A global initiative aiming to place a spotlight on glaucoma and encourage people to get tested has recently come to an end. World Glaucoma Week took place beween 7 to 13 March 2021. But not only has Moorfields Eye Hospital in Islington helped research the use of laser-based treatment for glaucoma, it is also exploring how patients with glaucoma can assess their vision at home using digital technology.
‘Glaucoma causes irreversible loss of vision’
Glaucoma describes a group of eye conditions. It is a progressive degenerative disorder that affects the optic nerve at the back of the eye. This is the nerve that leads from the eye to the brain. Once it gets damaged in glaucoma, it results in loss of the visual field. In short, glaucoma causes irreversible loss of vision.
Around half a million people suffer from glaucoma in the UK. Those who have it bad enough can get registered as sight-impaired or severely sight-impaired. As many as 10 per cent of those registered with a visual impairment have glaucoma. The figures are about two per cent of those over 40 and about 10 per cent of those over 75.
‘Glaucoma does run in families’
Glaucoma itself may be a term that is unfamiliar to most people. But it is something I have always known about, partly because there has been a history of the eye condition in my family.
This is also the case for Yetunde Obadeyi, Principal Optometrist at Moorfields Eye Hospital in London, and is one reason why she became interested in the study of glaucoma.
She says her first-hand experience of her relatives and knowing other people who have glaucoma and lost their vision due to the eye condition inspired her to learn more about it.
“Ethnicity does play a part, specifically people of African descent who are more likely to have open-angled glaucoma than any other ethnicity,” Yetunde says.
“Glaucoma does run in families.”
But before I have time to collect my thoughts, Yetunde adds that there is a hereditary element because “if your sibling or parents have glaucoma, you are more at risk of having it”.
TYPES OF GLAUCOMA
There are different types of glaucoma. Here are some below:
Open-angled glaucoma Most common form of glaucoma and one where the damage to the nerve occurs in the presence of an unobstructed/open drainage passage. This results in a build-up of pressure in the eye and damage to the optic nerve.
Closed-angled glaucoma A form of glaucoma that results when the eye cannot drain fluid properly because the drainage passage is narrow or obstructed. This results in a build up of pressure in the eye and damage to the optic nerve.
Congenital/Childhood glaucoma Occurs in very young children or even from birth, though this form is rare.
Secondary glaucoma Can occur after certain types of eye operations and which can result of in trauma or inflammation of the eye.
‘The older you are, the increased chance that you have of getting glaucoma’
Glaucoma is an eye disease that can affect people at a very young age or even right from birth, though this is very rare. However, Yetunde explains that when crunching the data, the biggest risk factors is age.
“The older you are, the increased chance that you have of getting glaucoma,” she says. If this is the case, then what is being done to help treat and prevent older patients?
Yetunde says that the NHS in England currently offers free eye examinations every year to anyone who is over 40 and has a first-degree relative, a parent, child or sibling with glaucoma, is entitled to free eye examinations every year.
Those over 60, who are at a higher risk of developing glaucoma, alongside those who already have the eye condition, are also entitled to free eye examinations.
She adds: “They don’t have to pay for their eye examinations and we’re trying to catch people as early as possible.
“That’s on the NHS, free eye examinations, which checks the eye pressure and does all the glaucoma tests.”
‘You can lose a lot of vision without actually knowing you’ve got glaucoma’
While speaking with Yetunde, I initially struggled to understand what could be done if glaucoma causes irreversible loss of vision.
She tells me how glaucoma treatment aims to try and save the remaining sight left so that it does not worsen.
“The thing about glaucoma is you can lose a lot of vision without actually knowing you’ve got glaucoma,” according to Yetunde before she adds how “It’s something that we call asymptomatic – it has no symptoms until you have lost a lot of vision.
“Lots of people are going around and may not know they have glaucoma because it usually starts with the loss of the peripheral vision, so you don’t notice it because your straight-ahead vision is fine.”
The fact that vision loss can be gradual means people may not know they have glaucoma until they go for a routine check-up with their local optometrist or until it is very end-stage and they start noticing problems and seek help.
Follows-up are also dependent on the severity of glaucoma. If the eye condition is caught early on, patients may require annual check-ups.
But Yetunde says, “if you’ve got very advanced glaucoma, and we need to keep a close eye on you, or if it’s not well controlled with the treatment, drops or laser, then it can be as often as every few months.”
‘The laser treatment is often offered as the first line of treatment for glaucoma’
The pathway from diagnosis to treatment has developed over time with research. According to Yetunde, a significant amount of glaucoma gets caught by seeing the local optometrist who tests for glaucoma at every eye examination. If they feel you may have glaucoma, you get referred to the eye hospital – such as Moorfields – to a glaucoma specialist, which is an eye doctor or ophthalmologist. At the hospital, further tests will be conducted and treatment initiated if the diagnosis is confirmed.
Current treatment, having been diagnosed, ranges from eye drops to laser treatment or surgery, something Yetunde describes as “the last resort”.
She adds: “People with glaucoma need regular follow-ups and monitoring of their condition to check if the treatment is working in the hospital.”
I am interested in finding out what research Moorfields Eye Hospital has conducted into glaucoma. Yetunde tells me that one of the most recent studies was the 2019 LiGHT Trial – the Laser in Glaucoma and ocular HyperTension trial. This procedure looked at the quality of life in patients who were newly diagnosed with glaucoma and were starting treatment with standard medicines – so traditional treatment versus a laser treatment combined with traditional therapy.
Yetunde adds it found “that the traditional treatment, in combination with the laser treatment, was more effective than traditional medicine at controlling glaucoma which was good.”
“Now the laser treatment is often offered as the first line of treatment for glaucoma.”
Alongside the laser treatments effectiveness, Yetunde says there could also be significant cost reductions to the NHS via this method as opposed to traditional drops and other surgeries for glaucoma.
Dr Bouremel and his @UCLeye team are building an optic nerve lab model to study glaucoma.
We're proud to support this pioneering project that bridges cell biology & microfluidic engineering. #GlaucomaWeek
??Learn more: https://t.co/E9OXEWEvBQ pic.twitter.com/kMzmTU7T6H
— Moorfields Eye Charity (@EyeCharity) March 10, 2021
‘We are trialling tests for glaucoma at home’
The coronavirus pandemic has affected all facets of public health.
Moorfields Eye Hospital has had to adapt the way it offers treatment, with one eye on distance.
Yetunde adds that “it is difficult to commute across London to Moorfields and even from across the UK to Moorfields,” before stating that “we are trialling tests for glaucoma at home”.
“Instead of coming to the hospital to do the visual fields test, – patients are checking vision at home using their laptops and computers to test their visual field.
“We’re seeing if that is as effective as the tests we do in the hospital.”
“We want to demonstrate their safety and efficacy so that patients don’t have to come so frequently, especially non-urgent patients can test themselves from home.”
But not all tests have been left to the patient to self-administer.
Yetunde explains how Moorfields Eye Hospital has also seen patients using diagnostic hubs – centres where patients can have a series of tests done in 45 minutes and be seen much quicker than waiting two or three hours for a doctor or consultant.
For her, “that’s been a complete change in service delivery and patients are really enjoying the quicker timescales of being seen and lesser long waits.”
