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Case study: Curing the most common form of blindness

Age-related macular degeneration is the most common cause of sight loss in the developed world. The NIHR supporting ground-breaking experimental research to restore vision in people affected by this disease. NIHR researchers at Moorfields have used tissue created by stem cells to successfully restore sight in people with wet age-related macular degeneration, whereas those in Oxford have undertaken the first trial of robot-assisted eye surgery in people with age-related macular degeneration.

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The challenge

Age-related macular degeneration (AMD) is a common eye condition that affects the central part of the retina, called the macula. It doesn't cause total blindness but it can make everyday activities like reading and recognising faces difficult.

There are two types of AMD. ‘Dry’ AMD is caused by a build-up of waste material under the macula that thins the retina. ‘Wet’ AMD occurs when abnormal blood vessels grow underneath the retina and leak blood and fluid, which can prevent the retina from working properly. Eventually the bleeding and scarring can lead to severe permanent loss of central vision.

Currently, treatment for wet AMD involves regular injections of anti-vascular endothelial growth factor (anti-VEGF) drugs middle of the eye to halt vision loss.

NIHR Biomedical Research Centres are leading the way in developing innovative new techniques to treat AMD and restore vision.

Pioneering stem cell therapy

Researchers supported by the NIHR Moorfields Biomedical Research Centre have used tissue created by stem cells to successfully restore sight in people with wet age-related macular degeneration.

The trial involved replacing the diseased cells at the back the patients’ affected eye with a patch made of stem cells  in an operation lasting one to two hours.

Douglas Waters, 86, from Croydon, London, was one of two people who had received the treatment at Moorfields Eye Hospital. He developed severe wet AMD in July 2015 and received the treatment three months later in his right eye.

In the months before the operation my sight was really poor and I couldn’t see anything out of my right eye. After the surgery my eyesight improved to the point where I can now read the newspaper and help my wife out with the gardening. It’s brilliant what the team have done and I feel so lucky to have been given my sight back
Patient Douglas Waters

After 12 months, both patients who underwent the treatment reported improvements to their vision. They went from not being able to read at all, even with glasses, to reading 60-80 words per minute with normal reading glasses.

Professor Lyndon da Cruz, consultant retinal surgeon at Moorfields Eye Hospital NHS Foundation Trust said

“The patients who received the treatment had very severe AMD, and their improved vision will go some way towards enhancing their quality of life. We recognise that this is a small group of patients, but we hope that what we have learned from this study will benefit many more in the future.”

This is the first time that complete engineered tissue has been successfully used in this way. The research could lead to an ‘off-the-shelf’ new treatment for AMD within five years.

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Robot eye surgery

Researchers supported by the NIHR Oxford Biomedical Research Centre have undertaken the first trial of robot-assisted eye surgery in people with age-related macular degeneration.

The approach, which was first tested in humans in 2016 and has now been fully investigated in a clinical trial, uses a robot to insert a fine needle under the retina to dissolve the blood that has leaked out in AMD. The latest study tested the surgery in three patients with AMD, all of whom experienced an improvement in their vision as a result.

Surgeon Robert MacLaren, who is Theme Lead for Surgical Innovation at the NIHR Oxford Biomedical Research Centre, said:

“This is a huge leap forward for delicate and technically difficult surgery, which in time should significantly improve the quality and safety of this kind of operation. The trial also showed that the robot has great potential for extending the boundaries of what we can currently achieve.”

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More NIHR research on age-related macular degeneration