Abstract
The human eye plays a pivotal role in the perception of the world that surrounds us. Among its various components, the retina, a neural tissue lining the innermost part of the eye, is critical for the vision. Therefore, detecting diseases and disorders of the retina that are potentially blinding, such as age-related macular degeneration in early stages is essential to preserving vision and preventing irreversible damage.Age related macular degeneration is a leading cause of vision loss in elderly people and is a progressive multifactorial retinal degenerative disorder that affects the central portion of the retina, known as the macula.
Age-related macular degeneration can be neovascular or non-neovascular; while patients with the non-neovascular form may be offered nutritional supplements to try and prevent neovascularization occurring, those with the exudative neovascular form are offered intravitreal (into the eye) injections of an anti-vascular endothelial growth factor agent to stabilise vision. Whilst patients with geographic atrophy (advanced form of non-neovascular age-related macular degeneration) traditionally had no treatment, two complement inhibitors given by intravitreal injections have recently achieved food and drug administration approval in the USA.
The introduction of a relatively new non-invasive imaging modality known as optical coherence tomography, has dramatically enhanced the diagnostic resources available to the ophthalmologists and it has quickly become part of the standard of care in most ophthalmic diseases. Optical coherence tomography represents a milestone in retinal healthcare due to its ability to improve early detection of disease and to guide the effectiveness of treatment, whilst being quick and comfortable for patients.
My main research interest during the last 10 years has been focused on both OCT and other non-invasive diagnostic technologies, and on treatment outcomes following intravitreal injections with anti-vascular endothelial growth factor in retinal diseases, particularly in neovascular age-related macular degeneration.
Following initial work on validating the use of the optical coherence tomography in age-related macular neovascularization and its diagnostic accuracy, my studies concentrated on analysing its sensitivity and specificity in polypoidal choroidal vasculopathy (a specific sub-type of neovascular age-related macular degeneration), on its response to treatment, and on the importance of patient education and awareness for early disease detection.
My work has resulted in national and international lecture invitations by various academic institutions, ophthalmology societies’ meetings and pharmaceutical industries’ advisory boards. Additionally, one of my published articles has pioneered and inspired the most recent tomographic diagnostic classification (2020) of polypoidal choroidal vasculopathy.
This body of published work contributes to optimising the diagnosis of age-related macular degeneration providing new insights based on tomographic findings, stressing the importance of its early detection, and studying its response to the treatment.
This thesis provides a narrative that combines 6 published peer reviewed research papers and 2 conference abstracts (subsequently published and found in the appendix of this narrative as supplemental material). Those are summarised on page 45, including title, study design and number of current citations. Their full text format follows on page 51, at the end of this thesis.
| Date of Award | 24 Apr 2025 |
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| Original language | English |
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| Supervisor | Rebecca Stores (Supervisor) & Richard Gale (Supervisor) |