Telescope in your eye that can see off age-related blindness
01:03 GMT, 11 December 2012
Dry macular degeneration is the leading cause of age-related blindness in Britain, and affects nearly 300,000 people.
Jeffrey Howell, 68, a retired managing director of an engineering company from Stourbridge, West Midlands, had a revolutionary 30-minute treatment to help him see again.
'There had been some eyesight issues in my family,' said Jeffrey Howell, who was diagnosed with age-related macular degeneration (AMD)
The day I realised something was wrong with my sight, I’d been sitting in traffic.
Looking at the car in front, I noticed what looked like a little bulge or kink in its outline and thought: ‘How unusual to design a modern car with a defect in it.’
I’d just turned 50 and had no problems with my sight, though I’d worn reading glasses since the age of 45 — but that’s not uncommon.
I realised there must be something wrong with my vision.
The problem was with my left eye.
My optician sent me to my GP who diagnosed a retinal thrombosis, a blockage of blood flow to the back of the eye.
Fortunately, I had private health insurance so went for a second opinion at Moorfields Hospital in London.
Doctors revealed that the GP had been wrong and in fact I had a form of age-related macular degeneration (AMD).
This is where the macula, the part of the eye responsible for central vision — that’s everything you see in front of you — becomes damaged.
Over time, your vision becomes blurred and dark, you can only see the edges of what you’re looking at, and things like reading get harder.
I had ‘dry’ AMD and it was a genetic form, which meant symptoms start occurring at a slightly earlier age.
There had been some eyesight issues in my family — four relatives may have had dry AMD, including my 92-year-old auntie.
I was told there’s a 50:50 chance my children will develop it.
The doctors said I’d be independent for a long time, but eventually I’d lose my driving licence. There was no treatment.
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'The operation involved having two lenses implanted in my eye, one in front of the other,' said Jeffrey
It was like being in a horror story. I’ve always been active and independent, and didn’t marry Jane for her to be my carer, but that seemed to be our future now.
A conversation with my neighbour changed everything.
He was having treatment at the London Eye Hospital for a different eye condition, but suggested I saw his specialist — Mr Qureshi — which I did, and I was stunned to discover there was now a solution for dry AMD.
The operation involved having two lenses implanted in my eye, one in front of the other, which would work like a small telescope and realign my vision away from the damaged area of the macula, and to a healthy bit instead.
I had to pay 22,000 to have the procedure privately, by cashing in a savings plan, because I’d lost my insurance cover when I retired.
I went in on July 10 for treatment on my left eye, and then a few weeks later had my right eye done.
The procedure was done under a local anaesthetic and was absolutely pain free, although I could sense Mr Qureshi doing things to my eye.
After about half an hour it was all over, then I relaxed for 30 minutes and we could go. I had an eye patch on for the first night which I removed the next morning.
At first it was like looking through a polythene bag, but this cleared after a few weeks.
Now the impact is just spectacular. My eyesight is so much better — I can fly fish and drive again, and can even read the time on the bedside clock if I wake up in the middle of the night.
I still need reading glasses, but I’ve gone from resigning myself to losing my sight to getting my freedom back.
It’s a relief knowing there’s a cure for my three children if they develop the same problem.
This isn’t a complete cure for dry AMD, but it’s a huge quality of life improvement — and being able to drive again is seriously very important for my independence.
Bobby Qureshi is consultant ophthalmic surgeon and medical director of the London Eye Hospital. He says:
AMD usually affects both eyes and is associated with getting older
We see the world around us with the help of light rays which travel through the eye. The lens focuses these rays on to the back of the eye — or retina — to create an image.
In the centre of the retina is a tiny layer of tissue (the macula).
This 1.5mm-diameter spot is packed with light-sensitive cells that control the eye’s central vision, enabling us to read, drive a car and recognise loved ones.
In dry AMD, the macula gradually becomes damaged. Waste products build up and form small deposits which damage the light-sensitive cells. The result is blurred central vision.
This debilitating condition usually affects both eyes and is associated with getting older. It’s most commonly seen in people aged 50 and above.
But it can also run in families. It’s thought as many as a fifth of patients may have a strong genetic link, as in Jeffrey’s case.
Dry AMD accounts for 90 per cent of cases of AMD — affecting about 300,000 people.
The ‘wet’ type of AMD makes up 10 per cent of cases and is caused by abnormal blood vessels forming under the macula and damaging its cells.
This is a lot more severe and without treatment vision can deteriorate within days.
There have been implantable lenses in the past which were approved for AMD, but these were often a last resort for people who had lost most of their vision, allowing them to see just a small image.
They also carried a small risk of damage to the front of the eye (cornea) because they were implanted just behind it.
Some types required up to ten stitches, which meant a longer healing time.
This new ‘telescope’ lens, called the IOL-Revolution, is a major breakthrough and we’ve only just started using it. It’s much safer as it is implanted away from the cornea.
Like ‘mini’ contacts, the lenses we use are plastic, 6mm wide and 1mm thick.
The aim is to divert images away from the damaged to the healthy part of the eye so that these images appear normal.
We use a laser to make a 1.5mm incision at the edge of the cornea and remove the patient’s real lens.
Then we widen the incision to 5mm and insert the lenses. Both lenses sit 2mm apart behind the iris in place of the patient’s real lens.
The lens at the front is convex and the one behind concave, so together they form a prism.
The lenses are deliberately not aligned so when the light enters the eye, the prism diverts this light away from the diseased tissue to create an image on a healthy part of the macula.
The lenses also act like a miniature telescope, slightly magnifying the image seen by the eye.
We close the incisions using three tiny 1mm stitches, finer than a human hair, in each eye, and remove them three months later.
The risks are the same as for standard cataract surgery — a very small chance of bleeding and infection.
In a small number of cases the macula may be very badly damaged — so we wouldn’t go ahead with treatment.
An advantage is that the lenses can be moved around, so if the AMD progresses later, I can move them again to reflect the image to a healthier part of the macula.
However AMD progresses very slowly, so in most cases this should be a treatment for life.
We’ve performed the operation on six patients now.
The cost is around 11,000 per eye — the lenses come from Italy and are currently recruiting for trials which begin in 2013, to develop our own version of the lens.
Our version would only cost around 200 a lens — affordable for the NHS.
We want to give this to the mass population. There are so many people out there who could benefit.
To find out about the trial, email: [email protected]
Anyone who takes part would get free treatment, though they may have to pay for tests.