Manchester Royal Eye Hospital administers its first gene therapy treatment

eye gene therapy big

Manchester Royal Eye Hospital (MREH) achieves a historical milestone, as it delivers gene therapy at this hospital for the first time. MREH is participating in a gene therapy clinical trial, in collaboration with Saint Mary’s Hospital, for patients with a rare genetic eye condition, x-linked retinitis pigmentosa (XLRP).

XLRP, for which there is currently no effective treatment, is one of the most common causes of blindness in young people.

XLRP is an inherited condition that eventually leads to blindness in adult men, most often by the end of their fourth decade. It affects the retina’s ability to respond to light, a result of abnormalities in the photoreceptors in the back of the eye.

In more than two-thirds of cases, the disease is caused by a mutation to the retinitis pigmentosa GTPase regulator (RPGR) gene. Common early symptoms include difficulty seeing at night in young males and a progressive loss in the visual field and clarity of vision as they age.

The gene therapy approach being used aims to introduce functional copies of the faulty RPGR gene into the cells of the retina. The purpose of the study is to evaluate the safety and efficacy of the treatment of XLRP in patients with the RPGR mutation.  In Manchester, the study is being conducted through a collaboration between MREH, Saint Mary’s Hospital and the NIHR Manchester Clinical Research Facility, a specialist facility for early phase clinical research.

The study is sponsored by NightstaRx Limited (Nightstar), a biopharmaceutical company based in London. Manchester was one of the sites chosen to conduct the study due to MREH’s world-leading expertise in ophthalmology and Saint Mary’s Hospital’s expertise in genetics.

The surgeon leading the trial in Manchester is Professor Paulo Stanga at MREH, University of Manchester and Manchester Vision Regeneration (MVR) Lab at NIHR Manchester Clinical Research Facility.  Professor Stanga said:

“Our ambition is to be able to offer our patients appropriate treatment across the whole spectrum of this disease.  This latest study is an opportunity for us to try and stabilise disease progression for those with an early stage of a specific type of retinitis pigmentosa, known as X-linked.”

Professor Graeme Black, Consultant in Genetics and Ophthalmology, University of Manchester/Central Manchester University Hospitals NHS Foundation Trust adds:

Dave Fellows, Chief Executive Officer of Nightstar commented: “This study highlights our commitment to helping patients with the devastating consequences of inherited retinal diseases such as X-linked retinitis pigmentosa. We aim to leverage our existing relationships with ophthalmology centres of excellence, such as Manchester, to conduct multicentre clinical trials. Our goal is to be the leader in ocular gene therapy.”

Sun damage to the eyes



Many of us know our skin needs protection from UV damage. However, our eyes are up to ten times more sensitive to UV damage than our skin and yet they are often neglected when it comes to protecting them, in fact 50% of people don’t protect themselves by wearing sunglasses.

Accumulated ultraviolet (UV) damage can cause eye diseases such as pterygium — a reddish eye growth that is mostly harmless, but can affect vision — eyelid tumours and cataracts.

Cataract is a cloudy eye growth more commonly seen in the elderly, but may also develop earlier in life or progress more rapidly in people who spend a lot of time outdoors without adequate UV protection.

If untreated, cataracts may lead to blindness. Pterygium, which presents as a benign wing-shaped lesion, usually occurs on the inner corner of the eye. But doctors are also seeing a number of double-headed pterygium cases, where the lesions appear on both the inner and outer corners of the eye, due to accumulated damage from high UV exposure.

A common early sign of UV damage to the eye is chronic or worsening eye dryness. Other symptoms include eye pain and tearing after a day out in the sun.

The danger is that early signs of UV-related eye damage are often unnoticeable and can only be detected during a comprehensive eye examination by an eye healthcare professional.

The easiest way to protect the eyes from UV damage is to choose the right eyewear and sunglasses, not all sunglasses are made equal.

Do children need sunglasses?

Up to 80% of the eye’s lifetime exposure to UV light is reached before the age of 18, which makes UV protection particularly important in childhood. Because children’s eyes have larger pupils and clearer lenses, they are more susceptible to sun damage. Plus, despite children generally spending more time outdoors than adults, 70% of them still don’t wear sunglasses in the UK.

Do Lenses with a darker tint give more protection?

Lenses with darker tints do not necessarily offer more protection. Lenses can appear colourless and yet provide 100 per cent UV protection. However, dark lenses which do not offer a sufficient level of UV protection can actually be more damaging because they cause the eye’s pupils to dilate (get bigger) and let in more harmful light.

Is Sun damage to the eyes is temporary?

Some sun damage is temporary, like some cases of snow blindness. But most damage develops over time, due to the cumulative effect of UV exposure, and eventually becomes irreversible. Clear parts of the eye, like the lenses, absorb UV light and gradually yellow, leading to cataracts. Sun damage also contributes to age-related macular degeneration.

Do I only need sunglasses when the sun is out?

Your eyes need protection from the sun all year round, even on cloudy days. Cloud cover only reduces the amount of UV light by 10%. In the evenings and mornings we also get more light from reflective surfaces like roads. Because UV is found in the invisible part of the light spectrum, we can’t see it or feel it. Plus, depletion to the ozone layer means it acts as less of a barrier, making UV protection even more important.

Can certain medical problems increase my risk for damage from UV rays?

Yes. People with cataracts (and those who have had cataract surgery), macular degeneration or retinal dystrophies should be extra careful.

Do all sunglasses offer the same UV protection?

The level of UV protection provided by sunglasses can vary. When choosing eyewear and sunglasses, consider the following:

• Ensure adequate UV protection to block harmful rays

Look for a label that says “UV400” when buying sunglasses or spectacles. This means they block light rays with wavelengths up to 400 nanometres, which protects against 100% of both UVA and UVB rays.

The shape and size matter

Your sunglasses should be well-fitted, cover your eyes and sit close to the face. For example, wraparound frames would provide better protection against harmful UV rays than round framed sunglasses that sit further away from the face. Due to differences in facial structures, the frame should also be adjusted for a comfortable fit to provide adequate coverage.

• Replace scratched sunglasses

Scratches on UV-coated lens can affect how well harmful UV rays are filtered.

Regular eye tests can save your sight



Fifteen percent of Britons risk losing their eyesight by not having regular eye tests, according to new research commissioned by Optegra Eye Health Care.

The Vision of Britain report found people were leaving their eye problems too long before treatment, leaving 9.8m living in fear of losing their sight.

The study of 2,000 people also revealed 50% of first time patients needed vision correction and one in 10 required glasses or treatment, despite thinking their eyesight was fine.

Nearly a quarter of respondents shied away from eye tests in fear of having to wear glasses and one in four mistakenly believed wearing glasses would make their eyesight worse. Despite shunning regular eye exams, the report showed 82% of British adults desired 6/6 perfect vision, with 60% admitting they valued their eyesight above any other sense.

Dr Clare O’Donnell, OO and head of Optegra Eye Sciences said: ‘Without regular eye examinations, problems are being left undiagnosed and untreated which can lead to serious vision damage.

‘It is vital for everyone to have regular eye checks, even if they suspect nothing is wrong with their eye sight. By giving up just 20-30 minutes of your time once every two years, you can potentially save your vision.’

In response to the study, Optegra has produced a 20-page report containing advice on day to day eye care, from identifying vision problems in children and myth-busting.

Study shows new test may spot glaucoma before symptoms begin

glaucoma fig2 mod

It might be possible to treat the main cause of permanent blindness before people notice any loss of vision, say University College London researchers, who have developed a new kind of eye exam that might spot glaucoma a decade before symptoms appear.

Glaucoma affects 60 million people around the world and most have lost a third of their vision by the time they are diagnosed.

The disease is usually caused by changes to the pressure inside the eye that kills the retina’s nerve cells.  As these cells become stressed and sickly, they start to change their chemistry and more fatty structures move to the outside of the cell.

The test uses a fluorescent dye that sticks to those cells in the retina that are about to die. Then all an optician has to do is look at the back of the eye and if the retina is illuminated in white fluorescent dots then the patient has a problem.

But it has been tested on just 16 people in safety trials and far more research is needed, the study says.

In Phase I clinical trials – the earliest form of trial designed to check new treatments are safe – the technique could spot the difference between they eyes of healthy patients and those with glaucoma.

Prof Francesca Cordeiro, from the UCL Institute of Ophthalmology, said “We are possibly talking five to 10 years before it would normally be identified.”

Current treatments to control the eye’s internal pressure can stop or slow down the progression of the disease, although they cannot reverse the damage already done.

Prof Philip Bloom, from the Western Eye Hospital in London, added: “Treatment is much more successful when it is begun in early stages of the disease, when sight loss is minimal.”

UCL’s study, published in the journal Brain, says more research is “clearly needed”.

Bethan Hughes, from the Wellcome Trust, which funded the research, said: “This innovation has the potential to transform lives for those who suffer loss of sight through glaucoma, and offers hope of a breakthrough in early diagnosis of other neurodegenerative diseases.

An eye exam would be a cheap way of monitoring the progression of diseases like dementia, Parkinson’s or multiple sclerosis than a brain scan. “Loss of sight as you age is an incredibly difficult disability, impacting quality of life and independence.”

Optometrist of the year Finalist

Nick Finalist DSCF2881

Congratulations to one of our optometrists, Nick Wingate, for becoming a finalist in the Optician Awards Optometrist of the year category.

Nick joined The Outside Clinic as an Optometrist in 1998.  Due to his evident passion for patient care and desire to progress company services, he became Head of Professional Services a year later.

Under his supervision, the clinical team has grown from 6 to over 100, with more than 100,000 patients nationally, having access to The Outside Clinic services each year.

The Outside Clinic is a leading, nationwide provider of domiciliary eye care. Providing the best patient-centric/focussed care has been key to The Outside Clinic’s growth and sector reputation, a position that Nick has been instrumental in enabling and maintaining.

During the last 18 years, Nick has played a pivotal role in evolving The Outside Clinic and its processes, procedures and protocols. This has resulted in a higher standard of clinical effectiveness and support to patients and staff alike. For the patients, this means they always have a point of contact, support and guidance at The Outside Clinic. These advancements have ensured that patients receive the best service possible in their own home.

He spent time on the Optical Confederation Education Committee and the Domiciliary Eye care Committee, helping to create guidelines to improve the quality of UK Domiciliary services, with the code of conduct he helped devise now widely adopted by the NHS.

Nick’s continued commitment to excellence has meant that investment in the latest portable equipment now gives domiciliary patients a service comparable to a high-street provider.

These investments include not only portable fundus cameras but also portable slit lamps and binocular indirect ophthalmoscopes. Internally, Nick has spearheaded the design and implementation of a secure, bespoke digital record keeping system, created specifically for the domiciliary environment.

This system allows for near instant information sharing with head office, augmenting the patient and staff support network, providing field staff with the assurance of a second opinion in the event that one is required. Digital records also help minimise errors from omitted data and illegible handwriting making the probity process easier for NHS area team representatives as well as The Outside Clinic’s own record audit process.

Nick recognised early on that domiciliary eye care was an under-provisioned service, with room for growth to provide essential services to housebound and vulnerable patients who are unable to visit a traditional high street practice.

This foresight has led the way for a significant increase in sight loss prevention for patients who would not have the means for ongoing eye health care without a domiciliary provider.

Constantly forward thinking, Nick maintains the mentality of ‘what else can we do to progress patient care?’

Nick’s passion for patient care has been imperative in the The Outside Clinic’s involvement in the community services pathways. A domiciliary provision of these services has helped improve housebound patient’s choice which in turn has assisted in avoiding anxiety and reduces the need to make avoidable, often arduous journeys to hospital eye clinics.

To further enhance patient care and sight loss prevention methods, Nick has provided invaluable contributions to researching new, pioneering treatments, through partnering in various clinical research projects such as:

Noctura – The introduction of the light therapy treatment, Noctura 400 (appendix) a drug-free, non-invasive mask for DBR/macula oedema.

The Provide Project 2014 – This College of Optometry study investigated the prevalence of visual impairment using eye examination data and qualitative data on attitudes and experiences of the research optometrists, individuals with dementia and their carers.

SENSE – COG – A multinational/ Multicentred Study of Visual and Audiological effects of dementia, with the University of Manchester.

ELI Lilly XET Study – with the Avon & Wiltshire Mental Health Partnership NHS Trust. Nick is carrying out the optical testing as part of the clinical trials into Alzheimer’s medication and ocular side effects.

Nick still regularly conducts home visits as he is still passionate about patient interaction. We receive lots of patient feedback surveys and letters complimenting Nick on his level of patient care, service and the dignity and compassion he shows when visiting his patients.

These visits also allow him to ensure The Outside Clinic processes are effective and that we are doing everything possible to maximise patient care.

Over the years, Nick’s contribution to The Outside Clinic and the optical profession as a whole has been invaluable. Through continued learning, research and growth of community eye care, there is no doubt new milestones will be achieved under his supervision that will go a long way to understanding and address the future growing demands on optical care requirements for an ever- ageing population.

The Optician Awards take place on 1st April 2017 and we wish Nick the very best of luck in for the Optometrist of the year award 2017.

Shop bought spectacles are preferred to those bought online


Study comparing over 300 pairs of spectacles found participants prefer shop bought specs over those bought online

A study commissioned by The College of Optometrists found that, when comparing spectacles bought online and those bought and fitted in optometric practices, customers preferred shop bought spectacles.

The study, published in the leading American journal Optometry and Vision Science, found that customers preferred shop-bought spectacles fitted by practice staff, ranking them higher overall than those bought online. Researchers from the University of Bradford and Cardiff University compared 154 spectacles bought online with 155 spectacles from UK optometric practices.  Participants completed a questionnaire on vision, comfort, fit, and how acceptable and safe the spectacles felt and all participants and spectacles were assessed at the University of Bradford eye clinic for clarity of vision, ocular muscle balance and fit and quality of the spectacle frames and lenses.

Mike Bowen, Director of Research for the College of Optometrists, said: “This study is important, not just because it’s the first of its kind, but also because of the rise in online purchasing. It’s important that optometrists explain to patients that someone trained in dispensing, can guide on the shape, fit and appropriateness of a certain pair of spectacles over another, which is particularly important for the elderly. As a sector, we need to prepare for the changing ways in which customers are shopping and ensure that consumers are getting a high quality service from whatever platform they choose to purchase.”

For consumers who cannot get to the high street to choose and buy spectacles, The Outside Clinic offer a free home visiting service where they will test your eyes in your own home and bring a wide selection of frames for you to choose from.

Google’s AI Reads Retinas to Prevent Blindness in Diabetics

Y0161013868G,"ABIDA, MAJID KHAN",2008-05-30,15:45:19,Color,#3,,0,3,1,1,5,13,50.0,2.42,000138BE:00005745,00000000:00000000/#00

Google researchers have worked with doctors to develop an AI that can automatically identify diabetic retinopathy, a leading cause blindness among adults. Using deep learning—the same breed of AI that identifies faces, animals, and objects in pictures uploaded to Google’s online services—the system detects the condition by examining retinal photos. In a recent study, it succeeded at about the same rate as human opthamologists, according to a paper published today in the Journal of the American Medical Association.

But the idea behind this AI isn’t to replace doctors. Blindness is often preventable if diabetic retinopathy is caught early. The hope is that the technology can screen far more people for the condition than doctors could on their own, particularly in countries where healthcare is limited, says Peng. The project began, she says, when a Google researcher realized that doctors in his native India were struggling to screen all the locals that needed to be screened.

In many places, doctors are already using photos to diagnose the condition without seeing patients in person. “This is a well validated technology that can bring screening services to remote locations where diabetic retinal eye screening is less available,” says David McColloch, a clinical professor of medicine at the University of Washington who specializes in diabetes. That could provide a convenient on-ramp for an AI that automates the process.

World Keratoconus Day


November 10 is the first World Keratoconus Day,  a national awareness day sponsored by the National Keratoconus Foundation. This day is dedicated to help raise awareness about keratoconus (KC), as well as educate and advocate for those living with KC.

We aim to do this by:

  • Encouraging people around the world to share their KC stories
  • Educating patients, friends and family about keratoconus
  • Collaborating with fellow KC organizations

Keratoconus, often abbreviated to “KC”, is a non-inflammatory eye condition in which the normally round dome-shaped cornea progressively thins causing a cone-like bulge to develop. This results in significant visual impairment.

14 million Brits not having regular eye tests


National Eye Health Week (NEHW) has revealed that almost 14 million of us aren’t having the recommended sight tests every two years – despite the fact that 55% of adults cite deteriorating vision as their biggest concern about getting older.

So if sight loss trumps both illness and hearing loss when it comes to our biggest fears, why aren’t we doing more to preserve it? This question becomes even more significant when you take into consideration the fact that around half of all cases of sight loss are actually preventable.

Regular eye tests also play a crucial role in detecting wider, more serious health conditions including high blood pressure, cholesterol, diabetes and even signs of strokes and tumours.

The Generation Eye Report highlights the value people place on their vision and the depth of their knowledge about eye health. Based on its results it shows there is still an urgent job to do in educating the British population…

The report focused on three key groups: 18 – 24 year olds (The Unseen Generation), their parents (New Presbyopes) aged between 45 and 54 and their grandparents aged 65 and over (The Low Vision Generation).

Worryingly it discovered that those aged 18-24 were the group whose quality of vision or state of eye health had most restricted or impaired their daily life (36%), with around a third (32%) not having an eye test in the last two years.

The report found 80% of 45 – 54 year olds said they’d experienced problems with their eye health in the last year. While 94% of over-65s wore prescription eyewear however almost a third (32%) didn’t know wearing the wrong prescription glasses or contact lenses could affect their eyesight.

These are pretty stark figures and there’s no doubt that a huge proportion of us appear to be in the dark about taking care of our eyes. So if there’s one key message people can take away from this year’s NEWH, it is to ensure you are taking the time to have your eyes tested on a regular basis.

National guidelines recommend eye tests should take place once every two years at a minimum, or once a year for over 65’s, but of course, if you notice any changes in your vision – no matter how big or small – it is crucial you pay your local opticians a visit immediately.

Parkinson’s Disease Could Be Diagnosed Through Eye Check




Although Parkinson’s remain to be the second most common degenerative diseases in the world, experts are still struggling to find a way to detect and treat the disease. But, researchers say they now have reasons to believe that it is now possible to diagnose this illness by a simple eye test.

Parkinson’s is a disease that affects the nervous system through the death of a cell. It usually shows signs after 70% of the neurons have already been damaged. Tremor is usually one of the symptoms; it is the shaking of the hands and leg that is unintentional. Doctors believe that once this sign shows, it is already worse.

Scientists are now challenged to research on how to detect the disease before it worsens. They are finding ways to diagnose the disease before the signs would show up.

Researchers are now working on detecting Parkinson’s through the retina since it is an extension of the Central Nervous System.  They have tried to induce Parkinson’s by injecting rotenone in mice. They were able to see that the retinal ganglion cells (RGCs) are swelling on the 20th day of injecting the neurotoxin before the mice show signs of Parkinson’s. This shows that they can already detect the disease before the signs show. On the 60th day of careful observations, the mice showed signs of the disease, according to WCCF TECH.

UCL Professor of Glaucoma and Retinal Neurodegeneration Studies, Francesca Cordeiro said “This is potentially a revolutionary breakthrough in the early diagnosis and treatment of one of the world’s most debilitating diseases. These tests mean we might be able to intervene much earlier and more effectively treat people with this devastating condition.”

According to Dr. Arthur Roach, Director of Research at the Charity Parkinson’s UK, through a BBC News report, there is “an urgent need for a simple and accurate way of detecting the condition, particularly in its early stages.”

Since these research are only tested to the mice and not humans, researchers must do some more tests until it is safe for humans. Patients with the Parkinson’s disease are hoping for the breakthrough, yet they need more time and right the tools for further research.