'It is my duty to help these people see'

'It is my duty to help these people see'

Macular degeneration is one of those conditions that those approaching late middle-age dread. For many of the 90,000 diagnosed annually, blindness is inevitable. But one man is determined to change this: Ahmed Nagiati El-Amir, who at 37 is already considered one of Europe’s leading eye surgeons. Mr El-Amir discovered his vocation while still a student at Charing Cross Hospital medical school.

‘‘We did very little ophthalmology but the little we did do interested me, so I decided to educate myself,’’ he says.

He started attending the weekly 7am ward rounds of Professor Alan Bird, a renowned surgeon at the Institute of Ophthalmology, Moorfields Hospital, in East London. The professor told him to go away; ward rounds were for trainee eye surgeons, not students. But he persisted, and the irritated prof started firing questions at him. El-Amir’s extracurricular studying paid off and he held his own. Prof Bird took him under his wing and guided him from them on.

After training at Moorfields, Mr El-Amir became a consultant ophthalmic surgeon at 32. He now works across several NHS hospitals in Berkshire and his private practice in Harley Street.

It was Prof Bird who set him on his current course. ‘‘I remember him saying to me that with the right innovation, in 10 or 20 years, eye surgeons would be treating patients for whom once we could do nothing. I felt challenged by this,’’ he recalls.

And so he focused on macular degeneration. The macula is a part of the retina – the back of the eye – responsible for central vision. The degeneration typically represents a tiny spot on the back of the eye, not much larger than a full stop. Yet it relates to a field of vision equivalent to two or three laptop screens. As this is in the centre of vision, it is particularly disabling: while retaining peripheral vision, sufferers become unable to see faces or read.

Macular degeneration usually affects people over 60 and is the leading cause of blindness in the UK. It is broadly divided into two categories: ‘‘wet’’ and ‘‘dry’’. While both result in the same central blind spot, they are different diseases.

The wet type, which makes up about 10 per cent of cases, is the result of blood vessels under the macula haemorrhaging and cutting off blood supply. There are several different treatments which, when injected directly into the eye, can slow the progression.

The dry type, which makes up the remaining 90 per cent (around 600,000 people), is caused by cells responsible for vision withering away. No one knows why this happens, though it’s likely genetics play a part. Its progress is slower than the wet form, but there are few treatments.

Once diagnosed, most wait to go blind. ‘‘It was for these people – those for whom we can do nothing at the moment – that I went into ophthalmology. It is my duty to find a way to help these people see,’’ says Mr El-Amir.

He has developed a technique using a series of lenses that are inserted into the eye. They act as a telescope, enlarging the image on to the area of the retina that is peripheral to the macula. The brain then does something surprising: it starts to adapt, using the healthy part of the retina to view central images. In effect, the lens system manages to trick the brain into ‘‘moving’’ the macula to another part of the eye not affected by the degeneration.

The technique has been used successfully before, but if people have had cataracts they were deemed unsuitable for it and since the vast majority of macular degeneration sufferers – well over 80 per cent – fall into this category, this was a major problem.

Mr El-Amir’s approach enables him to operate on those with a history of cataracts, meaning it could help save the sight of around 500,000 people. His technique involves multiple scans of the eye to understand its unique anatomy, and uses different ways to support the lens once in place.

Mr El-Amir is keen to make the surgery available on the NHS but says he will need to personally train surgeons initially because of the expertise required. The main stumbling block, however, is that the lenses are hand-made and therefore expensive.

Still, a cost-benefit analysis for the NHS shows it’s cheaper than providing care for macular degeneration sufferers, especially when accounting for the risk of falls and other injuries to which the visually challenged are prone. There is, moreover, 10 years of data from the US suggesting these lenses do work.

To operate on one eye costs about £15,000, so Mr El-Amir is looking at how to reduce this. The lens manufacturers say if demand increases, they could cut the price by a third, but NHS managers appear wary of committing themselves. Moorfields Eye Hospital, however, has expressed an interest in helping Mr El-Amir do trials to help convince the health service to offer the treatment nationwide, so he’s optimistic it could yet save the sight of many thousands currently condemned to blindness. ‘

‘You have to remain positive. You have to have hope,’’ he says.

For more information, visit: macularsociety.org and harleystreeteye.com

By Max Pemberton,

The Telegraph, Tuesday 10 March 2015

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