Radiotherapy in the eye can save your sight in MINUTES

WET age-related macular degeneration (AMD) is a leading cause of blindness. Margaret Rawlinson, 75, an acupuncturist and yoga teacher from Cookham, Berkshire, underwent radiotherapy for it, as she tells SOPHIE GOODCHILD.

THE PATIENT

While in Crete teaching yoga in September 2015, i was gazing out to sea and noticed the horizon appeared wavy. i put it down to the clouds or the waves being rough. But when i got home, i tried to read and the words were blurry.

My optician said he suspected i had wet AMD, when abnormal blood vessels form in your eye and damage it, so i was referred to a specialist.

The diagnosis was a bolt from the blue — i was devastated. i’m healthy and active and suddenly i didn’t know how long i had before my eyesight deteriorated to nothing.

Three weeks later, i hadn’t heard back about my NHS referral so, using my medical insurance, i went private.

The surgeon scanned my eyes and a couple of days later confirmed i had wet AMD in both, though only slightly in my left eye. i had three injections in my right eye over about three months to stop the abnormal blood vessels growing.

luckily, they weren’t too uncomfortable as i used yoga techniques to help me relax, but my eye was sore after each one.

i noticed an improvement a week after my first injection, but sadly this wore off after the third injection. And while my sight was better than it had been, i still had some blurriness.

i was worried that if my right eye went, i’d end up with very poor vision as my left eye has always been lazy. But at a followup appointment, my surgeon mentioned a trial he knew of.

he described the treatment as a form of radiotherapy that destroys the abnormal blood vessels in the eye. it was a one- off treatment and could mean i’d no longer need injections.

it sounded incredible, so in April 2016, i went to see Tim Jackson, the surgeon leading the trial. he carried out various tests and said i was suitable, but i decided i didn’t want to risk getting the placebo instead of the actual treatment, so chose to have the 15- minute procedure done privately the next day. T

he machine i sat at looked similar to the one opticians use to check your eyesight. My head was strapped in place and my right eye was pinned open with a special contact lens.

i was given anaesthetic eye drops and an injection (the same one you get for AMD) and was told to keep very still as the radiotherapy was targeted at the damaged area.

it was painless and over quickly — i went home without any bandages. i noticed an improvement after a few weeks and didn’t need glasses for driving. i still wear reading glasses, but the words are no longer blurry.

it’s now been more than a year since the treatment and i’ve not needed any injections. My monthly NHS check-ups have been changed to every two months because my sight is improving.

i’m still running my yoga classes and no longer need a light to read unless it’s dark.

THE SURGEON

Tim Jackson is a consultant ophthalmic surgeon at king’s college Hospital NHS Foundation Trust. The macula is a small area at the centre of the retina at the back of the eye which is responsible for the vision straight in front of us. it is covered with a layer of tiny light-sensitive cells which help to process images so we can see.

in AMD, the macula stops functioning efficiently so reading becomes difficult, colours are less bright and faces are harder to recognise.

There are two types — dry, when the macula’s light-sensitive cells break down over many years, and wet, when tiny abnormal blood vessels form in the eye.

These new blood vessels are fragile and grow under the surface of the macula where they leak fluid and blood, causing distorted vision and blindspots. Vision deteriorates over a few weeks, sometimes even within days.

The gold- standard treatment for wet AMD is injections of a drug (lucentis, eylea or Avastin) that stops the abnormal blood vessels growing. The jabs work by targeting a chemical called vascular endothelial growth factor, the key cause of abnormal blood vessel growth.

Patients often need several injections — on average six a year — to preserve vision. These can be uncomfortable and cause anxiety. (They’re also expensive — lucentis costs £551 and eylea £816.)

At King’s, we’ve been trialling a procedure called stereotactic radiotherapy (SRT). This uses targeted radiation beams to destroy the abnormal blood vessels.

The idea of using radiation came from cancer treatment — like cancer cells, the cells that form the abnormal blood vessels divide rapidly and can’t repair themselves, making them more vulnerable to the effects of radiation, which kills them off.

if effective, radiotherapy would reduce the number of jabs patients need, or stop them needing the injections altogether.

i have been involved in the STAR trial, which is testing how safe and effective SRT is, since 2015. There are 17 hospitals taking part, including King’s, the Royal hallamshire in Sheffield, and Solihull hospital near Birmingham. Patients can be treated at one of the trial sites and receive follow-up support in their local hospital.

This follows a study which showed that eye injections were reduced by a third in those who had radiotherapy compared to those who didn’t. This improvement was in patients whose abnormal blood vessels were leaking, like Margaret’s.

The procedure takes 15-20 minutes. First we give anaesthetic drops and an injection of Avastin — we found in trials that it makes the radiotherapy more effective, we don’t know why exactly, but it could be linked with radiotherapy taking time to be effective and injections being quick-acting.

next, we insert a disposable contact lens into the eye. This is held in place with gentle suction to stop the eye moving, it is also fixed to the end of a lever, which the surgeon can move to reposition the eye so the beams hit the macula. W

e transmit three rays of radiation through the eye and they overlap at the macula, giving it the full dose needed. This is safer than one beam because the tissue the rays pass through receives a lower dose that isn’t damaging.

We direct the rays with the help of software and a computer screen which shows images of the inside of the eye. The patient goes home immediately afterwards.

it takes about four months to notice a difference in vision, as this is how long it takes the abnormal cells to die off completely.

in Margaret’s case the therapy has meant she’s not needed any more injections for a year. The hope is that this will continue and those on the trial will see similar benefits.

SRT could be a widely available NHS treatment in a few years.