Looking to the future

On Friday evening, when I spotted the headline, ‘Robot operates inside eye in world first’, I was obviously intrigued and so naturally clicked on the link to have a read.  I was immediately engrossed.  The article reported that a team, led by Professor Robert MacLaren at John Radcliffe Hospital in Oxford, had used a robot in performing surgery to remove a membrane from the eye of a 70-year-old man.  The membrane had grown at the back of his eye, causing a hole in his retina and thereby destroying his central vision in that eye.  As I well know, this type of surgery would normally involve instruments being inserted into the eye and operated by hand.  Apparently, use of the robot involved the surgeon using a joystick and touch-screen to guide a thin needle into the eye, using a microscope to monitor its progress.  The tiny movements required for the intricate surgery at the back of the eye were achieved by the surgeon making large movements with the joystick.

I was very excited to read Professor MacLaren’s explanation: “Normally when we do this operation by hand we touch the retina and there is some haemorrhage but when we used the robot the membrane was lifted cleanly away.”  My excitement grew, as I read his comment, “We can certainly improve on current operations, but I hope the robot will allow us to do more complex and delicate operations that are impossible with the human hand.”  This made me think that perhaps, as using the robot is more accurate, surgery performed in this way could potentially result in less inflammation, thereby reducing the likelihood of development of PVR.  Since I’ve read that PVR is the main cause of failure of retinal reattachment surgery (and it’s certainly the case for me, unfortunately), this would be an impressive breakthrough!  Of course, I have no idea whether this would actually be the case, but it seems logical.

My excitement rapidly transformed into a slight feeling of queasiness, as I went on to read that the robot is also ‘able to filter out hand tremors from the surgeon.’  HAND TREMORS FROM THE SURGEON?!  I’ve had three vitrectomies under general anaesthetic and two under local.  For the latter, I was most concerned about keeping my head still.  I never even considered the possibility of worrying about potential HAND TREMORS FROM THE SURGEON!  [Shudders]  Great.  So now that’s just one more teeny little thing to worry about when the dreaded occasion of surgery number six comes along.  [groaning internally]  Still – maybe they’ll have perfected the robot by that time.  I can but hope.

I digress, but nevertheless appear to have meandered back to the main point, which is… hope.  From what I’ve read in the past couple of years, my main hope for the future of RD treatment has been in potential advancements in stem cell therapy.  I know that Professor MacLaren is also involved in research into gene therapy, as well as work on the so-called ‘bionic eye’, or retinal implant, which made the news earlier this year.  I was somewhat less excited about the retinal implant upon realising that it relies on an attached retina and a fully functioning optic nerve.  However, it was still fascinating to read about it.  I also found it incredibly moving to watch film footage of the lady with Retinitis Pigmentosa who had been fitted with the implant managing to read the time on a clock face after almost six years of blindness.

Another subject of research I’ve read about with interest has been the discovery in the US that a certain chemical could be used in eye drops to ‘dissolve’ cataracts.  As cataract surgery is commonplace and highly successful these days, this might not seem like such a big deal.  But it still requires a surgeon and an incision, and so there’s a subsequent risk of infection as well as a risk – albeit a small one – of retinal detachment following cataract surgery.  It would surely make everything so much easier if the cataracts could simply be ‘dissolved’ using eye drops.

One of the most difficult aspects of dealing with a serious eye condition which can lead to sight loss is the accompanying and relentless sense of fear.  Fear of what the future may hold; fear of losing independence; fear of blindness.  Reading about such fantastic advances in research and potential treatments of the future is hugely encouraging and helps to counteract a little bit of that terrible fear.  I really hope that such research will continue to progress well and that one day blindness might even become a thing of the past.

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