September 11, 2008

Ground-Breaking Surgery Sight and a Vision of the Future

We're all guilty of taking our eyesight for granted.

As you read this, some of you will wear glasses, some of you will wear contact lenses - but almost all of you will be unable to imagine not being able to read the headline on this page.

For some people however, this disturbing notion is slowly becoming a reality.

Age-related macular degeneration (AMD) is the most common cause of legal blindness in the UK in people over the age of 55.

The macula is a small point on the retina onto which light is focussed by the ocular lens.

Here, a dense collection of light-sensitive cells allow us to see straight-ahead and are needed to read, sew, drive and see fine details.

With AMD, small blood vessels can begin to grow abnormally behind the macula, encouraging the growth of scar tissue and destroying the cells which translate light into neural impulses.

This 'wet' AMD is found in about 10 to 15 per cent of cases and in some circumstances treatment may be available on the NHS to halt its progression, which is often rapid.

In the more common 'dry' form of AMD, yellow deposits called drusen accumulate under the retina, destroy macular cells and blur central vision.

For this, there is no cure and patients may gradually lose central sight in the affected eye, leaving a blank spot in the middle of their vision.

As it progresses, some patients will be unable to drive, read, see close-up detail or even recognise faces.

Until now, no treatment has been able to restore sight lost as a result of AMD.

However, for some patients a new surgical procedure promises a beacon of hope.

Seventy-three-year-old grandmother Mary Johnson first developed the wet form of the disease in her right eye four years ago.

She said: "At that time there wasn't a lot they could do about it, but I had treatment and it's improved a lot.

"Then, last April, I started having problems with my left eye as well."

As Mary's sight worsened, her husband Jack (80) became her eyes.

He said: "When you have macular degeneration simple things like eating become very difficult.

"You might go to a restaurant where they have green napkins and think it was a piece of lettuce!"

Mary adds: "My ten-year-old grandson kept telling me he was going to get me a guide dog. I could hardly see anything.

"In the end, I was registered partially-sighted and referred to Mr Aftab."

Consultant ophthalmic surgeon Mr Sakkaf Ahmed Aftab, who runs a clinic from Grimsby's St Hugh's Hospital, was one of the first surgeons to be trained in the IOL Vip (intra-ocular lens for visually impaired people) procedure.

The surgery is very similar to a cataract removal, in which the ocular lens is replaced with an artificial one behind the iris.

However, a second lens is also placed in front of the iris - creating a slightly magnified image much like a telescope. As a result, light entering the eye is directed to a healthy part of the retina and away from the macular scar, giving patients back some of their useful vision.

The procedure is painless, easy to carry out, and the effects are almost immediate.

Mary, of Kenmar Road, Laceby, was recently the first patient in the entire region to benefit from the ground-breaking surgery.

She said: "I noticed the difference more or less straightaway.

"When you have macular degeneration you no longer take your sight for granted, and being able to get out in the garden to pick up the weeds has meant so much to me.

"One day I was walking through town with my husband and I said: 'Look! I can see House of Fraser!' I was so excited that I was able to read the sign.

"Hopefully, with time, my sight will improve even more. But if I stay as I am now I will be satisfied.

"It's made a huge difference to my life and I can't praise Mr Aftab enough - he really is a wonderful surgeon and takes great joy in giving people their sight back."

Medical science is constantly striving to detect and treat AMD, but advances in this area are slow to reach the general public and are often prohibitively expensive for the majority of patients.

In many cases, a patient's eyesight has to deteriorate sufficiently for NHS-funded treatment to become available, although this policy can differ among Primary Care Trusts.

Mary said: "When I first heard about it my family said I must go for it. Your sight is so important, and they all backed me up.

"At first I thought it was too much money, but when I got home from the clinic that day Jack said you can't put a price on your eyesight.

"And although I've had to pay for it, it's been worth every penny."

Mary paid pounds5,900 for her surgery, but Mr Aftab is hopeful that the National Institute for Clinical Excellence - the state rationing body for health - will someday licence the treatment for use on the NHS.

He said: "When I first came to Grimsby in 2002 I brought a treatment with me called photodynamic therapy (PDT), which at that time was the latest treatment available for macular degeneration.

"But, it took two or three years for PDT to become available on the NHS.

"Likewise, it was several years before American drugs for AMD were licensed for use here.

"NICE has just started looking into getting the procedure licensed and hopefully, as more and more patients receive it, it will put the pressure on them to approve it."

Mr Aftab is quick to point out the surgery is not suitable for everyone, is not a miracle cure, and is only appropriate for patients who have lost a significant level of vision.

However, it can restore enough of a patient's sight to drastically improve their quality of life.

"This is a procedure for people who cannot see," he said.

"There's no way that after having this you would be able to read small print or start driving again.

"But that's why this work is so rewarding - because you are giving people back their vision when before they had none at all."

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