1. Cataract

1.1 We have developed a prioritisation system to help the scheduling of patients for cataract surgery.

1.2 Routine measurement of cataract outcomes demonstrates that those achieved at Moorfields NHS Trust exceed national standards.

1.3 A Cataract Unit is being developed for St Anne's Outreach, enabling fast-track cataract surgery to be conducted. This incorporates the extensive use of clinical guidelines developed at Moorfields NHS Trust so that primary care professionals are involved at every stage from direct booking to after care in the community. This model of care is to be replicated at other outreach units. As part of the St Annes unit a cataract phenotyping research centre is being developed to identify different models of cataract development.

  2. Glaucoma

2.1 Research in outreach clinics focusing on optometrist's ability to diagnosis glaucoma in primary care has identified potential weaknesses that can be improved with additional training.

2.2 The incorporation of telemedicine in outreach clinics has demonstrated an important role for this form of communication and identified a potential contribution to co-management of chronic disease between the Community and the Hospital Eye Services.

2.3 The glaucoma service has identified new genetic abnormalities in primary glaucoma, pointing the way for genotypic diagnosis to assist in both pathogenesis and prognosis. The genes for primary glaucoma will soon account for a sufficiently large percentage of this population in the UK to make genetic screening a helpful adjunct in management.

2.4 Longitudinal imaging studies in glaucoma patients and glaucoma suspects have identified both the limitations and the potential for this approach in management of chronic glaucoma.

2.5 Clinical and laboratory studies in glaucoma surgery have been designed to reduce the adverse events while maintaining good disease control.

  3. Age Related Macular Degeneration

3.1 Cross sectional and longitudinal studies of phenotypic variants of ARMD have allowed better classification of this group of diseases, with each possibly requiring different therapeutic approaches.

3.2 A preliminary study of photodynamic therapy has confirmed the limitations of its usefulness.
3.3 Laboratory studies in viral transfection of genetic material have shown the possibility for the correction of genetic defects in inherited retinal degenerations.

3.4 Surgical approaches to macular degeneration are currently being evaluated. These involve retinal rotation whereby the unhealthy retina is displaced from the foveal region, to be replaced with healthy tissue. This too may provide an appropriate therapy in selected patients with ARMD

3.5 Rehabilitation plays a significant part for patients with macular degeneration. We have an active research programme investigating new methods to enhance the role of viable retina in this condition, allowing patients to maintain visual independence.

  4. Inherited Retinal Disease

4.1 The programme of research in this field has had an impact on clinical management. Knowledge of the gene or gene locus allows full identification of the distribution of genes within a family, which is crucial to genetic counselling. The characterisation of the phenotype permits a more accurate prognosis to be made. Through the register a precise diagnosis can be made in a few minutes in a family new to us if it can be recognised as part of a pedigree known to us. In addition the gene or gene locus may be identified. Potentially, this can generate maximum benefit to management of current research.

  5. Diabetes

5.1 The Trust is collaborating in the development of screening programmes for diabetes, in line with the National Service Framework. Images are being assessed by the Trusts 'Reading Centre' to ensure quality control as well as adequate throughput.

  6. Cornea

6.1 The Trust has become a national referral centre for stem cell research, whereby laboratory techniques are being developed to identify the problems behind 'corneal surface disorders' and assist in their regeneration. A part of this work is directed towards contact lens wearers.