The Sight Loss and Vision Priority Setting Partnership
FORM A: LONG LIST OF UNCERTAINTIES FOR RETINAL VASCULAR DISORDERS
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 retinal vascular disorders 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 AND MONITORING
1
Is there any way to predict if branch retinal vein occlusion will occur?
2
What are the barriers that prevent diabetic patients having regular eye checks?
3
Should patients with type 2 diabetes have an eye test more frequently than once per year as is current practice?
4
Can the likelihood of getting progressive sight threatening diabetic eye disease be predicted?
5
What are the best methods for detection of visual deterioration in patients with diabetic retinopathy?
6
Is screening effective for reducing sight loss from diabetic retinopathy?
7
Can a method other than retinal photography be used to detect diabetic retinopathy?
8
In addition to using gestational age and birth weight as screening criteria for retinopathy of prematurity, could
additional factors be used to reduce the number of unnecessary screenings performed?
9
Is there a way to improve screening of premature babies for retinopathy of prematurity?
10
Can a blood test be developed to predict which infants are at risk of retinopathy of prematurity?
CAUSE AND PREVENTION
11
Why does Coat's disease affect only one eye?
No.
Uncertainty
12
Is there a genetic basis for Coats' disease?
13
What is the cause of Coats' disease?
14
If central retinal vein occlusion is manifest in one eye, how can we prevent the other eye from becoming affected?
15
What causes central serous retinopathy?
16
Is there any relationship between central serous retinopathy and late-onset age-related macular degeneration?
17
Can central serous retinopathy be prevented?
18
To what extent do diet and lifestyle affect the development of central serous retinopathy?
19
What are the causes of diabetic retinopathy?
20
How can diabetic retinopathy be prevented?
21
How can diabetes lead to sight loss?
22
In diabetic patients with retinopathy why does the retinopathy progress after cataract surgery?
23
24
Why do some people have much worse diabetic retinopathy compared to others with the same or similar risk factor
control?
Is there a relationship between Type 2 diabetes and age-related macular degeneration?
25
Is it possible to predict the onset and progression of diabetic retinopathy in pregnancy?
26
What is the effect of short term increases in blood sugar levels on the development of diabetic retinopathy?
27
What causes retinopathy of prematurity?
28
What are the best methods to prevent retinopathy of prematurity?
29
What causes retinal vein occlusion?
30
Can a retinal vein occlusion be prevented?
TREATMENT
31
What is the effectiveness of Lucentis (anti-VEGF) treatment for branch retinal vein occlusion?
32
Can new treatments be developed for branch retinal vein occlusion?
33
What is the role of complementary therapies in central retinal vein occlusion?
No.
Uncertainty
34
How effective and safe are intravitreal steroids or anti-VEGF treatment for retinal vein occlusion?
35
What is the most effective treatment for serous central retinopathy?
36
37
What rehabilitation programmes are best for the management of distorted vision, from retinal scarring due to central
serous retinopathy?
Can lifestyle modifications help to improve or reduce central serous retinopathy?
38
Can we reverse central serous retinopathy through diet and exercise?
39
Can new non-invasive treatments be developed to slow down the progression of diabetic retinopathy?
40
Can keeping the eyes partially light adapted at night slow or halt sight loss caused by diabetic eye disease?
41
Can lifestyle modifications or nutritional supplements slow the progression of diabetic retinopathy?
42
Can treatments be developed to restore some vision at the end stage of diabetic eye disease?
43
47
Can a fixed combination slow release monotherapy (preferably topical or intravitrial biodegradable) be developed
for diabetic macular oedema treatment?
Which of the anti-VEGF drugs is most cost effective and clinically effective for the treatment of diabetic macular
oedema?
What is the effectiveness of anti-VEGF treatment compared to intravitreal steroids or laser therapy for people with
diabetic retinopathy?
What is the effectiveness of NAVILAS laser treatment for people with diabetic macular oedema due to diabetic
retinopathy and retinal vein occlusion?
How can sight loss from diabetic retinopathy be prevented?
48
What is the best way to manage and reduce the risk of sight loss for people with diabetic eye disease?
49
52
Can eye exercises be effective in improving the speed of recovery of muscle palsy people with diabetic eye
disease?
Can an effective long lasting treatment for diabetic macular oedema, both ischaemic and non-ischaemic, be
developed?
What is the effectiveness of long term anti-VEGFs and intraocular steroids for the treatment for patients with severe
diabetic eye disease?
What is the most effective treatment for macular telengiectasia?
53
What is the efficacy and safety of anti-VEGF agents in the treatment of retinopathy of prematurity?
44
45
46
50
51
No.
Uncertainty
54
Can the treatment for retinopathy of prematurity be improved?
55
Can treatments be developed to restore vision in someone who is completely blind from retinopathy of prematurity?
56
Could nutritional supplements or dietary changes help reduce the damage caused by retinopathy of prematurity?
Glossary of terms:
Anti-VEGF treatment: Drugs which work by targeting a protein that is needed for the formation of new blood vessels form.
Central serous retinopathy: Characterised by leakage of fluid under the retina which causes gradual sight loss.
Complementary therapies: Forms of treatment that do not eradicate the cause of a condition but can help relieve symptoms.
Diabetic retinopathy: Condition caused by persistent or acute damage to the retina arising from diabetes.
Genetic: Characteristics that are inherited.
Gestational age: Relates to the age of an embryo or foetus.
Intravitreal/intraocular steroids: Anti-inflammatory drugs used to treat inflammation in the eye.
Ischaemic: A reduced blood supply to the retina.
Lucentis: An anti-VEGF drug which stops the abnormal blood vessels leaking, growing and then bleeding under the retina.
Macular oedema: The accumulation of fluid in the retina occurring in patients with diabetes leading to swelling of the retina and
blurred vision.
Macular telengiectasia: A blinding condition of the retina caused by dilated blood vessels.
Monotherapy: Commonly used to describe the administration of a single medication.
NAVILAS laser treatment: This laser treatment was designed to optimise the stability of retinal disease treatment.
Retinal photography: Method for examining the back of the eye to detect and monitor early signs of disease.
Retinal vein occlusion: Results from the blockage of the retinal vein that drains blood from the retina. It usually leads to a
painless decrease in vision. Obstruction of a branch of the retinal vein is called branch retinal vein occlusion.
Retinopathy of prematurity: Is a disease that causes abnormal blood vessel growth in the retina of premature babies.