Robot saved my sight by blasting my eye with radiotherapy
Sixteen months ago, Michael Edwards, from Fawsley in Northamptonshire, was diagnosed with age-related macular degeneration - a leading cause of blindness in the over-60s
Every month for more than a year, company chairman Michael Edwards went to a hospital miles from his home to have an injection into his eyeball.
The treatment was painful and often inconvenient — but he endured it for 15 months because it was saving his sight.
'However, while my sight didn't worsen, it didn't make any improvement,' says Michael. 'I still couldn't read.'
Yet now, thanks to a robot and the type of treatment usually used for cancer, he can see more clearly — and the same technique could one day improve the lives of countless others.
Sixteen months ago, Michael, from Fawsley in Northamptonshire, was diagnosed with age-related macular degeneration (AMD), a leading cause of blindness in the over-60s.
The condition was detected when Michael started to notice that things looked slightly out of focus, so went to have his glasses adjusted.
His optician referred him to an eye consultant at King's College Hospital in London, who last March confirmed that Michael was suffering from wet AMD in his left eye. This is the more aggressive, fast-moving type, where abnormal blood vessels form under the macula, the part of the eye responsible for central vision.
These vessels are prone to leaking blood, and vision can deteriorate within weeks — or even days. Left untreated, patients can lose their sight within three months.
Symptoms include blurred vision, blind spots in the centre of vision and straight lines appearing wavy.
'It developed so quickly,' says Michael. 'I was a bit naive as I didn't realise it would continue to deteriorate rapidly. Within a month of things going out of focus, everything looked blurred through my left eye.
'I couldn't focus or concentrate on anything close up, such as reading — my passion. I also couldn't focus on my computer screen. I love the theatre, but I stopped going because I couldn't see the actors clearly.'
Currently, wet AMD is treated with injections into the eyeball of a drug called Lucentis. These are given regularly, up to once a month, usually for life.
They target a chemical called vascular endothelial growth factor (VEGF), which promotes the growth of the abnormal blood vessels and also makes them leak.
Robots have been used to assist in surgery in the NHS for several years. More recently, they have also helped to administer radiation therapy to cancer patients — but the use of robot radiation therapy for non-cancerous conditions is novel
Blocking VEGF helps stop the growth of more vessels and makes the existing ones less leaky. However, the injections are not a cure — they only help to stop the condition getting any worse.
After more than a year of monthly jabs and no improvement, in May this year, Tim Jackson, a consultant ophthalmic surgeon at King's College Hospital, told Michael he would be a good candidate for a trial of a new treatment: a form of targeted radiotherapy that could reduce or even eradicate the need for Lucentis injections.
Known as stereotactic radiotherapy (SRT), the treatment is usually used to tackle very small cancers, such as those in the lung, but it's now being employed to destroy the abnormal blood vessels in wet AMD.
'Abnormal blood vessels that cause wet AMD are particularly vulnerable to the effects of radiation, which preferentially damages the diseased tissue,' says Mr Jackson.
'Results suggest the procedure is very safe, the main risk is collateral damage to healthy macular blood vessels.'
Mr Jackson says this damage occurs in about 4 per cent of cases and can affect vision. However, he adds that most patients who have the treatment have better vision than those receiving injections.
Studies have shown that in carefully chosen patients, SRT can reduce the need for eye injections by about half, with many patients no longer needing any.
'The injections work quickly but tend not to last long, whereas the radiation may take a few months to work — but when it does, it lasts for years,' says Mr Jackson.
The new treatment is delivered by an eye consultant using a robotically controlled machine for greater precision.
The patient wears a special contact lens to precisely position the eye, then the machine aims three separate beams of radiation in through the white of the eye, which overlap at the macula.
Splitting the dose into three means that other parts of the eye receive only one third of the full dose received by the macula.
The machine closely monitors eye position throughout the treatment, and the doctor repositions the eye as necessary to ensure the radiation goes to just the right place. It takes about 15 minutes and the total body dose of radiation is about the same as a dental X-ray.
Michael was a good candidate as his macula was not too damaged, though the vessels in his eye were leaking fluid. More advanced cases do not respond so well.
He leapt at the idea of having the treatment. 'The chance to avoid an injection in the eye every month was irresistible!' says Michael. 'I was told a robot would fire off the radiation into my eye — I felt this was the way forward.'
He had SRT in June. The day before, a fluorescent dye was injected into his eye to highlight the blood vessels that needed to be treated.
'On the day of the procedure, I was taken into a treatment room where I had to put my chin on a rest and a technician made sure my head was locked into position to avoid any movement.
'A light came across from my left; it was not at all uncomfortable.
'The process took about 25 minutes, and then it was all over. I felt fine, just a little tired.
'Afterwards, I couldn't see any better, but Mr Jackson had explained there wouldn't be an immediate improvement because it takes time for the eyes to recover.
'Two months on, I can definitely see more clearly and my vision is less blurry. And I'm still hoping there will be even more of an improvement in my sight.
'I now feel positive and more confident about the future.'
Robots have been used to assist in surgery in the NHS for several years. More recently, they have also helped to administer radiation therapy to cancer patients — but the use of robot radiation therapy for non-cancerous conditions is novel.
It has helped bring greater precision to cancer treatment, causing less damage to healthy tissues, and the technology is being used in prostate, colorectal, cervical and rectal surgery.
However, it is not widely available as robots can cost more than £1 million while servicing can top £100,000 a year. Also there are still question marks over whether the outcomes are improved.
'Like all advances in medicine, robotic surgery must be introduced only when it has been properly tested and we can be sure of its clinical benefit,' says Shafi Ahmed, a council member for the Royal College of Surgeons and a colorectal surgeon at St Barts Hospital.
'At the moment, we don't have enough evidence to warrant its use in all areas of surgery. We must also ensure that such a clinical benefit can justify the financial cost to the NHS.'
If the new treatment for wet AMD proves successful, the argument is that although initially expensive, the robot technology would save the NHS money, as each dose of Lucentis costs around £800 and needs to be repeated several times a year. SRT costs £1,250, but is given only once and may mean no more jabs.
Mr Jackson adds: 'As well as being a less invasive treatment, we anticipate SRT will result in better outcomes for patients by addressing the cause of the condition rather than just suppressing it.
'While not all patients are suitable for this new treatment, for those who are, we hope to reduce the burden of having to attend regular clinic appointments.'
In the trial, known as the STAR study, two-thirds of participants receive the active treatment and the remaining third have a placebo. The standard eye injections are continued throughout the trial if needed.
The study is currently accepting patients at around 20 participating hospitals across the UK.