News about health, vision, and sight provision - by Professor Adrian Hill

Benefits of a good walk

OAB’s recent survey of members’ interests identified walking as a primary activity of choice, so you may be interested to hear the results of new research from the University of Georgia, USA. The research suggests that a rigorous daily walk of around 40 minutes a time by people over the age of 60 decreases their risk of disability while simultaneously increasing their independence by as much as 40%. The research showed that senior citizens aerobic activity, or breathing ability, was considerably improved after just four months of regular daily walking. By comparison, a control group who didn’t walk saw their aerobic capacity fall by 9%.

Professor Elaine Cress, who ran the research, said that, as well as improving quality of life, the walkers were better able to perform daily tasks and had more energy for recreational activities. OAB are already considering getting some kind of recreational activity program together for clients and members alike in the future but, in the meantime, please feel free to call if you would like some words of encouragement or advice before getting out there and walking about.

Research into inherited visual impairment

Doctors at the University of Pennsylvania, USA, have managed to improve significantly the eyesight of 3 patients in their early 20’s with severe inherited blindness from Leber’s congenital amaurosis (LCA). This is an inherited eye condition that results in the early onset of blindness due to a deficient gene giving rise to premature degeneration of cells in the retina at the back of the eye. In the 3 patients the gene that was lacking, called RPE65, was inserted into the eye to restore a cycle of enzymes that regenerate vitamin A molecules, essential for converting light into nerve signals in the retina.

After 30 days, all 3 patients showed significant improvement in retinal sensitivity in their treated eye, with modest improvement in night and day vision corresponding to the small area of retina treated. Although these are early trials, it is believed that the method could be ready for use within 3 years to treat people suffering from some inherited diseases of the retina which, in Britain, affect around 20,000 people. Unfortunately, what is not yet known is how the whole retina will respond to such treatment, or what dose is required for a lasting effect.

Lucentis and Wet Macular Degneration

In August, the National Institute for Health and Clinical Excellence (NICE) overturned its earlier ruling on treatment for the wet form of age-related macular degeneration (AMD) with Lucentis, recommending that treatment should start with the first eye to present clinically. This means it is no longer necessary for people with this sight threatening eye condition to have to wait until the second eye is affected.

In Britain, AMD is the most common cause of blindness. It is a degenerative disease of the retina that affects central vision. There are two main types; wet and dry. In dry AMD, the retinal pigment cells and light receptors degenerate as a result of the general aging process and, so far, this condition is untreatable. In wet AMD, a small amount of fluid collects behind the central area of the retina which leaks from newly formed very thin blood vessels in the underlying tissues. This process is known as choroidal neovascularisation (CNV). Where there is CNV, the immediate surrounding retinal cells are at risk of dying. The trigger for this new blood vessel formation is the presence of an abnormal protein, known as a vascular endothelial growth factor (VEGF), which is responding to a compromised state of health in the retina.

The new treatment of wet AMD is directed towards preventing CNV leakage by preventing the VEGF from working, thereby arresting progressive damage and further sight loss. Lucentis is currently the most effective of these treatments. Typically, in AMD, about 70% of patients first see their doctor with both eyes affected and the standard approach is to treat the better-seeing eye if there is wet- AMD in both. Of the 30% who first see their doctor when just one eye is affected, about 10% a year (and 40% after 5 years) develop the disease in the second eye.

Initially, NICE recommended that treatment of the first-affected eye “would not fall within a range considered to be cost-effective use of NHS resources.” However, the Committee has now noted that use of Lucentis was likely to be cost-effective if the cost to the NHS was limited such that the manufacturer pays for the drug costs beyond 14 injections in the treated eye. Novartis, the manufacturer of Lucentis, agreed to this proposal and the recommendation now is that treatment commences when the first eye is affected. Although there is some uncertainty about the number and frequency of injections required, it is believed that people with better pre-treatment visual acuity are likely to benefit more from treatment than those with poorer pre-treatment visual acuity. Early detection from regular eye examinations is, therefore, important and older people should be more prepared to visit their optician (optometrist).