Some of the most important technological and treatment innovations over the past 12 months could transform the future of eyecare
1 Accurate diagnostics with AI
A remarkable piece of eye health research reported in Nature Medicine has shown that an artificial intelligence (AI) programme can make the correct referral decision for more than 50 eye diseases with 94 per cent accuracy. This matches world-leading experts.
The DeepMind system could revolutionise the management of eye tests, enabling healthcare professionals to spot conditions earlier and prioritise patients with the most serious diseases before irreversible damage sets in.
Pearse Keane, consultant ophthalmologist at London’s Moorfields Eye Hospital NHS Foundation Trust and clinician scientist at University College London Institute of Ophthalmology, says: “The number of eye scans we’re performing is growing at a pace much faster than human experts are able to interpret them. There is a risk this may cause delays in diagnosis and treatment of sight-threatening diseases, which can be devastating for patients.
“The AI technology we’re developing is designed to prioritise patients who need to be seen and treated urgently by a doctor or eyecare professional. If we can diagnose and treat eye conditions early, it gives us the best chance of saving people’s sight. With further research it could lead to greater consistency and quality of care for patients with eye problems in the future.”
2 Robot-assisted eye surgery
The first eye health research to determine whether robots can perform eye surgery safely and effectively has been acclaimed a success.
Carried out at Oxford’s John Radcliffe Hospital, the study involved 12 patients. Six received robot-assisted surgery and the remaining six standard manual surgery to remove a membrane from the back of the eye.
Using the robot, the surgeon was able to perform the procedure as effectively or better than with the traditional manual approach.
In the trial’s second phase, the team used the robot to insert a fine needle under the retina to dissolve blood in three patients who had age-related macular degeneration. All experienced an improvement in their vision as a result.
Robert MacLaren, Professor of ophthalmology, says: “This is a huge leap forward for delicate and technically difficult surgery, which in time should significantly improve the quality and safety of this kind of operation.”
The trial was conducted by the University of Oxford, supported by the National Institute for Health Research Oxford Biomedical Research Centre. Results were published in Nature Biomedical Engineering.
The trial builds on earlier pioneering work at the John Radcliffe Hospital, which in 2016 carried out the world’s first robotic eye operation.
3 Pain-free, cost-cutting laser treatment
A simple, safe, pain-free laser treatment not only works better than eye drops at preventing glaucoma from deteriorating, but could also save the NHS tens of millions of pounds a year, according to eye health research at Moorfields Eye Hospital and UCL Institute of Ophthalmology.
Gus Gazzard, glaucoma service director at Moorfields and reader in glaucoma studies at UCL, says: “These results strongly suggest that laser should be the first treatment for glaucoma in all newly diagnosed patients.”
The results could potentially improve global glaucoma treatment while saving the NHS up to £1.5 million a year in treatment costs for newly diagnosed patients. If the treatment proves to be as effective with previously diagnosed patients, Moorfields estimates annual savings to the NHS could reach up to £250 million.
Reported in The Lancet, the three-year trial is the largest ever of its kind. It involved 718 patients, newly diagnosed with glaucoma or ocular hypertension (higher than normal pressure in the eye).
Patients receiving laser therapy more regularly achieved the target intraocular pressure (pressure in the eye) than those having standard eye drops. Laser patients were also less likely to need treatment for glaucoma and cataracts.
4 Gene therapy to fill a therapeutic vacuum
The first gene therapy for inherited blindness represents a potential triumph for retinal and eye research, but it is generating extensive global controversy. Recently approved for use in Europe, it had an initial US price tag of $850,000, making it one of the world’s most expensive treatments.
Luxturna can restore vision in people with a rare RPE65 genetic mutation that causes progressive vision loss which begins in childhood. The RPE65 gene provides instructions for making a protein that is essential for normal vision. Most patients are blind by the time they become young adults. There is no other treatment for the disease. Treatment consists of injections of the RPE65 gene into the retina.
An estimated 337 people in the UK have inherited retinal disease. Mutations in both copies of the RPE65 gene are estimated to affect about one in 200,000 people.
Dr David Rind, of the US Institute for Clinical and Economic Review, says: “While the evidence is clear the therapy improves vision for patients over several years, the long-term duration of this benefit remains unknown. Assuming a ten to twenty-year benefit period, at list price the treatment does not meet standard cost-effectiveness thresholds.”
5 Bionic eye
A five-year study of a bionic eye tested by five patients with little or no sight marks a big step forward in eye health research, according to preliminary reports.
But the researchers stress they are a long way from achieving full vision for their research subjects. For example, a patient may be able to see an object without knowing if it is a mug or a baseball.
William Bossing, assistant professor of neurosurgery at Baylor College of Medicine, in Houston, Texas, says the research was designed to enhance optimal interface between the Orion bionic eye and the brain to enable the research participants to see forms and shapes.
Surgically implanted in the brain, the Orion includes a camera mounted on a pair of image-capturing eyeglasses. It delivers patterns of stimulation directly to the visual part of the brain; in other words, it can bypass broken optical nerves.
Daniel Yoshor, Baylor professor of neurosurgery, explains: When you think of vision, you think of the eyes, but most of the work is being done in the brain. Impulses of light projected on to the retina are converted into neural signals that are transmitted along the optic nerve to parts of the brain.”