Eye conditions are on the rise.
From cataracts to near- sightedness and macular
degeneration — millions of people worldwide suffer
from poor vision. Reading fine print is almost
impossible. You have to hold the book up to your face. Young people are increasingly
affected -- around 217 million people are visually
impaired, and 36 million are blind worldwide. Our sense of sight plays a
vital role in our lives, and things are very difficult
for people who are blind. Modern surgical techniques
are less invasive and can help
restore eyesight. It's a quantum leap —
a minor revolution. From stem cell therapy
to laser surgery — new treatments are
giving patients hope. This residential development
in the city of Mainz, Germany, is home to Lilli, her brother
Max, and their parents. 13- year-old Lilli is an ordinary
teenager - she goes to dance class twice a week, and she
likes to chat with her friends. Lilli has been near-sighted
since the fourth grade. She has minus 4 diopters
in her right eye, minus 0-point-5
in her left one. When Lilli takes off her glasses,
the world looks like this — even nearby objects appear blurred.
And her eyesight is continuing to deteriorate. I see things best when they
are very close, but it keeps getting worse. When I take
off my glasses, even my hand looks blurry. Anything
further away is even blurrier. Nearsightedness - or myopia -
is the result of the shape of the eye. Normally rays of light
entering the eye are refracted so that they focus on the
retina at the back of the eye. When the eyeball is too long
or the cornea too curved, the light focuses at a point
in front of the retina. Objects that are further
away appear blurred. Our eyes are designed for
distance vision. Spending a lot of time looking at nearby
objects puts strain on our eyes. Our eyes then gradually
deform so that we can see nearby objects more easily.
But then we end up not being able to see objects at a
distance as well. That's what's called being nearsighted. Myopia is partly hereditary.
Lilli’s parents are also nearsighted. Lilli has an appointment at
the Eye Clinic in Mainz for a thorough examination. Norbert Pfeiffer heads the eye
clinic, and is a specialist in near-sightedness. First comes the exam
with the slit lamp. So put your chin
on the chin rest. He first examines the ocular
fundus and optic nerve in both eyes. Near-sighted people
should get a vision exam at least once a year.
Myopia can promote the development of other serious eye disorders.
It increases the risk of retinal detachment and cataracts. Lilli is nearsighted, at minus
4 to 5 diopters. That's fairly nearsighted - not as much as
some, but it's quite a lot. She started out with a quarter
of a diopter, when she was about ten.
That tends to increase with age, until maybe age 18 or 20. For Norbert Pfeiffer,
Lilli is an example of how nearsightedness is on the rise.
He's investigating the cause of this increase in a large-scale
German study involving 15,000 patients. The study has
been underway for 12 years. The longer you go to school,
the more near-sighted you become. For every year you
go to school, you get a bit more near-sighted. And that
goes for university degrees — the longer you study,
the more nearsighted you become. So nearsightedness
has a behavioral component. So myopia isn't just hereditary
-- our lifestyle plays a role. Near-sightedness is linked
to educational levels and is on the rise worldwide. In Asia, even more young
people are nearsighted. In some countries,
up to 80 or 90 percent. We think one factor might be the age at
which children start school. In some Asian countries,
they start school when they're just three
or four years old. In Taiwan, for example,
myopia has reached epidemic proportions. Up to 90 percent
of schoolchildren in major cities are nearsighted.
Schools and universities are pressure cauldrons. The workload is
heavy - even more than in Europe. Long hours of
studying lead to more near- sightedness. What many don't
realize is that if myopia remains untreated,
it can even lead to blindness. Russ Khan shrugged off his
vision problems for years. A software engineer,
he was working on a new program when he suffered a retinal detachment.
He underwent 12 surgeries, but nothing helped.
Russ Khan is now blind. At one point,
he contemplated suicide. I can hear. I can move.
They’re always going to be there for me. That’s the love.
And because of the family bondings. They made me
realize that perhaps if I’m settled down more myself,
I can do something. I can still do something for myself and others. Russ Khan now goes to
schools to tell his story and raise awareness about
near-sightedness. In the classroom,
he tries to connect with the children on a personal level. Every half hour, we let our
eyes have a break. How long? Ten minutes, they reply. And lastly, how long should
you play outside every day? Two hours! The children are supposed to
give their eyes a break from schoolwork. But long hours
hitting the books is ingrained in Asian culture. It’s an
uphill battle. The WHO estimates that half the world's
population will be shortsighted within 30 years. But simple measures could make a difference. The most important thing is
to send children outside into the sunlight for two hours every day.
We know this is the best way to prevent
nearsightedness. An instrument
called a luxmeter is used to measure light intensity. You'd probably say there's
plenty of light in this office, enough to work by.
But the meter is showing 102.5 lux. That's not much light.
The light is much brighter outside. Even bright lamps are no
substitute for daylight. Eyes need sunlight — the chance to
view objects at a distance. Outside, the light intensity
is 100 times higher: I took the meter outside.
Even though it’s cloudy, we’re seeing 13,600 lux. That's much higher.
If it were sunny out, it would be even
higher than that. Bright sunlight can be up to
100,000 lux or more. It may seem trivial,
but daylight works wonders against nearsightedness. Back at the clinic,
Lilli is undergoing another a vision test. She's supposed to read
the numbers off the chart. She's asked if she can
read the largest number. Even the largest
number is blurred. Norbert Pfeiffer will continue
monitoring Lilli's vision and making sure she gets enough sunlight.
It's the only way to treat her nearsightedness
and preserve her vision. An eye clinic in Cologne,
Germany, specializes in other vision problems. Alfred Remmert is 60 years old.
He lives an hour away and comes here for treatment.
Remmert runs a company with over two thousand
employees and often travels abroad.
His vision has been deteriorating for some time now. This is what it looks like
out the window. This is what Alfred Remmert sees.
And it’s getting worse. It's all kind of foggy.
Blurry and foggy. Right now I'm still coping but ordinary activities
are getting more difficult. Alfred Remmert has come
here for a consultation with Claus Cursiefen. He's chief
physician at the clinic and a leading expert in corneal disorders.
His exam shows that Alfred Remmert is a
good candidate for surgery. The lens and cornea are clouded.
So two layers of the eye are clouded.
In one surgical procedure, we’ll try to eliminate both sources of
this clouded vision. We'll replace the lens,
and transplant the inner layer of the cornea. The transparent cornea is part
of the outer casing of the eye, and serves as a kind of windshield.
Behind it, the iris opens and closes to control
the amount of light entering the eye. The lens focuses the
incoming light to create a sharp image on the retina.
The optic nerve then transmits that information to the brain. Two hours later, the surgery
is underway. Claus Cursiefen is preparing the corneal transplant.
The clinic has its own eye bank - with corneas
from organ donations. The cornea does not have a direct
blood supply. For that reason, it can be removed up to
72 hours after death. Claus Cursiefen carefully
removes the edges of the cornea. The blue contrast agent
helps him guide the delicate incisions. The cornea is only a few
thousandths of a millimeter thick. Using a precision
instrument, he removes the inner layer of the cornea. The delicate tissue is rolled
up, and then placed on injector. The instrument will later
help him position the cornea in the patient's eye. The patient is wheeled into
the operating room. Alfred Remmert already under
general anesthesia. The eyelids are held
open with retractors. With three tiny incisions,
the diseased inner layer of the cornea is removed. This is the inner,
clouded layer of the cornea, which is selectively removed.
It is about ten-thousandth of a millimeter thick.
We only remove the diseased layer here and can leave the rest
of the cornea in place. That speeds up the healing process.
Just a few years ago, the entire cornea would
have been transplanted. Then the injector is inserted
into the eye and the thin corneal layer is unraveled. The blue-colored structure
in front of the eye is the transplant. Now we have to
put it in the proper position. Now we fill the eye with a gas.
The gas bubble presses the transplant firmly onto the
back of the cornea. We don’t sew it on — it’s held in
place by this gas bubble. The gas bubble pushes the
transplant onto the cornea. In order for it to attach properly,
the patient will need to lie on his back quietly for several days. Everything goes smoothly and
the surgery is a success. Sigrid Roters helps manage
the eye bank at the clinic. Today she retrieved a donor
eye from the pathology department.
The clinic in Cologne opened its eye bank in 2000. Sigrid Roters carefully
examines the eye for any sign of disease. Then she detaches
the cornea bit by bit. Human corneas are still used in
transplants, but artificial corneas are now under development. The doctor places the cornea
in a nutrient medium and maintains the incubator at
the perfect temperature, ready for the next transplant surgery.
Demand is high. 6,000 corneal transplants
take place each year in Germany and there are
another 6,000 recipients on the waiting list.
Of course, we would like to have more donors to meet this demand. Five weeks after the
procedure, Alfred Remmert is back at the Cologne clinic for
a checkup. Since corneas don't have their own blood vessels,
they're rarely rejected by the recipient’s immune system — unlike with donor hearts, for example. But he did have some
difficulties at first. I'm doing well now but the
first 14 days were hard. My eye was very sensitive,
I could hardly open it. My eye was watering and my vision
was blurred. Then my other eye started watering, too,
and felt the strain. But about ten days ago, things got a lot better. The surgery was a complete
success, and the healing process is going well.
Before the surgery, Mr. Remmert's vision was down to about 40 percent.
Now it's at 90 percent and it will
continue to improve. Alfred Remmert’s vision
in his right eye is almost normal again. The University Hospital in
Bonn, Germany, focuses on one of the most common eye
conditions in the Western world: age-related macular
degeneration, or AMD. Karin Krause-Zillich suffers
from what is called wet AMD. This is how healthy eyes see
the world. This is what Karin sees. She is almost
blind in her left eye. Wet AMD is less common
than the dry form, and it progresses more quickly.
At first Karin Krause-Zillich barely noticed the symptoms. When I was doing my make-up
and would close one eye to do the other one, I thought,
something’s not right. There’s a dark spot that shouldn’t be there.
Then I saw my ophthalmologist. He did several tests and I got a diagnosis. The macula is a small area in
the retina at the back of the eye. It's where our vision is
the sharpest and it contains most of the light sensing cells.
In AMD, blood vessels leak fluid or blood into the macula.
That leads to swelling, and damages the photoreceptors. Frank Holz specializes in
the treatment of macular degeneration.
Although AMD cannot be cured, its progression can be slowed. The dangerous thing about
this condition is that it irreversibly destroys the
photoreceptors located in the center of the retina, in the
macula, where our vision is the sharpest. That's what
allows us to read, recognize faces, and drive — so many
everyday activities rely on it. Once the macula is destroyed,
people find themselves with a serious disability. Karin Krause-Zillich comes
in for a check-up every four weeks. Left untreated,
the disease progresses very quickly. These green lines indicate
where a cross-section of the retina is being displayed.
This allows us to examine the structure of the retinal
layers, and see where there might be fluid. Today the news isn't good.
The scans show a small gray sickle on the retina.
Karin Krause-Zillich will need another injection of
the drug that's used to treat the condition. The preparations are complex.
Eyes are delicate organs. Everything needs to be sterile
to ensure that bacteria won't enter the retina. The drug is injected directly
into the eye. The drugs inhibit a growth factor that
promotes the formation of new blood vessels. The procedure itself
takes just a few seconds. It's like a little prick on your
finger. It's over in a moment and that's it.
I'm grateful this treatment exists. She's responding to the
treatment quite well. But we'll have to keep repeating it.
This is a chronic condition that won't go away or get better. Not all patients manage as
well as Karin Krause-Zillich. Many patients discontinue
treatment, and the drugs don't work for everyone. At the Sulzbach eye clinic
near Saarbrucken, doctors are investigating new therapies.
Boris Stanzel is a leader in
the field. He specializes in retinal
surgery and stem-cell research and is currently running a
major clinical study on AMD. Ingrid Moser is one of 150
patients who are taking part in the pilot phase of a new
stem-cell therapy. She was also receiving the injections,
but they stopped working. Using this scanner, Boris Stanzel
checks to see how quickly the disease is progressing. The macula is in the middle,
and here's the optic nerve. This black area around what
was the macula is where the cells have died,
and it's getting bigger. The disease is very advanced.
Ingrid Moser’s vision is only 5 percent of normal in her
right eye and 10 percent in the left one. The new therapy aims to
reprogram stems cells extracted from the
participants’ blood. Then the dead retinal cells will
be replaced with the reprogrammed ones. We're hoping to replace cells
in this layer here. Right here it's still healthy. And you can
see right here, they're missing. If we can get new cells to
take root in this area, then we might be able to revive the
outer portion of the retina, which is still in
relatively good shape. Another benefit of this kind
of stem-cell therapy is that it doesn't involve any
potential ethical concerns. We don't have to use
embryonic stem cells. We extract the stem cells from
the patient’s own blood, in much the same way that
you do in a bone marrow donation. Then we convert
them into the proper cells in the laboratory,
and implant them back into the patient again. The IBMT Fraunhofer Institute
is located just a short distance from the clinic,
and is collaborating in the development of the new therapy. Boris Stanzel is meeting with
Hagen von Briesen, director of the stem cell laboratory.
The two scientists will check on how the reprogramming of the
eye cells is coming along. The researchers here work
with cell cultures. First they reprogram the blood cells,
turning back the clock to return them to an
undifferentiated state. Next they multiply the cells,
and then reprogram them. Those will become new tissue cells
- including retinal cells. The new retinal cells can
be seen under a microscope. Reprogramming them is complex. We have to treat these cells
with specific biological factors. That allows you to return the
cells to their original state. It's quite an amazing
accomplishment, something we never dreamed we could do.
20 years ago, it would have been unthinkable. The researchers then preserve
the new retinal cells. To store them long term, they'll be
frozen in a container filled with liquid nitrogen at a temperature of minus
140 degrees Celsius. Each sample is scanned and
labeled for each patient. The container is then placed
in the stem cell bank. With 20,000 samples so far,
and 15 different partners in industry and medicine,
this stem cell bank is unique in Europe. It's a promising
project, and researchers hope that it might one day
provide new therapies for eye conditions that today
are untreatable. This therapy won't be
available any time soon. But we've been able to show that
the therapy would work in principle. Now we'll have
to get through the approval process, which is time
consuming and involves a lot of regulatory steps.
It's a process that takes several years here in Germany. The researchers have
laid the groundwork for a revolutionary new therapy
- using reprogrammed stem cells to restore vision.
In a few years, this might be a major advance in preventing
AMD-related blindness. At the Medical University of
Vienna, scientists are also staking out new territory.
Ursula Schmidt-Erfurth is director of the department of
ophthalmology and optometry, which is investigating
new diagnostic procedures for eye conditions. Our eyes are our window to the world.
But we can also look into the eyes,
into what’s happening inside them. We can look into the
clear cornea and the clear lens, which we also
call the clear media. Ophthalmologists can look
inside the eye and laser scanners can also make the
surface of the retina visible. Laser scanners can also peer
into the retina's deeper layers, and create a highly detailed image.
With 40,000 separate scans, the device can
examine the retina in 3D. Once the laser scanner creates
an image of the patient's eye, the high-resolution images
are analyzed with the help of artificial intelligence. The system, or the computer,
basically works just like the human brain. It learns and
gathers experience, and gets smarter. You can feed the
computer an infinite quantity of data from an infinite
number of patients and an infinite number of medical conditions.
And the system learns to how draw the
correct conclusions. Ingeborg Nowak suffers
from age-related macular degeneration. The 3D scan of
her left eye was compared to the images of thousands of other patients in the database
to detect cell changes. The new diagnostic procedure
identified tiny defects developing on her retina in
time for them to be treated. If that exam and the
follow-up treatment had been delayed, I probably would
have lost the vision in my left eye. In the data laboratory,
IT experts are fine-tuning the algorithms that will be
used to generate an accurate diagnosis and
devise personalized treatment regimens. The algorithm can analyze
millions of pixels very quickly. Then it tells us whether
the disease is progressing, whether the current
treatment is working, or whether a new therapy
might be more effective. The algorithms are so
effective that the system will soon be used to diagnose
other health conditions. We think that in the near
future, this system will allow us to reliably identify signs
of cardiovascular disease at an early stage,
and help prevent heart attacks in high-risk patients. Our retina is like a window
to our blood vessels -- tiny changes in our vascular
system can be identified in our eyes far earlier than
elsewhere in the body. One day, eye scanners might
be used as a kind of early warning system. Karin Schultz-Igast is about
to undergo surgery. She suffers from cataracts - the lenses
of her eyes have grown opaque. Cataracts gradually grow worse and can lead to blindness. This is normal vision, and this
is how Karin Schultz sees the world. The condition has a
major impact on her daily life. For example,
she can no longer drive. Stars at night look like little
flowers, for example. They have a halo of little
dots surrounding them. Cataracts grow more common as we age.
90 percent of people over the age of 65
will develop cataracts. Other symptoms include difficulty with
bright light, and difficulty seeing at night. Karin Schultz's vision has
deteriorated to the point where she's decided
to have surgery at the Augsburg eye clinic. A preliminary exam will show
how far the cataracts have progressed, and whether she’s
suffering from any other eye disorders. Three different tests
are carried out. The optician records the results. This is the front surface of the
cornea, the back surface, and its thickness ?. Here’s the
cornea, the anterior chamber depth, and the clouded lens,
and here we have key data about the cornea. Felix Rombold explains the procedure.
Doctors still don’t know exactly what causes cataracts.
They believe it’s part of the natural aging
process, which also affects our eyes. For Felix Rombold, this is a
routine procedure. He carries out 20 to 30 cataract
surgeries a day. The clouded lens is replaced
with an artificial one that remains in place for the rest
of the patient’s life. This special artificial lens also
reduces corneal curvature. It provides sharp distance
vision, with a lower range of about 60 to 80 centimeters away. Felix Rombold puts the
femtosecond laser into position. This technology
enables tissue to be cut with high speed and precision.
The device costs 500,000 euros. The doctor positions the eye
and cuts a circular opening into the anterior
capsule with the laser. The laser created a perfect
opening in the anterior lens capsule. I’m flushing the lens
with saline solution now so I can move it. The lens remains in its capsule.
With the help of the liquid, the doctor can move the
lens and gently remove it. Now I’ll to use the ultrasound device.
The eye remains stable. The laser dissolves the
nucleus of the lens, which is then extracted. Now we’ve completely
removed the lens. What remains is the patient’s own
lens capsule. The artificial lens is inserted into it. It’s high-precision work.
Cataract surgery has been transformed over
the past 10 years. The incisions are getting
thinner and thinner. Today they’re just two, or two and
a half millimeters thick. That means we’re intervening in the
eye, touching and moving the eye, far less. And that
in turn speeds up healing and considerably reduces the risk.
The rehabilitation phase is much shorter. Around 700,000 of these
outpatient procedures are carried out in Germany every year.
Complications such as bleeding inside the eye
or infections are rare. About 10,000 kilometers to the
south, a convoy is making its way through Rwanda
in eastern Africa. The ophthalmologist Silvain
El-Khoury is on board. He and his team are traveling from the
Kabgayi Eye Clinic to an outlying area.
The doctors make this journey only once a year. This is a mobile clinic.
We take all our equipment with us — our surgical microscope,
our instruments — and go to remote regions to carry out surgeries.
We mostly treat cataracts, which sometimes
even lead to blindness. The team has reached its
destination, an outpost an hour’s drive
from the clinic. The patients are already waiting.
Silvain El-Khoury's work is funded by the
German CBM aid organization. The outpost is a lifeline
for people who can't make the journey to the city. Philamene Nyirami has been
blind for five years now. She had to move in with her
daughter because she could no longer manage on her own. The exam shows that she has
cataracts, and the disease as progressed to an advanced stage. She can only see shadows
against the light. Light and shadows, basically,
maybe the outlines of shapes. But definitely not faces. Philamene Nyirami was unable
to make the trip to the city to see a doctor. It will depend on the
doctors here and God! I have confidence in doctors who
are always fighting for our good health. I can’t treat
myself, after all. I have to have hope in them. Silvain El-Khoury decides to
carry out the surgery on the left eye that same day.
The next day, he’ll operate on the right eye. One of the rooms is converted
into an operating room. Everything is adapted to the
conditions in Africa. The doctors use simple equipment
that requires little maintenance. They also employ a special
surgical technique. The main difference is that
I remove the clouded lens using what’s called the
fishhook technique. I use a sort of fishhook that I make
myself, out of a syringe. Now I’ll make a tunnel incision
through the sclera — about two millimeters from the limbus.
It’s a self-sealing incision, so no stiches are needed. 15 minutes later,
he’s reached the lens. Here’s the thick, clouded lens.
You can see that it’s turned a brownish red.
Far too clouded for anyone to see through it. Silvain El-Khoury now inserts
the artificial lens. It comes from India and costs only a few
euros, but it works. I use tweezers to slide it
into the same spot where the original lens was. I’ll turn it
a bit to make sure it’s in the right position. And then I’ll
flush the area out again. An antibiotic ointment
prevents infection. 25 minutes later, the surgery is done. The procedure went very
well, with no complications. The next day, Silvain El-Khoury
examines the patient. The doctor carefully
removes the bandage. Ask her: Does she see
my hand moving?” “Yes.” How many fingers am
I showing?” “Two.” “Now?” “Five.” The results look good.
Next comes a vision test. The surgery was a success.
Philamene Nyirami can see even the smallest symbols
at the bottom of the chart. I’m very happy to be able
to see the people around me, everything around
me, I’m very happy. This very gratifying, of course.
It reaffirms me in my work and in the life I’ve
chosen for myself. For the first time in years,
Philamene Nyirami is able to make her own way across the room.
She’s still a bit hesitant, but thrilled that she can see again.
The procedure cost about 30 euros. The world we’re working in is
much more difficult. We have fewer machines and
diagnostic options. The instruments we use are often
older ones. So we face a lot of challenges, especially when
it comes to surgery. But we have a good team.
They really do the legwork for us and make our own
work much easier. Two days later, Philamene
Nyirami’s other eye also has a new lens. She can see again.
Assistants from the CBM aid organization drive her and her
daughter as far as they can — to the end of the paved road. They’ll have to make the final
stretch home on foot. The day after surgery, the 20- minute
walk is a challenge — but she has a new life to look forward to. I’m really very proud to see
people smiling after a long time without vision. Then after
just like ten minutes, five minutes or ? their vision is
restored and a lot of persons who is useless becomes again
useful for their community, for the society and for
the country in general. Her children, grandchildren,
and the entire community have gathered to welcome her return.
The last years have been hard— unable to see,
she was isolated from day to day life. The entire village
shares in her joy. This is a miracle, that I can see!
I am very happy! I’m now celebrating with my children. Philamene Nyirami spent five
years waiting for surgery. Now her vision has been restored. In Rwanda and around the
world, a lot of progress in treating eye conditions has been made.
But new challenges are also emerging.
The use of smart phones, for example, is a problem.
And as life expectancy rises, eye disorders are also on the rise.
But there is hope. Eye surgery will improve.
More drug therapies will become available. I think
we’ll make a lot of progress in preventing the
deterioration of vision and the loss of vision in old age. New surgical methods,
better artificial corneas, retinal implant microchips — the
future of medical treatment to preserve vision is
a promising one. I’m really pleased. I’ll have
surgery on my other eye, too. Reprogramming stem cells is
a great leap forward — but researchers are
convinced that even more progress will be made. In the next few years,
we’ll see a great deal of potential in the field of gene therapy.
We’ll also see advances in pharmacological and
microsurgical therapies.
Thank you, that was very informative
2020 year or vision?