At Home Christian Jessen 2014 - 329

|promotion|
In this day and age
Age-related macular disease (AMD) is the most
common cause of permanent visual impairment
in the elderly. The risk of this disease increases
with age and affects 2% of the population over
50 rising to 20% in those over 85. The macula
is the central part of the retina (the light
sensitive layer at the back of the eye) and
is responsible for high-quality vision, essential
for reading, driving and recognising faces.
The disease occurs in two forms: dry and
wet. The dry form, the most common, causes
a gradual loss of central vision. The wet
form accounts for about 10% of all AMD and
is associated with the growth of new fragile
blood vessels beneath the retinal surface
which cause bleeding, leakage of fluid and
scarring. This leads to a more rapid, irreversible
deterioration of vision. Wet AMD can now
be treated and early detection is important.
An important early symptom is the
awareness of distortion of objects and/or
straight lines. Treatment involves the injection
of minute volumes of drugs - known as
Anti-Vascular Endothelial Growth Factor
(Anti-VEGF) agents, such as Lucentis, Eylea
and Avastin - into the eye, initially on a
regular monthly basis with an average of
five to seven injections in the first year of
treatment. These treatments are well tolerated
and performed in the clinic. Around 90-95%
of patients respond by either maintaining or
improving their vision, with 25-40% actually
having an improvement. Apart from
increasing age, smoking is also a highly
significant risk factor for this disease.
Diabetes
Diabetes affects over 4% of the population
with about 2.8 million people affected in the
UK. Diabetic retinopathy is a complication of
diabetes due to damage to the small retinal
blood vessels causing them to leak (with
swelling at the macula) and bleed and in some
cases causes the growth of abnormal fragile
blood vessels on the retina. Diabetic
retinopathy is the commonest cause of visual
impairment in the working age group. It is
usually treated by laser therapy and diabetic
macular swelling is now also treatable by
intraocular injections of anti-VEGF agents.
Early detection is important to prevent visual
impairment. There is fortunately a national
screening programme for this condition and
therefore all diabetics should receive an
appointment for annual retinal photography.
Prevention
Prevention is an increasingly important aspect
of health care nowadays. recommendations
to decrease the risk of developing some of the
eye conditions discussed above are:
* Avoidance of exposure to UV sunlight by
wearing a hat with a brim, and wearing
sunglasses with one of the following: the CE
Mark/British Standard (BS EN 1836:2005),
a UV 400 label, a statement that the
sunglasses offer 100% UV protection
* Quitting smoking
* Good nutrition (green, leafy vegetables;
brightly coloured fruit/vegetables which
contain the pigments zeaxanthin and lutein;
and other foods high in antioxidants)
* The ArEDS (Age related Eye Disease
Study) in the States has demonstrated that in
patients with moderate AMD a diet rich in
these foods (which contain vitamin C and E,
lutein, zinc, zeaxanthin and copper) can
slow the rate of progression of AMD
Paying regular visits to a high street
optometrist is also recommended as they
will often detect eye conditions before any
symptoms occur. The majority of adults require
a routine eye examination at least every two
'The macula is the central part of the retina,
responsible for high-quality vision, essential
for reading, driving and recognising faces'
There are new
surgical and laser
procedures available
MEET THE
ExPErT
Mr Sanjay Shah
BSc, MBBS, MRCP,
FRCS, FRCOphth,
DO (pictured, left)
Mr Sanjay Shah is a consultant
ophthalmic surgeon practising in
both central London and Surrey.
He is a consultant at Epsom and St
Helier University Hospitals NHS Trust,
Surrey, and has a special interest in
cataract surgery, glaucoma and
age-related macular degeneration.
In addition to the above, Mr Shah
has received a Clinical Excellence
Award for his work as a NHS consultant.
years. The following people are entitled to a
free sight test on an annual basis and should
take advantage of this facility:
* Under the age of 16
* Under 19 and in full time education
* On income support
* Over 40 with a family history of glaucoma
* Over 60, diabetics and those with
glaucoma (annual examination recommended)
The next steps
All of the above ocular conditions become
more common with increasing age. In common
with other European countries, the UK has an
ageing population. The proportion of people
aged 65 and over in the UK is projected on
present trends to increase from 16% in 2008
to 23% by 2033. The demand and need for
eye care and effective treatment will therefore
also be much greater and this represents a
significant challenge for the provision of
ophthalmic care in the future.
New surgical/laser procedures and
cutting-edge research into such areas as
gene and stem cell therapy will provide
exciting potential opportunities to not only
treat these conditions but, in future, also
both prevent and repair and replace
irreversibly damaged ocular tissues such
as the optic nerve in glaucoma and the
macula in AMD. If you feel that you are
experiencing any of the symptoms mentioned,
are worried about your eye health and wish
to seek expert medical guidance, simply
contact consultant ophthalmic surgeon,
Mr Sanjay Shah (pictured, above) today.
FOR MORE INFORMATION
Mr Sanjay Shah is available for private
consultation at the London Clinic in Harley
Street, London; Ashtead Hospital, Surrey;
The Clockhouse Medical Practice, Epsom,
and St Anthony's Hospital, Surrey.
Email sanjayshah@privatepractice.co.uk
or call his secretary on 020 8942 7020.

Table of Contents for the Digital Edition of At Home Christian Jessen 2014

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