IOO Genetics

How to reach Moorfields

Underground: Old Street - Northern Line

From Old Street Station leave by Exit 8 and follow the green line on the pavement.

The main entrance to Moorfields Eye Hospital in on the left.

Private and overseas patients should continue along Cayton Street and turn right into Bath Street: the John Saunders Suite is the first entrance on the right.

Bus

205, 43, 214 (City Road)

141, 271, 65 (East Road)

245, 55 (Old Street)

393 (Shepherdess Walk)

Train

The nearest mainline stations are Euston and Kings Cross; to reach Moorfields take the Undergound Northern Line to Old Street, a bus (205 from Euston, 214 from Kings Cross) or a taxi.

Professor Bainbridge’s research group is based in the Gene and Cell Therapy Group of the Department of Genetics, UCL Institute of Ophthalmology, and works in close collaboration with Professor Robin Ali FMedSci. 

Our aim is to protect and promote healthy eyesight by research to develop effective new treatments for disorders of the retina. These include inherited disorders, age-related macular degeneration and diabetes. Our research projects extend from the laboratory investigation of basic mechanisms of disease, through experimental models to the preclinical development of novel molecular therapies and clinical trials.

Retinal disease is a major research priority

Disorders of the retina are responsible for sight loss in the 2/3 of people with eye disease in the UK and are a priority target for Moorfields’ research strategy. Age-related macular degneration (AMD) affects 1.5 million people today and is likely to affect 1.8 million by 2020. Diabetic retinopathy affects ¾ million now and is expected to affect 1 million in 2020. Retinal disease in childhood is another key priority because it currently causes lifelong disability but may be particularly amenable to novel interventions; successful proof-of-principle for new treatments in inherited childhood blindness is expected to accelerate their application to common retinal disorders of aging. 

A new era of molecular therapy in retinal disease

Physical treatments, including laser or standard surgical techniques, have been the mainstay for management of retinal disease for decades. However, these approaches are effective for only a minority of conditions and until recently the majority of blinding retinal diseases were essentially untreatable. Systematic research in recent years has led to an improved understanding of the causes of common blinding retinal disease. This is now enabling the identification of targets and opportunities for therapy. The development of rationally-designed biological, gene and cell therapies, together with rapid advances in technology for the diagnosis of retinal disease and its progression have introduced a new era of intervention. The development of targeted therapeutic antibodies, for example, is having a major impact on the outlook for people with macular degeneration and diabetes.  At Moorfields we have demonstrated proof-of-principle that gene therapy can improve sight in childhood blindness and are translating preclinical success in cell transplantation into new interventions for people with retinal degenerations. 

The retina is uniquely suited to targeted intervention

Ocular tissues can be targeted precisely using modern microsurgical techniques. Furthermore, we are able to measure the impact of intervention in the living human eye non-invasively by optical imaging at an extraordinary level of cellular and molecular detail. These features account in large part for the recent successful proof-of-concept of new molecular interventions for retinal disease that have demonstrated remarkable progress in ophthalmology. Moreover, the eye is now widely recognised for its value in investigating pathological neuro-degenerative and microvascular disease, and as an important model system for developing novel interventions.

Professor Bainbridge’s research group is based in the Department of Genetics, UCL Institute of Ophthalmology www.ucl.ac.uk/ioo and works in close collaboration with Professor Robin Ali FMedSci

Posterior vitreous detachment

Posterior vitreous detachment (PVD) is a common condition that affects the majority of people with increasing age and is normally harmless.

The vitreous is an optically clear, gel-like tissue that fills much of the eye. In youth the vitreous is firmly applied to the retina, which is a sheet of light-sensitive nerves essential for sight.

With increasing age the vitreous typically becomes less cohesive and peels away from the retina. The process of vitreous detachment can proceed rapidly or very slowly. Many people experience no symptoms.

Floaters

Debris within vitreous that has detached from the retina floats in front of the retina casting shadows that are perceived as ‘floaters’. Floaters can take many forms including ‘flies’, lines, circles, clouds or ‘cobwebs’. Floaters can sometimes interfere intermittently with the ability to read clearly. Floaters can persist for some months but generally become less noticeable given time.

Flashing lights

As the vitreous detaches from the retina, mechanical stimulation of light-sensitive nerves is perceived as flashing lights (‘photopsia’). Flashing lights typically resolve once the process of vitreous detachment is complete.

Retinal tears and retinal detachment

Occasionally, traction of the vitreous at points of firm attachment to the retina can cause tears in the retina. Even small retinal tears can bleed into the vitreous, causing dense floaters, and can allow fluid in the vitreous to leak behind the retina causing detachment of the retina that threatens sight. Retinal detachment is typically perceived as a dense ‘shadow’ or ‘curtain’ that progressively obscures the sight in one eye.

The onset of new floaters, flashing lights or loss of vision justifies prompt specialist assessment to exclude sight-threatening retinal tears or detachment.

Treatment of retinal tears and retinal detachment

If recognised promptly, retinal tears can often be treated effectively using laser alone. Retinal detachment can usually be repaired effectively by surgery, which typically involves removal of the vitreous (vitrectomy), laser treatment to seal the tear, and injection of a bubble of temporary gas to keep the retina in place while it heals.

Vitrectomy surgery

Vitrectomy surgery is keyhole surgery involving removal of the vitreous gel to enable repair of retinal disorders including tears and detachment. The vitreous is replaced by fluid.

Vitrectomy surgery can be performed using local anaesthetic, sedation or general anaesthetic. Daycase surgery is routine but an overnight stay in hospital can be convenient for some people.

A bubble of gas may be injected to support the retina while it heals. A specific position may be advised to make the best use of the bubble. The presence of gas obscures sight but, as the bubble is absorbed during a period of 2 to 6 weeks, sight can be expected to improve. Normal activities  and air travel can be safely resumed once the gas bubble has been fully absorbed.

Discomfort and redness are common during recovery, especially if stitches have been used. Eyedrops are routinely prescribed for up to 4 weeks to help minimise inflammation and prevent infection. An eye shield may be used at night for comfort if desired.

Sight and comfort can be expected to improve progressively. Most people return to the clinic for routine review 1-2 weeks following vitrectomy surgery.

Deterioration in sight or comfort following surgery justifies urgent specialist advice.