The diabetic retinopathy and maculopathy, so diabetic eye disease is the second commonest cause of visual impairment in the working-age population in the UK and it is predominantly secondary to poor sugar control (poor glycemic control). There is now very good evidence that with very strict sugar level control over long periods you can significantly reduce the risk of complications such as diabetic retinopathy and diabetic maculopathy.
If control is poor over many years, the blood vessels at the back of the eye in the retina, the light-sensitive layer of the eye, can become leaky. Fluid and blood which should normally remain within those blood vessels, then seeps out of retinal blood vessels into the surrounding tissue, into the macula or the surrounding area and causes visual impairment. That means difficulty reading, difficulty recognising faces and difficulty with central vision.
The other thing that can occur with very poor sugar control over a long period is that abnormal blood vessels can start to grow. These blood vessels can grow from the nerve at the back of the eye or elsewhere on the retina. And in addition to them being abnormal, they can be fragile and bleed. This can cause loss of vision or can be also associated with (scar) tissue – they can contract and detach the retina which also can cause visual loss and requires surgical intervention.
Professor Michel Michaelides is a Professor of Ophthalmology at Clinica London. His special expertise is in Retinal Diseases, including Inherited Retinal Diseases, Age-Related Macular Degeneration, Diabetic Retinopathy and Maculopathy, and Retinal Vein Occlusions.
He has over 16 years experience in treating people with eye problems just like you and has published extensively in scientific journals about diabetic eye disease, age-related macular degeneration and inherited eye disease, and also lead multiple clinical trials investigating novel therapies. At Clinica London, he is responsible for Retinal Diseases both in adults and children.
Professor Michel Michaelides is an Institute of Ophthalmology professor and a highly skilled clinician. He is a national and international authority on inherited retinal disease. He works part of his time in the laboratory supervising PhD students working on genetic advances in inherited retinal diseases, and partly in clinical ophthalmology, applying his skills. Clinically he works directly with patients both at Moorfields Eye Hospital and here at Clinica London, where he sees private patients. He looks after patients with Stargardt disease, with retinitis pigmentosa, with cone dystrophy and many other strains of the thousands of minutely differing genetic eye diseases.
Many patients may feel put off by seeing a professor who works in the laboratory; however, Professor Michel Michaelides is also an extremely skilled clinician and gets on very easily with his patients, managing to cross the divide between academia and clinical work seamlessly. He sees both children and adults. The children are usually in their teenage years, as that is often when they realise they have an eye condition that may have been inherited, and they come along with their parents. Very often we have to get the child or teenager to see the orthoptist first to measures the field of vision and to make sure there is no squint. If they are old enough, however, he will see them without prior orthoptic testing.
When a teenager or an adult comes to see Professor Michaelides they will, first of all, have some special tests, which can include visual acuity, the normal intraocular pressure measurements and a more specialised imaging test, such as the scanning laser ophthalmoscopy and the ocular coherence tomography. This provides the professor with high-quality images of the disc and retina and also with autofluorescence, which is black and white pictures of the deeper layers of the choroid. The OCT machine is providing information about the actual layers of the cells of the back of the eye, particularly of the macula, which is the part of the retina responsible for colour vision and fine detail vision. They may also have an SLO, which is a scanning laser ophthalmoscopy of their retina. This provides a wide-angled view of the retina and optic disc appearance as well as information about the deeper choroidal layer of the eye.
Once the nurse has done the tests, which take about half an hour, the patient will see Professor Michaelides, and he will ask you about your family history and will examine your eyes after he has looked at the test results. Professor Michaelides will then advise you on the likelihood of your condition deteriorating and the timescale in which this might occur. He can tell you what help is available for maintaining or improving your vision, and whether there are any genetic treatments that you could benefit from. He will then summarise everything in a report. Professor Michaelides tries to deal with each patient in one visit as many of them travel from abroad to see him.
He has patients that come from India, Africa, other parts of Asia, South America and throughout the United Kingdom. He also has patients that travel from Eastern and Western Europe. Many of the genetic conditions affect families, particularly where there have been cousin marriages, and the inheritance pattern, therefore, has meant that somebody can be a carrier of the eye disease. So they may not actually have the condition themselves, but they then pass it on to the next generation. Therefore there are many Mediterranean families for whom cousin marriages – known as consanguineous marriages – have resulted in children having eye defects affecting their retina, inherited retinal or macular diseases.
Professor Michaelides will also provide advice on how the genetic defect has come into play and what the risk is for the person affected henceforth in passing it on to the next generation or the one after. He gives family genetic advice as well as individual ocular genetic advice.
Professor Michaelides works every Thursday afternoon at Clinica London, and you can book in to see him by booking a consultation by clicking the blue consultation button and filling in the form, requesting to see Professor Michaelides.
You can usually get an appointment to see the professor within two to three weeks, but you may not necessarily be able to see him within a week as he is often fully booked, or he is lecturing internationally or nationally. Professor Michaelides looks forward to seeing you at Clinica London, and I am pleased to recommend him to you.
For a consultation in London at Clinica, prices range from £200-£400.
Please book a consultation for a written quote with a full breakdown of treatment costs.