But after the excitement of the discovery comes the question – will the NHS approve the use of the drugs on patients?
The
Macular Societywas delighted when new treatments for eye disease caused by diabetes were discovered, and heartened when NICE approved their use.
They knew that many patients have lost their sight or been forced to pay thousands of pounds for private treatment to keep their vision.
But there is concern that some part of the NHS have not implemented NICE’s guidance - and that patients may be losing more sight than they should as a result.
Helen Jackman, Chief Executive of the
Macular Society, explains that medical retinal services are “already bursting at the seams dealing with age-related macular disease (AMD)”.
Since 2008 retinal clinics have been able to slow the progression of some macular diseases via drugs – they now have the added responsibility to use the newly approved drugs to treat diabetic macular oedema (DMO).
Wet age-related macular degeneration and swelling of the macula caused by diabetes and blood clots in the eye can all be treated with drugs injected into the eye. Tens of thousands of people are affected by these conditions every year.
“It is not cure but it slows the progression,” says Jackman.
“Diabetes and blood clots in the eyes can be treated very effectively, and we are pleased that NICE has approved the new drugs,” says Jackman.
“A secondary or side effect of diabetes is retinal damage, caused by changes in insulin levels.”
The macula is a 4 mm oval-shaped yellow spot near the centre of the retina of eye. It contains the largest concentration of cone cells in the eye and is responsible for central, high resolution vision.
“Underneath are lots of blood vessels,” explains Jackman.
“In some people with diabetes some of the blood vessels become leaky causing a build up of fluid in the retina. Drugs injected into the eye can stop the leaking..”
The new drugs do not prevent DMO but can stop people from losing their sight, via a series of injections.
“When NICE approves a new drug the clinical commissioning groups (CCGs) and NHS Trusts have 90 days to work out how to introduce them,” Jackman says.
“They are legally obliged to do that. We are concerned those business plans are not being put in place.
“We have written to CCGs twice about the funding of retinal services.
“At first we wanted to alert them, but we are still receiving anecdotal concerns from around the country.
“Our concerns so significant that we have written under FOI to confirm how these plans are being put in place.”
The
Macular Societyaims to find out the real state of eye care services across the country - at the moment patients face “a postcode lottery”, with some CCGs and Trusts providing a good service, while others do not.
“In terms of public policy and awareness among the public, eye health is not seen as a priority,” says Jackman.
“There has only been a treatment on the NHS for AMD since 2008 and it is only in the last few years that people started to understand the disease and the knock-on effect of losing one’s sight.
“It is huge, devastating. It can lead to isolation and loss of confidence. It robs older people of their independence, confidence and quality of life and adds to the pressure on other health and social care services.”
Patients have to be given the treatment quickly and regularly.
“Before 2008 there were drugs but they were not approved by NICE - we lobbied very hard to have Lucentis to be funded by NICE,” says Jackman.
“There were some treatments from the mid 2000s but people had to pay for them privately.
“Until these drugs were discovered people were just told they were going to go blind.
And it was devastating that there was no treatment at all.
“So from 2008 there was an expectation that people would have the injections required for a few months.
“Now 26,000 to 40,000 people a year are going into macular services, that number is just building and it is a ticking time bomb.”
Jackman says that while many clinicians are working hard to deliver the services needed, there has to be a shift in the level of resource.
The Royal College of Ophthalmologists’ guidelines say wet AMD patients should be followed up every 4 weeks.
A recent paper by leading ophthalmologist, Simon Kelly, shows that diabetic patients who were made to wait for treatment had less good outcomes than those who received prompt care.
The
Macular Societyand the Royal College has surveyed ophthalmologists to find out what is happening on the ground.
A similar survey last year found that 85% of clinics could not treat wet AMD patients within the Royal College guidelines.
“We fear our new research will show little or no improvement,” says Jackman.
“There is also dry AMD for which there is no treatment and those people need support and access to low vision services.
“Low vision services are even further down the pecking order.”
There also needs to be investment in research and stem cell therapy.
The
Macular Society’s FOI requests to CCGs and Trusts in England will provide picture of what is happening around the country.
“We will lobby the CCGs where services are not in place and where there are long delays for treatment,” says Jackman.
“We will be informing MPs in the areas worst affected.
“There is an urgent need for CCGs to review their funding of these retinal diseases and for CCGs and trusts to give these diseases the priority they deserve.
“It is not acceptable that people lose their sight when good treatment is available and approved for use in the NHS.”