A chance of second sight
The medical stories that grab headlines are more likely to be depressing than uplifting and not all the important factors are equally well covered.
We have now had news of a possible treatment that might improve the eyesight of the elderly enormously. One of the most common causes of virtual blindness in older people is age-related macular degeneration (AMD).
There are two types, wet and dry. Wet macular degeneration is more disabling than the more common dry macular degeneration. If the early, encouraging signs of the use of stem-cell treatment of the condition are confirmed, it is one of the best bits of medical news that older generations have had for years.
But not all the news is good. The fact that the life expectancy of oldies, especially older men, is no longer increasing so uniformly across the country and has levelled off has been rather hidden but it needs exposure. We must not allow penny-pinching measures to prevent older people from retaining their sight so that they can take part in family life – reading, watching television and remaining part of the community.
In my nearly thirty years as a medical correspondent, it was relatively easy to appreciate which medical advances were given top billing by the Department of Health – because they were not only of proved efficiency but also because they were relatively cheap or even offered a cost saving to the NHS. Medical advances or statistics that were costly were, and probably still are, played down.
I was once told by a top civil service doctor to keep quiet about a recent advance in prostatic medicine. I was warned that the procedure would prove so expensive that it could ruin hospital budgets and seriously damage the NHS.
I should, I was advised, simply allow its advantages to be appreciated slowly, as knowledge of them crept across British medicine. I told him that I couldn’t agree to this. Not to accept improvements in techniques for the early diagnosis of prostate cancer and the early recognition of the changes in the prostate was likely to cost thousands of lives – too high a price to pay for administrative ease.
My adviser smiled dejectedly, poured us both another drink, and then said that he would have to warn me of the cost of this approach: it would affect every aspect of my work and life. The authorities would not only investigate, denigrate and rubbish my medical and journalistic activities but would also undermine my social and domestic life.
Dry AMD tends to advance slowly and, every year, we oldies can have our eyes examined and the damage to them mapped. We, with expert supervision, can assess the extent of the dry macular degeneration and estimate its likely effect, if any, on our everyday sight. In contrast, wet macular degeneration proceeds relatively rapidly and, as it does so, tends to block out central vision with an opaque fog.
The older patient loses the sight of the central part of any scene. People become unrecognisable, traffic becomes impossible to negotiate and pavements become hazardous. Reading, whether newspapers or books, becomes a past pleasure. Card games have to be given up, as do golf and tennis. Family life, without seeing faces with their ever-changing expressions, is hard to engage with.
It is great news that the work of the London Project to Cure Blindness, funded by the Macular Society, has devoted its initial attention to wet rather than dry macular degeneration.
Two patients were chosen for the study. The results of using stem-cell implantation into the affected eyes, an operation taking between one and two hours, has been remarkable. Douglas Waters, a man aged 86 from Croydon, can read newspapers and help with the gardening again, after treatment at Moorfields Eye Hospital in London.
It is hoped that many thousands of patients will soon be treated by Professor Lyndon Da Cruz of Moorfields and Professor Pete Coffey from University College London and the Institute of Ophthalmology; and we will soon find that the strength of their work has been confirmed and spread throughout Britain.