A ray of hope

Eye problems can be terrifying as you get older, but new techniques and drug treatments mean that help is hand, suggests Deborah Wain

During a shopping trip, Linda Davies noticed the vision in her right eye had clouded over, which she thought was caused by a stray eyelash.

But what began as something seemingly innocuous became serious when a blood vessel in her eye burst and had to be operated on. Within a few weeks, she was left with a black hole in the centre of that eye’s vision, which meant she could no longer distinguish the features on someone’s face.

Davies’s problem was age-related macular degeneration (AMD) – a condition that affects the macula, or the central part of the retina that gives detailed colour vision, and is the biggest cause of blindness in over-55s in the UK. It has attracted much publicity recently with the news that Dame Judi Dench is a sufferer, to the extent that she can no longer read scripts but has them read to her.

Dr Bobby Qureshi

There are two kinds of macular degeneration: wet, which occurs when abnormal blood vessels develop underneath the macula, often rapidly; and dry, which develops when cells in the macula break down over time. Many patients have a combination of the two.

Wet AMD, the kind affecting Davies’s right eye, is typically treated with intravitreal injections of the drug Lucentis, now funded through the NHS, which inhibits the growth of blood vessels.

However, her eye was too badly damaged to benefit, so she was reliant on the sight in her left eye, but there was further bad news when she learned this was affected by dry AMD and deteriorating.

For Davies, hope came in the form of a magnifying lens implant known as an intraocular lens implant for visually impaired people (IOL-Vip). It does not halt degeneration but is the first effective treatment to improve central vision for the majority of patients with the dry form of the condition.

Two small lenses are inserted into the eye. Acting in combination, they work like a miniature telescope, slightly magnifying the image and diverting it to a healthier part of the retina which takes over the role of the macula.

The operation is also suitable for patients with stable, established wet AMD if scarring on the central area of the retina is limited.

Davies, 65, a retired secretary from West Sussex, only heard about the treatment by chance after reading about a talk being given by eye surgeon Bobby Qureshi, consultant at the London Eye Hospital.

He went on to perform Davies’s procedure, and two years on she says: “Nothing could be done for my right eye but having the implant in my left eye has meant that I can still do things I enjoy like read, work on the computer and watch television.

“I’m also allowed to drive as long as long as my eyesight stays at this level, which means a lot to me as it’s my independence. I still have to wear two pairs of glasses but that’s something I can live with.”

The potential for improvement in a patient’s vision can be tested before the lens implant by using a special simulator and this is a hugely important part of the process, says Qureshi.

“Even an improvement that might not sound dramatic can be very significant for the patient’s quality of life,” he says.

The procedure, which cost Davies around £9,000, can also help patients with other progressive macular diseases such as macular holes, myopic degeneration or hereditary retinal diseases such as Stargardt’s or Best’s disease.

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