Lowering pressure within the eye is essential to treating glaucoma, one of the leading causes of blindness in people over the age of 60, according to the World Health Organisation. The condition, where the optic nerve becomes damaged because of increased pressure caused by fluid build-up within the eye, is estimated to affect about 80 million people worldwide.
Eye drops, oral medicines, lasers and invasive surgery have traditionally been used to treat glaucoma. Surgery, usually the last resort, is advised when eye drops and lasers have not worked or are not suitable. So far, the standard method of surgery has been a trabeculectomy, where a new pathway is created so fluid can drain away easily.
Now, new devices that are less invasive and offer a quicker recovery time is available to glaucoma patients in the UAE.
In February, Cleveland Clinic Abu Dhabi announced that three patients at the hospital were the first to be treated with an innovative outpatient procedure. The minimally invasive PreserFlo MicroShunt procedure involves inserting a small stent into the eye’s drainage system to shunt intraocular fluid and lower internal eye pressure. The technology also helps reduce or eliminate the reliance on medication in most patients.
Novel approach
The operation is performed under a local anaesthetic and takes about 30-45 minutes, and the patient is discharged the same day after a few hours’ observation in the clinic.
“Glaucoma is a leading cause of blindness around the world and is also one of the main causes of vision loss in the UAE,” said Dr Jason A. Goldsmith, a staff physician in the Eye Institute at Cleveland Clinic Abu Dhabi. “The expansion of our minimally invasive surgical options with the introduction of this novel approach to treat glaucoma means that even patients with advanced disease can be treated safely, with minimum downtime and positive results in most cases.”
The procedure is only recommended to patients where medication – such as eye drops – have not worked, and where there is a significant risk of permanent vision loss without surgery, Dr Goldsmith said.
Meanwhile, the ophthalmology team at Sheikh Shakhbout Medical City (SSMC) is taking a different approach to glaucoma treatment.
In November, SSMC staff performed their first intelligent eye implant using an eyeWatch device, a fully adjustable system of tubes that drains away excess fluid to lower ocular pressure that has been compared to a tap in the eye.
The eyeWatch includes an implant inserted through the skin at the front of the eye that is then connected to a drainage tube that carries excess fluid to the back of the eye to be reabsorbed. A built-in mechanism allows surgeons to open and close the device using a magnetic pen.
“The eyeWatch implant is a drainage system of tubes that drains away excess fluid to lower the pressure on the eye,” Dr Omnia Awadh Hamam, Consultant Ophthalmologist at SSMC said in a media statement. “Relieving pressure helps us stop the progressive loss of vision brought on by glaucoma, which is the main cause of blindness.”
The procedure is one of the more common procedures for implants into the eye and typically takes up to two hours to complete, she said.
“The device cannot aid in restoring the vision that has been lost in glaucoma patients, however, it can help to stop the gradual loss of sight by reducing the pressure on the eye.”
Awareness of glaucoma has grown in recent years. While the condition is most common in people over 40, it can also occur in younger people. Glaucoma is usually symptom-free until it causes irreparable damage to a person’s vision or even blindness.
Early diagnosis of glaucoma is essential, and testing for glaucoma is both quick and painless. Doctors advise everyone over the age of 38 to have their eyes checked as frequently as they check for blood pressure and general health evaluations.
Those who have diabetes may be more susceptible to developing glaucoma. Patients with diabetic eye disease may be hit by sudden, severe attacks of neovascular glaucoma, a particularly severe form of the condition that requires immediate treatment.
Aggressive types
“It is interesting to note that the types of glaucoma seen in patients in the Middle East are a lot more aggressive than glaucoma conditions seen in patients in some other regions. This is mainly because of the higher rates of diabetes. Neovascular glaucoma and pseudoexfoliation glaucoma are the two most common types of glaucoma and are the most severe, said Dr Hamam. She said the eyeWatch procedure treats all types of glaucoma.
The diagnosis of glaucoma and other optical conditions is also improving. An automated artificial intelligence-based screening system, the iPredict, now allows for the screening and early identification of diabetic retinopathy (DR), age-related macular degeneration (AMD), and glaucoma risks.
The system captures high-resolution images of the patient’s eyes with an ocular camera. These are then submitted to the iPredict system and results are available in a fully automated report within 60 seconds. The entire test can easily and reliably be completed within five minutes, the company said.
“This technology could be particularly useful in identifying someone who has slipped across the boundary to progress into severity,” Dr Theodore Smith, Professor in Ophthalmology and Neuroscience at Icahn School of Medicine at Mount Sinai, New York, said.
The product has been approved for use in the UAE and Australia and has also received the European-conformity CE certification, according to a statement from developer iHealthScreen. It is indicated for use by healthcare providers in clinics, hospitals or other healthcare facilities.
“This is a major milestone for iHealthScreen. iPredict eye disease diagnostic tools will help prevent blindness for millions of people and save insurers countless millions of dollars in avoidable healthcare cost,” said Dr Alauddin Bhuiyan, Founder and CEO of iHealthScreen.
AI-enabled vision screening for children
Eye impairments can now be detected as part of their routine check-up for children with the help of a new smartphone-enabled, integrated vision screening application.
GoCheck Kids helps detect vision abnormalities that can lead to learning deficiencies and permanent vision loss, including blindness if not identified early. Launched in February, the app will be rolled out to school health clinics and children’s outpatient clinics at the Emirates Health Services corporation (EHS).
The solution uses photo screening instead of traditional white wall charts. It pairs an iPhone screening app with a data management portal and an image review service. Since it does not require children to be able to read or respond verbally, paediatricians can screen even very young children to ascertain if they need to be referred to an ophthalmologist for further examination.
“Early detection of vision problems for children is an important step in preventing any major future complications,” said Mubaraka Ibrahim, Acting Chief Information Officer of Information Sector at EHS. “The advanced technologies support this approach as they provide the medical staff with accurate and innovative solutions that can detect health problems before they get worse and contribute to treating them more quickly and effectively.”
Aisha Suhail, Director of Primary Healthcare at the Ministry of Health, said the app would enable EHS to perform a new comprehensive vision test for children. “This test has proven its effectiveness in many countries around the world and contributed to treating children at the right time during their growth. This will allow us to treat vision problems correctly and control the damages to the vision.”
More than 6,500 paediatric care team members in the US and Europe use the app for early screening.
