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Age Related Macular Degeneration (AMD) – the latest research

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AGE-RELATED MACULAR DEGENERATION (AMD)

What is AMD?

Age-related macular degeneration (AMD) is a disease that affects the macula, the part of the eye that allows a person to see fine detail. AMD gradually destroys the sharp, central vision, which is needed for seeing objects clearly, and for common daily tasks such as reading and driving.

AMD causes no pain and, in some cases, advances so slowly that people notice little change in their vision. In others, the disease progresses faster and may lead to a rapid loss of vision in both eyes. AMD is a leading cause of vision loss in the western world for individuals over the age of 60, and is thought to affect over three million people in the UK alone. AMD occurs in two forms: wet and dry.

Where is the macula?

The macula is located in the centre of the retina – the light-sensitive tissue at the back of the eye. The retina instantly converts light into electrical impulses, known as nerve signals, and sends them on to the brain for image interpretation.

What is dry AMD?

Dry AMD occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. As dry AMD gets worse, a person may see a blurred spot in the centre of his or her vision. Over time, central vision is gradually lost in the affected eye.

The most common symptom of dry AMD is slightly blurred vision. A person may have difficulty recognising faces and may need more light for reading and other tasks. Dry AMD generally affects both eyes, but vision can be lost in one eye while the other eye seems unaffected. One of the most common early signs of dry AMD is ‘drusen’ in the eye, possibly combined with pigment abnormalities.

What is drusen?

Drusen are yellow deposits under the retina often found in people over age 60, and in isolation do not normally cause vision loss. In fact, scientists are unclear about the connection between drusen and AMD, but have found that an increase in the size or number of drusen raises a person’s risk of developing either advanced dry AMD or wet AMD.

An eye care professional can detect drusen during a comprehensive dilated eye exam.

What is wet AMD?

Wet AMD is another advanced stage of AMD and is generally preceded by early or intermediate dry AMD. Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile and often leak blood and fluid. The blood and fluid raise the macula from its normal place at the back of the eye, and damage to the macula occurs rapidly.

With wet AMD, loss of central vision can occur quickly.

What are the stages of AMD?

AMD has three stages, all of which may occur in one or both eyes:

1. Early AMD – people with early AMD have either several small, or a few medium-sized drusen. At this stage, there are no other symptoms and no vision loss.

2. Intermediate AMD – people with intermediate AMD have either many medium-sized or one or more large drusen. Some people see a blurred spot in the centre of their vision. More light may be needed for reading and other tasks.

3. Advanced AMD – in addition to drusen, people with advanced dry AMD or advanced wet AMD have a breakdown of light-sensitive cells and supporting tissue in the central retinal area. This breakdown can cause a blurred spot in the centre of the vision. Over time, the blurred spot may get bigger and darker, taking more of the central vision. Individuals may have difficulty reading or recognising faces until they are very close.

If a person has vision loss from dry AMD in one eye only, he or she may not notice any changes in overall vision. With the other eye seeing clearly, the individual can still drive, read and see fine details, and may notice changes in vision only if AMD affects both eyes.

Which is more common – the dry form or the wet form?

The dry form is much more common, although scientists are still not sure what causes it. More than 85 per cent of all people with intermediate and advanced AMD combined have the dry form.

However, if only advanced AMD is considered, about two-thirds of patients have the wet form. Because almost all vision loss comes from advanced AMD, the wet form leads to significantly more vision loss than the dry form.

Can the dry form turn into the wet form?

Yes. All people who have the wet form of AMD had the dry form first. Dry AMD can advance and cause vision loss without turning into the wet form of the disease. The dry form also can suddenly turn into the wet form, even during early stage AMD. There is no way to tell if or when dry will turn into wet AMD.

The dry form has early and intermediate stages. Does the wet form have similar stages?
No. The wet form is considered advanced AMD.

Can advanced AMD be either the dry form or the wet form?

Yes. Both the wet form and the advanced dry form are considered advanced AMD, and vision loss can occur with either form, although in most cases, only advanced AMD can cause vision loss. People who have advanced AMD in one eye are at especially high risk of developing advanced AMD in the other eye.

Causes and Risk Factors

Who is at risk of developing AMD?

The greatest risk factor is age. Although AMD may occur during middle age, studies show that people over age 60 are clearly at greater risk than other age groups. For instance, a large study found that middle-aged people have about a two per cent risk of developing AMD, but this risk increased to nearly 30 per cent in those over age 75.

Other risk factors include:

• Smoking – smokers have an increased risk of developing AMD

• Family History – individuals with immediate family members who have AMD are at a higher risk of developing the disease

• Obesity – research studies suggest a link between obesity and the progression of early and intermediate stage AMD to advanced AMD

• Poor nutrition lacking in lutein /zeaxanthin rich diet (nutrients found in green leafy vegetables such as curly kale and egg yolk)

• Race – Caucasians seem to be more likely to lose vision from AMD than those with darker skin

• Gender – women appear to be at greater risk than men

Can a person’s lifestyle make a difference?

A person’s lifestyle can play a role in reducing the risk of developing AMD. So it’s important to remember to:

• Eat a healthy diet that’s high in fruit, fish and vegetables, specifically green leafy vegetables

• Avoid smoking

• Maintain a normal blood pressure

• Maintain a healthy weight and exercise regularly

Symptoms and Detection

What are the symptoms of AMD?

Dry AMD: The most common early sign for dry AMD is blurred vision. As fewer cells in the macula are able to function, people will see details such as faces or words in a book less clearly.

Often this blurred vision disappears in brighter light. If the loss of these light-sensing cells becomes great, people may see a small but growing blind spot in the middle of their field of vision.

Wet AMD: The classic early symptom for wet AMD is that straight lines appear crooked. This results when fluid from the leaking blood vessels gathers and lifts the macula, distorting vision. A small blind spot may also appear in wet AMD, resulting in loss of one’s central vision.

Neither dry nor wet AMD cause pain.

How is AMD detected?

An eye care professional may suspect AMD if the person is over age 60 and has had recent changes in central vision. AMD is detected during a comprehensive eye exam that includes a visual acuity test, dilated eye exam, and tonometry (a measurement of intraocular pressure).

An eye care professional also may perform other tests to learn more about the structure and health of the eye. For example during an eye exam, the patient may be asked to look at an Amsler grid – a grid of straight lines with a black dot in the centre. The patient will be asked to cover one eye and stare at the black dot. While staring at the dot, they may notice that the straight lines in the pattern appear wavy, and that some of the lines are missing. These may be signs of AMD.

If an eye care professional believes the patient needs treatment for wet AMD, he or she will suggest a ‘fluorescein’ and/or ‘indocyanin green angiogram’ to identify any leaking blood vessels and recommend treatment.

What does AMD mean for the patient?

For many, AMD is a shock which can be compounded by lack of information, empathy and support available. Patients are frequently told that little can be done to treat the condition, leaving them feeling both angry and depressed.

People with AMD are more likely to become depressed than the general population, and depression can increase the difficulty of adjusting to the disease (Quality of life in age-related macular degeneration – Royal Holloway University of London, 2006). Indeed, a US cross-sectional study of 151 patients living with AMD reported that the rate of depressive disorder was twice that generally found among elderly people living in the community.

Those living with AMD may lose their independence, requiring help with personal and household tasks and other aspects of daily life. Shopping, cooking and general mobility are also more difficult for people with AMD than those of a similar age with no visual impairment. An additional prospective study of AMD patients with recent (within six weeks) loss of vision to their second eye found that of the 51 participants, 33% met the criteria for clinical depression (a higher rate than 16% found in the wider community), of whom only one was receiving treatment for depression, suggesting low levels of pre-existing depression (Source: Rovner, Casten and Tasman – Effect of depression on vision function in age-related macular degeneration (Journals of Ophthalmology, 2002).

Other health problems associated with age such as arthritis and osteoporosis serve to impair quality of life still further.

Visual hallucinations, known as Charles Bonnet Syndrome, and common in those with visual impairments, can also occur with AMD. While benign and frequently short-lived, research suggests that few are warned that AMD can cause hallucinations and may not report them, featuring dementia. Such unnecessary worry may further damage quality of life.

Rehabilitation, including the provision of low vision aids and training in their use, has been proven to benefit those with AMD, improving visual function and assisting quality of life. Psycho-social interventions, such as peer support groups, also help sufferers adjust to the disease.

Treatment

How is wet AMD treated?

Wet AMD can be treated with laser surgery, photodynamic therapy, and injections into the eye. None of these treatments are a cure for wet AMD, and the disease and loss of vision may progress despite treatment.

1. Laser surgery – this procedure, which is performed in a doctor’s office or eye clinic, uses a laser to destroy the fragile, leaky blood vessels. A high-energy beam of light is aimed directly onto the new blood vessels and destroys them, preventing further loss of vision.

However, laser treatment may also destroy some surrounding healthy tissue and some vision. Only a small percentage of people with wet AMD can be treated with laser surgery. It is more effective if the leaky blood vessels have developed away from the fovea, the central part of the macula.

The risk of new blood vessels developing after laser treatment is high. Repeated treatments may be necessary, and in some cases, vision loss may progress despite repeated treatments.

2. Photodynamic therapy – a drug called ‘verteporfin’ is injected into the arm. It travels through the body, including the new blood vessels in the eye, and tends to “stick” to the surface of the new vessels.

Next, a light which activates the drug is beamed into the eye for around 90 seconds, which destroys the new blood vessels and leads to a slower rate of vision decline. Unlike laser surgery, this drug does not destroy surrounding healthy tissue. Because the drug is activated by light, the patient must avoid exposing skin or eyes to direct sunlight or bright indoor light for five days after treatment.

Photodynamic therapy slows the rate of vision loss, but does not stop it or restore vision in eyes already damaged by advanced AMD. Treatment results often are temporary and a person may need to be treated again. Photodynamic therapy is relatively painless, takes about 20 minutes and is normally performed in a dedicated hospital clinic.

3. Injections – wet AMD can now be treated with new drugs that are injected into the eye (anti-VEGF or anti-angiogenic therapy). Abnormally high levels of a specific growth factor occur in eyes with wet AMD and promote the growth of abnormal new blood vessels. This drug treatment blocks the effects of the growth factor.

A person will need multiple injections that may be given as often as every month. The eye is numbed before each injection, and the patient may need to remain in hospital for a period of time after each session for monitoring. This drug treatment can help slow down vision loss from AMD and in some cases improve sight.

How is dry AMD treated?

Once dry AMD reaches the advanced stage, no form of treatment can prevent vision loss. However, intake of certain antioxidant vitamins and zinc can delay and possibly prevent intermediate AMD from progressing to the advanced stage, in which vision loss occurs.

The US National Eye Institute’s Age-Related Eye Disease Study (AREDS) found that taking Bausch & Lomb’s PreserVision, a high-potency nutritional supplement containing antioxidants and zinc, significantly reduces the risk of advanced AMD and its associated vision loss. Slowing AMD’s progression from the intermediate stage to the advanced stage will save the vision of many people.

Age-Related Eye Disease Study (AREDS)

What is the dosage of the AREDS formulation?

The specific quantities of antioxidants and zinc used by the AREDS researchers were 500 milligrams of vitamin C; 400 International Units of vitamin E; 15 milligrams of beta-carotene (often labelled as equivalent to 25,000 International Units of vitamin A); 80 milligrams of zinc as zinc oxide; and two milligrams of copper as cupric oxide. Copper was added to the AREDS formulation containing zinc to prevent copper deficiency anaemia, a condition associated with high levels of zinc intake.

Bausch & Lomb’s PreserVision Original formulation, which was proven safe and effective by the AREDS study, is available in soft gel and tablet forms. The new PreserVision Lutein soft gels replace beta-carotene with lutein and are suitable for smokers.

Who should take the AREDS formulation?

People who are at high risk for developing advanced AMD should consider taking the formulation in consultations with their health care provider or personal physician. A person is at high risk of developing advanced AMD if he or she has either:

1. Intermediate AMD in one or both eyes.
-OR-
2. Advanced AMD (dry or wet) in one eye, but not the other.

The AREDS formulation is not a cure for AMD, nor will it restore vision already lost from the disease. However, it may delay the onset of advanced AMD. It may also help people who are at high risk of developing advanced AMD keep their vision.

Can diet alone provide the same high levels of antioxidants and zinc as the AREDS formulation?

No. High levels of vitamins and minerals are difficult to achieve from diet alone. However, previous studies have suggested that people who have diets rich in fruit, fish and vegetables, specifically, green leafy vegetables, have a lower risk of developing AMD.

Can a daily multi-vitamin alone provide the same high levels of antioxidants and zinc as the AREDS formulation?

No. The formulation’s levels of antioxidants and zinc are considerably higher than the amounts in any daily multi-vitamin. If a person is already taking daily multi-vitamins and his or her doctor suggests taking the high-dose AREDS formulation, it is recommended that the individual review all vitamin supplements with his or her doctor prior to taking the AREDS formulation.

Because multi-vitamins contain many important vitamins not found in the AREDS formulation, a person may wish to take a multi-vitamin along with the AREDS formulation. For example, people with osteoporosis need to be particularly concerned about taking vitamin D, which is not in the AREDS formulation.

How can a person take care of his or her vision once diagnosed with AMD?
If a person has dry AMD, he or she should have a comprehensive dilated eye exam at least once a year. An eye care professional can monitor his or her condition and check for other eye diseases. Also, if a person has intermediate AMD in one or both eyes, or advanced AMD in one eye only, the doctor may suggest that the individual take the AREDS formulation containing the high levels of antioxidants and zinc.

Because dry AMD can turn into wet AMD at any time, a person should obtain an Amsler grid from their eye care professional. It is recommended that the individual use the grid every day to evaluate his or her vision for signs of wet AMD. This quick test works best for people who still have good central vision. If a person detects any changes in the appearance of this grid or in his or her everyday vision while reading the newspaper or watching television, he or she needs a comprehensive dilated eye exam.

If a person has wet AMD, a doctor would normally advise immediate treatment. After laser surgery or photodynamic therapy or anti-VEGF anti-angiogenic therapy, a person will need frequent eye exams to detect any recurrence of leaking blood vessels.

Studies show that people who smoke have a greater risk of recurrence than those who don’t. In addition, a person should check his or her vision daily at home using the Amsler grid and will need to schedule an eye exam immediately if any changes are detected.

What can a person do if he or she has already lost some vision from AMD?
If a person has lost some sight from AMD, he or she should not be afraid to use his or her eyes for reading, watching TV, and other routine activities. Normal eye use will not cause further vision damage. These individuals should also ask their eye care professional about low-vision services and devices that may help make the most of their remaining vision.

Many community organisations and agencies offer information about low-vision counselling, training, and other special services for people with visual impairments. Macular Disease Society is of particular value to many existing AMD sufferers. The Royal National Institute of the Blind (RNIB) also provides support and services for those experiencing vision difficulties and loss.

Current Research

What AMD research is currently being conducted?
Research is conducted globally to help provide better ways to detect, treat, and prevent vision loss through AMD. Currently, scientists are:

• Studying the possibility of transplanting healthy cells into a diseased retina – a London-based project to cure AMD has recently been launched, following £4 million donation from an anonymous American donor. This will involve a study where patients will be treated for dry AMD with injections of Retinal Pigment Epithelium (RPE) into the eye. The RPE itself has been developed under laboratory conditions from embryonic stem cells. The study is likely to take at least five years to complete, and will be undertaken by Moorfields Eye Hospital in conjunction with the Institute of Ophthalmology at University College London and the University of Sheffield

• Evaluating families with a history of AMD to understand genetic and hereditary factors that may cause the disease

• Looking at certain anti-inflammatory treatments for the wet form of AMD
• AREDS II further examining the role of vitamins, lutein, omega-3 fatty acids and zinc

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Spire offers new injection for age-related blindness

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London: A new quick procedure not widely available on the NHS which treats age related blindness disease is now available at 13 Spire Healthcare hospitals around the UK.

Age-related macular degeneration (AMD) affects the central part of your vision and occurs mainly in older people. About one in 100 people aged 65-75 and one in eight people aged over 85 suffer from serious AMD that can result in complete loss of central vision.

There are two types of AMD known as the wet kind and the dry kind. Wet AMD is more destructive and is characterised by abnormal blood vessels growing at the back of the eye. These extra blood vessels leak and can cause rapid loss of sight.

Mr Timothy Dabbs, a specialist eye consultant at Spire Leeds Hospital said:
“Although Wet AMD progresses rapidly and is destructive it is treatable. We inject a special drug under a local anaesthetic to control the growth of abnormal blood vessels in the eye.

“On average a patient will need six injections, they are quick procedures
and patients can normally go home about an hour later. Although they may
not regain full sight, the treatment will often prevent further damage and in some instances can reverse some of the damage already caused.”

Erika Bennett, a patient recently treated at Spire Leeds Hospital, said:
“From not being able to read at all I can now read with my reading glasses.
There is a small improvement with every injection and the treatment itself isn’t painful.

“The staff at the hospital made me feel very comfortable. I had lots of confidence and trust in Mr Dabbs as he made sure he explained every detail of the procedure to me. I would recommend anyone suffering with this condition to try this treatment.”

How to tell if you have AMD
If you’re concerned that you or someone you know may be suffering from AMD, the best self test is to look directly at a straight line such as a door or window frame and using only one eye at a time to see if there is a noticeable kink in the frame which appears to move with your gaze. Your optician will be able to confirm if there is deterioration in your eyes.

The Hospitals currently offering this treatment include:

Spire Bushey Hospital

Spire Cambridge Lea Hospital

Spire Cardiff Hospital

Spire Edinburgh Hospital

Spire Gatwick Park Hospital

Spire Harpenden Hospital

Spire Leeds Hospital

Spire Leicester Hospital

Spire Manchester Hospital

Spire Norwich Hospital

Spire Southampton Hospital

Spire Sussex Hospital

Spire Wellesley Hospital

About Spire
Spire Healthcare is one of the leading independent hospital providers in the UK, with a 25 year heritage of customer service and clinical excellence. It was formed in 2007 from the sale of BUPA Hospitals to leading private equity company Cinven.

Spire Healthcare has 25 hospitals across the UK, providing services for private and insured patients as well as NHS funded patients under the government’s Choose and Book scheme. It also offers cosmetic and weight-loss surgery.

Its hospitals carry out more than 160,000 in-patient and day-case treatments a year and work with over 3,000 consultants. It is proud to be the first independent hospital group to publish clinical outcome data.

The injection that cures wet macular eye degeneration

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London: A new treatment for the “wet” version of age related macular degeneration (AMD) in the form of a painless injection into the eye is available for the first time in the UK.

AMD which attacks the macula, located at the back of the eye at the centre of the retina. The macula enables us to see directly what is in front of us and pick out fine detail. It helps us with everything from reading and driving to recognising faces and seeing colour.

In the early stages of AMD central vision may be blurred or distorted, with objects looking an unusual size or shape and straight lines appearing wavy or fuzzy. Those suffering from the condition may see lights, shapes and colours that are not actually there.

Laurence Whitefield, Consultant Ophthalmic Surgeon at Capio Eye in London’s Harley Street explains: “AMD is the most common cause of poor sight among people over the age of 60 in the UK. It is unclear what causes AMD, but it becomes more likely as a person ages as, with time, the delicate cells of the macula become damaged and worn out.”

There are two forms of AMD – a less severe ‘dry’ form, and the rapidly degenerating ‘wet’ AMD which develops quickly as fragile blood vessels grow behind the retina often leak fluid and blood. This results in scarring and rapid sight loss.

There two breakthrough treatments for wet AMD are known by the brand names Avastin or Lucentis and have been shown to stabilise sight in 95% patients suffering from wet AMD and improve sight in one third. Neither of these treatments are generally available through the UK’s state health service, the NHS.

Mr Whitefield says: “In the US ophthalmologists who specialise in retinal disease have been using Avastin(r) for some months to treat patients with wet or neovascular form AMD. Results have shown that the treatment controls the abnormal blood vessels in AMD, increasing vision. Lucentis is a very exciting development because it can be used to treat all types of AMD.

“Thousands of people a year in the UK get wet AMD leading to rapidly sight loss. This treatment provides patients with a way of recovering their sight. Even patients well below the threshold for registration as blind have been shown to benefit from the treatment”.

Both Avastin and Lucentis treatments consist of three injections into the eye that stop the development of leaky blood vessels that trigger AMD.
Further injections are sometimes necessary, depending on a patient’s progress. The procedure is painless and patients do not need to wear eye pads. The treatment works on patients suffering recent deterioration of vision and is not suitable for those who are already blind or who have established scarring of the retina.

The new drugs are known as anti-VEGF drugs and work by targeting VEGF (Vascular endothelial growth factor), a protein that helps the formation of new blood vessels. In the case of AMD these new blood vessels are unstable and tend to leak fluid and blood under the retina. The resulting scarring then causes irreversible sight loss. The anti-VEGF drugs inhibit the growth of new blood vessels, thereby minimising the risk of scarring.

The costs of the procedure are £500 for the initial consultation with the surgeon and the diagnostic tests to determine whether the treatment is appropriate, then £650 for the first treatment injection and £550 for subsequent treatments. Patients will need the first treatment and then usually at least two more. The speed of results vary by patient.

Contact information: Capio Eye is a private hospital based in London’s Harley Street which offers the very best in eye care, refractive and cataract surgery. www.capioeye.co.uk”>

Please contact us for more information or to make an appointment.

Free phone : 0800 – 169 20 20
Telephone : + 44 (0)20 703 410 30
Fax : + 44 (0) 20 703 410 32
E-mail : capio-eye-enquiries”>

Address : Capio Eye London
114a Harley Street
London W1G 7EL

Antioxidants do not prevent degenerative eye disease

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Melbourne: A diet rich in antioxidant vitamins and minerals does not seem to prevent the degenerative eye disease known as age related macular published on www.bmj.com today.

Age related macular degeneration is the leading cause of visual loss in older people. It is caused by the progressive break down of light sensitive cells in the macula, located in the centre of the retina at the back of the eye. Sufferers do not go blind, but find it virtually impossible to read, drive, or do tasks requiring fine, sharp, central vision.

Risk increases with age and smokers are thought to be more susceptible.

Antioxidants (such as vitamin C, vitamin E, various types of carotenoids, and zinc) are thought to reduce oxidative damage to the retina. But the evidence to support the role of dietary antioxidants in preventing macular degeneration remains unclear.

So researchers at the Centre for Eye Research Australia, the University of Melbourne analysed the evidence to examine the role of dietary antioxidants or dietary supplements in the primary prevention of age related macular degeneration.

They identified 11 studies (seven prospective studies and three randomised controlled trials) involving 149,203 people. A range of common dietary antioxidants were investigated and all the studies were carried out amongst well nourished Western populations with an average follow-up period of nine years.

Importantly, all the studies adjusted for age and smoking in their analyses.

The antioxidants investigated differed across studies, but when results were pooled they showed that vitamin A, vitamin C, vitamin E, zinc, lutein, zeaxanthin, α- carotene, β-carotene, β-cryptoxanthin and lycopene have little or no effect in the primary prevention of early age-related macular degeneration.

None of the three trials found antioxidant supplements to be protective in the primary prevention of early age related macular degeneration.

Despite some study limitations, the authors conclude that there is insufficient evidence to support the role of dietary antioxidants, including the use of dietary antioxidant supplements, for the primary prevention of early age-related macular degeneration.

Currently, cigarette smoking remains the only widely accepted modifiable risk factor for the primary prevention of early age-related macular degeneration, and patients seeking advice on this condition should be encouraged to quit, they add.

An accompanying editorial by Jennifer Evans at the International Centre for Eye Health supports these findings and says that reducing the prevalence of smoking is probably the most effective method of reducing the population burden of this common cause of visual loss in older people.

Thousands may go blind as UK government denies key drug to elderly

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London: The UK government’s drug watchdog is refusing to allow doctors to precribe a drug which could save the sight of thousands of elderly people who live in England and Wales.

At the same time the drug – Macugen – is available on the public health service, the NHS, to those living in Scotland.

Macugen is used to treat the wet form of age-related macular degeneration, where veins leak causing blindness.

The watchdog, the National Institute for Health and Clinical Excellence. said another drug, Lucentis, could be used but only if patients have gone almost blind in one eye and the disease is far progressed in the other.

It also restricted the use of Lucentis to a specific type of the condition which affects only around 20 per cent of sufferers.

There are around 26,000 new cases of wet AMD, which affects the macular region at the back of the eye, in the UK every year.

Based on Nice’s recommendations, 80 per cent of these patients – more than 20,000 a year – will be left to go blind. Macugen and Lucentis, known as antiVEGF drugs, stop the deterioration of the sight.

On Monday the Scottish Medicines Consortium, the rationing body north of the border, approved Lucentis for all NHS patients after previously giving the green light to Macugen.

It is the latest example of post-devolution Scotland giving its patients access to many drugs denied those in England and Wales, which is covered by NICE.

The drugs are also available in many other countries including Germany, France, the Netherlands, Italy, the U.S. and Australia.

Nice’s draft guidance, which is up for consultation, was greeted with anger from charities, clinicians and opposition politicians. The Royal National Institute of Blind People said it was ‘outraged’.

Head of campaigns Steve Winyard said: ‘Anti-VEGF drugs have the potential to halve the number of people going blind each year and patients in the UK who can benefit from them must all have them – and quickly.

‘It is simply unacceptable that Nice is recommending that only a small minority of patients within England and Wales will benefit from these ground-breaking treatments. Nice must reconsider.

‘Anti-VEGF drugs are cost- effective. It is much more expensive to support someone once they have lost their sight than to provide sight-saving treatment.’

Tom Bremridge, chief executive of the Macular Disease Society, said: ‘Limiting the treatment options to 20 per cent of patients who would benefit is unjustifiable and allowing one eye to go blind before treating the second is cruel and totally unacceptable.’

Winifred Amoaku, consultant at the Royal College of Opthalmologists, said the two drugs worked differently. She attacked the fact that only Lucentis had been given the go-ahead because some patients would benefit more from Macugen.

‘Both treatments should be made available to opthalmologists,’ she said. ‘One treatment doesn’t fit all and opthalmologists should be able to prescribe the most suitable option for their patient.’

The Nice ruling comes despite a study published in the New England Journal of Medicine which found that the sight of nine out of ten patients given Lucentis improved or stabilised after two years of treatment.

Lucentis costs up to £2,000 per injection or £28,000 for a full course of treatment, which is 14 injections over two years. Macugen is around £1,800 per injection or £36,000 for a full course of 20 injections.

Dr David Gillen, medical director of Macugen manufacturer Pfizer, said: ‘Macugen has been shown to maintain vision in patients will all types of wet AMD and has a licence to reflect this.

‘From a cost perspective, it has been convincingly demonstrated that Macugen’s cost-effectiveness can be enhanced when treatment is started at an early stage before too much vision is lost.’

Stem cell surgery for ageing eyes available within five years, predict doctors

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London: British scientitsts are working on a proecdure to use stem cells as a cure for age-related macular degenertion, a leading cause of blindness in the elderly.

The first 45-minute operation would use stem cells grown in a lab to cure the dry form of the diseease and it is estimated that the procedure will be available within five years.

The improvement in sight is likely to be great enough for the the blind to regain the ability to carry out everyday tasks such as reading or driving.

The pioneering stem cell surgery tackles age-related macular degeneration (AMD), the most common cause of blindness in the elderly. There are about 300,000 sufferers in this country and the number is expected to treble in the next 25 years to around one million as the population ages.

AMD, which affects a quarter of over-60s in the UK and more than half of over-75s to some degree, occurs in two forms. While the ‘wet’ form can be combated with drugs, there is no treatment for the ‘dry’ form which accounts for 90 per cent of cases.

The treatment centres on human embryonic stem cells grown in a laboratory. These are ‘blank’ cells with the power to turn into different cell types and are used to create small patches identical to the cells damaged in the eyes of AMD sufferers.

Packaged into a syringe, the patch is injected into the back of the eye where it replaces damaged cells and restores sight.

The technique is being developed by scientists and doctors from University College London, Moorfields Eye Hospital, also in London, and Sheffield University, working together in the London Project to Cure Blindness.

Their work has been boosted by a £ 4million donation from an anonymous American benefactor.

Project director Professor Pete Coffey said: ‘This could have a tremendous effect on a huge population who have no current therapy.’

The technique has been tested on rats suffering from a condition similar to AMD and their sight was restored.

Further evidence that the technique is likely to succeed comes from human operations. In these, the researchers restored vision using healthy cells taken from the corner of the patient’s own eye.

In some cases, the transplants were so successful that the patients were able to read, cycle and use a computer.

However, such surgery is extremely complex and time-consuming and so unlikely to be suitable for large-scale use. Using ‘readymade’ patches of cells would greatly simplify the operation, making it suitable for use on millions.

The scientists are now working on making such patches, measuring just four by six millimetres, which will be injected into the back of the eye under local anaesthetic in an procedure lasting between 45 minutes and an hour. The patient, who would have to take drugs to stop the cells from being rejected by the body, could go home the same day. After two to three weeks, vision should start to improve.

It is not yet known how long the effects will last but the patients who had transplants of their own cells are still benefiting from the treatment which took place two and a half years ago. While the patches are most likely to benefit those in the early stages of AMD, the researchers believe it should be possible to adapt them to treat those in later stages.

It is hoped that the technique might also benefit those who have lost their sight as a complication of diabetes.

Consultant surgeon Lyndon da Cruz of Moorfields Eye Hospital said that within ten years the procedure could become as commonplace as cataract surgery.

He said: ‘If we can do a single procedure in a person under local anaesthetic in 45 minutes, it’s feasible.

‘The science is something we can work on but the surgery has to be something we can deliver to many people.’

Eye experts said the research offered real hope to sufferers of AMD. Tom Bremridge of the Macular Disease Society said: ‘This development is exciting and encouraging for current and future generations of AMD patients.

‘While treatments for “wet” AMD are advancing rapidly, sadly, patients with “dry” AMD have had no prospect of any viable therapy.’

Professor Alistair Fielder, of the charity Fight for Sight, said the research represented ‘a real chance to tackle an untreatable condition and bring hope to many’.

He added: ‘It is marvellous to think that clinical trials could start within four years.’

Although many believe it is wrong to use embryonic stem cells – plucked from an embryo in the first days of life – in medicine, sophisticated laboratory techniques mean it should be possible to generate a treatment for millions of people from cells derived from a single embryo.

Stem cell research offers hope for treating and curing a host of conditions.

In recent work, British experts have succeeded in growing a ‘ miniliver’ – a tiny bundle of liver cells – from stem cells, while Israeli scientists have grown a tiny section of beating heart tissue from stem cells gleaned from human embryos.