Eye care advances that may prevent blindness

Judith Stout of Rotterdam was having problems with her vision. She’d seen eye doctors for years because of an autoimmune disease that caused eye inflammation, but it had never affected how she saw things. Suddenly, things were looking blurry and discoloured. “When I saw landscapes at night, they were not in colour anymore but grey and misty,” Stout says. 

When she visited her ophthalmologist, the 35-year-old was surprised to be diagnosed with a form of glaucoma.

The disease—a leading cause of blindness in Europe—is often associated with ageing. Stout’s glaucoma probably stemmed from her eye inflammation, but like most glaucoma patients, she had too much fluid pressure building inside her eye, which can damage the optic nerve, leading to vision loss. 

When glaucoma is caught early, many can preserve their sight with prescription eye drops. Stout used the drops, but they didn’t help. “There was only one solution: an operation.” A surgeon implanted a stent in Stout’s eye, hidden beneath the upper eyelid, to relieve pressure. It’s a relatively new procedure; ten years ago, her vision in that eye would have been compromised permanenetly. 

“Now I can see normally again,” says Stout. 

Hidden pressure-relieving stents. Laser-guided surgery. Implanted micro-telescopes. Treatments for eye diseases have come a long way in recent years. 

“Blindness worldwide dropped by around 40 per cent over the last 20 years, while in developed countries such as Europe, it dropped by 50 per cent,” says Dr Serge Resnikoff, an ophthalmologist in Geneva and a spokesperson for the International Council of Ophthalmology. Yet millions of people are still affected, even in developed nations. More patients need access to cutting-edge treatments.

“Across Europe, there are huge differences,” says Ian Banks, chair of the Brussels-based European Forum Against Blindness. “We work to help patients get better access to treatments. Some are revolutionary and make all the difference between blindness and normal living.”

Here are the advances that are helping people see. 

Around three per cent of Europeans aged between 40 and 80, or nearly seven million people, have glaucoma, a condition with no outward symptoms in its early stages.

The miniscule stent that relieved Stout’s harmful eye pressure is the latest treatment. It’s been called “the last resort of glaucoma treatment”.

Another treatment may be coming soon: contact lenses to deliver glaucoma medication.

“It’s not easy to put in eye drops,” Resnikoff says. “Any new administration system where people don’t need to put in drops every day would be major progress.”

Medication-dispensing lenses have been tested in animals, and they effectively deliver medication for up to a month. More research is needed to determine whether or not they’re safe for humans. 

Hormones may be another possible weapon to thwart glaucoma. A recent study found that women who take oestrogen-only hormone-replacement therapy (HRT) have a lower risk of glaucoma. 

“Prior work has demonstrated that exposure to oestrogen may lead to lowering of intraocular pressure,” says study author Dr Joshua D Stein, associate professor of ophthalmology at the University of Michigan.

By the age of 50, about 18 per cent of Europeans have cataracts, a clouding of your eye’s lens that blurs vision and can make your pupils appear white in advanced cases.

More than half of the population develop them by 80.

Modern cataract surgery, in which a doctor removes your cloudy lens and inserts an artificial one, has been available since about 1950. Phacoemulsification surgery became standard in the 1990s. It uses incisions smaller than in past procedures and doesn’t always require sutures. 

A new laser-guided surgery makes it easier to treat cataracts. Says Leroy, “The laser makes a much more refined incision in the capsule around the lens than in phacoemulsification. It heals more easily.”

Fewer than five per cent of cataract procedures today are done with lasers, but it’s growing in popularity. Says Resnikoff, “The cost of equipment is quite high, but I think this is going to become the standard within a couple of years.”

A complication of diabetes is diabetic retinopathy, which causes blood to leak from small vessels in the retina, significantly obscuring your field of vision. 

“Even though the number of people getting diabetes is increasing, the number of people going blind is not, because treatment has improved,” Resnikoff says. 

For years, patients received laser surgery. More recently, intraocular injections have had positive results. Ophthalmologists may inject steroids to reduce fluid accumulation; or anti-vascular endothelial growth factor (VEGF), which blocks the growth of new blood vessels and makes them less fragile.

Stela Prgomelja, 44, of Belgrade, Serbia, has had vision loss from diabetic retinopathy, but doctors have stabilised her sight.

“I was very lucky to stop it. I see little black spots that will not come off. That’s the blood from the small vessels,” she says. “If you don’t prevent the bleeding, you can become blind.”

Anyone with diabetes should see an ophthalmologist annually. “The earlier you treat, the better the visual outcome will be,” says Dr Hansjuergen Agostini, a retinal specialist at the eye centre of the University of Freiburg
in Germany.

Age-related macular degeneration (AMD) robs its victims of sight, sometimes gradually, sometimes suddenly.

It affects the macula, the part of the eye that helps you see things crisply directly in front of you.

“The patient with AMD always has good vision in his peripheral field,” Agostini says. “He can walk through a room but can’t see the face of a man in front of him.”

There are two forms of AMD: wet and dry, together affecting more than five per cent of people in Western Europe. Ninety per cent have the dry form, which is often a consequence of ageing; the macular tissue thins out over time, which can make it stop working properly. This form of AMD usually impairs vision gradually. There’s no cure or treatment for dry AMD, although doctors may recommend dietary supplements.

Wet AMD occurs when abnormal blood vessels develop and leak beneath the macula. Vision loss can be more sudden and dramatic than in patients with dry AMD. The standard treatment for wet AMD is monthly anti-VEGF injections. Intraocular implants may soon make treatment easier. “Companies are working to put an implant in the eye that releases, continuously, a small dose of anti-VEGF antibody,” Leroy says.

Some AMD patients who have lost their central vision have miniscule telescopic lenses implanted in one eye. The telescopic lens magnifies objects in the field of vision, which makes it easier for patients to see objects or read signs at a distance with that eye. 

“It’s not being used widely and I’m not sure if it will take off,” Leroy says. “Magnification brings things closer but reduces the field of vision.”

As you age, especially as you reach your 70s and beyond, your eyes produce fewer tears.

Over time, you may need drops to stay lubricated. Technology use worsens dry eye; blinking spreads tears across the eye’s surface, but people tend to blink less when they use computers. 

Eyedrops can soothe and lubricate, but their preservatives may cause allergic reactions. “One of the advances in artificial tears in the last ten years is preservative-free drops that use special canisters that are very good at keeping the drops sterile,” Leroy says.

To produce new dry-eye treatments, researchers are using computer mapping to determine how tears travel across the surface of the eye,
otherwise known as the tear film. Says Resnikoff, “Dry eye isn’t only about the volume of tears, it’s also about the composition of the tear film.” 

Many people lose their sight despite doctors’ best efforts, but technology has helped some to regain their vision.

For 30 years, Keith Hayman, 66, from Lancashire, was completely blind, due to an inherited condition. But in 2009, he received a retinal implant that helped him see again. Hayman wears special eyeglasses with a miniature camera that takes video images. A computer transforms the images into signals, which prompts his retinal implant to emit small pulses of electricity stimulating his retina’s remaining cells to transmit visual information to his brain. Hayman can see shapes and outlines, as well as the contrast between light and dark.

“You can’t see features on someone’s face, but you’re not just stuck in the dark—you can tell there are people around you.” Hayman says. “It’s made a big difference.”

Vision is precious, and if we take steps to protect our sight, we will have a good possibility of keeping it. “Way over half of blindness is preventable,” Banks says. “It’s not all about very costly treatment, either. It’s a lot about early diagnosis.” 

It’s advisable for everyone aged over 40 to avoid eye problems by having an annual examination by an eye-care practitioner. Anyone suffering from diabetes should control their blood sugar and also have an annual eye check. Says Judith Stout: “I tell everyone to get their eyes checked.”