Vision and Health 2018

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MARCH 2018 HEALTHAWARENESS.CO.UK

Vision and Eye Health ‘The silent thief of sight’: Professor Keith Martin Discusses breakthroughs leading the fight against Glaucoma

PHOTO: TOM OLDHAM FOR THE RSBC EVERY BLIND CHILD CAMPAIGN

UNITING THE OPTICAL PROFESSION FOR 40 YEARS 14 - 16 APRIL 2018 | BIRMINGHAM NEC

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IN THIS ISSUE

Top tips for using eye drops IGA Chief Executive, Karen Osborn

Living with Glaucoma: A patient perspective Understanding and managing the condition

Why a routine eye check might save your life Mr Michael Burdon, President of the Royal College of Ophthalmologists

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ONLINE

A simple eye test can check your vision — and your general health The health of our eyes is precious so it’s important to protect it with regular eye examinations, which can also highlight other health concerns.

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By Tony Greenway

n recent years, the general public has become increasingly aware of the importance of regular eye examinations. They are mindful of eye conditions such as macular degeneration, glaucoma and cataracts, and know that the earlier these are identified, the better they can be managed and treated.

More of us understand that sight tests can help gauge the state of our general health, too, picking up signs of diabetes or high blood pressure, for instance. What may be less well known is that by looking into the back of the eye, an optometrist can even detect evidence of more serious disorders, such as high pressure around the brain.

Dramatic innovations in technology Follow us

These breakthroughs have been made possible because of advances in technology. “For example, many optometrists now have a scanner that can look at every layer of the retina and precisely diagnose wet macular degeneration, picking up problems at the earliest stage,” says Daniel Hardiman-McCartney, Clinical Advisor, College of Optometrists.

“Not only is that great for people — because it gives them peace of mind knowing whether they have a problem or not — it’s also great for the NHS. That’s because having this kind of infrastructure outside of hospitals frees up eye clinics and consultants, and allows them to focus their precious resources on serious or complex cases; and it means more and more people are able to access eye care in the community.” facebook.com/MediaplanetUK

New possibilities to combat myopia

Daniel Hardiman-McCartney Clinical Adviser, College of Optometrists

“Research into myopia is rapidly evolving.”

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This is also an exciting time for eye care and vision research. Take myopia — or shortsightedness — for instance. This is a condition which is currently twice as prevalent as it was in the 1960s, for reasons that are not yet fully understood. What is known is that we are most likely to become shortsighted between the ages of six and thirteen.

“Research into myopia is rapidly evolving,” says Hardiman-McCartney. “First of all, there are a number of studies looking into the underlying causes of shortsightedness. Plus, there is ongoing research into drug treatment to discover if eye drops could be given to children who are slightly shortsighted in order to reduce how shortsighted they ultimately become.” For the first time, steps are @MediaplanetUK

being taken to ensure that myopia can be managed — not simply corrected when it occurs.

The importance of regular testing This campaign investigates various eye conditions, diseases and breakthroughs and makes clear that if you have any concerns about your vision or eye health, it’s important to visit an optometrist.

Most people have a practice nearby. Depending on their circumstances, they may even be entitled to a free sight test on the NHS. Even if they have to pay, a test is relatively inexpensive. It’s also usually quick. In just 30 minutes or so, a professional will appraise their vision, check the health of their eyes and look for signs of any other health concerns. Surely that’s half an hour well spent?

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Children grow up to be poor or lonely just because they are blind SPONSORED

By Tony Greenway Without the right support at the right time a blind child can experience severe problems in adulthood including depression, anxiety and chronic unemployment.

Over 35,000 people in the UK under the age of 25 are vision impaired. It is a disability that doesn’t just impact the child, it has serious consequences for both parents and siblings as they struggle for advice and support following the diagnosis of their child’s sight loss.

“Eighty per cent of a child’s development up to the age of four is gained

through the use of their sight”, says Dr Tom Pey, Chief Executive of national charity the Royal Society for Blind Children (RSBC). “These early skills include the ability to interpret body language and other non-verbal signals, vital to the later development of the young person’s emotional intelligence allowing them to make friends and work well with others.”

What childhood sight loss is really like Children under the age of 11 who are blind or severely vision-impaired are more likely to suffer from depression, anxiety and loneliness than their sighted peers: a condition which, if it persists into adulthood, could result in the individual becoming isolated and chronically unemployed.

Yet there is insufficient professional support for the child or their parents who face a daily and uphill struggle to maximise their child’s potential. Loneliness becomes the plight of the vision impaired young person at an early stage in their life. Research tells us that

Dr Tom Pey Chief Executive, Royal Society for Blind Children (RSBC)

“If parents get the right support at the right time, the devastating consequences of childhood sight loss can be avoided.”

two out of five blind children have no local friends to play with; nine out of ten won’t grow up to have a long term job; and as a result are very likely to live on or below the poverty line.

“Parents need the right support at the right time,” says Dr Pey. “If they get it then the devastating consequences we see today can be avoided.”

“We are calling for wider acceptance of the psychological consequences of sight loss amongst professionals who provide care and support to the blind child. Great progress has been made in the medical treatment of childhood eye conditions we now need to apply the same level of scientific rigour to understanding and promoting the child’s emotional development.”

The RSBC’s Family Support Service can be a vital link in this chain of support but it is only by us working together as integrated teams that we will maximise our collective impact.

children, RSBC has launched the campaign, Every Blind Child (as pictured on the front cover). This features the real voices and experiences of blind and vision-impaired children and aims to ensure that, by 2020, 11,000 families have access to an RSBC Family Support Worker.

The Family Support Service is available in many regions across England and Wales. The specialist team gives families immediate, one-to-one emotional and practical support for as long as it’s needed.

Info: We are here to help

If you think we can support a blind child and their family in your area, please get in touch by giving us a call on 020 3198 0225 or send us an email at: enquiries@rsbc.org.uk.

RSBC – raising awareness To raise awareness of the challenges faced by blind and vision-impaired

Read more on rsbc.org.uk/our-services

Essential research for glaucoma therapy is underfunded SPONSORED

By Tony Greenway More funding is needed if breakthroughs are to be made in glaucoma research, says a Trustee of a leading eye research charity. The results could have a huge impact on the landscape of eye health.

Glaucoma causes cell death in the optic nerve and, if left untreated, can lead to blindness. Professor Francesca Cordeiro has been involved in glaucoma research for the past 26 years. In that time there have been huge advances in the fight.

“One of the first big breakthroughs in glaucoma management was the introduction of once-a-day eye drops,” says Cordeiro. “Before that,

patients were having to administer eye drops three or four times a day. The way clinicians examine the visual field of patients has also improved, which changed the management of glaucoma and is now a much better indicator of the disease.

Plus, eye surgery has developed, thanks to the use of lasers and standardised methodologies.”

Diseases that lead to blindness are under funded None of this would have been possible without intervention from charities - such as Fight for Sight - and other organisations that fund innovative, pioneering, early stage glaucoma research. Even so, notes Cordeiro, more money is needed if further breakthroughs are to be made. “Diseases such as glaucoma, which lead to blindness, seem to attract less funding than diseases which can kill,” she says.

“That’s why support from charities is so important. Without their help, we simply wouldn’t have made such big strides in glaucoma

Professor Francesca Cordeiro Trustee, Fight for Sight, Imperial College and Professor of Ophthalmology and Professor of Glaucoma and Retinal Neurodegeneration, UCL

“If left untreated, glaucoma can lead to blindness.”

research — and more people would have lost their vision as a result.”

“Breakthroughs in eye treatments can be applied elsewhere in the body,” says Cordeiro, noting that more emphasis should be placed on eye health research. “Glaucoma is a neurodegenerative disease, like Parkinson’s or Alzheimer’s,” she says.

“Ophthalmology should be better recognised in the medical field and I’m hoping that underfunding in this area will ultimately improve.”

Glaucoma-induced sight loss cannot be restored Glaucoma, notes Cordeiro, is both cruel and ubiquitous: it is currently the second largest cause of sight loss in the UK. It’s age-related, so the risk of it developing rises from the age of 40, and its chronic form is often symptomless. And while sight loss to glaucoma can’t be restored, regular treatment can help prevent further vision degeneration — so early diagnosis is essential. This is why, last year, there was much excitement when it was announced

that Cordeiro and her team had developed an eye test, which could help detect the earliest signs of glaucoma.

Cordeiro believes that, with proper research funding, glaucoma will one day be a disease of the past. “New breakthroughs in stem cell and gene therapy treatments could make a real difference to glaucoma patients going forward,” she says. “We need to do more to raise awareness of eye research and demonstrate that this is an area of medicine which is really worth funding.”

Info: Fight for Sight is the UK’s leading eye research charity, funding pioneering research to understand what causes different eye diseases and sight loss conditions and to find ways of preventing and treating them.

Their aim is to stop sight loss and create a future everyone can see.

Read more on fightforsight.org.uk

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My eye problems meant I couldn’t see to walk at night

Nia Malene Martin Member WGPA, Founder Glaucoma Eyes International

By Tony Greenway Nia Malene Martin was just a teenager when she was diagnosed with glaucoma. She had to stop driving and couldn’t go out with friends at night because she couldn’t see to walk.

She became lonely and depressed.

I have several eye conditions: glaucoma, inflammation and ocular edema, which is a build-up of fluid in the macula. Specialists aren’t able to find any underlying reason as to why my eyes are particularly susceptible.

I was first diagnosed with glaucoma in 1986 when I was 15. I had been experiencing foggy vision and rainbow halos when I looked at light. I was referred to an ophthalmologist who started me on a full range of tablet and eye drop medication.

The diagnosis totally changed my life. It was shocking at first. I didn’t know what glaucoma was and I became depressed. I couldn’t continue with school and sat in my room playing music. Unfortunately, my family didn’t really understand my problem and I started living on my own and had to find work. I remember feeling very alone.

At that point, my eyesight was failing. Vision in my left eye was just five per cent — although it was better in my right eye at 90 per cent. I am now scrupulous with eye drop treatment, and my left eye currently has 40 per cent vision. Vision in my right eye went as low as 20 per cent, although I had surgery in 2016 and it’s now up to 40 per cent.

Living with glaucoma has been difficult. Many people don’t understand the condition and it has affected me socially. I can’t drive anymore, and I don’t always feel comfortable going out with friends at night when I can’t see where I’m walking.

There are no guarantees it will continue, but vision in both my eyes is now stable. I aim to keep it that way! Medication has changed drastically over the last 32 years. It’s much better now.

My advice to anyone who thinks they may have glaucoma is: don’t wait.

See an ophthalmologist. I run a glaucoma support group for people who are terrified they will go blind — and my advice to them is: breathe.

Everything is going to be okay. And the earlier it is found and treated, the better the outcome.

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A brighter future for glaucoma diagnosis and treatment

By Tony Greenway Once, new innovations in glaucoma treatment were thin on the ground. Now a number of breakthroughs are beginning to emerge that point to a more positive future for patients.

This is an exciting time to be working in the field of glaucoma research, says Professor Keith Martin, President of the World Glaucoma Association. “In terms of innovation and new treatments, glaucoma was trailing behind other eye diseases, such as macular degeneration,” he notes. But now a number of interesting breakthroughs are beginning to emerge.

In its early stages, glaucoma — a deterioration of the optic nerve,

which first affects peripheral vision — often has no symptoms. “That’s why the disease is known as ‘the silent thief of sight’,” says Martin.

“Vision can become slightly blurry at the periphery, but this might not be noticed until central vision is affected. By then it’s often too late to reverse the damage.”

If you are of Afro-Caribbean origin, or very shortsighted, you should be tested more often Early diagnosis is vital because treatment is available that can slow the progress of the disease. An optician will look at your optic nerve, measure your visual field and test the pressure within your eyes. It’s

sensible for people under 40 to have an eye examination every five years; although if you have a family history of glaucoma, or are of Afro-Caribbean origin, or very shortsighted, then your risk is increased so you should be tested more often. As the risk of glaucoma increases with age, those over 40 should also have more frequent eye examinations.

Glaucoma patients can present with increased pressure inside the eyes, known as intraocular pressure, or IOP. However, it should be stressed that even those with normal levels can develop glaucoma.

To treat the disease effectively, it’s important to lower pressure, which can be done using eye drops, laser treatment or surgery.

At Santen, we are committed to tackling vision loss and supporting people with eye-related conditions.

We have been dedicated to ophthalmology since 1899 and are fascinated by the science that helps us improve treatments for glaucoma, dry eye and other eye conditions.

We continue to support patients and the ophthalmology community throughout 2018 and beyond, making people aware of the importance of regular eye tests and encouraging people to take charge of their own eye health.

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Normal Vision

PHOTO: INTERNATIONAL GLAUCOMA ASSOCIATION

“Controlling the pressure in your eyes over the course of 24 hours reduces the risk of the disease getting worse,” says Martin. “The problem is, most studies show that only half the people who are prescribed treatment actually use it. They may take eye drops for a while but then either forget or give up. But if you have been prescribed eye drops, you must use them every day.”

Once-a-day eye drops are preferred Anything that can be done to make treatment less burdensome for the patient should be welcomed. “That might mean developing better tolerated eye drops or simply making eye drop bottles easier to open,” says Martin. The

more eye drops patients are given the less likely they are to use them, which is one reason why eye drops that only need to be used once a day rather than two to four times a day have been an important advance.

In the last few years, a range of fluid-draining devices have been developed that can be implanted in the eye via minimally invasive surgery. “These devices are designed to lower IOP and reduce the need for eye drops,” says Martin. “Unfortunately, we don’t know — yet — how they will work over the long-term; plus they may be less appropriate in the treatment of severe or advanced glaucoma, where very low eye pressures are required. So there is still more research to be done in this area to

Professor Keith Martin President, World Glaucoma Association

“The disease is known as ‘the silent thief of sight’.”

develop new devices that achieve even lower eye pressures in the long-term.

“However, we now understand more about the pathology of the disease and this is opening up the possibility of treating glaucoma with gene therapy and stem cell therapy. We’re starting to learn how to restore function to the injured optic nerve, and while the work is still at an early stage and confined to animals, techniques to regenerate the optic nerve are also evolving rapidly. In future there is the prospect that we may be able to improve the vision of glaucoma patients, as well as being able to slow the decline of the disease.”

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Glaucoma, “the silent thief of sight”

Professor Stephen Vernon Vice-President, Royal College of Ophthalmologists

By Tree Elven Glaucoma 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 Professor Stephen 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 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.”

Could you have glaucoma?

The only way to know if your eyes are healthy and your vision is accurate is to have your eyes checked by an optometrist.

G

laucoma has no obvious symptoms in the early stages, but advanced glaucoma can lead to serious loss of sight.

With early diagnosis, careful monitoring and regular use of treatments, the vast majority of people with glaucoma will retain useful sight for the rest of their lives.

What is glaucoma?

Glaucoma is the name given to a group of eye conditions. The main nerve (the optic nerve) becomes damaged – usually as a result of increased pressure in the eye. This can lead to misty and patchy vision, which worsens if left untreated.

Karen Osborn Chief Executive, International Glaucoma Association (IGA)

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Nearly everyone finds eye drops difficult to use

What happens if you find you do have glaucoma?

People with suspected glaucoma will be referred by an optometrist to a hospital. Newly diagnosed people will be treated and monitored at hospitals and then discharged to the community if the glaucoma is considered stable.

Hospital eye clinics across the UK have never been so busy. Increasing numbers of our people with glaucoma are facing delayed or cancelled appointments, which is causing a good deal of worry. To help with this the IGA has put together a guidance

place of your next visit, what will happen at the next appointment and who will you see.

Find out when the next appointment should be and what should be the maximum time between appointments. Be both persistent and politely assertive.

If you specifically need to see your consultant at the appointment – for example if you have received conflicting information or have issues troubling you – ask specifically to see the glaucoma consultant.

Appointment intervals vary and depend on how your glaucoma is responding to treatment. Be advised by your consultant when you should next attend.

sheet to help anyone having problems with appointments. It is aimed at people new to the system as well as those familiar with eye clinics.

What to do if you are struggling to get an appointment: Find out how the hospital appointments system works. Can you book ahead? Is the information in a format that is accessible to you?

Make a note of the name of your consultant or doctor, the time and

Most people with glaucoma are treated with eye drops, which help to reduce the pressure in the eye and to modify the risk. Nearly everyone finds it difficult to use eye drops.

Used regularly, as prescribed, eye drops keep the pressure at the right level for you, which reduces the risk of vision loss. All glaucoma eye drops may cause mild irritation, but people should continue using the eye drops and report any problems to their consultant 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.

Only research will cure blindness Please support our Glaucoma Research Appeal

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Top tips for using eye drops 01

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03

Wash your hands.

Find a comfortable position (sitting on a chair, standing in front of a mirror, laying on bed).

Shake drop bottle gently.

05 04 Lean back, pull down lower lid.

Administer one drop, close your eye and put your finger over the inside corner of your eye for up to two minutes.

06 Repeat with other eye, if necessary.

07 If you have to put more than one type of drop in the eye, wait five minutes between drops.

08

09

If you wear contact lenses, remove the lens before you use the drops 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.

10 If you can’t tell if a drop has gone in the eye, keep the bottle in the fridge, then you will feel the colder liquid.

SOURCE: INTERNATIONAL GLAUCOMA ASSOCIATION

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