NNUH paving the way in tackling UK’s leading cause of blindness
Pam Brown
The Norfolk and Norwich University Hospital is taking part in a ground-breaking nationwide research study, ‘STAR’, which aims to reduce or remove the need for ongoing eye injections for patients with Wet Age-Related Macular Degeneration (AMD) – a leading cause for blindness in the UK.
Age-related macular degeneration (AMD) is an eye condition that causes a loss in central vision, where eyesight becomes increasingly blurred, and means reading becomes difficult, people’s faces are difficult to recognise and colours appear less vibrant. Wet AMD develops when abnormal blood vessels form underneath the macula – the small area at the centre of the retina responsible for what we see straight in front of us – and damage its cells. Without treatment, vision can deteriorate within days.
NNUH is one of around 20 participating hospitals across the UK taking part in the study, and anyone with the condition who might be interested in taking part in the study is welcome to contact the team to find out more.
The national study is being led by clinicians at King’s College Hospital, London. The study involves a robotically-controlled system to deliver highly-targeted, low-dose radiotherapy to treat those with the condition with the hope of significantly reducing or diminishing the need for eye injections.
Aseema Misra, NNUH Consultant Ophthalmologist and Principal Investigator on the STAR study said: “We are absolutely delighted to be taking part in this study. Wet AMD affects patients over 50 years old, and as Norfolk has a significantly older population, I feel it is very important we are involved in this research. We want to raise awareness of the ‘STAR’ study and show how it can benefit those affected by the condition. Patients with Wet AMD have to dedicate a significant amount of time to hospital visits for their eye injections, and some can feel stressed and anxious about their visits. If we can reduce this in any way, it would be fantastic for our patients.”
Currently those with Wet AMD require regular eye injections every 6-8 weeks to ensure their vision does not deteriorate. Drugs are injected into the eye targeting a chemical called Vascular Endothelial Growth Factor (VEGF), which causes the condition. The injections do not cure Wet AMD but they help to preserve sight.
In the new one-off, non-invasive treatment, three rays of radiotherapy are beamed through the white of the eye to overlap at the macula. The therapy is delivered by a consultant ophthalmologist using a robotically-controlled machine to ensure precision treatment.
Milind Kulkarni, Chief of Surgical Division at NNUH said: “It is important that our teams are at the forefront of advancements in treatments for patients. This research study is a big step forward for those patients affected by Wet AMD, and we are delighted to be taking part in such a significant and large, nationwide project. Thank you to those participants who have already taken part and to Aseema and the team for driving this forward.”
The nationwide study is funded by the National Institute of Health Research (NIHR) and the Medical Research Council (MRC) partnership.
Case Study: Pam Brown
It was on a Tuesday morning back in April 2016 when Pam Brown, 78, noticed something a little different about her vision. “I had closed my right eye to apply make-up when I noticed that all I could see was a big orange globe. I was preparing for a three-day trip away with friends so I ignored it and carried on getting ready,” she explained.
On Pam’s journey back home to Norwich she had noticed that the colour green on shrubs and trees looked slightly different and that she had also been feeling constantly tired and lethargic. That week, Pam decided to call her opticians to relay her symptoms. “The lady on the other end of the phone instructed me to go immediately to A&E”, she said.
Pam was diagnosed with the condition Wet AMD and it was then when she started receiving monthly injections to help preserve her vision. Pam said: “It really was a massive shock for me, as I felt fit. Well, as fit as a seventy-eight year old feels- no pain, no discomfort just the usual geriatric twinges!”
“I was asked by a member of the STAR Research Team at NNUH if I would be willing to take part in the research programme. I was given full details of what would be involved so I could have a think about it.”
“For me, it was an easy decision. My great grandmother was blind, my grandmother and mother had glaucoma and my late sister had signs of glaucoma. I needed to think about my daughters’ future and whether they might be affected.”
Pam, who was joined by her youngest daughter, went down to London to participate in the study in December 2016. “The day was very straightforward and I was very supported by all the people I met. What happens now can improve the vision of future generations, and I was very willing and only too happy to help. I am very grateful to everyone I have met, and will continue to meet, during my STAR experience.”
Participants are in the study for two years, and are scheduled to visit the clinic three times in the first two months and then every month for the first two years. For the remaining two years, participants will have two study visits, one at the end of the third year and one at the end of the fourth year. In between these two visits participants will attend the clinic to receive standard NHS care, as appropriate.
NNUH is recruiting participants with Wet AMD until December 2017. If you or someone you know suffers with the condition and might be interested in taking part in the study or would like more information, please contact NNUH Ophthalmology Research Team on 01603 288870.
Notes to editors
AMD, of which there are two main types (Wet and Dry), affects patients over 50 and is the leading cause of sight loss in the UK. The condition develops when the part of the eye responsible for central vision (the macula) is unable to function as effectively as it used to. Wet AMD – the more serious form of the condition – occurs when abnormal blood vessels form underneath the macula and damage its cells. Without treatment, vision can deteriorate within weeks or even days.
The standard treatment for Wet AMD involves the injection of drugs into the eye targeting a chemical called Vascular Endothelial Growth Factor (VEGF), which causes the condition. The injections do not cure Wet AMD but they help to preserve sight. It is anticipated that the new treatment will reduce or eliminate the need for further eye injections. Studies have already shown that in carefully selected patients stereotactic radiotherapy can reduce eye injections by about half, with many patients needing no further injections at all, and vision was better than in those who only received eye injections.
If proved successful, the new treatment will not only be more convenient for patients, who currently have to visit an eye clinic on a regular basis, but it will also be more cost-effective for the NHS. The cost of giving each injection is around £800 (inclusive of staff and equipment etc.) and needs to be repeated several times each year, whereas the radiotherapy treatment costs £1,250 but is required only once.
For more information about the STAR study, please visit: http://www.starstudy.org.uk/