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For GP's, Optometrists and other medical specialists

Photobiomodulation

I was involved with the Lightsite II trial using the Valeda photobiomodulation system. Although it is not a miracle cure, it may slow down the rate of visual loss, through using using specific light wavelengths to improve mitochondrial function in the retinal cells. It is administered in the clinic using the Valeda machine (made by Lumithera). Patients undergo three blocks of treatment each year. Each block consists of The aim is to slow down the rate at which bison deteriorates. Patients with reasonably good vision can respond well, and see a few more letters on the chart after treatment, but those with severe visual loss are unlikely to notice any improvement.

This treatment should be considered for patients with high risk of intermediate dry AMD and/or progressing geographic atrophy. This exciting new treatment which is now available for private patients at James Paget University Hospital. See www.lumithera.com for more information about

A US LIGHTSITE III trial in March 2023 reported statistically significant results where treatment reduced the rate of patients developing geographic atrophy to 5.7% in the Photobiomodulation treatment group compared to 21.6% of patients having sham treatment. However, this is a new treatment, with more research needed to confirm these initial positive trial results.

 

https://www.businesswire.com/news/home/20230315005170/en/LumiThera-Announces-Sustained-Vision-Improvement-for-24-months-in-Dry-Age-Related-Macular-Degeneration-Subjects-from-US-LIGHTSITE-III-Clinical-Trial-Data

Wet ARMD

Wet ARMD treatments using injections should be thought of as a way of controlling the disease, not as a one off cure. Research is moving rapidly in this area and treatment regimes are variable. The most important step is to get the condition detected and treated as soon as possible, giving the patient the best chance of maintaining good long-term vision. The condition can be picked up early by an OCT scanner, common in many opticians. However, it

is easy for even very good optometrists to miss the early stages of wet ARMD without an OCT scanner. A retina examination can assess a patient’s possible likelihood of developing wet age related macular degeneration. Patients with high risk features such as retinal pigmentation and multiple soft confluent retinal drusen, or patients who are already blind in one eye from wet ARMD should consider having three monthly OCT scans to for early detection.

Standard practice remains using an Amsler grid to help patients detect early changes of wet ARMD, although this method is not particularly reliable.

 

Smoking is a risk factor for developing visual loss from wet ARMD, and should be strongly discouraged. Alternatively, a healthy diet with plenty of green vegetables is highly recommended. Vitamin preparations can be bought, which may have small beneficial effects.

 

If patients experience the Charles Bonnet phenomenon of hallucinations, it is vital that they are reassured that this is not a form of madness, is a scientific event, and can usually be improved by better lighting, and by understanding the experience. Some patients find moving their eyes helps stop hallucinations faster.

More information

 

www.lumithera.com

www.macularsociety.org/

RNIB: http://bit.ly/255aQoR

Cataract Advice

There are a range of post surgery choices for ongoing retention of good sight. Glasses are a simple solution. Multifocal lenses (or premium lenses) offer the best chance of not needing glasses at all after surgery, but they usually cost considerably more and the quality of the vision may be worse than with a fixed focus lens, with glare and halos being common problems.

Diabetic or elderly patients should consider seeing a specialist in retinal diseases. Wet age related macular degeneration is often misdiagnosed as early cataract by optometrists and GPs who do not have access to Ocular Coherence Tomography retinal imaging systems. These are available within East Point Consulting Rooms, the private clinic at James Paget University Hospital. Permanent severe loss of vision is largely avoidable if there is early detection, and diagnosis isn’t delayed.

 

Likewise patients with a medical history of uveitis, retinal detachment, glaucoma or corneal disease should be referred to a specialist who regularly treats these conditions in their NHS practice.

Uveitis

If your patient has uveitis, check that they aren’t experiencing any other related issues, like the ones listed below.

  • Bloody diarrhoea

  • Abdominal pain

  • Crohns disease

  • Ulcerative Colitis

  • Shortness of breath and cough

  • Coughing up blood

  • Tuberculosis

  • Low back ache

  • Joint pains

  • Mouth ulcers

  • Genital ulcers

  • Behcets

  • Herpes or cold sores

  • Rash

  • Psoriasis

  • Raised painful lumps on arms or legs (Erythema Nodosum)

  • Sarcoidosis

  • Lymphoma

  • HIV

  • Syphilis

  • Multiple Sclerosis

Neurological

Patients with unexplained loss of vision are often referred to neuro-ophthalmologists.

Common conditions seen include

·    Optic neuritis

·    Homonymous hemianopia (stroke affecting the vision)

·    Pseudotumor cerebri

·    Pituitary Adenoma

·    Meningiomas

·    Giant Cell Arteritis

·    Cranial nerve palsies

·    Nystagmus

·    Optic disc drusen

·    Pseudopapilloedema

·    Horners syndrome

·    Unequal pupils

·    Visual loss associated with dementia
 

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