Inside this issueNew eye health indicators

The Sir Jules Thorn Stem Cell Research Unit

Making contrast count

Patient days

Retinal disorders and thyroid eye disease

Fundraising challenges and successes

VisibilityUpdate on how charitable support is making a difference Issue 3 Summer 2013

Professor Peng Tee Khaw awarded knighthood in Queen’s Birthday HonoursProfessor Peng Tee Khaw, Moorfields Eye Hospital’s director of research and development and one of our leading eye doctors and researchers, was awarded a knighthood for services to ophthalmology in the Queen’s Birthday Honours.

Professor Khaw, who specialises in glaucoma surgery both for paediatric and complex adult cases, joined Moorfields and our research partners at the UCL Institute of Ophthalmology in 1987. He was appointed as a consultant in 1993 and as a professor in 1998. His distinguished career spans the fields of medicine and clinical research and is reflected in the breadth of clinical, academic and director roles he holds. Until May 2013, he was also president of the Association

for Research in Vision and Ophthalmology (ARVO), the world’s largest eye and vision research organisation, the first UK-based president in the association’s 85-year history.

Commenting on his award Professor Khaw said: “I am very humbled to have been awarded this incredible honour. I feel I have received this on behalf of all my colleagues here at Moorfields, UCL and around the world with whom I have been privileged to work, and who transform the lives of so many people every day.”

Visibility Summer 2013

2 News

Moorfields is playing a leading role in measuring the country’s eye health as part of a national initiative to tackle the leading causes of preventable sight loss.

Prevention of sight loss: a public health priority

Two consultants, Miss Parul Desai and Mr Richard Wormald, and principal statistician Dr Catey Bunce are part of a group of experts working with the government to improve the measurement, interpretation and collection of the incidence of certifiable blindness, partial sightedness and the numbers of people who have lost their sight from macular degeneration, diabetic retinopathy and glaucoma. These three conditions are the biggest causes of preventable sight loss in England.

Faced with an ageing population and an exponential rise in blinding conditions the government has placed eye health high on the public health agenda by introducing a public health indicator to track incidence which will aid the planning of services from April 2013.

Explaining the necessity for the indicator Dr Catey Bunce said: “The indicator provides a new focus on eye health and provides opportunities to improve eye health services and outcomes at a national and local level. All the leading patient groups and professional bodies strongly support this first ever national eye health indicator and are pleased to have worked together with the government to develop it.“

Moorfields’ new integrated patient support service is now successfully assisting those patients who have to come to terms with various sight threatening diseases, treatments and certification for visual impairment. It offers counselling, emotional and psychological support, practical advice and information on services outside the hospital which range from help with staying in work to visual aids.

Made up of two nurse counsellors, four eye clinic liaison officers and the Certificate of Visual Impairment team it is supported by a number of charitable organisations, including the Marie-Louise von Motesiczky Charitable Trust, Friends of Moorfields, Action for Blind People and Moorfields Eye Charity.

Launch of the new integrated patient support service

Art at MoorfieldsThe Friends of Moorfields is supporting the development, over the next three years, of an Arts Programme to introduce the positive benefits of art into the healthcare environment, as part of its 50th anniversary celebrations.

The first major event was a special private view to celebrate World Sight Day on 11th October last year, of the BlindArt collection, donated by the charity of the same name, which encourages participation and interaction with art for the visually impaired.

Part of the collection is on permanent display on the ground floor at the main hospital in City Road where regular music recitals, also part of the programme, are also held. There is a special ‘Insight’ exhibition on 14th November to showcase art produced by staff and patients. If you would like to find out more about the programme of activities, please contact art@moorfields.nhs.uk or telephone the Friends on 020 7251 1240.

Visibility Summer 2013

3 Supporting research

Visibility Summer 2013

Step inside the Sir Jules Thorn Stem Cell Research UnitFirst established in 2005 as the UK’s first Medicines and Healthcare products Regulatory Agency (MHRA) accredited cultured stem cell facility, the unit is licensed to manufacture a variety of human cells for the production of cell therapies for clinical use. Its work proved so beneficial that the Sir Jules Thorn Charitable Trust provided a generous donation and in 2011 it was re-housed in a new state-of-the-art cleanroom suite at the UCL Institute of Ophthalmology.

The Cells for Sight stem cell facility has a sophisticated air handling and filtering

plant which supplies the air at the correct temperature and humidity with minimal particulate contamination, essential for its production purpose. It currently has two main users, the Cells for Sight Ocular Surface Programme and The London Project.

Cells for Sight Ocular Surface ProgrammeThe main focus of the programme is the cornea, the transparent layer at the front of the eye. This layer is maintained by a pool of stem cells that reside at the edge of the cornea called the limbus, which ensures the integrity of the cornea helping it to stay transparent. If the cornea is damaged, for example, by chemical burn, or the stem cells are lost through disease, the front of the eye becomes scarred and opaque resulting in vision loss.

The programme aims to take the patient’s own cells and ‘grow’ a replacement cornea, a process that takes about three weeks. This can then be surgically attached to the affected eye. Ideally these cells will be taken from the patient’s

own unaffected eye, but where both eyes are affected, cells can be obtained from donor eyes or potentially other tissues. The research team is now in the final stages of validating a new process and aims to start treating patients later this year.

Age-related macular degenerationThe London Project, which began in June 2007, aims to prevent blindness and restore sight in patients with age-related macular degeneration (AMD). The goal is to replace the cells,essential for “seeing” lost to thedisease, at the back of the eyewith human stem cells whichhave been transformed into thecells affected in AMD. Theseare the support cells for the

photoreceptors known as retinalpigment epithelium (RPE) cellsand the photoreceptors.The cells will be surgically implanted into a clinical population of AMD patients.

It is these cells that are being cultured in the unit and which involves a complex manufacturing process.

Vital researchThe project will commence human clinical trials later this year. Professor Julie Daniels, who heads up the Cells for Sight team says: “The facility is vital for the development of novel sight saving treatments. This high specification suite of laboratories is at the forefront of cell therapy research and clinical trials at Moorfields Eye Hospital.”

Launch of the new integrated patient support service

Visibility Summer 2013

4 Supporting research4

Support and participationcontinues for a programme of events aimed at increasing patient and public involvement in either ophthalmic research at the hospital and the Instituteor enhancing knowledge about current and future research and different conditions.

These free one day events, hosted by our National Institute for Health Research Biomedical Research Centre and the UCL Institute of Ophthalmology, enable Moorfields patients and professionals to learn from each other. Patients help identify key topics for future research and discuss with each other and specialists their everyday experiences of disease. All activities and interactions inform the development of further research on our joint site.

Four events took place during 2012: a Birdshot Day in March; a Retina Day in April; a Diabetes Eye Day in November; and a Thyroid Eye Disease Day in December. In 2013, a small Paediatric Uveitis event was piloted and a Cornea and External Diseases event is planned for October this year.

Patient days

There is evidence that only a small number of retinal ganglion cells are needed to maintain visual

function. Professor Astrid Limb and her team are focused on the development of cell therapies for treating end stage glaucoma using a population of stem cells, known as Müller stem cells.

These cells are present in the adult human retina and can be grown in the laboratory to produce nerve cells. Due to their characteristics, they have potential for transplantation to replace damaged retinal ganglion cells or provide the environment to protect these cells and prevent further damage.

The team has developed techniques to make Müller stem cells become retinal ganglion cells.

At present they are refining methods to facilitate cell transplantation into the eye and hope to be able to develop a cell therapy in the near future. It is well recognised that Müller stem cells are responsible for the spontaneous retinal regeneration observed in the zebrafish after injury. However, despite these cells being present in the human eye, spontaneous repair does not occur in patients with retinal disease.

Professor Limb’s team

is examining molecular mechanisms that prevent these cells from growing and becoming nerve cells when there is the need to repair the retina. Using specialised protein analysis techniques (proteomics), her laboratory is comparing protein profiles of normal and diseased retina from the adult human eye, with those of the normal and injured retina of the adult zebrafish.

So far they have identified differences between proteins found in normal and inflamed human retina and are examining the role of some of these proteins for their ability to induce Müller stem cells to grow and become retinal neurons in the laboratory. The ultimate aim is to identify factors that can be targeted with drugs to induce self-repair of the retina without the need for invasive surgical procedures.

Müller stem cells are present in the adult human retina and can be grown in the laboratory to produce nerve cells.

Developing a treatment for end stage glaucomaGlaucoma is a major cause of visual disability characterised by loss and damage of the nerve cells (retinal ganglion cells) that connect the light sensitive part of the eye (retina) with the optic nerve and send visual signals to the brain. Although current therapies can control disease progression, there is no available treatment for patients with late stage or aggressive disease.

Visibility Summer 2013

5 Supporting research

Vision specialists are asked by architects and designers what contrast levels are

sufficient for accessible buildings, products and services. But current guidance documents fail to provide an adequate answer.

Deputy Director of the Institute of Ophthalmology Professor Gary Rubin is working with Hilary Dalke FRSA, Professor of Design and principal investigator on a study with 100+ vision impaired patient volunteers to provide data on the visibility of surface boundaries determined by contrast. The results of this study will be used to upgrade the current British Standard: 8493 on Light

Reflectance Values (LRV). For these purposes, contrast is calculated as the difference in light reflectance values between two adjacent surfaces.

For visually impaired people to travel about safely and efficiently, they must be able to see the boundaries between objects accurately, reliably, and confidently – seeing a column on a station concourse for example. These volunteers are being tested in the Virtual Environment Laboratory, a large open space with carefully standardised lighting.

About 90 volunteers have been tested and another 15 are scheduled. Professor Rubin expects the modelling phase to take about four to

six weeks and is aiming for completion in September. Further work may be required to generalise the standardised laboratory measurements to natural environments, but the research team’s previous work shows that there is a strong link between the two.

Professor Rubin anticipates this research study will make it possible to predict visibility for around 90% of all registered visually impaired people. This should give professionals in the built environment and design industries much needed guidance on contrast requirements for accessible design.

Making contrast count for the visually impaired

Participants being tested for visual acuity by Hilary Dalke FRSA, Professor of Design and principal investigator for this project.

Exploring thyroid eye diseaseThyroid eye disease (TED) is a common disease that affects predominantly patients with autoimmune thyroid disease. It is characterised by an expansion of the fat pocket behind the eye, which pushes the eyeball forward, leading to significant disfigurement, eye pain and sometimes blindness.

Moorfields consultant Mr Daniel Ezra is leading research into developing new treatments for TED. His approach is to use novel 3D diseased

cell models to investigate what causes the increase in the soft tissue volume behind the eye. Mr Ezra and his team are using tissue from patients to grow cells in the laboratory for their work. The team are interested in how cells respond to environmental forces. Already their new discoveries include the identification of the role of pressure in transforming connective tissue cells into fat cells and they have tested new drugs to see if they stop these cells from transforming into fat cells.

The built environment presents unpredictable physical and psychological barriers for three million vision-impaired people in the UK. Public spaces can be inaccessible if the level of visual contrast between elements in environments is insufficient.

Visibility Summer 2013

6 Supporting research

Professor Robin Ali and Professor James Bainbridge have an extensive research programme to develop stem cell therapy for the treatment of retinal disorders such as Stargardt’s disease, retinitis pigmentosa (RP) and age-related macular degeneration (AMD). They are working on developing techniques to replace light-sensitive photoreceptor cells, and also the retinal pigment epithelium (RPE) cells that support them. Loss of these two cell types are the main cause of blinding retinal conditions. Professor Bainbridge is currently undertaking a trial of human embryonic stem cell (hES)-derived RPE transplantation for advanced Stargardt’s disease and this is Europe’s first clinical trial involving transplantation of hES-derived cells.

The two investigators have also recently demonstrated proof-of-principle for photoreceptor transplantation by successfully transplanting immature light-sensitive photoreceptors into several mouse models of retinal degeneration, restoring vision and enabling treated mice to

navigate a maze. In order to advance to clinical trials of photoreceptor cell transplantation they are now developing methods to produce suitable donor cells from embryonic stem cells.

This effort has been given a major boost by the opening of a new stem cell research laboratory (pictured), equipped with the latest cell culture technology. The facility, which is dedicated to Professor Ali’s and Professor Bainbridge’s stem cell research programme, was made possible through a generous donation to Moorfields Eye Charity.

Stem cells for retinal disorders

Two-photon microscopy Over the last 15 years, Professor Robin Ali’s research group at the UCL Institute of Ophthalmology has been at the forefront of developing gene and cell therapy approaches aimed at restoring sight. His research programme now aims to further dissect the mechanisms of retinal degeneration in order to maximise the effectiveness of the treatments that his group has developed.

The new stem cell research laboratory in action

The two-photon microscope that Professor Ali’s team has purchased with charitable support will allow them to answer with unprecedented detail a broad set of questions concerning retinal degeneration. They will be able to understand how retinal circuits are modified following degeneration and

which immune cells respond to degeneration in a living mouse. The high resolution of two-photon microscopy will also allow them to specifically guide electrodes to transplanted cells in order to study their properties. They will also be able to use this equipment to image the visual cortex in anaesthetised

mice, to understand how the brain responds to retinal gene and cell therapy. The team is very much looking forward to using the microscope when it is installed later this summer. Professor Ali commented, “This amazing microscope will be invaluable for our entire research programme.”

Visibility Summer 2013

7 Fundraising successes

75 get on their bikes in the RideLondon-Surrey event

Jennifer runs marathons after losing her eye In January 2012 after an entirely routine eye test, Jennifer Shepherd was diagnosed with an aggressive melanoma in the cilliary body of her left eye. There had been no change in her vision, no pain or discomfort so she had no idea anything was wrong. Two weeks later at Moorfields, she had the eye removed. Jennifer says:

“Thankfully, unlike many with cancer in general, my prognosis was good. It’s made me value my health and my sight. Losing one eye has really

had no effect on my life, but I certainly appreciate my remaining one a lot more. I’m not going to take my luck for granted and want to help in some small way to fund research to beat cancer and to support the research facilities at the hospital.”

Jennifer signed up for four half and one full marathon and ran them over eight months. Her parents joined her for the Brighton Marathon and together they raised £1,800!

This August, 75 cyclists will be taking on a 100-mile cycling challenge in aid of Moorfields Eye Charity through London and leafy Surrey.

Making up our team are staff, grateful patients and friends and relatives of patients.

Glaucoma consultant Keith Barton is riding with his brother, Alan, consultant anaesthetist David Celaschi and fellow Dan Lindfield to raise money for glaucoma research. Also riding are: Ian Akroyd; Ruth Ball; Damien O’Brien; Nicholas Puls and Prateek Buch and Manjit Megat from the UCL Institute of Ophthalmology. Another 10 cyclists are riding for the Fairy Queen Dream Team, organised by Elly Chapple whose daughter Ella suffers from aniridia. They are hoping to raise £7,000 to support Aniridia research at Moorfields and the UCL Institute of Ophthalmology.

Zoe’s Vision Disco raises £6,800 Twelve-year-old Zoe Pearman was diagnosed with uveitis three years ago. Since then she has undergone pioneering surgery to save her sight but has to take various tablets, have weekly injections and use eye drops up to 25 times per day. Zoe may also have another operation in the future. None of this has diminished her enthusiasm for disco dancing, a talent she put to use in aid of uveitis research when she raised over £6,800 at a fundraising disco in her hometown of Epping in Essex. Zoe says: “There are

many children who attend Moorfields,

also with very serious eye conditions. My

consultant, Dhanes Thomas, really needs to raise more money so they can do research into early diagnostics and hopefully save other children’s sight.”

8 Fundraising

Visibility Summer 2013

UK Events 2013 October Royal Parks Half Marathon, Halloween Moonrider Halloween Fright Hike

UK Events 2014April Brighton Marathon

May London 2 Brighton run/walk, London 2 Cambridge Moonriders

June Ride UK 24, Trans Pennine Challenge

July London 2 Brighton Moonrider

August Prudential RideLondon-Surrey 100

September Thames Path Challenge, UK End 2 End cycle ride

Overseas challenges are also available, including climbing Mount Kilimanjaro like supporter Mitesh Mashru or following in fundraiser Charlotte Rudman’s footsteps and trekking the Great Wall of China (above).

For further information on how you can get involved, please contact Rebecca on 020 7566 2486, and Aliyah on 020 7566 2565 or email eyecharity@moorfields.nhs.uk

Iam so grateful for the wonderful treatment I have received from Moorfields since I was first referred to

the hospital back in 2006. I visit two or three times each month and although the journey takes two and a half hours each way, I wouldn’t want to be seen anywhere else. This is the best place in the world for treating eye problems. There is so much research being done here to develop new treatments for all sorts of eye conditions.

How can you not want to give something back when you have experienced the great care

provided by staff at Moorfields?Setting up donations by

Direct Debit each month to Moorfields Eye Charity was a very easy decision to make. Although I would have liked to give a lump sum to support the work being done, I found these small payments much more manageable, while giving me the flexibility to easily increase my giving if I am able.

Please think about joining me in setting up a regular gift of whatever you can afford. I feel so glad to be playing my small part, helping to make a difference now and in the future.

Jill Willshaw

Moorfields patient and regular giver

Moorfields’ staff are rising to the events challenge this year in aid of Moorfields Eye Charity. Michele Nicolai ran the Brighton Marathon; Ian Akroyd, Tracy Griffiths and Tracy Luckett completed the Nightrider event, Karen Reeves and Rebecca Kingdom-Kruszewski will be swimming a mile in open water in the Great London Swim in August;

and Yvone Enever, Nancy Campbell and Abu-Bakra are running the Royal Parks Half Marathon in October.

Taking on the challenges

Our Nightrider team of 10 have raised over £5,000 to date.