “The number of patients will increase by 44% over the next 20 years in our ageing population –a huge increase that will be quite a drain on the health services,” explains Vernon. “You can’t just diagnose, give out some eye drops and forget about it: treatment needs to be monitored and adjusted as necessary. “It can be very hard to prevent loss of sight when a patient has been detected late. It’s better to have glaucoma diagnosed than not. Everyone, get regular checks.” Tree Elven

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Artificial intelligence is changing the way we diagnose eye disease Andrew Lotery Scientific Committee Chair, The Royal College of Ophthalmologists Professor of Ophthalmology, University of Southampton

Artificial intelligence is highly topical in the world of healthcare and for all the right reasons. It is transforming the way healthcare practitioners and doctors detect disease, enabling quicker diagnosis and therefore more effective treatment plans for patients. This is particularly true for eye disease.

or ophthalmologists (the eye doctors that perform surgery on the eyes and manage patients with eye disease) artificial intelligence tools are starting to help interpret the millions of photographic images that are produced in today’s eye centres in the UK. Eye patients regularly have digital images taken of their eyes to diagnose and assess possible diseases such as macular degeneration. These images include photographs of the retina, the tissue that senses light. Crosssectional images of the retina are also regularly obtained. These advanced optical coherent tomogram (OCT) scans show all the different cellular layers the retina contains and can have over a million data points in one single image. Retinal photographs are an important part of the national diabetic retinopathy screening programme in the UK. With diabetes on the increase, many people do not realise that this condition can lead to sight loss if it’s not treated.

Diabetes can affect eyesight Diabetes affects small blood vessels, damaging the retina. When the blood vessels in the central area of the retina (the macula) are affected, it’s known as diabetic maculopathy. Screening is a way of detecting the condition early before any noticeable changes affect vision. Diabetic retinopathy doesn’t usually cause any noticeable symptoms in the early stages. The convergence of increasing computing power and the ability to access and quickly diagnose the millions of scans by the limited number of eye doctors and technicians currently working in the healthcare system, would be almost impossible. This is why computers and the way we use their learning abilities can make such a difference to the number of patients that can be diagnosed early and eventually treated to save their sight. AI can detect your age, gender, blood pressure and smoking habits from retinal photographs An early example of the power of this approach includes a study of retinal photographs where, after a period of training on several hundreds of thousands of retinal photographs, computers were able to analyse photographs of an eye and very accurately predict the age of the patient, their gender, their blood pressure, whether they smoked and what their blood sugar measurement was likely to be. No human could look at a retinal photograph and accurately

generate such information. A collaborative study between Moorfields Eye Hospital and Google DeepMind demonstrates how a computer algorithm could analyse OCT images and make accurate referral suggestions, which are comparable to the standards of a clinical experts; therefore deciding whether that patient has a sight threatening problem that requires urgent attention or not. AI can help experts diagnose more patients more efficiently What this means for the future is that computer algorithms generated by artificial intelligence will help manage patients more speedily and as accurately as clinical experts. This will help us manage the everincreasing number of patients who have serious eye problems such as macular degeneration or diabetic retinopathy. The power of artificial intelligence will also help us better understand the fundamental cause of diseases too, and institutions are investing in the future. The Wellcome Trust has recently funded a project to use artificial intelligence to find the earliest changes in the visual system that cause macular degeneration. The exciting expectation is that the research, which I am leading, will ultimately develop new treatments to save sight. Read more at healthawareness.co.uk

Only research will cure blindness Please support our Glaucoma Research Appeal

www.nerc-charity/glaucoma-appeal

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The microscopic implant that treats glaucoma Glaucoma can lead to sight loss – even blindness – if it’s not diagnosed and treated early. Consultant Ophthalmic Surgeon, Gok Ratnarajan describes the treatments that could help save your sight. Q. What is glaucoma? A. ’Glaucoma is a serious, progressive eye disease. If left untreated, it can lead to blindness. Glaucoma usually occurs when the optic nerve is damaged by an increase in the pressure of the fluid in the eye when the fluid can’t drain properly. 'It’s estimated that around half a million people in the UK are currently diagnosed with glaucoma - but that many more are going undiagnosed and experiencing the steady, permanent eye damage glaucoma can cause without realising they have the condition.’

Q. So I can have glaucoma without realising it? A. ’Yes. We call glaucoma the ‘silent thief of sight’, because there are often no obvious symptoms until significant damage has been done to the eye. The less sensitive peripheral vision - your side vision - is usually the first to be affected by pressure damage to the optic nerve, which can be difficult to detect without an eye test.’

Q. How should I protect my sight then? A. ‘Annual eye tests are the best way to check the health of your eyes and for the start of glaucoma. Free eye tests are available on the NHS if you are over 60, or, if you are over 40 and have close family that have been diagnosed with glaucoma as you are considered to be at a greater risk of developing glaucoma. (Other circumstances can entitle you to free eye tests too - go to nhs.uk for a full list).’

Q. What will happen if I’m found to have glaucoma? A. ‘Damage to the optic nerve from glaucoma is permanent and irreversible, so it’s really important to get the fluid pressure in the eye under control as quickly as possible. The most common treatment for this at the moment is prescription eye drops, sometimes up to three or four different types in combination which will help to slow fluid production and/ or increase drainage out of the eye - and will sometimes need to be applied up to three times a day, every day, for the rest of your life.’

0,36mm

The iStent inject® Device (enlarged image)

Mr Gok Ratnarajan BSc MBBS FRCOphth MD

Q. Daily eye drops sound like hard work. Is there an alternative?

Q. Surely putting titanium stents into an eye is asking for trouble?

A. Yes. The eye drops needed to treat glaucoma

A. ’No. It’s a safe surgery, with a significant

can cause uncomfortable reactions in some people like redness, soreness and dryness. The commitment required to use them regularly can be problematic for some people too, particularly if some of the drops need to be kept refrigerated, or instilled frequently - which is where MIGS, Minimally Invasive Glaucoma Surgery can help.

number of studies to back up its efficacy and safety1. The procedure is performed under local anaesthetic while you’re awake. It’s painless and takes just five to ten minutes. We often recommend, where appropriate, adding it into cataract surgery if someone has both cataracts and glaucoma. You can’t see the stents once they are in place and visual recovery is rapid. There is a very good chance that patients will be on a reduced number of eye drops or none at all (under the management of the ophthalmologist). More than 400,0002 implants that have been implanted globally.’

Q. Eye surgery? Isn’t that a bit extreme? A. ‘No. Surgery used to be reserved for only

Q. How can I get this treatment?

the most severe cases of glaucoma - but things have moved on dramatically in the last 10 years, and there are now highly-refined, safe and minimally-invasive surgical techniques we can use that can be performed under local anaesthetic in no time at all, which can help control glaucoma and potentially reduce the need for eye drops. ‘Glaucoma laser surgery is an option - but one of the most effective MIGS for controlling openangle glaucoma (the most common form of the disease) at the moment involves inserting two tiny 0.4mm titanium iStent inject® implants in the eye’s natural drainage pathway to help control intra-ocular eye pressure.’

A. ‘First, you need to see a consultant for a full assessment of your condition, to find out if it’s suitable for you. It’s available through the NHS in some areas - usually, where appropriate, as an add-on to cataract surgery or for uncontrolled eye pressure problems. It’s also available through some private healthcare schemes.

About Glaukos

About Gok Ratnarajan

Glaukos Corporation is an ophthalmic medical technology company focused on the development and commercialisation of breakthrough products and procedures designed to transform the treatment of glaucoma, one of the world’s leading causes of blindness. Our mission is to pioneer and lead the global glaucoma market with micro-scale injectable therapies that advance the existing glaucoma standard-of-care and enrich the lives and treatment alternatives for glaucoma patients worldwide.

Mr Gok Ratnarajan BSc MBBS FRCOphth MD is a full-time Consultant Ophthalmic and Glaucoma Surgeon at the world-renowned Eye Unit in Queen Victoria NHS Foundation Trust in East Grinstead, West Sussex. Actively involved in clinical research, he publishes regularly in peer-reviewed journals and has won numerous awards for his research at national and international level.

Mandy Francis