eyes

World Sight Day, 11 Oct 2018, is an opportunity for the eye health community to come together. In the lead up to world sight day, we asked two European leaders from the NGO community “what would be the one big thing you would change in eyecare in Europe? Harmonisation for healthy eyes, a view from Fabienne Eckert Tackling the growing burden of preventable sight loss in Europe warrants high-quality, common standards of eye care across the continent. Therefore, eye care in Europe would greatly benefit from further harmonisation of European optometric and optical education and clinical practice. The legal scope of practice of eye care professionals varies greatly from one country to the other, which means that the standards of vision care differ as well. Historically, optometry schools across Europe developed professional criteria according to local principles and curricula. However, both patients and professionals increasingly move across-borders, either to seek professional care abroad or to offer services in another country. There is a growing need to ensure that patients can benefit from high-quality eye care wherever they go. We at ECOO are driving the change to meet this challenge. In order to do so, we developed the European Qualification in Optics and European Diploma in Optometry to stimulate uniform practice. Much work is still to be done, and it is important that eye health is integrated in various other policy agendas, including the one for healthy ageing and road safety. It’s all about prevention, a view from David Hewlett With an ageing global population, increasing levels of myopia amongst the urban young and large populations without access to elementary forms of eye care, these global challenges require global solutions. To achieve this, each World Health Organization Region must play its part. In Europe, we still have a lack of public...
High-tech innovation and advanced surgical techniques have transformed the field of ophthalmology, with new treatment options making surgery faster and more accurate. We speak to Professor Rudy Nuijts, a leader in the field of cataract surgery, about the radical changes he has seen and what the future may hold. How has cataract care changed since you began working as an ophthalmic surgeon ? I was trained in extracapsular surgery which involved making incisions of at least 6mm to remove the patient’s lens. In the early 1990s, ophthalmologists in the Netherlands started to embrace phacoemulsification – a new alternative where the lens is broken into tiny fragments using ultrasound energy before being removed. That changed everything. How did these advances help patients? The recovery process was much faster and there was less post-operative astigmatism . Since then, technology has improved further: the machinery we use results in a more stable anterior chamber, with less risk of posterior capsule rupture and there is much more choice and versatility in the range of lenses available for implantation. Are there other technological advances that have improved outcomes for patients? The introduction of multifocal intraocular lenses (IOLs) has meant patients can be spectacle-independent after cataract surgery. Instead of just fixing the cloudy vision caused by their cataract, patients can now have a refractive lens implanted which improves their vision. These include toric IOLs which allow us to correct astigmatism and make patients spectacle independent for distance. Another big leap forward has been multifocal lenses. Most surgeons in Europe have, over the last year or two, moved from bifocal to trifocal lenses. This has big advantages for patients. For example, with multifocal trifocal lenses they can read at intermediate distances – for iPads or reading a computer screen, this is a distinct advantage. Bifocal lenses were...
The treatment options for people with vision problems have changed dramatically over the past decade. New technologies have improved outcomes, reduced patient discomfort and brought an unprecedented level of choice for patients. We spoke with Dr Kaweh Schayan-Araghi, a consultant ophthalmologist at Artemis Klinik in Germany, about the progress he has witnessed and what the future may hold. How have treatment options changed for your patients? Over last ten years or so, the treatments available have improved for people with myopia (short-sightedness), astigmatism (defect in the eye resulting in distorted images), and cataract (a clouding of the lens). Looking back, the options for patients with astigmatism were especially few for those with low or moderate astigmatism – interocular lenses were really only used for people with much higher astigmatism and it was quite difficult to get a precise correction. Limbal relaxation incision was also used to correct astigmatism. This involves cutting into the cornea but, to be frank, the outcome was quite unpredictable and uncomfortable for patients. Most endured itching, rubbing and a feeling that there was something in their eye for three or four weeks. What is available today? The most dramatic change has been the evolution from implanting just clear lenses to implanting a refractive lens which actually corrects vision: we are now addressing cataracts and correcting vision in a single surgery. This would previously have required two separate operations. So, in a lot of cases we are not just clearing the cataract, the patient could be rid of glasses or have reduced dependency on glasses for the first time in decades. What kind of attitudinal shift have you seen in ophthalmology? In the past, the goal of surgery was to improve ‘best corrected vision’. This implies that patients continue to wear glasses. Today, surgeons want to achieve...
People with a rare eye disease known as retinitis pigmentosa (RP) suffer a gradual loss of vision; some become completely blind. Now, an innovative new approach to treatment has given dozens of people the chance to see again. With the help of a retinal implant, special glasses and intensive training, people who were blind have a new way of viewing the world which could one day benefit people with other degenerative eye diseases. We spoke to Professor Marie-Noelle Delyfer, University Hospital of Bordeaux, who has already performed eight such operations. What is retinitis pigmentosa (RP) and what is the prognosis for patients? RP is actually around 300 distinct genetic disorders that lead to the loss of photoreceptors on the retina. Some affected individuals have a reduction in their visual field while others become blind. With such a rare disease, it is difficult to describe a typical patient. Some lose their sight early in life or in early adulthood but there are others who become blind only in their 70s or 80s. Until 20 years ago, there were no treatments at all and the disease was not well understood. The first genetic cause of the disease was identified in 1984 – before that it was thought of as an inflammatory disease. What treatments are available? Some pharmaceutical therapies help to maintain photoreceptors but this only slows the progression of the disease – it’s not a cure. In the longer-term, there is some research on gene therapy targeting the mutations responsible for RP. How can technology help? I have used a new technology, from SecondSight, with eight carefully selected patients living with end-stage RP. These patients have an electrode array implanted in their retina. They wear glasses that are fitted with a camera that ‘sees’ their surrounding environment. This signal is sent...
High-tech innovation and advanced surgical techniques have transformed the field of ophthalmology, with new treatment options making surgery faster and more accurate. We speak to Professor Rudy Nuijts, a leader in the field of cataract surgery, about the radical changes he has seen and what the future may hold. How has cataract care changed since you began working as an ophthalmic surgeon ? I was trained in extracapsular surgery which involved making incisions of at least 6mm to remove the patient’s lens. In the early 1990s, ophthalmologists in the Netherlands started to embrace phacoemulsification – a new alternative where the lens is broken into tiny fragments using ultrasound energy before being removed. That changed everything. How did these advances help patients? The recovery process was much faster and there was less post-operative astigmatism . Since then, technology has improved further: the machinery we use results in a more stable anterior chamber, with less risk of posterior capsule rupture and there is much more choice and versatility in the range of lenses available for implantation. Are there other technological advances that have improved outcomes for patients? The introduction of multifocal intraocular lenses (IOLs) has meant patients can be spectacle-independent after cataract surgery. Instead of just fixing the cloudy vision caused by their cataract, patients can now have a refractive lens implanted which improves their vision. These include toric IOLs which allow us to correct astigmatism and make patients spectacle independent for distance. Another big leap forward has been multifocal lenses. Most surgeons in Europe have, over the last year or two, moved from bifocal to trifocal lenses. This has big advantages for patients. For example, with multifocal trifocal lenses they can read at intermediate distances – for iPads or reading a computer screen, this is a distinct advantage. Bifocal lenses were...
Consider this: about 60 million people in Europe have diabetes. Out of those who have it for more than 20 years, 75% will develop some form of diabetic retinopathy (DR). It’s a startling statistic. Early detection of DR can prevent blindness, which is why people with diabetes should be tested every year. But because so many people have diabetes – and the numbers are rising – screening everyone for this debilitating eye disease is a huge challenge. For one thing, we do not have enough ophthalmologists to check the millions of eyes at risk of DR. And even if we did, the cost would be significant. New approaches are urgently needed. Fortunately, there is a solution on the horizon. By combining sophisticated cameras with artificial intelligence (AI), we can make diabetic retinopathy screening more efficient and cheaper – helping to deal with the growing demand for this crucial service. ‘Deep learning’ is a powerful kind of AI that can detect specific features in an image of the eye with high sensitivity. It allows health professionals to diagnose the stages of retinopathy in milliseconds. At DreamUp Vision, we are using this technology as a SaaS platform, as well as integrating it into a fundus camera – the kind of camera that ophthalmologists use to scan the eye. The technology is so flexible that any healthcare professional could scan a patient’s eye and get an immediate answer if the patient has signs of the disease or not. This could go a long way to addressing the shortage of ophthalmologists, while bringing expert care to people who do not live near specialist health centres. Learn by doing The incredible thing about this kind of AI is that it learns : the more eye scans it sees, the more accurate it becomes. We are...