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Early diagnosis is key in glaucoma, says expert

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A leading eye surgeon is warning that two million people are at risk of losing their vision to a condition often dubbed the ‘silent thief of sight’.

As part of World Glaucoma Week (March 12-18), Newmedica ophthalmologist Mr Velota Sung is highlighting the dangers of glaucoma – the leading cause of irreversible blindness worldwide – and stressing why early diagnosis through routine eye tests is key. 

With the NHS under increasing pressure, and ophthalmology being the busiest outpatient department, community opticians and ophthalmologists are well placed to support the NHS in the fight against glaucoma. 

Glaucoma is a name for a group of eye conditions that cause gradual damage to the optic nerve and can ultimately lead to loss of vision if not treated.

Currently, as many as half of all cases of glaucoma go undiagnosed. If this continues, the Royal College of Ophthalmologists anticipates a 44 per cent increase in demand for glaucoma services by 2035.

Ophthamology attendances made up almost nine per cent of all NHS hospital outpatient appointments in 2019/20.

But only 64 per cent of ophthalmology patients were seen within an 18-week timeframe during the first five months of 2022 – 18 weeks being the maximum waiting time set out in the NHS constitution.

Mr Sung is Newmedica Glaucoma Lead, co-founder of the UK Paediatric Glaucoma Society, and a consultant at Birmingham and Midland Eye Centre, one of the biggest eye hospitals in the UK. 

He said: “In an overwhelming number of cases, people never know they have glaucoma because it develops slowly. Typically, there are no symptoms initially. You might experience dimmer periphery vision, but our brains are so brilliant they fill in the gaps for us. Up to 50 per cent of a person’s vision could be lost and they wouldn’t notice they had a problem.

“Early intervention is essential if we’re going to cut down the risk of irreversible vision loss due to glaucoma. We therefore need a coordinated approach.

“One of the best ways to detect if you have glaucoma is by going for an eye test with an optician every two years, or more regularly if you’re in an at-risk group. If an optometrist detects signs of glaucoma they will refer you to an ophthalmologist who can coordinate treatment.”

The biggest risk factor is age. Glaucoma is most common in adults in their 70s and 80s. But you’re also at higher risk if you have a parent or sibling with it, are from African, Caribbean or Asian descent or if you suffer with another medication condition such as diabetes.

Among the well-known people affected by glaucoma have been U2 frontman Bono, actress Whoopi Goldberg, former astronaut and US senator John Glenn, and the King of Rock ‘n’ Roll, Elvis.

Mr Sung, an examiner for the Royal College of Ophthalmologists and holder of the Bronze National Clinical Excellent Award, added: “People shouldn’t think ‘that won’t happen to me’, because one in five people will suffer from sight loss in their lifetime and glaucoma is the biggest cause. We know one in five people don’t go for regular eye tests, so it’s very important that we all do if we’re to reduce our risk.

‘Glaucoma is not a disease you can cure. It’s something you have to manage, often with eye drops. Catching it early is key because these drops can slow the progression of the disease.’

Newmedica works with the NHS, GPs and opticians to help treat and manage a range of advanced eye conditions in communities, providing swift access to care and taking some of the pressure off busy NHS waiting lists. In 2022 Newmedica treated more than 16,000 glaucoma patients and 200,000 patients in total across its 28 sites across England.

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Alzheimer’s expert on bridging the gap between ‘bench’ research and the community

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“Imagine it’s construction season in Michigan. Normally, it might take you 10 to 15 minutes to get from point A to point B.

“But when there is construction, it slows you down, now taking 15 to 20 minutes. And if the highway is closed, it might take you even longer.”

Irving Vega is describing what happens when cells in the central nervous system stop working or die.

More commonly known as neurodegeneration, its devastating consequences affect countless millions of people worldwide.

Alzheimer’s and Parkinson’s are perhaps the two best-known neurodegenerative diseases. But the disorder is also responsible for Huntington’s disease, Amyotrophic lateral sclerosis (ALS), and motor neuron disease, amongst others.

Expanding on his building analogy and how such work can slow down the flow of traffic, Dr Vega says: “That’s what happens in a brain that is undergoing neurodegeneration. The streets start to close, and it takes longer and longer to reach that memory to a point that you don’t have any alternative route to get from point A to point B, and that memory is completely gone.

“For some individuals, they can live all their life with those pathological hallmarks in their brain and never have clinical presentation. For others, they have the clinical presentation at 70.

“But it’s not because they developed it when they were 70. They probably were developing that since they were in their 40s.”

The likelihood of developing a neurodegenerative disease rises dramatically with age. And as life expectancy increases, more people than ever are predicted to be affected by such diseases in the coming decades.

Improving our understanding of what causes neurodegenerative diseases and developing new approaches to understanding, treating and hopefully one day preventing them, has been Dr Vega’s life work.

Dr Irving Vega. Image: MSU College of Human Medicine

A neuroscientist at Michigan State University (MSU) in the US, he spends much of his time in his laboratory studying the impact of certain proteins on the development of neurodegenerative disorders, most notably Alzheimer’s.

But when he’s not conducting research, Dr Vega makes time to engage with students about their interest in science. and to go out into the community to talk about Alzheimer’s, a cruel and insidious disease which currently affects around 55 million worldwide and mercilessly robs patients of their memories, social skills, independence, and eventually their life.

He says: “I’ll go to the Hispanic Centre. I’ll go to the school system in Grand Rapids. I’ll go anywhere they invite me.”

The associate professor in the Department of Translational Neuroscience at MSU, adds: “I believe it’s important to build that bridge of communication between researchers and members of the community so that we can provide access to the new knowledge that we develop.”

While that outreach often happens in West Michigan, Dr Vega also collaborates with institutions elsewhere.

“I want to bring attention to the importance of building a bridge of communication between researchers and the community so that, in a way, we are actually better informed on what the important questions are that are relevant for the community so that we can go back to the bench and then do our research,” he explains.

Dr Vega obtained his undergraduate degree from the University of Puerto Rica at Mayagüez on the Caribbean island where he was born and raised. He was a National Institutes of Health Maximising Access to Research Careers, or MARC, fellow.

He then earned a doctorate from Rutgers University in New Jersey, and completed his postdoctoral fellowship in the Department of Neuroscience at the Mayo Clinic in Jacksonville, Florida, where he developed his research career focusing on the pathobiology of Alzheimer’s disease.

Dr Vega developed his interest in working with the community during his time at the University of Puerto Rico’s Rio Piedras campus, where he rose through the academic ranks from assistant professor to assistant dean of research.

In addition to his analysis work, Dr Vega grew an undergraduate training programme to enhance diversity in neuroscience and after joining MSU in 2014, he continued with both his research and his interest in mentoring students and reaching out to the community.

In 2022, Dr Vega was recognised as a Red Cedar Distinguished Faculty for his community-engaged research.

Located on MSU’s Grand Rapids campus, Dr Vega’s laboratory focuses on three main areas.

First, the researchers study the mechanisms that cause tau proteins – which help stabilise the internal structure of neurons in the brain – to clump together, leading to toxicity within the cells that house them.

It was this team that in 2019 identified the tau protein EFhd2 – a novel amyloid protein associated with pathological tau in Alzheimer’s disease. They are currently evaluating the role this protein plays with Alzheimer’s disease to establish models that could be used to test potential therapeutics against tau aggregation.

The second focus of Dr Vega’s lab is investigating the potential links between intestinal bacteria changes, inflammation, and Alzheimer’s disease.

A third area of focus is the development of better diagnostic tools for Alzheimer’s disease. Dr Vega and his colleagues are currently looking at non-invasive methods to detect biomarkers (such as the tau protein); checking whether race and ethnicity affect those levels; as well as looking to identify new biological molecules that could eventually lead to better diagnostic tools.

Dr Vega and his team never lose sight of the fact that Alzheimer’s disease is more than just a strand of research and that in America alone it affects 6.7 million people. He says that in Michigan alone it’s forecast 220,000 people will be living with the disease by 2050.

He says the illness disproportionately affects communities of colour.

“We know that people in the Latino community are at a higher risk of developing these illnesses, but we don’t know exactly why.”

Dr Irving Vega in his lab at MSU’s Department of Translational Neuroscience. Image: MSU College of Human Medicine

He adds that while there’s consensus on the risk factors – metabolic disorders, diabetes, high cholesterol, hypertension – contextual or social factors related to ethnic and racial health disparities are less clear.

About 13% of Hispanics older than 65 have Alzheimer’s or another type of dementia. And Hispanics are 50% more likely than their peers to develop Alzheimer’s or other types of dementia.

“There are a lot of barriers to access health care. There are barriers to accessing healthy food. There are barriers to quality education. There is discrimination, and there is higher social stress due to discrimination,” he says. “The high levels of stress lead to biological changes in the individual.”

He admits that coming up with solutions is not easy.

“We know what is very good for your brain: exercise, good quality of sleep, a healthy diet. For underserved populations there are things that prevent people from doing exercise. There’s no safety on the roads or at the park. Sometimes they have two jobs and no time to exercise. Maybe they are not eating well or sleeping well. There’s a lot of things that we can do to reduce the risk, but we have a huge fight against us to achieve health equity.”

Dr Vega recently presented his research in front of 35 community members at the request of the Catholic Diocese of Grand Rapids.

He talked about how the brain works, the different regions of the organ that are responsible for different tasks, and how they coordinate with each other to produce an outcome.

Then, he discussed neurodegenerative diseases, their risk factors and how to mitigate them. Hence his drawing on the construction analogy; a relatable comparison highlighting the raw horror of cognitive decline, as patients’ families and friends are forced to watch the comprehensive disintegration of their loved one’s brain.

Dr Vega says: “Once I get to that part of my presentation, people start asking ‘How I can reduce my risk?’

“This is the third part of my talk — explaining how you can reduce your risk of developing these diseases. If you sleep well, this is what happens to your brain. If you eat well, this is what happens to your brain. If you exercise, this is what happens to your brain.”

He says community members enjoy having researchers explain their work to them. He believes researchers stay inside their lab to their own detriment.

“Sometimes by not being connected with the community and people living with the diseases that we’re trying to understand, we miss a lot of points and references on how these diseases affect people in different ways and the risk factors that contribute to them.”

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NIHR Dementia TRC appoints new leaders

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The incoming chair of an internationally renowned, UK-based dementia research network has said it is critical experts “seize the moment” and pool their knowledge to enhance patients’ chances and accelerate the launch of new treatments.

Dr Catherine Mummery is set to take over the helm of the National Institute for Health and Care Research (NIHR) Dementia Translational Research Collaboration (D-TRC).

Joining her as joint deputy chairs at the alliance will be NIHR Newcastle’s Biomedical Research Centre theme lead, Professor John-Paul Taylor, and Dr Vanessa Raymont, director of research and development at Oxford Health NHS Foundation Trust.

The new leaders will spearhead the next five years of clinical dementia research development and delivery, bringing together top experts in the field and guiding pioneering translational exploration into the syndrome – a key part of the Dame Barbara Windsor Dementia Mission launched in August 2022 in the late actresses memory to speed up the growth of treatments and contribute to the Government’s goal of doubling funding to £160m by 2024/25.

Dr Catherine Mummery

Speaking about her appointment Dr Mummery, who leads the cognitive disorders service at the National Hospital for Neurology and Neurosurgery in London, and is head of novel therapeutics at the Dementia Research Centre at UCL, said: “This presents a unique and timely opportunity to make the UK a global leader in early phase clinical trials in dementia.

“We are entering a new era in potential treatments for AD and other diseases. It is critical we seize the moment and come together as a community to speed up therapies and optimise chances for our patients.”

The D-TRC works within the national network of NIHR Biomedical Research Centres, along with clinical research facilities and members of the devolved nations. The new leadership team will also collaborate with the charities Alzheimer’s Society and Alzheimer’s Research UK.

Dr Mummery will be taking over from Professor David Burn, the Pro-Vice-Chancellor of the Faculty of Medical Sciences at Newcastle University, who has been critical in building momentum and galvanising the D-TRC over the last 12 months by leveraging research-related grant funding. During that time £7.17m has been channelled by the D-TRC into new dementia research.

Professor Burn, who has an international reputation for research in dementia associated with Parkinson’s, provided expert input into the All Parliamentary Group on Dementia. He also offered his expert advice to the Department of Health and Social Care on the ‘Dementia Moonshot,’ the British Government’s 10-year plan to increase funding to tackle the syndrome, which currently affects around 900,000 people in the UK.

UK patient numbers are expected to exceed one million by 2030 and 1.6 million by 2050.

Professor John-Paul Taylor

Professor Taylor comes to his role as joint deputy chair having published over 200 peer reviewed articles and edited two books in the field of dementia and old age psychiatry. Currently acting as the chief investigator for the NIHR HTA COBALT trial assessing the clinical and cost-effectiveness of memantine in patients with dementia and Parkinson’s disease, he said creating a pathway for people living with an ongoing decline of brain functioning to take part in observational assessments, is important to him.

“At the moment, approximately less than one in 100 people living with dementia take part in dementia clinical trials in the UK. Addressing this challenge is critical to discovering new and effective treatments.

“As joint deputy chair of the Dementia TRC, I am immensely excited that I can contribute to this fantastic initiative. It means that, at scale, we will be able to offer many more people living with dementia the opportunity to take part in meaningful clinical trials.”

Dr Raymont added: “Being appointed to the role of joint deputy chair of the Dementia TRC is a huge honour. Looking back on my experience of dementia research over the last 30 years, this is truly an exciting time.

“I look forward to working with my colleagues in the Dementia TRC and beyond, to bring the amazing infrastructure we have in the UK together to further clinical trials.”

Dr Vanessa Raymont

Dr Richard Oakley, associate director of research at Alzheimer’s Society said he welcomed the new appointments and “the increase in investment that this vital piece of the UK clinical trial infrastructure is going to receive.

“The benefits of hosting clinical trials are convincing. In 2019, the total estimated income for the NHS from delivering commercial clinical trials across all disease areas was £355m.

“A growing industry pipeline in dementia means this is an area of huge opportunity for UK clinical research. We are at a turning point in the fight against dementia. Now is the time to invest in clinical research.”

Dr Oakley’s support for the appointment has been echoed by David Thomas, head of policy at Alzheimer’s Research UK. He said: “We are delighted that Cath, John-Paul and Vanessa are taking on these roles. I know that they have the skills and experience to maximise this opportunity. They will aim to raise the UK’s profile in dementia clinical research on a global stage. We look forward to working with them on this important agenda.

“There is an urgent need to futureproof the UK’s clinical trial capacity and infrastructure. This is essential for attracting industry investment to the UK and increasing the number of people with dementia who take part in trials.”

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