Implant for poor vision helps treat AMD

Age-related macular degeneration is a leading cause of blindness.

Bronwen Dunn, 83, a retired administrator from Stoke-on-Trent, had a new operation to improve her sight, as she tells OONA MASHTA.

THE PATIENT

Six years ago I started suffering from eyesight problems. Print in newspapers and books became blurred and after a few months of this, I went to my optician who said I was very likely to be suffering from the early stages of age-related macular degeneration (AMD).

Both my eyes were affected, though my right was worse.

I’d known someone who had AMD, so I knew exactly what it was — I was scared that eventually I might go completely blind.

One of the most recently designed implantable lenses is the Scharioth Macula Lens. Initial results of an international small study showed it can magnify images by 300 per cent (compared with 30 per cent for ordinary glasses)

My optician said I’d need the diagnosis confirmed by a hospital eye specialist — so I saw my GP, who referred me to the eye clinic at the Royal Stoke Hospital.

Three weeks later, hospital tests confirmed AMD. The macula, the part of your eye that helps you see straight ahead, becomes damaged. This was why I could only properly see the edges of what I was looking at, and reading small print was impossible.

I had ‘dry’ AMD, which is caused by a build-up of waste products in the eye, and for which there isn’t any drug treatment.

The doctors recommended I eat lots of green vegetables and take a dietary supplement called Macushield to try to prevent my eyesight from getting worse. But all my life I’ve eaten healthily as I dislike junk food, so the dietary advice didn’t make any improvement.

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At the time, my eyesight wasn’t too bad, although I had to use a magnifying glass to read.

Then, four years ago, my eyesight deteriorated so much I had to give up reading. I also had to give up driving, a huge blow as I lost a lot of independence and started relying on my son, Adrian, 60, for lifts.

I went back to the hospital in March last year and the consultant recommended I had a cataract removed in my right eye to try to improve my sight, even though it wasn’t related to the AMD.

But despite the operation, there was no change in my sight. I was very disappointed. I also stopped being able to recognise people’s faces and it was very depressing.

Then last summer I saw an advert for a new implant for AMD, where they implant a lens in each eye which would magnify what you saw, and would be much stronger than glasses.

After her operation Bronwen Dunn is able to read again for the first time in four years

I had to pay to have the procedure privately as you can’t get this particular implant on the NHS. I saw the surgeon in March — he told me the implants aren’t a cure, as they don’t repair the macula, but I was willing to take the risk because it could improve my quality of life.

I had my right eye done five weeks ago and hope to have the implant in my left eye soon. The procedure was done under a local anaesthetic and I didn’t feel anything, but I was aware the doctor was doing something to my eye.

It took 15 minutes and I went home afterwards. I had an eye patch for the first night, which I was allowed to take off the next day, and had to take two types of eye drops a day.

Now I’m reading for the first time in four years — I still need reading glasses, but I’m able to enjoy reading books again, which is important to my quality of life. I’m still hoping for even more of an improvement, which my surgeon said might happen.

THE SURGEON

Brendan Moriarty is a consultant eye surgeon in South Manchester and an adviser to NICE.

Age-related macular degeneration is the most common cause of sight loss.

It attacks the macula, which is responsible for ‘straight-ahead’ sharp vision — it causes a central blind spot and blurred sight that makes reading and recognising faces, as well as daily activities such as cooking, difficult, if not impossible.

AMD occurs because of wear and tear in the retina, the part of the eye that converts light into messages to the brain.

The retina turns light into electrical signals sent to the brain through the optic nerve. Then the brain translates the electrical signals into images.

At the centre of the retina is the macula, made up of millions of light-sensing cells that provide the sharp, detailed central vision.

Photo of what a person with age-related macular degeneration (AMD) sees (from top normal, worse and worst)

In normal eyes waste products from cells there are carried away in the bloodstream, but this system declines with age and the waste products start to build up.

Over time these products damage the delicate cells of the macula. This is dry AMD and accounts for 90 per cent of cases, or about 300,000 people. Vision loss is gradual, occurring from around the age of 60.

The other form, wet AMD, occurs when tiny blood vessels start to grow under the macula in an attempt to remove the waste products, these blood vessels can leak beneath the macula, causing sudden and dramatic vision loss.

As the macula is only responsible for central vision, patients usually still see things with the edge of their eyes, their peripheral vision as it is called.

Previously there was no drug treatment for dry AMD. There is some evidence that a diet high in vitamins A, C and E, as well as substances called lutein and zeaxanthin, may slow the progression.

Now there are several types of implantable lenses available for it. NICE has approved implantable lenses as a treatment for advanced AMD, so they’re likely to become more widely available on the NHS — but the procedure should be monitored, as NICE has requested more research into its long-term safety and effectiveness.

The operation needs only a tiny 2.5mm incision — other macula lenses usually need a larger one — so recovery is quicker. The lens helps patients to see better close up.

It is not a cure as the macula is not repaired, but it can significantly improve vision and quality of life. It is designed for patients who have had cataract surgery, but it can also be implanted simultaneously during a cataract operation. Patients have a local anaesthetic injected around the eye, then I make a tiny incision in the cornea, the transparent part of the front of the eye.

Through it I insert a small acrylic folded lens using forceps, to sit on top of an artificial lens inserted during a cataract operation. So it is like a piggy back: two artificial lenses on top of the other like a telescope.

Two tiny plastic feet keep the lens held securely.

The benefit of this procedure is that it can be reversed. So if a patient was unhappy with it or in future they wanted to try a different lens, it can be removed.

What are the risks?

Infection, which can be treated with antibiotics.
It doesn’t work for every patient, but the doctor will be able to identify those it will help. ‘For some people with advanced disease a magnifying implant may be very helpful, although the published evidence is limited,’ says Tim Jackson, a consultant ophthalmic surgeon at King’s College Hospital, London. The Scharioth implant is potentially exciting and I look forward to seeing further results, so we can find out who might benefit, balance of risk and benefit, and the long-term outcomes.’
The procedure costs about £6,700 for each eye.