Custom-built robot could help people living with eye disease

12 June 2024 - Experts at King’s College Hospital and King’s College London are using robot radiotherapy to improve patients’ experience while also reducing cost

Researchers have developed a new robot system to treat wet neovascular age-related macular degeneration (AMD). In a landmark trial, the custom-built, robotically controlled device administered a one-off, minimally invasive dose of radiation, followed by patients’ routine treatment with injections into their eye. The results, published in The Lancet, found that AMD patients who had the robotic radiotherapy required fewer injections to control their disease compared to standard treatment.

The study lead and first author on the paper, Professor Timothy Jackson, King’s College London and Consultant Ophthalmic Surgeon at King’s College Hospital, said: “Research has previously tried to find a better way to target radiotherapy to the macula, such as by repurposing devices used to treat brain tumours. But so far nothing has been sufficiently precise to target macular disease that may be less than 1mm across.

“With this purpose-built robotic system, we can be incredibly precise, using overlapping beams of radiation to treat a very small lesion in the back of the eye.

“Patients generally accept that they need to have eye injections to help preserve their vision, but frequent hospital attendance and repeated eye injections isn’t something they enjoy. By better stabilising the disease and reducing its activity, the new treatment could reduce the number of injections people need by about a quarter. Hopefully, this discovery will reduce the burden of treatment that patients have to endure.”

Wet AMD is currently treated with regular injections into the eye. Initially, treatment substantially improves a patient’s vision. But, because the injections don’t cure the disease, fluid will eventually start to build up again in the macula, and patients will require long-term, repeated injections. Most people require an injection around every 1-3 months, and eye injections, costing between £500 and £800 per injection, have become one of the most common NHS procedures.

One of the first people to benefit from the new way of giving treatment was 75-year-old Peter Frewin, who lives with his wife and granddaughter in Bromley. Before the trial, Peter’s very first injection cleared a dark ‘spot’ that partially blocked the vision in his left eye. This treatment enabled him to drive normally, but an average of four injections a year were required to keep the condition stable. However, following the trial, Peter was able to go two years without a further injection and in subsequent years has continued to require fewer repeat treatments. Last year (2023), he was even able to go the whole year with just the one injection. Peter said: “My experience has been great; I definitely felt a beneficial effect as it went on for a nice long time before a further injection was needed. I felt relieved, and it is great that I can continue to drive. I’ve a lot to be thankful for.”

The research trial was led by doctors at King’s College Hospital NHS Foundation Trust and researchers from King’s College London, in collaboration with the University of Oxford, the University of Bristol and Queen’s University in Belfast. Dr Helen Dakin, University Research Lecturer at the University of Oxford, said: “We found that the savings from giving fewer injections are larger than the cost of robot-controlled radiotherapy. This new treatment can therefore save the NHS money that can be used to treat other patients, while controlling patients’ AMD just as well as standard care.