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Glaucoma is one of the major causes of blindness world-wide and is characterised by visual loss arising from death of retinal ganglion cells. One important form, angle-closure glaucoma, is particularly prevalent in Asia. Based on experience of large-scale epidemiological surveys, UCL researchers devised a classification for angle-closure glaucoma that has become the international standard for this condition. The research been used as the basis for the development of the current framework for the management of angle-closure glaucoma, informing the development of both new and revised guidelines used around the world.
Glaucoma affects around 2% of people over 40 years of age and almost 10% of those over 75. There are more than one million glaucoma-related outpatient visits to hospital eye services annually. Once lost through glaucoma, sight cannot be restored. Therefore early detection (mainly by optometrists) and appropriate management of the condition are crucial to maintaining a sighted lifetime. Uncertainty and variation exist in clinical practice and service delivery. Research undertaken by academic staff at City University London has led to:
In addition, City research on the scope of therapeutic practice by optometrists and the development of clinical management guidelines (CMGs) strongly influenced the decision to extend independent prescribing to optometrists. CMGs developed at City were incorporated into the Map of Medicine and other national ophthalmology primary care pathways. Research on a repeat-measurement-enhanced glaucoma scheme generated a National Institute for Health and Care Excellence (NICE) Quality, Innovation, Productivity and Prevention (QIPP) Case Study and informed Joint College Commissioning Guidance on Glaucoma and Local Optical Committee Support Unit (LOCSU) schemes. City's Standardised Patient research, where actors play the role of patients to collect evidence on actual clinical practice, is unique in optometric research and has been referred to by experts and relied upon in the defence of optometrists' actions in several clinico-legal cases before the General Optical Council.
Fundus autofluorescence imaging has transformed understanding of retinal disease and brought enormous benefit to millions of patients world-wide. By visualising what is predominantly a lipofuscin signal from the retinal pigment epithelium, retinal diagnosis is now much more sophisticated, therapy can be better targeted to an individual patient's needs and clinical trials can use area of loss of autofluorescence as an outcome measure. Certain inherited retinal disorders have distinctive patterns of altered fluorescence and ageing changes can be followed with much greater precision. A global industry has built up around the devices required to image retinal autofluorescence safely.
Recent advances in MRI brain scanning developed at the UCL Institute of Neurology have underpinned major improvements in the surgical treatment of epilepsy. Information about the location of critical brain structures, such as the optic radiation that carries visual signals, and language areas of the brain, are used to identify the risks of neurosurgery in specific individuals. This helps to inform patient choice and to reduce the risk of loss of any part of the visual field or language when performing the surgery. UCL's pioneering use of these imaging techniques during surgery, with correction of the movement of the brain that occurs during surgery, showed that this approach reduced the occurrence of serious loss of vision to zero. This information is now used in epilepsy surgery every week at the National Hospital for Neurology and Neurosurgery and is being rolled out to other centres.