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9.39 pm
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): I congratulate my hon. Friend the Member for Bolton, North-East (Mr. Crausby) on securing the time for this debate. I hardly need say that sight, and the risk of losing it, is an important subject. Age-related macular degeneration--or AMD--affects about 500,000 people in the United Kingdom, mainly, but not exclusively, the elderly.
Before I enlarge a little on what my hon. Friend has told us about the origins and effects of AMD, I join him in paying tribute to the voluntary organisation that he mentioned in his constituency. The national health service owes much to support given by interest groups that are often formed by the sufferers of particular diseases. Therefore, I extend my appreciation to the work of the Bolton Macular Disease Society.
I shall say a little about the Government's position on possible advances in the treatment of AMD. We have already demonstrated the priority that the Government attach to the eye care of the elderly by the reintroduction of free sight tests for everyone aged 60 or over, but we need to make sure that the national health service stays sensitive to new advances in the treatment of eye disease and can quickly identify the people who might benefit from them.
AMD is the most common cause of sight loss in people over 60. Although it is severely disabling--my hon. Friend described the condition graphically--it seldom leads to complete sight loss because only the central vision is affected. That means that most people with macular degeneration should have enough side vision to maintain a degree of mobility and independence.
I know that some concerns have been expressed that AMD is becoming more common among younger or middle-aged people. In fact, we have always known that people in their 40s contract this condition--congenital sight defects, glaucoma, diabetic retinopathy and AMD each account for about 10 per cent. of people registered blind under the age of 64. However, we are not aware of those figures changing significantly. AMD in particular, and loss of sight more generally, remain in most cases diseases of old age. Out of 300,000 people registered blind or partially sighted, two thirds are over the age of 75.
As macular degeneration is an age-related process, it often involves both eyes, although they may not be affected at the same time. Some people find that their visual cells simply stop working, with an effect--as my hon. Friend described it--a bit like the colours fading in an old photograph. That is known as "dry" degeneration. The dry type is the more common form--we estimate that it affects almost 90 per cent. of those with AMD. The onset of this condition tends to be slow and both eyes are usually affected symmetrically.
Vision tends to deteriorate gradually and the loss is not always severe. Unfortunately, there is not yet a proven treatment for the condition, but the worst effects can be alleviated with low vision aids such as magnifiers, telescopes and, increasingly, closed circuit television cameras that project an enlarged image on a display in front of the patient's eyes. Better lighting and large-print books can also be helpful.
The other type of macular degeneration is known as wet degeneration. It is less common--we estimate that it affects about 10 per cent. of patients with AMD--but it tends to have a more severe and rapid effect on the central area of vision. Blood vessels from one layer at the back of the eye grow in an abnormal fashion into the macular area. These blood vessels may leak or bleed causing a rapid and significant reduction in central vision. That tends to affect one eye at a time, but there is a risk of the same thing occurring in the other eye over the following months.
About 10 per cent. of people with wet AMD--in other words only a very small proportion of all AMD sufferers--might be suitable candidates for laser treatment. It is normally successful only if the condition is picked up early, and even then not all patients are suitable. Unfortunately, with laser treatment there is also the risk that lesions may continue to progress and that vision may become even worse after the treatment.
I am happy to say that, as my hon. Friend suggested, research is under way into a process that offers exciting prospects of increasing the accuracy and effectiveness of laser treatment. The treatment is known as photodynamic therapy and involves the use of a photosensitive dye, which, when activated in the back of the eye by a light source, closes abnormal retina blood vessels. The underlying abnormal blood vessels should then be easily identified and selectively destroyed without damaging the overlying sensory retina.
That research project, which is being conducted at the St. Paul's eye unit in Liverpool, is due to take two years and is now in its second year. As my hon. Friend said, the results so far are promising, but the key test will be whether the treatment offers real and, above all, lasting improvements to the patient's sight.
If, as we all hope, the outcome of the research is positive, we will, as my hon. Friend has emphasised, need to consider carefully whether that means that laser treatment could be provided more widely than it is now. How that consideration should best be done depends in part on the exact outcome of the research. The Government have established a new process for evaluating developments in medical science, and one option would be to ask the National Institute for Clinical Excellence to evaluate the new treatment. Whatever the process for evaluating the research, I can assure my hon.
Friend that it will be as quick and as thorough as it needs to be for the welfare of AMD patients and the NHS as a whole.I would not want to leave my hon. Friend or the House with the impression that the photodynamic project is the only research into AMD. There are no fewer than 19 projects looking at AMD and another 47 which have considered promising options such as sub-macular surgery have recently been completed. I sincerely hope that some of that research leads to more effective treatments for what is a very distressing condition.
If the treatment were endorsed, the next step would be to ensure that the people who might benefit from it were identified and referred as promptly as possible. The measures that we took last year to extend the eligibility for free NHS sight tests to people aged over 60 will be an excellent start.
Ophthalmic opticians, whom I know prefer to be known as optometrists, have practices on almost every high street. When testing someone's sight they are also required to conduct an examination of the health of the eyes. Opticians can already identify the signs of AMD and, with additional advice and training, could single out the cases of wet AMD that might be susceptible to the new treatment. I also envisage a system of local protocols with hospital ophthalmology departments to make sure that patients are referred promptly for treatment.
My hon. Friend mentioned the Amsler grid, which may be used in some cases to highlight visual distortions that may be symptomatic of AMD. That test is not a substitute for regular eye tests, which, if carried out at least every two years, should ensure that any signs or symptoms may be picked up in the early stages when treatment can be effective in preventing sight loss.
People under 60 are also eligible for NHS sight tests if they are on low incomes or predisposed to eye disease. Even for those on higher incomes the cost of a private sight test is seldom more than £18. In the past, we have collaborated with the Royal National Institute for the Blind on publicity campaigns encouraging people to have their sight tested regularly, and if it would help we would not hesitate to mount another effective campaign highlighting the risks to sight from AMD and the benefits of early diagnosis and prompt treatment.
We have also recently announced new measures to tackle the wide variations in service experienced by patients with cataracts. We have asked local services to put forward proposals for a slice of the £20 million that has been allocated for the next two years, which will help to modernise eye surgery. We believe that, with the elderly population increasing, improving the standard of eye care will represent a step towards improving the quality of their lives.
I hope that I have allayed my hon. Friend's fears that we may not be sufficiently responsive to advances in the treatment of this sight-threatening disease. Although we all hope very much that the research will fulfil its potential, I say as a note of caution that we cannot prejudge its outcome. If it is positively evaluated, we have the facilities to ensure that those people who might benefit are promptly identified and treated.
- Adjourned accordingly at eleven minutes to Ten o'clock.
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