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BRITISH BROADCASTING CORPORATION
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Programme no. 3 - Ageing Eyes
RADIO 4
THURSDAY 23/02/06 2100-2130
PRESENTER:
MARK PORTER
CONTRIBUTORS:
ALEX IONIDES
PRODUCER:
PAULA MCGRATH
NOT CHECKED AS BROADCAST
MYERS
Hello, when did you last have an eye test. As we get older regular check ups not only make sure that our reading glasses are strong enough but that they can pick up any early signs of serious sight threatening conditions. Diabetic retinopathy, glaucoma and macular degeneration are the top three concerns. Early diagnosis and treatment is the best chance of saving sight or at least of halting or slowing further deterioration. But is there anything that we can do for ourselves to prevent these largely age related eye problems or indeed if we have a problem how can we make the best of our failing eyesight? Well if you've got concerns about changes in your vision call us now: 08700 100 444 is the phone number or you can e-mail checkup@bbc.co.uk and talk to my guest today who is Alex Ionides, he's a consultant eye surgeon at Moorfields Eye Hospital in London.
I must just ask you this Alex - the last pair of reading specs that I picked up I bought in the supermarket, should I in fact have gone to the optician and had a proper eye test?
IONIDES
Not necessarily. If you've got good distant vision without any glasses and all your problems are really with reading close up then to get some ready readers from the supermarket or the chemist is fine. But you are not having a general eye check by an optometrist to make sure you don't have any glaucoma, early signs of macular degeneration or cataract. So whilst on one level it's perfectly acceptable, you're missing out on a lot of the benefits that a high street optometrist can give you.
MYERS
I take your point. Okay, thank you very much we'll go to our callers and their particular questions. And Larry is waiting to speak to us, he's in Somerset and has been diagnosed with cataracts. Larry, so are you about to have an operation for this?
KAVANAGH
No, the point is that I don't know when I should have one.
MYERS
Okay what has your eye specialist said?
KAVANAGH
That I've got developing cataracts.
MYERS
Developing cataracts.
KAVANAGH
Yes.
IONIDES
Well as I'm sure you know a cataract is a cloudy lens, it's very common, a cataract operation is the commonest operation performed on the NHS and when to operate is in some ways quite a simple topic and that it really is whenever the hazy, cloudy foggy vision is beginning to affect your lifestyle. So if you find you can't read, or drive or watch television that's the time to start to get on with the surgery.
MYERS
Is it affecting you in fact Larry?
KAVANAGH
The description actually does fit yes.
IONIDES
In the old days one used to have to wait until the cataract ripened but with new technology we can operate a lot earlier, so the moment you find your lifestyle is curtailed because of your vision get on and have the surgery.
MYERS
And is it a fairly simple procedure Alex?
IONIDES
It is, it's now performed under a local anaesthetic, it can take under half an hour, sometimes 10-20 minutes. It's usually performed as day case surgery so you don't have to spend a night in the hospital. You have drops to take after it for up to about three weeks but it now tends to be a lot more straightforward. Like any operation it does have risks associated with it that your specialist should discuss with you but on the whole they are remote and minimal.
MYERS
Larry, does that answer your question?
KAVANAGH
I think it pretty well does.
MYERS
Okay. So ...
KAVANAGH
As I understand there's no dramatic change I should expect but there's general ...
MYERS
Getting worse - if it gets worse and it makes life difficult to do the things that you want to do then it's time ...
KAVANAGH
... actually does fit my case - all the points very well.
IONIDES
One advantage of having a cataract surgery is for people that are very long sighted or very short sighted when we put the new implant in we can make it so that those people no longer need glasses for distance but will of course need glasses for reading. So that in those few cases does have an additional advantage of early cataract surgery. I don't know if that applies to you.
MYERS
Okay thanks for that call and thanks for those comments. I mean what used to be a really a very major problem for people, I mean they did go blind as a result of cataracts and it just is not in the same way a life or a sight threatening condition.
IONIDES
That's right and also the long waiting times for cataract surgery have gone down in recent years, down to about under three months in most centres around the UK.
MYERS
Okay thank you very much for that. Let's go to another caller, thanks for the call Larry, Dennis now, Dennis Wilkes who has heard that MD - which I think is the shorthand for macular degeneration - can be passed down in families. Dennis, is that a concern for you, is macular degeneration in your own family?
WILKES
It is indeed. My age is 78, I developed wet macular degeneration, which is the worst type of course, and I've heard that it can be passed down through a gene. I'm concerned that this may have passed down or could be passed down to my two sons, both in their - 40 years of age.
IONIDES
Yes you're right in that in macular degeneration can be passed down through families but not by a single gene. So it's by no means inevitable that your two sons will have inherited a gene from you for this disorder. Macular degeneration is euphemistically called the wear and tear of the retina, as I'm sure you know, it affects the central retina only, the peripheral retina will always remain intact, so the sense of blindness, meaning total darkness, will never come along but unfortunately the central retina is very important for reading, looking at people's faces. And when that's damaged by the macular degeneration it makes life extremely difficult, as you know.
MYERS
How is it affecting you Dennis, what vision do you have?
WILKES
Well I have very little vision in my left eye, I have some vision, although blurred, in my right eye and I'm receiving treatment at the moment called laser treatment to try and prevent further degeneration.
IONIDES
Yes, there are two kinds of laser treatment. There's the classic laser, which works by destroying the retina, and there's a newer kind of laser treatment called PDT - photo dynamic therapy - which some people call a cold laser which hopes to destroy the blood vessels that cause wet macular degeneration, helps to destroy those without damaging the retina. But that can benefit some people but not everybody.
WILKES
I am receiving that treatment currently, unfortunately not on the National Health.
IONIDES
That is very true, despite some of the government guidelines that it should be available on the NHS there are lots of local funding problems as well as manpower problems of specialists that have the equipment to be able to perform the treatment. And the treatment needs to be performed more than once, often three, four, five times at few monthly intervals and it can get expensive.
MYERS
Dennis, you came on in the first instance asking about the chances of this being passed on to your sons, I think there's some reassurance that it will not necessarily pass on by any means. But I wonder if that raises the question, Alex, in people's minds as to what you might do, is there a kind of screening to look out for this in the early stages, for example?
IONIDES
There is screening to be able to look out for it, unfortunately the screening - it really involves symptoms, if the patient has symptoms of it then they should seek early advice and for some of the early cases the PDT can be helpful. Once it has advanced, as it has in one of Dennis's eyes, then unfortunately there is no more treatment that can be - can be beneficial.
MYERS
And Dennis's sons, I think he said, were in their 40s so is it something that if it were to strike it would come on as early as that or are we talking about something that really is into your 60s perhaps 70s?
IONIDES
More in the 60s than the 70s. There are rare families where it is inherited, it can come along earlier, but ways to try to prevent it coming on - smoking is associated with macular degeneration, so stop smoking and whilst there's been a lot of interest in antioxidant vitamin supplements there's been not a lot of evidence that it can help for everybody.
MYERS
Okay let's take that actually on because Janice is waiting in West Sussex. Thank you for your call Dennis. But Janice is interested in some of the supplements and some of the newer things coming through, which seem to be available and have some promise. Janice, Lucentis, I think is something that you're interested to hear more about.
TILLING
Oh hello. Yes I'm phoning - my mother has wet AMD and like your other caller one eye has gone and just like your other caller the - well the PDT laser didn't work. So one eye went because the hospital didn't catch it in time, we're now at another hospital and she's had a drug injected directly into her eye and this is called Avastin. But we've been told that there's another drug called Lucentis that is supposed to work even better. And we're wondering how we might get hold of this and again we're not on the National Health for this unfortunately.
MYERS
Let's have a bit of a run down as to what these drugs are, if you would first please Alex and whether they are likely to be helpful, mention of Avastin, mention of Lucentis, I expect there are other drugs that - whose names we don't know. What is the role of drugs in something like this?
IONIDES
Going back a tiny bit, there are two main types of macular degeneration - wet and dry - the old fashioned nomenclature that still holds and the wet type is where new blood vessels grow underneath the retina and can bleed suddenly and with catastrophic effects on the central vision and that's why it's called wet and that's why the laser treatment is trying to destroy these new blood vessels before they grow and before they have the chance to bleed. And Lucentis and other products are antiangiogenic factors, so they are aimed to prevent the blood vessels from growing. And this can be injected into the eye as your caller said and this can help to, at monthly intervals, into the eye itself, to prevent the blood vessels from growing. Unfortunately studies with this are early, the results are not proven and the fact that there are a number of these different drugs with small differences between them show that there's not one that works and many people are trying it out, as well as the PDT, the cold laser that is, and the other laser - all these different treatments are around because there isn't one single treatment that really works.
MYERS
It's not surprising I guess though Janice that you would want to try whatever may offer any kind of hope. You said it's your mother did you?
TILLING
Yes, yes.
MYERS
And she's struggling with it obviously?
TILLING
Yes, yes, because the diagnosis wasn't given for the first two years and one eye went completely and now obviously the last eye is very important.
MYERS
Is there a point here about picking these things up as early as possible and again to stress the point Alex how can you either get screening, if you have any sort of concerns, or what can you do even to test yourself - is there a simple do-it-yourself test even?
IONIDES
A simple test would be to look at a straight line, such as a door frame, and see if it's kinked in any way. There's Amsler grids which we hand out in eye clinics, which are just looking at a grid, almost like graph paper, and if you look at that with one eye in turn and see if those grids are straight and parallel or whether they're distorted in any way and that can be a sign of early macular changes and then that would need a referral on to a local eye unit.
MYERS
And what about this business of one eye and then the other eye - if one goes are you automatically going ...
IONIDES
Increased likelihood though not inevitable.
MYERS
Okay so that's a matter of possibilities rather than probabilities between one eye and the other eye.
IONIDES
With your last caller trying to get hold of Lucentis, there's still trials going on for Lucentis and I think she'd have to contact the local eye department to find out where the trials are going on, I know there are colleagues at Moorfields Eye Hospital that are doing trials on various of these drugs, it would be worthwhile her contacting the help line at Moorfields to see if she could get involved.
MYERS
Okay Janice if you'd like to try that, thanks very much for raising the question. We go to Canterbury and talk to David Alexander, who's also interested in something to help with this macular degeneration. What is it you want to try or are trying perhaps David?
ALEXANDER
Yes, I was told by friends a few weeks or months ago that lutein capsules or tablets or lutein oil, l u t e i n, was good for macular degeneration and they'd heard cases where people's eyesight had improved dramatically. Well I have macular degeneration in one eye, [indistinct words] some years - three, four maybe, years ago I noticed, as was mentioned in the previous call, a kink when I was coming out of the car park I noticed the vertical bars at the end of the roadway all had a little kink about halfway down them. Which was a bit worrying so I got my eyes tested and they said you've got macular degeneration. I went and saw a specialist at the local hospital and he thought he might be able to do something about it but on examination found he could do nothing. It's not particularly disadvantaging me, although my eyesight has deteriorated generally since then. I don't think somehow it's anything to do with macular, I think it might just be cataracts and blurring - I'm 87, so ...
MYERS
Well you're sounding in good shape anyway.
ALEXANDER
Everybody says I'm in good shape and they use words like remarkable and things like this, I don't know quite what they mean.
MYERS
Tribute to you. Okay but let's try and answer that.
IONIDES
It does sound more like a macular problem rather than the cataract and it might be part of the dry macular generative disease which gives a very slow distortion of central vision. And as for the lutein, which is a pigment which has a protective role at the back of the eye, again there's been no evidence that increasing dietary intake can help. Although with all the recent interest and studies in the dietary supplements a good healthy diet with plenty of green vegetables and some people talk about the yellower vegetables, such as yellow sweet peppers that might help, there's been no strong evidence, so I can't say yes it'll help you. And I'd be very surprised if anybody did have a dramatic improvement in their vision from taking these dietary supplements but it can't be a bad thing.
MYERS
And would it do you any harm?
IONIDES
No it wouldn't do you any harm if it was in the diet. Some of the very high tablets, vitamin tablets, that you can get with the antioxidants - vitamins A, C, E and zinc - have practically toxic levels in them, if you were to take the full dose.
MYERS
So the word is really look after yourself, perhaps not go overboard with supplements because they may not help ...
IONIDES
That's right.
MYERS
... and they may possibly be dangerous.
IONIDES
And again the smoking issue.
MYERS
Okay, David thanks for that. We've got another - or we've had several e-mails about looking after yourself and I'll pick one here from Richard Thompson who's saying that he's in his mid-50s and he's saying that he exercises regularly, tries to keep the rest of his body functioning in tip top condition, is there anything that he can do to help keep deterioration of his eyesight to a minimum. He says he's short sighted and has got astigmatism, so these are sight problems. And he has presbyopia, this business with the reading specs. So he wants to do the best for himself to stay in good shape, anything?
IONIDES
Eye exercises? Well as a dull old conventional doctor I have to say no they don't work. But at the turn of the century, last century, William Bates - an American - published a book called Perfect Vision Without Glasses , whereby he advocated eye exercises. And there are a number of followers of his around today that will do weekend courses on how to exercise your eyes and get rid of glasses. I'm afraid I don't think they work. You're welcome to try them as long as you don't spend too much money wasted on them really.
MYERS
And what about keeping yourself generally physically fit? You've already said that smoking, as for so many reasons, is a bad thing. But in terms of extra - extra sort of efforts to keep fit and healthy will they have an impact on your eyes?
IONIDES
Not particularly, no, your eyes are pretty much going to do what they're going to do, there's nothing to prevent cataract, macular degeneration, glaucoma, obviously keeping fit and well and having a good diet is always a fabulous thing to strive towards.
MYERS
Okay, alright, thanks for that. And we'll go to London where Jenny Coupe is waiting to speak to us. Jenny, your story please.
COUPE
Oh hi. Well I got macular degeneration very suddenly - I woke up one morning and realised I couldn't see out of my right eye. And so it all became a horrible, horrible shock a couple of months ago. And I don't mind admitting I hit rock bottom. Now I - first of all I just didn't want to do anything but now I've spent this morning - I went to the low vision clinic and sat there for a couple of hours and I was very disappointed at what they could offer me because I have been to the RNIB and seen all the wonderful things that you can get. My world would come to an end if I couldn't read. So I just wanted to say that if you're feeling very low because you've just been diagnosed and you realise you can't see the television, you can't read the paper, you can't use your computer you can - I know it's going to cost me a lot of money but I'm back up to the RNIB and I'm going to get some equipment so that I can start living again.
MYERS
Jenny, yes, well done, exactly right, good for you. I mean that is very positive out of quite a difficult situation. And picking that up with you Alex, the idea the low vision clinic, presumably attached to the hospital, hasn't really offered very much and Jenny has gone and found a bit more. I mean what is available and what is the sort of minimum that people perhaps should be offered and can really make very good use of, so they make the most of ...?
IONIDES
Yes in some ways recent advances in the digital and television age have certainly overtaken in what some LVA - low vision aid clinics - in the NHS can supply. Partly because of cost. What they can supply are the magnifiers for near vision, the telescopes for distant vision. But what they can't supply so much are the digital cameras that can help to magnify close and distant images to get your reading close up and seeing television into the distance. There are CCTVs, close circuit televisions, which can magnify - a little camera that magnifies the letters and the bills that you'll receive and can put them on to a screen in front of you and massively enlarge letters to help you read again. And these are the main ...
MYERS
So there is the technology and that's very, very good news but of course the cost comes into it. But what about with macular degeneration, as I'm understanding it, you lose that central vision, does it always make it very difficult even with these vision aids to see?
IONIDES
Yes, these vision aids are trying to magnify images, so that you use your peripheral retina, which is the only healthy retina left to you, to perform the function of the macular, which is very difficult, it takes a lot of training, it takes a lot of perseverance and a lot of inward energy to keep going with the various low vision aids to try and get some use out of them, it can be very upsetting and frustrating.
MYERS
Okay, thank you very much and thanks for phoning us Jenny with that information. We'll go to Mike Wagstaff who's in South Wales and wants to talk about glaucoma, which we haven't picked up on so far. Has had glaucoma for over 20 years. So where are you up to with your eye problems then Mike?
WAGSTAFF
It's pretty good at the moment - my eyesight - there's been very little degeneration over 20 years. I've had a succession of treatments, the first is Timoptol, Timolol I think it is, which reduced the pressure of - the eye pressure considerably, bringing it down to a low normal. Gradually it's starting to creep up, went on Xalatan or I should say added Xalatan, which again brought the pressure down. Started to creep up very slowly and then latterly on Dorzolamide, which again had the effect of reducing the pressure considerably but became intolerant of it and had to ...
MYERS
So you're looking for some new drugs are you?
WAGSTAFF
I'm just wondering if there's anything new on the way. The pressure is gradually rising, it's not desperately high.
MYERS
And obviously that's what we're talking about here - glaucoma being essentially high pressure inside ...
IONIDES
Not always but mostly. It's pressure that's too high for the - too high for the eye and that is transmitted to the optic nerve at the back of the eye and progressively damages it, decreasing the visual field, so you get areas of visual field missing, that you're not aware of, so it's a very important disease to be screened for.
MYERS
And just to be clear, not quite anything to do with high blood pressure in the rest of the body?
IONIDES
No, not to do with high blood pressure, that's right, nothing to worry about. And there have been a lot of advances in drop treatments recently. You've mentioned you've gone from Timolol on to Xalatan. Xalatan's one of the new prostaglandin analogues. And if that's no longer beginning to control the pressure there are some other prostaglandin analogues that can benefit people. They have subtle differences, they're sold under different names of Lumigan and Travatan. Now they can sometimes help where Xalatan cannot. But if it looks as if your pressure's going to go up higher there are sometimes laser treatments and also surgery that can be undertaken to prevent you losing any further vision. Glaucoma, just like diabetic retinopathy and macular degeneration, are one of the three age related problems that cannot be cured but they can be contained. And certainly with glaucoma damage limitation is very possible with treatments.
MYERS
Mike I hope that's helpful. I want to quickly squeeze in a call from Marguerite because she wants to raise the question of diabetes, in this case her dad's got Type II diabetes. And there is a risk, I think, to the eye with diabetes. A quick question Marguerite?
MURPHY
Hello my father is 87, he has already suffered from blood sugar, he's got neuropathy in his feet, and in order to prevent any further damage to his health I'm interested in being able to tell him the possible consequences and how bad it can get and how quickly can eye damage happen if you don't look after your blood sugar levels.
IONIDES
Yes, no blindness can result, it's imperative to have a hospitalised service look at you - look at his eyes and book any treatment going if he needs it.
MYERS
Okay, I hope that's helpful, that is the last call that we can take I'm afraid, once again time beats us, it always does. That's all we have time for in this programme but thank you very much to my guest - Alex Ionides - and for all your calls and your e-mails. There's further information on our action line, the number to ring there is 0800 044 044. If you wish you can listen again to the entire programme, you can go to the 成人论坛 website and that's at bbc.co.uk/radio4. And I hope you'll be back with us at this time Thursday afternoon at three next week when we'll be talking about problems of headaches and migraines. Until then I hope you have a very good week.
ENDS
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