- Over a quarter of million people suffer from blindness, but most cases are avoidable
- New ultra-precise lasers are faster, safer and yield better outcomes
- Pioneer Josef Bille believes he can wipe out blindness in a decade
- Retina mapping can pre-empt the effects of ageing
A tragedy of blindness is that it is rarely necessary. Of over 250 million people suffering visual impairment around the world, four in five cases are preventable or curable.
Needless suffering on this scale has made blindness a key priority of the WHO, and a growth area for treatment. An expected 32 million cataract operations will take place in 2020, up from 12 million in 2000.
Leading the charge is Dr. Josef Bille, the pioneering scientist who invented eye surgery using laser -- actually an acronym for "light amplification by stimulated emission of radiation" - at his University of Heidelberg lab, and was among the first subjects of the experimental procedure in 1986.
Bille has subsequently gained dozens of patents and launched multiple companies that have together provided the majority of the 280 million laser surgeries carried out in the world to date. He recently received the EPO lifetime achievement award but rather than winding down, the legendary opthalmist is raising his sights once again.
"There shouldn't be any blind person ten years from now in the world," says Bille.
Key to his ambition are femtosecond lasers; ultra-short and focused beams of light that efficiently target the bumps and film of a cataract without any cutting that can cause collateral damage or complications in the healing process.
The lasers are precise enough to pinpoint individual molecules and subtly adjust their focus while leaving healthy material alone. Numerous tests have proved they offer significant safety advantages over existing best practice.
"It's a treatment which can make every eye perfect," says Bille. "We call it perfect vision, it is twice as good as normal vision, so you see twice as fine detail at much better contrast... Five times better contrast vision at dim lighting conditions, rain or in foggy areas."
Perfect Lens, a Californian company that Bille works with, has adapted the cut-free process to plastic for advanced contact lenses, and the scientist expects it to make the jump to "in vivo" - in a living human - within a few years. Technolas, another of his clients, in one of the few companies to offer the femtosecond service.
But Bille's assault on blindness is on several fronts. Development of another of his inventions, "wavefront" scanning, provides a map of the retinas of each patient so that surgeons can tailor their procedure.
The German claims such ultra-detailed scans can provide information that could be used to forestall the effects of ageing.
"There are first signs of deterioration of the functioning of proteins inside the cells twenty years before onset of any detectable micro-morphomatic change in the eye, so we have to look at the 50-year-old patient, and then if you detect it early you can set treatment which interferes with the metabolism of the cell."
Bille's belief in these technologies and excitement about their potential is widely shared in the ophthalmic industry.
"Femtosecond technology has really surged in the past two to three years, with a lot more applications for it," says Laura Straub, Editor-in-Chief of Cataract & Refractive Surgery Today Europe magazine. "Femtosecond cataract surgery is really coming into its own, allowing more precise treatments... and taking out the manual aspect of the procedure."
But while Straub feels femtosecond procedures could have a major impact in the fight against the worst conditions such as glaucoma, its impact could be stalled by prohibitive costs of around $500,000 per unit, with just a handful currently in use.
"The cost is a huge factor, with a 'click fee' (for each use) in addition the system itself... the developing world is not going to have access for some time."
Bille's target of 10 years to eliminate blindness may prove optimistic, with far more basic methods such as early screening used to tackle impairment in many of the worst affected parts of the world.
But since he was told that laser surgery would not work almost thirty years and hundreds of millions of operations ago, the world's leading ophthalmist has always been motivated to "try new things they say couldn't be done."
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