Experts now seeing advances on treatment of preventable blindness

Preventable blindness is the new buzz term among eye doctors, many of whom will gather in Dublin later this month (October 25th and 26th) to discuss the latest treatments for eye diseases such as age-related macular degeneration (AMD) and diabetic retinopathy.

The international AMD and retina congress, which is organised by the European School for Advanced Studies of Ophthalmology, will host more than 1,000 eye surgeons from 45 countries. Their main mission is to keep up to date on therapies for wet and dry AMD and find out the practical applications for artificial visions, stem cell treatments and gene therapies, according to Prof Francesco Bandello, the chairman of the scientific committee of the congress.

Meanwhile ophthalmologists, opticians and optometrists have set out a three-year strategic plan to highlight how preventable blindness can best be treated in Ireland. The big breakthroughs in treatment (anti-VEGF injections) for AMD and diabetes maculopathy (a central vision form of retinopathy that affects older people) has meant ophthalmologists are treating five times the number of cases than three years ago. “This workload isn’t going to go away because we are dealing with a maintenance treatment for these patients whose numbers will increase with our ageing population,” says Marie Hickey-Dwyer, ophthalmic surgeon and president of the ICO.

The organisation says that 10 more ophthalmic consultants are needed within the public health service to manage patient numbers in public eye clinics. The message from eye specialists is that we need regular check-ups for eye diseases, many of which remain symptom-free in the early stages.

“It’s important for people to remember that eye health is part of your general health and often when an eye problem presents, it can be an indicator of another underlying medical condition. The eye is not an isolated unit and has complicated relationships with numerous other bodily systems and functions including the brain and the nervous system,” says Hickey-Dwyer.

For instance, keeping your blood pressure under control is very important in relation to central retinal vein occlusion which is the second most common vascular cause of significant sight loss after diabetes-related sight loss, according to Hickey-Dwyer. Maintaining a healthy body weight, exercising regularly and not smoking are other factors that will influence eye health just as it does overall health. Knowing your family eye health history is also crucial for early diagnosis.

AMD is the leading cause of sight loss in older people in Ireland. The condition affects the central vision in one eye and often goes on to affect the other eye. People often only discover they have it when they have almost lost the sight in one eye.

“Often people miss it in one eye and only come for treatment when they have lost the sight in that eye. I always advise people to do a simple test – covering one eye and then the other to check that they can see the kitchen clock,” says Hickey-Dwyer. The wet form of AMD (although less common than dry AMD) progresses most rapidly but is highly treatable with anti-VEGF injections once diagnosed early.

Glaucoma is another eye disease that remains symptomless in the early stages yet can result in severe visual loss. Once diagnosed early, it is treatable with eye drops. Cataracts are easily removed to improve sight.

It is estimated that 75 per cent of age-related eye conditions in Ireland are preventable with early diagnosis and medicines or surgery. This is in line with the World Health Organization’s aim to eliminate 75 per cent of preventable sight loss by 2020.

At the forthcoming Dublin congress, American ophthalmologist Dr Marco Zarbin will discuss new clinical trials that are investigating the use of other medicines (eg ones that activate the immune system to attack abnormal blood cells or those that attack cells that protect the abnormal blood vessels from the therapeutic effects of VEGT inhibitors) alongside anti-VEGF injections for wet or neo-vascular AMD.

“Evidence from early clinical trials involving some of these [biological] agents suggests that combining these therapies with anti-VEGT injections may yield benefits that exceed those seen thus far using anti-VEGF agents alone,” says Zarbin.

See www.esaso.org/13th-amd-retina.congress-2013