“Our professional field is constantly evolving,” says Professor Carroll Webers. He is head of the University Clinic for Ophthalmology at Maastricht UMC+ in the Netherlands, where he started in 1993 as an ophthalmologist with glaucoma (high eye pressure) as a special focus area. Since then, the field has been expanding rapidly and encompasses a wide range of applications for patients. Such as treatments for eye disorders caused by diabetes, retinal detachment, glaucoma, and macular degeneration (which is an age-related phenomenon that affects the retina).
Technological developments play a key role in what can be achieved in ophthalmology. Webers gives a brief glimpse into how the Maastricht university clinic is contributing to these developments.
Being able to see again
Notably with the research on stem cell technique carried out by his colleague Professor Rudy Nuijts, for example. A technique that is especially interesting for people who have become blind in one eye as a result of a burn or a caustic substance in the eye.
Together with the Italian cell biologist Graziella Pellegrini and the company Chiesi Pharmaceuticals, Nuijts developed a technique whereby stem cells from the healthy eye are used to grow a new membrane. Nuijts extracts the stem cells which are then sent by courier to Italy. There, Pellegrini cultivates these cells, which takes about two weeks. After that, they are returned to the Maastricht UMC+ as a new membrane. Nuijts subsequently attaches this to the damaged eye. In the Dutch television program Dokters van Morgen (Doctors of Tomorrow), they show how Anne-Mieke King is able to see again after being blind in one eye for many years.
Less intrusive cataract operations
“A groundbreaking innovation,” Webers declares, “but not one that many people will have to undergo. That certainly is the case for cataract operations. At a later age, plenty of people’s own lenses become cloudy, which is what we call a cataract. In the Netherlands, cataract surgery is carried out about 180,000 times a year. The blurred lens is then replaced by an artificial lens. Up until the 1990s, the incision had to be at least as large as the own lens, about 10 millimeters, and that had to be stitched up again. Webers: “In general, the smaller the surgical procedure, the faster the patient’s recovery. With laser techniques, we only need an opening of 1.6 millimeters to replace the blurred lens. Because the incision is so small, stitches are no longer necessary.”
“I always joke with my patients by saying that both their eyes are about the same age. That implies that they have cataracts in both eyes.” For years, the guideline was that one eye was operated on first and after two weeks, the other eye followed. Recently, the Maastricht UMC completed a study showing that it is possible to operate both eyes at once.
Fewer hospital visits
“You first operate on one eye. Then you take a totally new set of instruments, new fluids, a new jacket, new gloves, and you operate on the other eye.” Since July, patients can come to Maastricht UMC+ for this double-sided operation. This has been stepped up in part due to corona. “Because in this corona crisis you naturally want patients to be hospitalized as little as possible. If you operate them separately on both eyes, they will just end up coming to the hospital twice as often.”
Patients not only need to be examined less often, but it also makes a difference in terms of home care, Webers notes. “After this kind of operation, patients have to have eye drops. A substantial proportion of this is done by home care services. Initially, patients have to get drops four times a day for a week, then three times a day for a week, then twice a day for a week, and then once a day for a week. If that can be done with two eyes at the same time, it would make a huge difference.”
His original specialism, glaucoma, is also advancing. “Every eye has a certain pressure by nature. An eye would never be a beautiful ball otherwise. With glaucoma, the pressure is in principle too much for that eye and in the long run, this leads to irreparable damage. In the end, the patient becomes visually impaired and blind.”
There are approximately 350,000 people in the Netherlands who are walking around with glaucoma, Webers adds. High eye pressure can be treated with eye drops, laser surgery, and minor surgical procedures. But the real innovation is a “very small stent, which you can also insert into a blood vessel.” The hollow tube makes it easier for fluid to drain away, Webers goes on to explain. A project is being carried out by the University Clinic for Ophthalmology at Maastricht UMC+ in conjunction with the Brightlands Campus Chemelot. Ophthalmologist Henny Beckers is in charge of the project.
Eye tissue bank
Finally, Webers goes on to talk a little about ‘his hobby.’ “You don’t really know in advance how sensitive a patient is to that eye pressure. The problems only manifest themselves at a later stage. If I knew how sensitive someone is, I might or might not opt for a more intensive treatment.” In order to gain more understanding of that sensitivity, the clinic collects body tissue from all glaucoma-compatible patients for research. “Of course, we ask for permission to store blood and the tissue and fluid that’s lost during surgery. The ‘eye tissue bank’ now contains samples from around 1500 patients.
Webers explains that you can make blood cells, stem cells, and optic nerve cells from those stem cells. “You have to do all sorts of things to achieve this. But it can be done.” These cultivated optic nerve cells are put under pressure under laboratory conditions. “We want to develop an instrument that allows us to show whether a patient is very sensitive to eye pressure or not. This will give us an insight into how great the risk is that that patient will become seriously visually impaired over the course of her or his life. Then you also have a better idea of how extensively you should treat them.”
In addition to sensitivity, Webers also hopes to gain a deeper understanding of what the innate protective factors are. “It could be your genes or your diet, for example.” You could add protective substances to the cultivated optic nerve cells to see if that cell would then become less vulnerable, Webers continues. “Those substances can vary a lot from one individual to another. You may be sensitive to all sorts of substances contained in green vegetables, whereas I am not at all. In that case, the advice would be: Take nutritional supplements. And for me: Don’t do that. To us, this is Personalized Medicine. Highly innovative but still at an experimental stage.”
This article is a follow-up to: Electronic lens offers a medical solution for eye disorders.