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Mar
16

Minimally Invasive Glaucoma Surgery (MIGS) – The iStent

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iStent

There is currently a lot of interest in newer surgical techniques for treating glaucoma. Until recently, if the intraocular pressure could not be controlled with drops, and in some cases laser treatment, glaucoma specialists resorted to glaucoma surgery, either trabeculectomy (where a trapdoor flap is created to relieve pressure), or a tube. Whilst successful, these operations are invasive, time consuming, and carry risks and significant side effects.

Minimally invasive glaucoma surgery is an alternative approach – whereby one or more very small stents (tubes) are inserted into the drainage part of the eye (the trabecular meshwork). These procedures are less invasive, and quick to perform. I have recently become one of the first group of surgeons in the UK to start using the “iStent” (there’s definitely a joke in there somewhere about being an iSurgeon…).

The iStent is a tiny hollow tube that is made out of titanium metal, and is only 1 mm long. It is thought to be the smallest medical device to be implanted in the human body. It is inserted into a specific part of the microscopic drainage canal structure of the eye (Schlemm’s canal – part of the trabecular meshwork). It’s inserted using a microscope, thereby improving the drainage of aqueous fluid and lowering the eye pressure.

The surgery time is quite quick, (5–10 minutes) and the iStent procedure is often combined with cataract surgery. An ideal candidate for use of the iStent would be a patient with mild glaucoma, who is taking one or two glaucoma drops, and who is embarking upon cataract surgery. Following surgery, we would hope that the patient might be able to stop a glaucoma drop.

As a minimally invasive procedure, most specialists, myself included, believe that the iStent is a mild treatment that offers benefits to some patients. It is certainly not a “miracle”, but it has the advantage of minimal side effects. So far, my early results are encouraging, and I look forward to following up my early patients to establish its usefulness in the long term.

Finally, and worth mentioning, is that although the iStent is made of metal, it is non-magnetic titanium, so patients are safe to have future MRI scans!

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Jan
20

The 11th Pan-Hellenic Vitreo-Retinal Meeting – and archeology…

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I was invited to speak recently at the 11th Pan-Hellenic vitreo-retinal meeting, held in Athens. This was a welcome chance to catch-up with my many Greek friends and colleagues. Some I trained alongside and others I have helped train during their time spent at Moorfields. I was invited to oppose the motion of a debate “screening is mandatory in uveitis”. My brief was to argue that it is not necessary to perform endless blood tests to diagnose inflammatory eye disease (uveitis).This practice is usually not necessary, is wasteful of resources, and can cause patient anxiety.
Debates are quite popular in medical society meetings, as they are a way of summarising the science that might support both sides of an argument to the audience. Of course, the truth sometimes resides somewhere in the middle, but I think, on balance, that I helped to defeat the motion. After the meeting, I was invited to join colleagues on a 2 day guided tour of the archaeological sites of the Peloponnese. This was an excellent opportunity to meet ophthalmologists from across Europe and share experiences, whilst at the same time seeing some fascinating archaeological sites.
On the tour, we visited Olympia , the site of the ancient Olympic Games. We stayed overnight in a charming mountain retreat, and were surprised by the light dusting of snow the next morning. That morning we then visited Mycenae, which is the centre of the Bronze Age Mycenaean civilization, from 1600 BC to 1100 BC, that predates that of classical Greece. We visited a Mycenaean tomb, possibly of Agamemnon, and the impressive remains of the palace. Finally, we visited Epidaurus, which is the site of the best preserved amphitheatre in Greece. This is still used occasionally to stage plays, and can hold 16, 000 people. This theatre is famous for its remarkable acoustics – for example an actor’s whisper from the stage can be heard with perfect clarity by all audience members, even by those seated up in the “gods” in the highest and cheapest seats of amphitheatre. Also of interest to the group, as surgeons, was a small adjacent museum exhibiting some archaeological finds, including some fine surgical instruments, as this area was a centre for healing. I wonder if they had ophthalmologists?

I also did my best to help the Greek economy by stocking up on honey and olive oil…

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Dec
17

Merry Christmas and a Happy New Year!

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We would like to wish all our patients, clinic staff and our optometrist and GP colleagues a very happy Christmas and a healthy New Year! With best wishes from Mark, Sylwia, Avni, Anabela, Sandrine and Chris

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Feb
01

Using lasers in cataract surgery….the femtosecond laser

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Mark was invited to present at a conference at Moorfields Eye Hospital a couple of weeks ago, devoted to the use of femtosecond laser in cataract surgery. This allowed those initial surgeons who’ve spearheaded the use of femtosecond laser in cataract surgery in the UK to share their experiences. The audience were primarily surgeons interested in taking up the technique in the future (this surgery is well established but few surgeons have taken it up in the UK, in part due to lack of availability and high cost of the equipment). There’s a huge amount of interest in the surgical community in this technique – it’s the first major technological advance in cataract surgery for over 2 decades! Mark and his colleagues discussed future improvements in design with his colleagues and the manufacturers, most of whom were present and following the proceedings with great interest.

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Dec
17

Merry Christmas and a Happy New Year!

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We would like to wish all our patients, clinic staff and our optometrist and GP colleagues a very happy Christmas and a healthy New Year! With best wishes from Mark, Sylwia, Avni, Anabela, Sandrine and Chris

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Dec
03

Euretina 2014

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Mark attended and lectured at the “Euretina” 2014 meeting in London recently. Held at the ExCel Centre, this is one of the world’s largest congresses devoted to retinal disorders. The aim is to allow specialists with an interest in retinal disorders to share clinical experience, research ideas, and keep up to date with this rapidly expanding field. Over 5000 delegates attended.

As an invited speaker was Mark was able to meet with associates and colleagues as far flung as Australia and Canada, as well as Europe.
Mark says: “Enormous progress has been made in the treatment of retinal disorders in the last few years. Our treatments have been revolutionized by medicines injected into the eye. The principal treatments involve medicines that block a protein called Vascular Endothelial Growth Factor (VEGF) – this protein is one factor that causes abnormal blood vessels to grow under or within the retina and leak fluid. Injection therapy, which is painless, now allows successful treatment in many patients with wet macular degeneration, diabetic macular swelling (oedema) and retinal vein thrombosis. Early therapies required frequent injections (monthly) but newer anti-VEGF drugs have been developed to reduce the frequency of injections so it is much less burdensome for the patient.”

Mark also attended interesting presentations of other emerging therapies such as gene therapy and retinal implants. However these treatments, although promising, are still in their infancy.

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May
29

Femtosecond laser assisted cataract surgery evening

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Thank you to all the optmometrists and allied health professionals who came to Mark’s lecture at the Royal Society of Medicine.  The subject of the lecture was “Femtosecond laser assisted cataract surgery – Is it worth the hype?”.  This generated a huge amount of interest as it’s a relatively recent technological advance in cataract surgery (there are only 2 machines in the UK), and Mark is one of the few consultants using this new technique regularly in the UK.  The general agreement was that yes, it probably is worth the hype!

The lecture was followed by a wine tasting with Ray O’Connor, our wine expert, giving everyone a chance to mingle and discuss patients, practices…and wine.

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Feb
08

Greek Odyssey

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The Moorfields Macula Course is one of the most prestigious ophthalmic events, and attracts attendees from all over Europe , who come to learn about the latest developments on retinal disorders.  For the first time the course was held in Thessaloniki,  Greece, with excellent participation from local and regional ophthalmologists.  One of my interests is ocular inflammatory disease (uveitis) and I gave 2 lectures  (“Diagnostic Testing”, and “Clinical features of uveitis and how to avoid the pitfalls”).

The lectures were very well received, and the meeting allowed a large number of prominent British consultants to make links with the local ophthalmologists, exchange ideas and compare the issues we face…..

In between lecturing,  many of us visited the world famous tomb of Philip II (Alexander the Great’s father, at nearby Vergina), which is the only intact and undisturbed tomb ever found in Greece.  Quite amazing!

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Feb
08

The Missing 50%…..

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The Moorfields International Glaucoma Symposium was held recently in London.  A whole session was devoted to the “missing 50%”. In essence, study after study has shown that at least 50% of patients with the commonest type of glaucoma are undetected in the community. This applies to all the developed world.  Elsewhere (e.g. in Africa) it may approach 70%. Why is this important?

Well, the hidden 50% or more of patients who have undetected glaucoma are at increased risk of losing vision, as their disease is untreated. Early glaucoma is usually symptom-free, and the question is how we detect these individuals in the community.  The key message is that all individuals should be encouraged to see their optician (optometrist) on a yearly basis as they can easily test for glaucoma.  Men are particularly bad at attending!

Public health campaigns, radio campaigns, and community screening programs in high risk communities may also play a role.

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