Researchers from Oxford Population Health’s Health Economics Research Centre, with colleagues from King’s College London and King’s College Hospital NHS Foundation Trust, have successfully used a new robot system to improve treatment for debilitating eye disease. The study is published in The Lancet.
The custom-built robot was used to treat wet neovascular age-related macular degeneration (AMD), administering a one-off, minimally invasive dose of radiation, followed by patients’ routine treatment with injections into their eye. Wet AMD is a debilitating eye disease, where abnormal new blood vessels grow into the macula, the light sensing-layer of cells inside the back of the eyeball. The vessels then start to leak blood and fluid, typically causing a rapid, permanent and severe loss of sight.
Globally, around 196 million people have AMD and the Royal College of Ophthalmologists estimates that the disease affects more than 700,000 people in the UK. The number of people with AMD is expected to increase 60% by 2035, due to the country’s ageing population.
Wet AMD is currently treated with regular injections into the eye. Initially, treatment substantially improves a patient’s vision, but because the injections don’t cure the disease, fluid will eventually start to build up again in the macula, and patients will require long-term, repeated injections. Most people require an injection around every one-three months, and eye injections, which cost between £500 and £800 per injection, have become one of the most common NHS procedures.
Key findings:
- Following treatment with robot-controlled radiotherapy, patients then needed fewer injections to effectively control the disease compared with standard treatment, potentially saving around 1.8 million injections per year around the world;
- Treatment with the robotically controlled device saves the NHS £565 for each patient treated over the first two years.
The study lead and first author on the paper, Professor Timothy Jackson, King’s College London and Consultant Ophthalmic Surgeon at King’s College Hospital, said ‘Research has previously tried to find a better way to target radiotherapy to the macula, such as by repurposing devices used to treat brain tumours. But so far nothing has been sufficiently precise to target macular disease that may be less than 1mm across. With this purpose-built robotic system, we can be incredibly precise, using overlapping beams of radiation to treat a very small lesion in the back of the eye.
‘Patients generally accept that they need to have eye injections to help preserve their vision, but frequent hospital attendance and repeated eye injections isn’t something they enjoy. By better stabilising the disease and reducing its activity, the new treatment could reduce the number of injections people need by about a quarter. Hopefully, this discovery will reduce the burden of treatment that patients have to endure.’
Dr Helen Dakin, University Research Lecturer at Oxford Population Health who led the economic evaluation for the new treatment, said ‘We found that the savings from giving fewer injections are larger than the cost of robot-controlled radiotherapy. This new treatment can therefore save the NHS money that can be used to treat other patients, while controlling patients’ AMD just as well as standard care.’
The research was jointly funded by the National Institute for Health and Care Research and the Medical Research Council and recruited 411 participants across 30 NHS hospitals.