The Ophthalmology speciality is one of 30 specialities which bring together communities of clinical practice to provide national networks of research expertise. It is made up of research-interested clinicians and practitioners at both national and local levels. Our job is to ensure that the ophthalmology studies that are included in our national portfolio of clinical research receive the right support to ensure they are delivered successfully in the NHS.
About two million people in the UK live with a form of visual impairment, about one in 30 people. As more and more people live longer, conditions such as age related macular degeneration and glaucoma become more common.
The Eye Research Group Oxford (ERGO), based in The Oxford Eye Hospital, was set-up in 2009 to support high quality clinical research into eye diseases. ERGO has close links with the University of Oxford and collaborations UK-wide. We have over 30 studies at present, and some highlights are detailed below.
The ERGO team has more than 16 members including clinical lead, Susan Downes; clinical research nurse manager, Alexina Fantato; research nurses; research project administrators; research coordinators and a research photographer and graphic designer.
Oxford is now a centre for the European Reference Network (ERN) and has been designated as a centre of excellence for Ophthalmology rare diseases within this network. The lead is Susan Downes and the coordinator Alexina Fantato.
Eye disease and sleep:
The Somnus Sleep Wake study investigated the impact of eye disease on body-clock function, identifying a number of individuals with impaired sleep. The follow-on trial, Sandman, is recruiting patients with disrupted sleep and is led by Susan Downes and Russell Foster with coordinators Colm Andrews and Sophie Marlowe.
Robert MacLaren leads the surgical programme for ‘gene therapy’ and clinical trials into the potential of a ‘robotic arm’ to provide surgical precision during eye operations. Robert MacLaren also led a trial on implanting retinal prostheses (or the ‘bionic eye’) for end-stage retinal disease This was a fruitful collaboration and the study is now closed and no longer recruiting patients.
Eye disease and genetics:
Susan Downes leads the Oxford team on the UK Inherited Retinal Disease Consortium (UKIRDC), working with Stephanie Halford, clinical genetics, Clare Arnison-Newgass, and Lidia Milla, who liaise with families to help find a genetic diagnosis by identifying new variants in new and known genes. This is vital in establishing a diagnosis, enabling genetic counselling regarding inheritance patterns and disease prognosis.
The pioneering gene therapy trials programme, the largest in the world, is led by Professor Robert MacLaren, who heads a large laboratory research team as well as the clinical support team including Anna Rudenko and Brian McCann. This is seeing promising outcomes in patients with rare inherited eye disease. Patients can be affected at any age and inherited retinal diseases are characterised by increasing visual difficulties over time, thus this treatment aimed at stabilising the condition is an important innovative therapy.
Patient with Retinitis Pigmentosa:
Research into common eye conditions:
There are also many studies for more common conditions such as age-related macular degeneration (AMD). Treatments have come a long way for ‘wet’ AMD and visual impairment has decreased significantly since the introduction of intravitreal anti-VEGF eye injections to treat the condition. These injections help to prevent the formation of abnormal, leaky blood vessels at the back of the eye. Untreated these lead to scarring and irreversible damage. It is only through testing in clinical trials that new, longer lasting drugs are identified.
Telangiectasia Type 2 (MACTEL) is a condition characterised by abnormal blood vessel development at the macula leading to visual loss over time. Peter Charbel-Issa leads on this, assisted by Daniel Buttress working together with The Lowy Research Medical Centre to create a registry of patients, collect blood samples for genetic studies and detailed clinical information about the condition. A new treatment has been developed as a result of earlier studies. Selected patients with MACTEL in Oxfordshire may be eligible for this treatment.
Preventing blindness in premature babies:
One of ERGO’s research priorities, led by C.K Patel, and supported by clinical research assistant Caroline Justice, is to improve care of premature babies who are at risk of visual impairment from a detached retina. This includes developing innovative ways of taking pictures of the retina.
Eyesight and diabetes:
The global rise of diabetes is associated with an increase in complications, including diabetic retinopathy, which is a leading cause of vision loss. In two studies co-ordinated by the Northern Ireland Clinical Trials Unit , EMERALD and DIAMONDS, Samia Fatum and Christine Kiire lead in Oxford to examine whether it is safe for stable treated patients to be followed up by obtaining adequate imaging of the back of the eye that will be interpreted by trained imaging technicians. This would remove the need to be seen by an ophthalmologist and assess whether patients find this acceptable.
The DIAMONDS study examines whether a newer laser technology, subthreshold micropulse laser, works as well as the conventional laser and whether it is associated with fewer side effects. We are also working with Liz Pearce, a researcher from King's College London, who is taking forward previous research by Christine Kiire and Victor Chong to evaluate markers of inflammation in the blood, trying to correlate these with the patterns of diabetic eye disease, in order to better understand its mechanisms. Investigating the role of genetic predisposition to developing different types of diabetic eye disease is also ongoing as part of the CGDME study.
Inflammation of the eye:
We are carrying out research into personalising therapies so our patients have the best chance to be on a treatment which gives them the best response. Our aim is to broaden the treatments we can offer for patients with uveitis, or inflammation within the eye, through the HUMBOLDT trial led by Sri Sharma.
Measuring eye disease:
Investigating methods of how to quantify the impact of eye disease on vision, the visual pathway, visual performance, the brain, as well as its effect on mood and wellbeing involves a range of techniques. These include measurement of vision led by Jasleen Jolly and imaging of the retina using Adaptive Optics Scanning laser ophthalmoscopy led by Hannah Smithson, Mital Shah, Laura Young and Susan Downes. Using MRI imaging to see how vision is processed in the brain and what occurs in different disorders is being led by Holly Bridge’s team. The information can then be used to assess how well new therapies are working as well as to better understand the effect of the disease. We are also interested in the psychological impact of eye disease.
Find ophthalmology studies in your area using the map below:
Click here for ophthalmology research news from across England.
Visit the Royal Berkshire NHS Foundation Trust website for information on ophthalmology studies taking place in Berkshire.
Visit the Buckinghamshire Healthcare NHS Trust website for information on ophthalmology studies taking place in Buckinghamshire.
Visit the Milton Keynes University Hospitals NHS Foundation Trust website for information on ophthalmology studies taking place in Milton Keynes.
Visit the Oxford University Hospitals NHS Foundation Trust website for information on ophthalmology studies taking place in Oxfordshire.
Find studies you could participate in at bepartofresearch.nihr.ac.uk.