Download Corneal And External Eye Diseases - Sight Loss and Vision Priority

The Sight Loss and Vision Priority Setting Partnership
FORM A: LONG LIST OF UNCERTAINTIES FOR CORNEAL AND EXTERNAL EYE DISEASE
The uncertainties listed on this form have been gathered from a survey and consultation with people affected by sight loss, their
partners, relatives and carers and eye health professionals. The survey submissions relating to corneal and external eye diseases
were checked and formatted into questions. Where there were duplicates, or very similar submissions, these were combined. The
questions below are defined as uncertain because they cannot be answered by an up-to-date systematic review of relevant
research evidence. You are being asked to choose and rank 10 of the uncertainties below. You may wish to choose 10 from a
single category or choose 10 from across a number of different categories. Please see Form B for instructions on this prioritisation
exercise.
There is a glossary of terms at the end of this document.
No.
Uncertainty
DETECTION, DIAGNOSIS & MONITORING
1
Can we improve the imaging of diseased corneas to the level of imaging for other eye diseases?
2
What is the most effective way to monitor severe dry eye conditions?
3
How can we detect early signs of keratoconus?
4
Should children with no symptoms but have a parent with keratoconus be tested for the condition?
5
How is the progress of keratoconus best quantified?
6
Is early detection beneficial for cross-linking treatment to prevent progression of keratoconus?
7
Which individuals should be screened for keratoconus?
CAUSE
8
What causes dry eye?
9
What is the relationship between dry eye condition and multiple sclerosis?
10
What is the genetic bases for a pre-disposition to Fuchs’ corneal dystrophy?
No.
Uncertainty
11
What is the cause of keratoconus?
12
What is the genetic component of keratoconus?
13
Is keratoconus linked to allergies?
14
What is the relationship between the genes of keratoconic, asthma and eczema suffers?
15
What is the relationship between contact lens wear and the development of keratoconus?
16
Do oestrogen levels, of childbearing women, play a role in the progression of keratoconus?
17
What is the relationship between keratoconus and stress?
18
What is the relationship between blepharitis and other eye conditions?
19
What is the cause of blepharitis?
PREVENTION
20
How can we prevent corneal scarring after ocular burns?
21
How can we prevent corneal infections for wearers of contact lenses?
22
How can we reduce the incidence of corneal ectasia?
23
24
Are there any foods or eye exercises that could help to delay the onset of sight loss due to normal ageing of the
cornea?
Can we prevent sight loss connected to shingles in the over 65's?
25
Can dietary measures prevent dry eye?
26
How can we prevent dry eye?
27
What are the risk factors other than environmental factors in the incidence of dry eyes in the younger population?
28
How can we prevent Fuchs’ corneal dystrophy?
29
What life-style factors affect the development of Fuchs’ corneal dystrophy (e.g. diet, smoking, ultraviolet light
exposure in bright sunshine, laser eye treatment for long or short sightedness, etc.)?
How can we prevent pterygium from causing a refractive error which results in blindness?
30
No.
Uncertainty
31
How can we prevent keratoconus?
32
Should people at risk of developing keratoconus be treated with corneal cross-linking?
33
How can we prevent microbial keratitis?
PROGNOSIS
34
What is the likelihood that conjunctivitis can cause blindness?
35
What causes keratoconus to progress and can we prevent progression?
36
Why does keratoconus often only affect one eye?
37
How does a health professional predict the likelihood that a patient with dry eye would benefit from regular use of
tear supplements?
TREATMENT - CORNEAL TRANSPLANTS
38
How can we prevent corneal transplants from rejection?
39
How can we eliminate the risks of failure associated with corneal transplant?
40
41
How can we prevent or treat raised intraocular pressure resulting from the use of steroids following corneal
transplant surgery?
What is the best post-operative drug management regime for corneal transplant patients?
42
What role, if any, does tissue matching play in preventing possible corneal transplant rejection?
43
45
Is it feasible to perform corneal transplant surgery in people with underlying conditions e.g. glaucoma which may
increase the chance of rejection?
What is the likelihood of developing topical, as opposed to systemic, immunosuppressants to reduce the risk of
corneal transplant rejection?
Which type of corneal transplant is best for Fuchs’ corneal dystrophy?
46
What is the most effective way of preventing herpes recurrence in a corneal transplant?
47
Is there any way of ensuring more predictable results for people needing corneal transplants for keratoconus?
44
No.
Uncertainty
TREATMENT - DIET, SUPPLEMENTS, LIFESTYLE
48
What is the effectiveness of Omega 3 fatty acids, zinc and other products in relieving symptoms of dry eye?
49
Can dietary measures, nutritional supplements or complementary therapies affect the progression of keratoconus?
TREATMENT - CONTACT LENSES
50
How can we create more comfortable lenses for keratoconus correction to allow longer wear times?
51
What is the effectiveness of soft contact lenses compared to hard lenses in terms of providing the best vision and
the least trauma?
What is the effectiveness of rigid gas permeable contact lenses for newly diagnosed patients with keratoconus?
52
53
How can keratoconus sufferers who are long term hard lens wearers avoid damage to the cornea as a result of the
lens wearing?
TREATMENT - GENERAL
54
What is the most effective treatment for infective conjunctivitis?
55
Can we develop a non-surgical cure for keratoconus?
56
Is there any treatment to stop the progression of keratoconus?
57
What is the most effective treatment for keratoconus?
58
What is the most effective palliative care for keratoconus?
59
What is the effectiveness of collagen cross linking for keratoconus?
60
What is the role of anti-inflammatories for patients with advanced keratoconus?
61
62
What is the most effective treatment for the suppression of allergies in patients with keratoconus who rely on gas
permeable contact lenses for sight?
Is Keraflex likely to be an effective and low risk treatment for keratoconus?
63
Can we develop a cure for dry eye?
64
What is the most effective treatment for dry eye?
No.
Uncertainty
65
Could investment in psychological support for people suffering from corneal erosion syndrome be beneficial?
66
Is it possible to identify strategies to reduce eye irritation produced by looking at TV or computer screens, for
people with corneal erosion syndrome?
67
Is it possible to measure the progress being made with interventions for corneal erosion syndrome?
68
What benefits are there in using hot compresses to treat a chalazion?
69
How can pterygium be prevented, and/or treated?
70
Would the use of prophylactic lubrication slow down the growth of pterygium in dry or dusty conditions?
71
What interventions are available for the effective treatment of trichiasis?
72
Can iris cysts be removed effectively and safely?
73
74
How can we better manage severe ocular surface disease in children, such as blepharokeratoconjunctivitis and
vernal keratoconjunctivitis?
What is the most efficacious surgical treatment for corneal limbal stem cell deficiency?
75
Do we have a way of reducing corneal scarring caused by shingles?
76
Can we develop a cure for blepharitis?
77
78
What is the most effective treatment to aid sight recovery for dry eyes with corneal scarring in cases of Stevens
Johnson Syndrome?
What is the most effective treatment for blepharitis?
79
How can we improve treatment to save eye sight from microbial keratitis?
TREATMENT - NEW
80
Can we develop artificial corneas to treat corneal disease?
81
Can we develop stem cell treatments for corneal diseases including keratoconus and Fuchs’ corneal dystrophy?
82
Can keratoconus be treated with lasers?
83
Can a gene therapy treatment be developed for corneal diseases such as keratoconus and Fuchs’ corneal
dystrophy?
No.
Uncertainty
84
Is it possible to reshape the cornea to correct the curvature in keratoconus?
85
How can we develop eye drops which would increase natural corneal collagen cross-linking in keratoconus?
86
87
What is the most effective way to maintain health and strength of the endothelial layer for patients with Fuchs’
corneal dystrophy?
Could some sort of implants into the eye help to alleviate dry eye?
88
Can we develop a permanent treatment for dry eye?
89
91
Is it possible to grow large numbers of healthy corneal endothelial cells from a small number of original cells from a
patient and then transplant the new cells back into the patient to treat Fuchs’ corneal dystrophy?
For those with a genetic pre-disposition, what early treatments might be possible to delay the onset of Fuchs’
corneal dystrophy?
Can we develop a new treatment for Salzmanns nodules?
92
How can we develop treatments for acanthamoeba keratitis that are non-toxic to the anterior surface?
93
Can we develop a treatment to aid tear production for dry eyes affected by Stevens Johnson syndrome?
90
Glossary of terms:
Corneal cross linking treatment: A treatment to slow the progression of keratoconus.
Endothelial layer/cells: Innermost layer of cells in the cornea.
Environmental factors: Outside influences on health such as social circumstances, drugs, diet etc.
Genetic: Characteristics that are inherited.
Cornea Imaging: Technique for mapping the surface curvature of the cornea.
Intraocular pressure: A measure of the fluid pressure inside the eye.
Keraflex: Treatment for corneal reshaping in keratoconus.
Palliative care: Special type of care help for someone who cannot be cured or treated.
Prophylactic lubrication: Preventive lubrication to slow down or treat certain conditions.
Rigid gas permeable contact lenses: Rigid contact lenses made of oxygen-permeable polymers.
Stem cells: Cells that have the potential to become any type of cell in the body.
Supplements: Additional intake from the ‘usual’ diet to provide nutrients.