Gene therapy breakthrough could improve sight

After years of exploration, I was delighted to read that scientists at Oxford Uni have succeeded in restoring the sight in people with a form of degenerative eye disease.

Choroideremia affects about 1 in 50,000 people who see their eye sight deteriorating as the light-detecting cells in their eyes die, usually becoming completely blind during their mid-life – a disease not dissimilar to the more widely known retinitis pigmentosa. There has been lots of research in this area but this is the first real world example of success.

Whilst the long-term effects are still unknown, the fact that the trial has had such early successes is a huge step forward and will give real hope to those suffering from various genetic eye diseases.

And it doesn’t stop there. There are many diseases with genetic components that affect eyesight, such as glaucoma which a number of my patients suffer from, and I am hopeful that the same principle could be used to treat a raft of similar diseases in the future.

What is especially heart-warming, is that the research was funded by the Tommy Salisbury Choroideremia Fund set up by the parents of Tommy, a 13-year-old boy from Kent who was diagnosed with the disease eight years ago. Wouldn’t it be great if he reaped the rewards of the research?

Read more about it here

Contact lens specialist symposium 2013

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Cameron Optometry were invited to attend the first CLSS specialist contact lens symposium in London last weekend.

World leading experts , and great speakers such as Pat Caroline, Randy Kojima, and Eef van der Worp presented some of their most recent research , and clinical experience in the field of contact lenses. Covering Interesting topics such as myopia control in children and scleral lens fitting, the lectures did a brilliant job of condensing the most recent global research into highly relevant information for contact lens fitting.

My only improvement for next time would be the venue. As you’ll see from the photo we spent the weekend in what was essentially a war time underground bunker!

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The cornea…but not as we knew it

Patients often tell us that at each visit we unveil some new exciting gadget or piece of technology for investigating the health of their eyes. It seems like that to us too! In this ever changing tecnhological world though, where our tools to image your eyes are constantly improving, what doesn’t usually change is our understanding of the structure of the eye……until now…

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The transparent cornea at the front of the eye is merely 0.5mm thick , and has always been understood to have five distict layers. When you put your chin on the slit lamp during your consultation we can identify these separate layers which provides vital information as to the severity of your eye condition. However Prof Harminder Dua of Nottingham university has discovered a new layer in the cornea. At only 0.001mm thick the layer was discovered by experimentation on human eyes donated to research banks.

The implication of this discovering could be very important for corneal surgery and the understanding of eye conditions such as acute hydrops, descemeteocele and some corneal dystrophies effecting the deeper layers of the cornea.

During corneal surgery tiny air bubbles are injected into the corneal stroma. If these bubbles burst then damage is caused to the patients eye, but by injecting under the strong Duas layer we may reduce the risk of tearing and damage.

Prof Dua suggests that many of the eye conditions that we know to affect the back of the cornea could relate to the presence of this new found layer. Corneal hydrops is one such condition. It is a buildup of fluid in the cornea that is common in patients with keratoconus and might be caused by a tear in Dua’s layer.

 

Computer games could be good for your eyes

It’s not the sort of advice you might expect from your optometrist but current research from  McGill University in Canada suggests that playing the video game Tetris may be an effective way of improving a lazy (amblyopic) eye.

Good vision requires more than just a healthy eye. The eye sends electrical signals via the optic nerve to the part of the brain used for visual processing. We call this process the visual pathway or visual system. The visual system is not fully developed at birth. Good development requires each eye to be seeing well in order to build the connections between the eye and the brain. If one eye sees better than the other, the connections it builds will be stronger, leading to a dominant eye that suppresses the other one. This development continues from birth until about 8 years old.

During this time there is a chance to balance the two eyes by covering the stronger eye forcing the weaker eye to behave better. This is only successful in some children and generally accepted not to work in adults at all. The earlier that treatment is started the better the outcome. This is why eye testing from about 3 years old is advised in all children. This should be even earlier if you have a family history of eye problems, if you think you see a squint in your child’s eyes or have any concerns that they are not seeing well.

So could video games offer the answer to improving vision in adults who currently have no other treatment options? By connecting differently shaped blocks as they fall in Tetris, the eyes are forced to cooperate with each other, alleviating suppression of the weaker eye and retraining the brain to use both equally. Results from recent research suggested promising improvements in the vision of the weaker eye and in 3D perception.

Unfortunately kids, this has not been trialed on children yet, although an American trial is planned for later this year. So while we are not advising video games over homework quite yet, this might bag you another few minutes on your DS!

Eye scan can monitor the extent of MS

As you may have noticed at your eye appointments over the last couple of years, in addition to taking a retinal photograph of your eyes we offer a scan of the deeper retinal layers, using our Optical Coherence Tomographer (OCT) scanner.

Being one of the first practices or hospitals to have this equipment in Edinburgh we have been learning more and more of the value of these scans as our experience grows and research continues. The most recent neurological research suggests that OCT measurement of the retinal thickness may offer a fast and effective way to monitor progression of Multiple Sclerosis (MS) The research suggests that patients with relapsing MS had rates of retinal thinning up to 42% quicker than those without replases. Perhaps as more therapies are developed to slow MS progression testing retinal thickness will be a useful tool in monitoring how effective these treatments are.

As ever, the eye provides a window to the health of the rest of the body. While we use the OCT more commonly to detect and monitor early signs of eye disease, particularly glaucoma and all types of macular degeneration , we also see the value in having these scans done in your healthy eye to establish baseline data that could be invaluable in the future.

AAO 2012 Phoenix – Day 1: A nerd’s paradise

If you love eyes, AAO is like Nirvana. Is your chance to be as nerdy as you like about eyes and no one thinks you’re weird or boring!

I only made it to 4am before I was wide awake but fortunately had a 7.15am start with a breakfast meeting about contact lenses and happy patients. It was OK but I wasn’t inspired to be honest.

Things improved as the day took a decidedly geek turn with a whole hour devoted to the the vitreous humour (of course the Yanks spell it incorrectly). For those of you casting your mind back to A-Level biology the vitreous is clear the jelly like substance that fills most of the eye ball and is 99% water. How can you talk for an hour about a transparent bag of gel that’s 99% water I hear you ask? Well you can and it’s fascinating.

If any of you have experienced flashes and floaters then you may have had a PVD which we talked about in some detail. There is even hope for a new treatment for problems associated with PVD and a possible cure for floaters. This new wonder drug comes out in the US in 2013, so we’ll have to see how long it takes to come to the UK.

Then I had an excellent summary of the latest lenses for keratoconus. We’re pretty much at the leading edge of keratoconus in the UK and so there wasn’t too much new here but there are a couple of new designs coming out this year which sound quite exciting and now I know how to fit them, it should give us a running start when the arrive in the UK.

The afternoon was a bit of binocular vision (how the eyes work together as a pair) and a very interesting discussion of the value of OCT in Glaucoma and other optic nerve analysis. The OCT is scanner that we will have used on you if you’ve come in for an eye exam in the last year or 2.

I’m such a party animal I stayed up until 8pm before crashing out!

AAO 2012 Phoenix – Day 2: A view into the future

Well day 2 has been even better than day 1 although it was another 4am start. I’m like a kid in a sweet shop, there are so many interesting lectures I’m having a hard time choosing.

I opted for “What’s new in retina” which was a good choice. The chap (a retinal surgeon) was giving us a sneak peak at some brand new (not even released or published) information about some very exciting new drugs available to treat macular degeneration. You may have heard of Lucentis which is widely used but this next generation drug is used in combination and looks to have incredible results. This kind of research just isn’t accessible in the UK which makes the effort of coming out here feel very worthwhile and exciting to see what’s coming round the corner.

A bit more stuff on injections for macular degeneration rounded out the morning and has given me some rather exciting ideas for where we could go in the future with optometry in Scotland.

The afternoon was a workshop on “Advanced Retinal Examination – 3 mirror and scleral indentation” which is not as bad as it sounds. This was a great chance to practically brush up on some skills to examine the peripheral retina to check more thoroughly for problems like retinal detachment. It was so useful I went an bought a new lens to put my new skills into practice in Scotland and take advantage of the great exchange rate.

Tonight I ‘partied’ until 8pm again but stayed up catching up on emails until 9pm!

Long eyes less likely to have diabetic retinopathy

Finally some good news for the short sighted as people with long axial lengths (that is the length of the eyeball, front to back) are less likely to suffer from diabetic eye disease.

Myopia or shortsightedness is where rays of light are focussed in front (or ‘short’) of the retina rather than on it leading to blurry vision. It is easily corrected optically but high myopia can cause many physical problems as the eye is usually larger than normal which causes the focussing short fall – the retina is too far away, if you like.

Myopia is described as pathological when you get up to the doubel digits on your prescription and is linked to an increased risk of a form of macular degeneration, glaucoma and retinal detachment. The larger sized eye means the retina is streched thin over a larger area and so is more fragile and prone to damage.

This study showed that the longer your eye the less likely you are to have all forms of diabetic retinopathy (mild, moderate, severe). It’s rather interesting as it flies in the face of almost every other condition. The authors didn’t speculate why they through this might be the case but it will undoubtedly lead to more research as an estimated 1-2 billion people have myopia and 300 million have diabetes worldwide.

Glaucoma plugs could stop the need for drops

A trial of a new method of delivering glaucoma medication by using a slow release punctum plug has started.

Glaucoma usually requires patients to permanently take drops once or twice a day to reduce pressure inside the eye. Patients often find it difficult to remember to take the drops or hard to get them int the eye and methods which overcome these issues would be very useful.

After an initial small trial in Singapore showed promise, this longer South African trial uses a punctum plug containing the popular glaucoma medication travoprost (Travatan) which is taken in drop form once a day. The plugs will be trialled over a period of 2 months with pressure being monitored regularly for any signs of change.

Punctum plugs are normally used for helping treat dry eye by blocking the tear ducts

Bionic eyes shows continued success

An Australian group have restored some minimal sight to a patient through an implanted bionic eye.

The implant is connected to an external head mounted camera which sends impulses to electrodes planted underneath the retina. The patient was able to see light and dark and some shapes where she had previously seen nothing for many years.

There are currently over 10 different bionic eye projects around the world at various stages but no one to date has got much further than providing very rudimentary vision. One of the most advanced is the Argus II model in America.

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