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Vision & Eye Health HEALTHAWARENESS.CO.UK
VISION 2020
Mercy Jeyasingham discusses the global initiative for eliminating avoidable blindness by 2020 P2
GLAUCOMA AWARENESS
Regular eye tests are key to detection. Prof Stephen Vernon explains the risks P6
The silent thief of sight If undiagnosed, Glaucoma can lead to blindness. Diagnosis and treatment is key to managing the condition PHOTO: JOSE A THOMPSON
R E V
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1-3 APRIL 2017 | BIRMINGHAM NEC www.optrafair.co.uk/register THE UK’S LEADING OPTICAL EXHIBITION
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IN THIS ISSUE
New standards Mr Bruce Allen on improved procedures aiding laser surgery p8
Young eyes Dr Susan Blakeney reviews how best to take care of your child’s eyes p10
Blind football Keryn Seal talks to us about why he was inspired to take up the sport
Leading effective cross-sector initiatives for people with sight loss Mercy Jeyasingham, CEO, VISION 2020 UK, the umbrella body for the eye health and sight loss sector, outlines some of the challenges for the sector.
T
he World Health Organization and International Agency for the Prevention of Blindness set the task of eliminating avoidable blindness by the year 2020, the ambitious global initiative from which VISION 2020 UK derives its name. Despite this elusive goal, we have seen progress made through prevention and early intervention, as well as supported access to timely treatment and self- management. This edition of Vision and Eye Health focusses on glaucoma and, in particular, why Follow us
early diagnosis and treatment is critical, serious eye conditions and surgical solutions, living with glaucoma and driving and lenses.
Get checked Glaucoma describes a group of conditions that is the leading cause of sight loss globally. It is a priority area for the member organisations and Standing Committees of VISION 2020 UK. Many people are unaware that this often symptomless condition can lead to permanent sight loss. Raising awareness is therefore crucial.
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Mercy Jeyasingham CEO, VISION 2020 UK
“We have seen progress made through prevention and early intervention” @MediaplanetUK
It is presumed by many that an appointment with an optometrist is unnecessary until something goes wrong, but regular eye tests will check the pressure of the eyes and examine the optic nerve – important in the detection of glaucoma. Individuals with a family history of glaucoma are entitled to a free eye examination. People of African descent are also more likely to develop glaucoma and at an earlier age. Eye tests are therefore important not just for when you think you need glasses but also to pick up early signs of @MediaplanetUK
things potentially going wrong with your eyes. We are at a time when the demand on hospitals is rising. There are 7 million outpatient appointments a year for eyes (representing 10 per cent of all appointments), an increase of 30 per cent over the last 5 years. It is therefore important for people to understand their eyes more and know how to treat irritating but non urgent conditions. I hope this issue helps to support and give advice to people in understanding their eyes and knowing when to seek professional advice. Please recycle
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Shining a light on glaucoma
Glaucoma is often described as the ‘silent thief of sight’ due to its gradual onset. In the early stages the condition is often symptomless meaning that only an eye health professional can test for it and detect it.
O
ver time, glaucoma causes pressure to build on the optic nerve causing damage which, if left untreated, can lead to blindness. A routine eye test with an optician can detect signs of the condition and the sooner it is picked up, the higher the chance of successfully treating it. In order to raise awareness of glaucoma and encourage regular eye examinations, Specsavers has launched a health information campaign in partnership with the International Glaucoma Association (IGA). The £1 million initiative coincides with this week’s World Glaucoma Week1, from March 12-18. Glaucoma affects more than 64
million people2 worldwide making it the leading cause of irreversible blindness globally3. According to a recent study men are at greater risk of losing their sight than women.
Ensuring an early diagnosis Independent research which focussed on the eye condition glaucoma, carried out by City, University of London4, showed that men are 16 per cent more likely than women to suffer advanced vision loss on diagnosis of the condition. The reason for this is because men simply do not seek medical treatment as readily as women. Karen Osborn, CEO of the IGA, says: “Glaucoma is found in two per cent of the UK’s population aged over 405. Most of those people have a slow
developing form of the condition and we estimate that half of all cases – that’s over 300,000 people6 – remain undiagnosed and could be unaware that they are slowly losing their sight. “The health awareness campaign the IGA is working on with Specsavers will educate about the importance of regular eye examinations before significant sight is lost. Once sight is lost it cannot be recovered.”
Prevention is key RNIB (Royal National Institute of Blind People) and Specsavers’ ‘State of the Nation’7 report revealed that nearly 14 million people in the UK are not having their eyes tested every two years as recommended, leading to a huge burden on the economy
“Glaucoma is found in two per cent of the UK’s population aged over 40” due to easily preventable vision-related issues. Sally Harvey, Chief Executive of RNIB, said: “We welcome any initiative that encourages people to look after their eye health. “Regular eye tests and early detection on the high street, followed by timely intervention and management of eye health conditions, could help save your sight.” By World Glaucoma Week, every Specsavers store will have at least one optometrist who has completed
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Photo: Specsavers
the WOPEC (Wales Optometry Postgraduate Education Centre) Level 1 glaucoma accreditation, reinforcing their skills in detecting glaucoma and monitoring the signs of its progression, with Level 2 set to be achieved by September. Specsavers clinical spokesperson, Dr Nigel Best, says: “The only way to know if your eyes are healthy and your vision is accurate is to have your eyes checked by an optician at least once every two years.” Robert De’prose from Romford in Essex was diagnosed with glaucoma at the age of 50. It was an eye examination at Specsavers in Romford which resulted in the diagnosis and emergency surgery to save his sight.
Robert says: “I’m incredibly blessed that I was cared for by the Specsavers staff and they were able to refer me so quickly. Hearing the news was really sobering but I have to thank every single person involved in saving my sight. I’d strongly encourage others to get their eyes tested.” For more information visit: glaucoma-association.com specsavers.co.uk/eye-health/ glaucoma
1
http://www.wgweek.net/
2
Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040 : A Systematic Review and Meta-Analysis Yih-Chung Tham, BSc Hons, Xiang Li, BSc, Tien Y. Wong, FRCS, PhD, Harry A. Quigley,MD, Tin Aung, FRCS (Ed), PhD, Ching-Yu Cheng, MD, PhD
3
http://www.iapb.org/vision-2020/what-is-avoidable-blindness/glaucoma
4
“Cases of advanced visual field loss at referral to glaucoma clinics – more men than women?”, David P Crabb, Luke J. Saunders, Laura A. Edwards, Publ 9 Nov 2016. http://www.city.ac.uk/news/2016/november/ men-more-likely-to-present-with-advanced-sight-problems-than-women
5
http://www.nhs.uk/Conditions/Glaucoma/Pages/Introduction.aspx
6
https://www.eyecaretrust.org.uk/view.php?item_id=630
7
https://www.rnib.org.uk/sites/default/files/RNIB%20State%20of%20 the%20Nation%20Report%202016%20pdf.pdf
To donate to the IGA, text TEST17 £5 TO 70700 [Charity registered in England and Wales No.274681 and Scotland No. SC041550] To donate £3 to RNIB text GLAU17 to 70070 [Charity registered in England and Wales No. 226227 and Scotland No. SC039316]
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NEWS
insight
Glaucoma and driving: The facts By Tree Elven
T
he International Glaucoma Association (IGA) regularly receives calls from people unsure about whether they should be driving. CEO Karen Osborn clarifies. As with many conditions, glaucoma is easier to manage the earlier it’s detected. The IGA encourages everyone to have an eye check every two years, or more often if advised by a medical professional. “It’s less of a shock if you are at least aware of the condition,” says Osborn. “Glaucoma often has no early symptoms, so it’s important to monitor your eyesight. “We often have people asking whether or when they need to report an eyesight condition to the government’s Driver and Vehicle Licensing Agency (DVLA). Very often they are quite anxious about the possible loss of their licence. If you do have a glaucoma diagnosis, there is a new online notification system making it easier to inform the DVLA online. Our data shows that nine out of 10 people tested by the DVLA will be safe to drive.”
Help is at hand As well as advising the public, the IGA works with vision professionals so that they understand the requirements around driving. The high street optometrist can provide regular eye health checks, which can help detect glaucoma in the early stages. If the glaucoma is advanced and there has been serious sight loss, the optometrist and hospital eye clinic should advise the driver with glaucoma that they should not drive until they have reported to the DVLA. The DVLA may require further tests to assess fitness to drive. Pharmacists are also key to ensuring proper treatment: “Sometimes people are putting eye drops in incorrectly so that they run down the cheeks or over the lids. We had a call today from a gentleman who hadn’t realised that glaucoma doesn’t just clear up – he needs to use drops for life. Your pharmacist or the IGA website can help.”
Prevent sight loss before it’s too late By Tree Elven
Current and future treatments
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.
Glaucoma is one of the most common chronic eye diseases in old age, affecting around some 2 per cent of those over 40 and 10 per cent of the over-85s, says Professor Stephen Vernon, a glaucoma specialist and Vice President of The Royal College of Ophthalmologists. “The name covers various conditions relating to damage to the optic nerve. Glaucoma generally develops over the course of years, though some types develop in a matter of days or weeks, and it is even possible to be born with it.” Because it usually takes the form of chronic or slow onset without symptoms, regular checks for early detection are essential, says Vernon. “It’s commonly understood to affect your peripheral vision, but in fact glaucoma initially affects bits of the sight relatively close to the central vision, causing blank patches which gradually spread outwards and inwards. It can eventually lead to total loss of vision, and still commonly does in places like Africa where detection levels are lower than in Europe.”
Prof Stephen Vernon Vice President, Royal College of Ophthalmologists
What should I 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 .”
Over two million people in the UK have a significant degree of visual impairment. This number is projected to double by 2050. Yet, less than 2% of UK medical research funding is directed at eye disease, sight loss and blindness. Please help us combat blindness. Make a donation now at: www.nerc-charity.org.uk/donate
Read more on phone: 0117 325 7757 or email: info@nerc.co.uk Registered charity no: 1156134 healthawareness.co.uk
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 onegene 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 per cent 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.”
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Setting new standards in refractive surgery
By Tree Elven Improved patient information as well as enhanced regulation in the area of laser eye surgery are key issues addressed in updated guidelines due out this month.
Over 100,000 laser refractive surgery procedures are performed in the UK each year to decrease dependency on prescription glasses or lenses. “People who want to lead an active life choose refractive surgery,” says Mr Bruce Allan, Consultant Ophthalmic Surgeon at Moorfields Eye Hospital. “It’s entirely elective. There are different procedures to suit most age groups, and it’s primarily functional rather than cosmetic – there’s a reason why professional sportspeople don’t wear glasses.” The surgery is not available on the NHS or via private medical insurers – a situation which is unlikely to change, he believes, because of the demand
Photo: Thinkstock
for healthcare in nonelective areas. However, many people are unaware that it can be carried out in private clinics within a hospital setting. “The risks of laser refractive surgery are similar to those of continuing with contact lenses, and modern procedures are generally very safe wherever you choose to have them done,” says Allan. “Local private clinics offer
convenience and location benefits; a hospital setting may offer enhanced continuity of care and access to a wider range of specialised procedures.”
Improving processes Mr Bruce Allan Consultant Ophthalmic Surgeon, Moorfields Eye Hospital
New standards being introduced in March by the Royal College of Ophthalmologists aim to improve patient information, making it evidence-based, clear and consistent, Allan
explains. The guidelines will also recommend that surgeons meet their patients at least one week before the procedure – this is already standard in most hospital settings and in some local private clinics. “It’s important to meet and feel comfortable with the surgeon, to understand the procedure and discuss risks and care after surgery.” LASIK, SMILE and surface laser surgery are the three most common procedures. The use of multifocal implants – particularly popular in the 50+ age group – has come on “in leaps and bounds” over the past 10 years. Another area that’s moving fast is big data: “With technology, we can gather outcome data much faster instead of waiting years for the results of clinical trials. We hope to build current data programmes into a national database. Big data shows how small changes influence outcomes.”
British Wireless for the Blind Fund (BWBF) exists to help visually impaired people feel more connected to the world around them. Living with sight loss can be very isolating. Many blind people often lead lonely lives, unable to read a newspaper or watch the television.
Our charity provides specially adapted audio equipment to blind and partially sighted people across the UK. A radio can give a visually impaired person back their independence and provide them with news, information and entertainment and, more impor-
tantly companionship – a friendly voice in an often lonely world. All BWBF radios are adapted for easy use, with larger tactile buttons for simple navigation and have colour contrasting controls to assist people with residual vision. British Wireless issues radios on free loan to people who are registered blind or partially sighted, resident in the UK, over the age of eight and in receipt of a means-tested benefit to ensure it is supporting the people who are most in need.
To find out more about the work of BWBF, or if you or someone you know qualifies for a radio and you would like more information, please phone
01622 754757 or go to www.blind.org.uk
Moorfields Private – providing ophthalmic care to patients from across the world Moorfields Private is the London-based private division of the world-renowned Moorfields Eye Hospital NHS Foundation Trust, with a reputation as a centre of excellence for providing ophthalmic care to private patients from the UK and across the world. For over 200 years Moorfields has pioneered research, employed the brightest minds and delivered visionary eye care. We are proud to be considered the world’s leading destination for expert eye treatment, and continue to set standards for the rest of the world to follow. Being part of the Moorfields heritage offers the reassurance that you will have access to world-class consultant eye specialists providing treatment and care for private patients with a wide range of eye problems, from common complaints to the most complex eye health conditions and for those requiring sight correction treatment, such as refractive laser and lens exchange.
World-class care Our key ingredient is continuity of care, delivered only by Moorfields consultants, supported by a team of specialist trained nurses and dedicated support staff. At every visit, you will see the consultant of your choice who will lead every aspect of your care, from the first outpatient appointment to surgery and after care.
To make an appointment or for more information Please contact our dedicated New Patient Enquiry Team, quoting “Vision17” on:
Phone: 020
7566 2083
Email: enquiries@moorfieldsprivate.co.uk
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A seamless pathway for patients Consultations and diagnostic services are delivered in our newly opened Outpatient Centre in the hospital’s City location or in our Outpatient Centre at Upper Wimpole Street in the West End, with treatment being undertaken in private en-suite facilities within our City hospital’s Admissions and Refractive Suites.
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TIPS
Using eye drops to help treat glaucoma Most people with glaucoma are treated with eye drops which help to reduce the pressure in the eye, but many find them difficult to use. The International Glaucoma Association (IGA) offers their top tips for using eye drops. ■■ Wash your hands ■■ Find a comfortable position
(sitting on a chair, standing in front of a mirror, laying on bed) ■■ Shake drop bottle gently ■■ Lean back, pull down lower lid ■■ Administer one drop, close your eye and put your finger over the corner of your eye for up to two minutes ■■ Repeat with other eye, if necessary ■■ If you have to administer more than one type of eye drop, wait for five minutes in between ■■ If you wear contact lenses, remove the lens before you administer the drop and wait 15 minutes before putting the lens back in the eye ■■ Get into a routine: if your eye drop doesn’t need to be in the fridge put the bottle by your toothbrush. If you use a drop more than once a day, make sure the times are evenly spaced ■■ If you don’t know if a drop has gone in the eye, try keeping it in the door of a fridge, you will then feel the drop going in the eye Used regularly as prescribed, eye drops keep the pressure at the right level for you, which reduces the risk of loss of vision. All glaucoma eye drops may cause mild irritation, but people should continue using the eye drops and report any problems to an eye specialist at the next clinic visit. If a person cannot tolerate the irritation, you should arrange to see your GP or eye specialist as soon as possible.
Travelling
If you do need to keep drops cool, when the weather is hot, you can purchase a cool wallet from the IGA which prevent your drops from becoming warm for up to 48 hours.
Check their behaviour: Diagnosing young children with eye conditions can be difficult. Photo: Gabby Orcutt
Looking out for your child’s eye health By Tree Elven
New research indicates that myopia is more than twice as prevalent among children in the UK now than 50 years ago. We review how to take best care of young eyes.
A recent study part-funded by the College of Optometrists shows that 16.4 per cent of children in Britain are myopic (short-sighted) these days, as opposed to 7.2 per cent in the 1960s. “We’re not sure why that is,” says Dr Susan Blakeney, a Clinical Adviser at the College. “It’s a very complicated issue, and we don’t know how much it’s affected by environment, activity or genes. There’s some evidence that children who spend more time outdoors are less likely to become short-sighted, but again, we’re not sure why.” What we do know is that it’s “never too soon” to be aware of your child’s eye health. Other potential problems are longsightedness, astigmatism, lazy eye and squints. “Pre-school kids don’t always notice that they can’t see well,” says Blakeney. “It sounds bonkers, but remember, they don’t know what everyone else can see. We recommend that your child undergoes school screening, if it’s available, or that you take them to an optometrist on the NHS. It’s not just about wearing glasses – it’s important for children’s eyes to receive
Dr Susan Blakeney Clinical Advisor, College of Optometrists
clear images to ensure healthy development of the connections between the back of the eye and the brain.”
What should parents be looking out for? “Watch their behaviour,” she recommends. “If the child doesn’t look at you straight, take them in for a check. A baby should be able to recognise you and follow you with their eyes from about six months. Other indicators are if a child isn’t doing as well as expected at school, or is bumping into things, or showing poor hand/ eye coordination.” Parents should act on any concerns raised by teachers because they have the advantage of being able to compare your child’s behaviour with that of a peer group, she says.
Risk factors It’s also vital to be aware of family history such as myopia,
needing strong glasses, squints or lazy eye. If there is a family history, Blakeney recommends testing a child’s eyesight from the age of three. If there is no history, the recommended age is four or five. “The eye/brain connections are really important, and if they’re disrupted, the sooner we know the better,” she explains. “You’d be surprised how many parents don’t bring children in earlier even when they know there’s a family history. Myopia is very unusual in babies, but there are soft, bendy frames for glasses for babies. Children don’t need to be able to write or even speak – we can test them simply by shining a light in their eyes. They’re never too young.” Parents need to be aware of both eyes, says Blakeney. You can check your child’s sight by asking them to look at something across the road and then covering one eye at a time. If they cannot see it properly with both eyes separately, get them tested. Because myopia is a worldwide issue, there is research going on everywhere, says Blakeney, who is myopic herself. “Though it takes time to run effective trials, there is exciting work being done in myopia control.”
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