In the early NINETIES, people receiving a diagnosis of wet macular degeneration would have learned two things: their vision would get worse and there was no treatment available. The only option was a referral to a low-vision specialist to discuss how to function with dwindling sight.
Today’s outlook is very different, says Dr. Phil Hooper, chair of the Council on Advocacy at the Canadian Ophthalmological Society. For the majority of people with wet macular degeneration, devastating vision loss can already be prevented. For dry macular degeneration, treatments are evolving and now entering the clinical trial stage.
Improved vision health outcomes for people with macular degeneration, which affects 1.4 million Canadians, are due to “a shift in our ability to treat this disease,” says Dr. Hooper. “It is one of the areas where we’ve seen huge advances over the last decades.”
Other areas with significant forward momentum include refractive surgery, cataract surgery and cornea transplantation, along with the ability to earlier detect and better treat glaucoma, he explains.
Cataract surgery, for example, has become much safer and more predictable due to “improved techniques, equipment and lens implants for restoring the focus to the eye,” says Dr. Hooper.
One of the most commonly performed surgical procedures world-wide, cataract surgery enables many to retain their vision and independence, says Dr. Yvonne Buys, president of the Canadian Ophthalmological Society. Yet the selection of the power for the lens implant in cataract surgery is not an exact science, which means that, currently, patients may still require glasses afterwards.
“However, there is work on a light adjustable lens, which could be safely and non-invasively reshaped with a laser after surgery to correct for these errors and negate the need for glasses after cataract surgery,” she says. “This could be revolutionary.”
Also benefiting from an evolution in drugs plus technology enabling earlier detection and better treatment are people with glaucoma, a group of eye conditions with damage to the optic nerve that can result in irreversible vision loss and affects more than 500,000 Canadians, says Dr. Hooper.
A number of newly introduced devices and procedures, often referred to as minimally invasive glaucoma procedures (MIGS), may result in greater safety and faster healing than traditional glaucoma procedures, says Dr. Buys. “This is exciting for both the patient and the surgeon; however, the outcomes of these procedures in slowing disease progression remain unproven.”
The results of new therapies and procedures often take some time to evaluate, says Dr. Buys, who believes a key barrier to all Canadians benefiting from advances in ophthalmology is “the increased cost of innovation.”
Variations in health care coverage translate to different realities for patients across the country. “There can be a significant cost to new drugs and therapies for patients without supplemental insurance, depending on where they live,” says Dr. Hooper.
At the same time, a number of provincial governments have delisted routine eye examinations for those between the ages of 20 and 65 unless they have a known eye disease, says Dr. Buys. “The problem is that many people with early eye disease are not aware they have an issue until the disease is advanced, and, in many cases, the vision loss cannot be reversed.”
Early detection is important, agrees Dr. Hooper. “People need to be aware of the risks for eye disease, including aging or diabetes, where timely intervention can prevent vision loss. Having regular eye examinations can help to make sure Canadians don’t miss out on opportunities.”
Dr. Buys adds, “I hope World Sight Day will encourage Canadians to think about their eye health.”
More information at www.cos-sco.ca.