Kate Brassington Macular Degeneration Interview

Kate Brassington Macular Degeneration Interview

Age-related macular degeneration (AMD) is the leading cause of central vision loss in people over the age of 50 in Australia. There is no cure, but researchers at the Centre for Eye Research Australia (CERA) are working on several promising new treatment options.

Over a thousand people from all over Australia and overseas have put up their hands to be part of a world-first clinical trial for early AMD, led by CERA's Professor Robyn Guymer. One of those volunteers was Patricia Keith, a 73 year-old retired ophthalmic nurse from Melbourne.

'When I was first diagnosed with the early stages of AMD, I felt hopeless and a bit depressed," said Patricia. 'I used to worry constantly if my vision was getting worse and would check every day for any signs of progression."

Since being accepted into the trial for a new nanosecond laser treatment, Patricia feels like she has finally regained some control of her life. 'Sight is so precious and I treasure my independence so anything I could do to preserve this was worth a shot. Why sit back and do nothing?"

The laser treatment, created by Australian company Ellex Medical Lasers Ltd, is quick, painless and has shown some very encouraging early results.

Other CERA researchers are looking at improving treatment options for people with the more advanced stages of the disease.

-Wet' type AMD is currently treated with regular injections into the eye. While these injections are often effective in stabilising vision, potential side effects include a risk of infection and for patients, they can be uncomfortable and painful.

'We are investigating novel ultrasound drug delivery devices and nanoparticle technologies as an alternative to injections. If the new drug delivery systems prove successful, they will provide a revolution in the practical management of many eye diseases," said Dr Hong Zhang, Head of CERA's Drug Delivery research unit.

Meanwhile in the Neuroregeneration unit, Dr Alice Pébay is leading a team of stem cell scientists with the intention to model AMD and other diseases in the laboratory. The researchers create stem cells from skin or hair cells and then turn these into retinal cells. 'Our goal will be to grow new eye cells in the laboratory, to understand the mechanisms leading to the degeneration observed in AMD and find novel drug or cell treatments for AMD," said Dr Pébay.

The message for patients is clear: hope is in sight. 'A decade ago, there were no effective treatments for AMD and now, we have good treatments for wet AMD and are working towards treatments for early AMD," said Prof Guymer.

'Combined with our knowledge about prevention (quit smoking and maintain a healthy lifestyle), we're well on our way to beating the most common cause of blindness in Australia."

Macular Degeneration Awareness Week is an initiative of the Macular Disease Foundation.
www.mdfoundation.com.au

The pilot study of the nanosecond laser was conducted in 2010-2012 with support from the Victorian Government. The current Laser intervention in Early AMD (LEAD) trial is supported by funding from the National Health and Medical Research Council (NHMRC) and in partnership with Bupa Health Foundation.

Left: Normal vision
Right: What a person with AMD might see

Macular Degeneration Common Questions

Question: How common is AMD?

Age-related macular degeneration is the most prevalent after the age of 50 years. One is 7 people over 50 are affected by AMD. Two out of three people over 90 will develop AMD, and one in four in that age group experience significant loss of vision from it.


Question: What are the symptoms?

Blurred or distorted vision
Slow recovery of visual function after exposure to bright light
Reduced central vision


Question: What are the causes?

The causes of age-related macular degeneration are currently not fully understood. Evidence suggests the condition has a genetic link. People with a family history of AMD have a 4-fold increased risk of developing AMD. Other risk factors associated with AMD include ageing and smoking.


Question: Can I prevent AMD?

A healthy diet with fresh fruit and leafy green vegetables, and not smoking may help reduce the risk of developing AMD. Smoking increases the risk three times


Question: What treatment is available?

-Wet' AMD is often treated with injections into the eye however there is no effective treatment for AMD at present. Low vision aids and services offer support for people with age-related macular degeneration.

Question: AMD research

The Macular Research Unit at the Centre for Eye Research Australia is working on a wide range of projects to improve diagnosis and treatment for AMD and to progress towards a cure. Professor Robyn Guymer leads the unit and is a recognised world leader in research and clinical management of AMD.

Macular Degeneration Nanosecond Laser Treatment Common Questions

The Centre for Eye Research Australia is conducting a world first randomised controlled trial of a new laser treatment for age-related macular degeneration (AMD).


Question: What does this trial hope to achieve?

AMD is a progressive condition that can lead to vision loss and blindness. Currently there is no specific treatment available for early AMD.

This trial aims to demonstrate the ability of a novel laser treatment to slow or partially reverse the progression of AMD, before vision is lost.


Question: What is nanosecond laser treatment?

The treatment will involve the use of a laser device - known as retinal regeneration or 2RT laser therapy – to deliver a controlled nanosecond dose of laser energy into the eye. The laser has been designed by the South Australian-based ophthalmic company, Ellex.

In applying the laser to the affected eye, researchers aim to eliminate the yellow deposits, known as -drusen' that are present in the retinal tissue of AMD patients. It's hoped the elimination of drusen from the retina will reverse the degenerative processes caused by AMD.


Question: What are results of the pilot study?

The interim 12-month results from the trial of 24 high-risk patients with early AMD have shown that the laser can improve the function of a patient's retina.

After 12 months, around two-thirds of patients experienced sustained improvement in their visual function in the treated eye, with the majority of patients also noting an improvement in their untreated eye.

A patient's visual function typically improved in the area of the eye that had the most damage. It's this damage that typically leads to complications of AMD and subsequently, severe vision loss. In addition, the treatment appears to be safe, with research showing no evidence of laser damage to photoreceptor cells.


Question: Who can participate in the multi-centre randomised control trial?

Patients with early yet high risk AMD in both eyes may be eligible to participate. The trial is conducted at two sites – Sydney and Melbourne and participants will be recruited from Victorian and NSW ophthalmology clinics. Interested patients should contact their eye care professional for a referral. Referrals can be addressed to:
Kate Brassington
Centre for Eye Research Australia
Royal Victorian Eye and Ear Hospital
Level 1, 32 Gisborne Street


Question: What can trial participants expect?

Only patients with early AMD who have not experienced vision loss are able to participate in this trial. More information can be found on the CERA website or by phoning (03) 9929 8373.


Question: What is AMD?

AMD is a degenerative condition affecting the central area of the retina called the macula. The macula is a small area at the back of the eye which is responsible for fine and reading vision. There are two forms of AMD, known as -wet' and -dry'. Dry AMD, the more common of the two, is characterised by gradual loss of vision. Wet AMD can lead to rapid and severe vision loss. AMD is the leading cause of vision loss in Australia. Fifteen per cent of people over 50, or half a million Australians, live with early AMD. The prevalence of this disease increases exponentially with each decade of life and almost a quarter of people over 90 are vision impaired as a result of AMD.


Question: Who is CERA collaborating with on this project?

The trial is being conducted by CERA researchers in partnership with Ellex and the University of Melbourne. The study will be conducted at the Royal Victorian Eye and Ear Hospital (Melbourne) and Marsden Eye Specialists (Sydney).


Question: How is the trial being funded?

The trial is supported by funding from the National Health and Medical Research Council (NHMRC) and a Bupa Health Foundation Award.

Interview with Kate Brassington

Question: How is Macular Degeneration diagnosed?

Kate Brassington: Age-Related Macular Degeneration is diagnosed by an Eye Specialist when they have a look at the back of your eye and take a series of images to confirm


Question: Can Macular Degeneration affect the younger population?

Kate Brassington: Age-related Macular Degeneration does not generally affect anyone below the age of 50. There are other (diseases usually genetic) that can affect the macula in younger people.


Question: How do Macular Degeneration and Age-related Macular Degeneration differ; is it just the age of diagnoses?

Kate Brassington: They are the same diagnosis but Age related Macular Degeneration is commonly shortened to Macular Degeneration.


Question: Can you talk about the treatment options that the Centre for Eye Research Australia is working on?

Kate Brassington: Currently we have a trial involving a novel nanosecond laser to try and slow or halt the progression on Age related macular degeneration called the LEAD trial. It is a multi-centre study for participants with the early stages of the disease.


Question: What is involved for participants in the LEAD trial?

Kate Brassington: Participants involved in the LEAD trial are randomised to either treatment or a placebo group and one eye receives the laser. They are then seen biannually for 3 years and during this time they may receive the laser again. At the end of the trial we will analyse the results to see which group had the higher rates of progression to the late stages of the disease.


Question: How does the treatment created by Ellex Medical Lasers Ltd differ from Laser Eye surgery?

Kate Brassington: Lasers are used a great deal in ophthalmology for many different reasons. The 2RT laser is designed for the retina and is approved for use in diabetic macular odema and is being trialled for use in AMD. What is commonly known as Laser eye surgery is used to correct peoples refraction so they do not need to wear glasses or contact lenses, and is used at the front of the eye on the cornea.


Question: How soon will it be until these treatments are available for those suffering from Macular Degeneration?

Kate Brassington: The results from the LEAD trial won't be known for 4-5 years.


Question: Is it more difficult to treat Macular Degeneration that has progressed due to late diagnosis?

Kate Brassington: No, AMD is a difficult disease to treat because there are many factors involved in the disease and currently there is only treatment for the wet type of the late disease. It is better to have early diagnosis in the wet type as less damage is done.


Question: What advice would you give someone who'd recently been diagnosed with Macular Degeneration?

Kate Brassington: If you smoke to quit, to date the only modifiable risk factor for AMD is smoking those who smoke are at a increased risk of developing AMD. It is also important to eat a healthy diet with lots of green leafy vegetables and coloured vegetables and attend regular eye checks.


Interview by Brooke Hunter
Caption: Professor Robyn Guymer using the pilot nanosecond laser therapy on a patient.
(Images courtesy of CERA PhD student Erica Tandori)