New and emerging treatments for corneal disorders

The National Institute for Health Research (NIHR) Horizon Scanning Research and Intelligence Centre (HSRIC), working with Fight for Sight, has identified 130 new and emerging technologies and procedures for treating corneal disorders. Together, they have the potential to help thousands of people with conditions such as keratoconus. However the report reveals a lack of developments for the leading causes of sight loss in corneal disorders and main reasons for corneal transplant.

At the moment the only way to treat severe corneal disorders is by surgery to transplant a donor cornea. The UK Transplant Registry recorded almost 4000 such operations in 2015-16. But there is a shortage of donors and transplants mean patients must take lifelong immunosuppressants. So there is a real need for more options.

Fight for Sight, the main UK charity dedicated to funding pioneering eye research to prevent sight loss and treat eye conditions, was keen to help support NIHR. In 2012-13, the charity co-ordinated the Sight Loss and Vision Priority Setting Partnership (PSP) in association with the James Lind Alliance (JLA). The aim was to set priorities for eye research according to the questions patients, relatives, carers and eye health professionals would most like to see answered. It was the first major consultation in this area.

Top of the priorities for corneal disorders was to find out whether new therapies such as gene or stem cell treatments can be developed. The current horizon scan for new and emerging treatments was conducted to address this question.

NIHR searched a wide range of electronic sources including scientific publication databases, clinical trial registries, industry news sites, licensing bodies and ophthalmology organisation websites. They also contacted clinical experts to suggest technology developments that they were aware of, and for their opinion on what we found. Fight for Sight facilitated patient focus groups to incorporate their thoughts.

Tracey Genus, Analyst at NIHR HSRIC said:

“It’s clear that a wide range of technologies for corneal disease is under development at the clinical stage. However many are in development outside of Europe and may take time to reach the NHS, if indeed they do.

“And while there were plenty of developments for astigmatism, more needs to be done to address conditions such as Fuchs endothelial dystrophy and post-cataract surgery corneal oedema. These are major causes of sight loss and of the need for corneal transplant. Around 1 in 3 and 1 in 5 transplant surgeries respectively are due to these conditions.”

Carol Bewick is Fight for Sight’s Director of External Affairs. She said: “We have learned from the focus groups on corneal disorders that safety, immediate- and long term risk to sight and risk of rejection are the key concerns for patients. This is something that everyone developing technologies needs to keep in mind.

“The Sight Loss and Vision Priority Setting Partnership was all about making sure that eye research can address the questions that are most important for the people who experience visual impairment every day. We think it’s vital to keep that involvement going as we try to answer the PSP questions.”

The full report and a 2-page summary are available on the NIHR HSRIC website.