Research trial will use femtosecond laser surgery for NHS cataract patients

A research trial to assess the benefits of the latest high-precision laser technology in routine NHS cataract operations is underway at Moorfields Eye Hospital.

It will be the first time that femtosecond laser surgery will be widely available on the NHS for cataract patients.

The trial, which has been funded by the National Institute for Health Research (NIHR), will assess whether this type of laser assisted cataract surgery leads to improved vision and quality of life for people undergoing cataract surgery.

The multi-centre trial which will enrol more than 800 people, will take place at Moorfields Eye Unit at St Ann’s Hospital in north London with a second centre at Wolverhampton Infirmary beginning at a later date. Patients will be randomly assigned to one of two treatments –half will undergo surgery with some of the steps performed using the femtosecond laser and half will have standard cataract surgery. Patients will be followed for a year after surgery and the study will last for almost four years.

Age-related cataract is the leading cause of visual impairment in the world and cataract surgery is the most commonly performed eye operation worldwide. One in three people in Britain is predicted to require treatment at some stage and 300,000 cataract operations take place in the UK each year. Moorfields performs more than 15,000 cataract procedures a year, across all locations where the trust has surgical facilities. 

A cataract is the medical term for when the natural lens in the eye becomes cloudy. With standard cataract surgery, the surgeon performs all the steps to deal with a cloudy lens, including making the incisions, using ultrasound to break the cataract into tiny particles, washing the cataract particles out of the eye and then inserting a new artificial lens into the eye.

In contrast, the femtosecond laser automates some of these steps. Using laser pulses that last one millionth of a billionth of a second, the machine makes the incisions and breaks up the cataract into small pieces before the surgeon starts the operation. The laser procedure takes approximately five minutes and is done before the patient enters the operating theatre.

Moorfields consultant ophthalmologist Mr Mark Wilkins, who is leading the group of clinicians and researcher, working on the study, said: “Although the technology has existed for some time, it has generally only been available for private patients, without a body of evidence to show if it improved outcomes for patients. The study aims to find out if laser assisted cataract surgery leads to better outcomes – such as improved vision and quality of life – and fewer complications for NHS patients scheduled to undergo routine cataract surgery.” Mr Wilkins added “We want to assess the possible overall benefits for the NHS.  Although cataract surgery is very safe we are also interested in finding out whether patients perceive the standard of care to be higher if the laser is used?”

Mr Vincenzo Maurino, consultant ophthalmologist and cataract service director, a co-investigator for the study, said that by automating more than 50% of the cataract surgery procedure, it will be possible to see if there are fewer complications by introducing a robotic element to the surgical process.

“There are already great outcomes from the current cataract procedure but by making some of the steps of the surgery more robotic we can see if this does or does not translate into an increased number of cataract operations performed and reduced waiting times for cataract surgery. The study should be able to answer those questions and prove the best way forward for the cataract surgery of the future,” said Mr Maurino.

The design of the study has involved patients who contributed their views through two facilitated focus groups. These were held at the NIHR Biomedical Research Centre at Moorfields and the UCL Institute of Ophthalmology in March 2013 and January 2014 to discuss different aspects of the trial proposal. Patients gave their views of having their eyes treated in different ways, experiences of their surgery and aftercare, and what the outcome measures should be.

It was agreed that an evaluation of vision was essential and the impact of the treatment on quality of life was also important. Patients have helped develop a patient information sheet, which will be given to every potential participant in the study and a consent form, which will need to be signed by every patient who agrees to join it.

Notes to editors

The National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme funds research about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest NIHR programme and publishes the results of its research in the Health Technology Assessment journal, with over 700 issues published to date. The journal’s 2013 Impact Factor (5.116) ranked it two out of 85 publications in the Health Care Sciences and Services category. All issues are available for download, free of charge, from the website. The HTA Programme is funded by the NIHR, with contributions from the CSO in Scotland, NISCHR in Wales, and the HSC R&D Division, Public Health Agency in Northern Ireland. www.nets.nihr.ac.uk/programmes/hta

NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology is a partnership between Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology.  Established in April 2007, its purpose is to conduct 'translational research' that is designed to take advances in basic medical research from the laboratory to the clinic, enabling patients to benefit more quickly from new scientific breakthroughs.  Our centre is currently one of 12 biomedical research centres that were awarded in 2007 to NHS/university partnerships with an outstanding international reputation for medical research and expertise, and experience of translating that research into the clinical setting.  For further information, please visit www.brcophthalmolgy.org/ 

Moorfields Eye Hospital NHS Foundation Trust is one of the world’s leading eye hospitals, providing expertise in clinical care, research and education.  We have provided excellence in eye care for more than 200 years and we continue to be at the forefront of new breakthroughs and developments.  We are an integral part of one of the UK’s first academic health science centres, UCL Partners, and now we are part of one of the first science health networks. We were one of the first organisations to become an NHS foundation trust in 2004.  For further information, please visit www.moorfields.nhs.uk.

UCL Institute of Ophthalmology is one of a number of specialised research centres within UCL (University College London) and is, together with Moorfields Eye Hospital, one of the leading centres for eye research worldwide. The most recent Research Assessment Exercise confirmed the outstanding quality of research carried out at the Institute, with 40 per cent of investigators ranked 4* (world-leading) together with a further 30 per cent ranked as internationally excellent. The combination of the Institute’s research resource with the resources of Moorfields Eye Hospital, which has the largest ophthalmic patient population in the Western World, opens the way for advances at the forefront of vision research.  For further information, please visit www.ucl.ac.uk.

About the NIHR The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence, and systems represent the most integrated health research system in the world. For further information, visit the NIHR website www.nihr.ac.uk

This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

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