Hearing aids and cataract surgery are strongly linked to a slower rate of age-related cognitive decline, according to new research by University of Manchester academics.

According to and , cognitive decline- which affects memory and thinking skills- is slowed after patient’s hearing and sight are improved.

The rate of decline was halved following cataract surgery and was 75% less following the adoption of hearing aids.

The research on cataract surgery - which is published in  today– was carried out using 2,068 individuals who underwent cataract surgery between Wave 2 and Wave 6 of the English Longitudinal 91直播 of Ageing survey from between 2002 to 2014.

They were compared with 3,636 individuals with no cataract surgery.

And the research on hearing aids, published in the Journal of the American Geriatrics Society in July, was carried out using 2040 participants in the American Health and Retirement survey from 1996 to 2014

Both surveys assess cognitive decline by testing memory, asking participants to recall 10 words immediately and then at the end of the cognitive function module.

The researchers compared the rates of decline before and after the patients had surgery or started wearing a hearing aid.

Dr Dawes said: “These studies underline just how important it is to overcome the barriers which deny people from accessing hearing and visual aids.

“It’s not really certain why hearing and visual problems have an impact on cognitive decline, but I’d guess that isolation, stigma and the resultant lack of physical activity that are linked to hearing and vision problems might have something to do with it.

“And there are barriers to overcome: people might not want to wear hearing aids because of stigma attached to wearing them, or they feel the amplification is not good enough or they’re not comfortable.

“Perhaps a way forward is adult screening to better identify hearing and vision problems and in the case of hearing loss, demedicalising the whole process so treatment is done outside the clinical setting. That could reduce stigma.

“Wearable hearing devices are coming on stream nowadays which might also be helpful. They not only assist your hearing, but give you access to the internet and other services

Dr Maharani said: “Age is one of the most important factors implicated in cognitive decline. We find that hearing and vision interventions may slow it down and perhaps prevent some cases of dementia, which is exciting- though we can’t say yet that this is a causal relationship.

“Other studies have attempted to look at rates of cognitive decline- but have not really succeeded as it’s hard to take into account demographic factors.

“But the beauty of this study is that we’re comparing the progress of the same individuals over time.”

‘’ is published in Plos One.

‘’ is published in the Journal of the American Geriatrics Society

This research is funded by the European Commission’s Horizon 2020 Framework

A leading scientist from The University of Manchester has been chosen for a coveted national award by leading sight loss charity the .

38, is one of the winners in this year’s Macular Society Awards for Excellence. He has been rewarded in the Rising Star of the Year category for his pioneering research into macular disease. It’s a case of second time lucky for Dr Clark, who is based at the University’s Faculty of Biology, Medicine and Health, having previously been shortlisted for the award in 2017.

Dr Clark’s work has focused on the links between a person’s complement system, part of the immune system, and macular disease. Extensive laboratory work has helped Dr Clark and his team gain a much greater understanding of macular disease and they have developed a new drug for the condition called Coalexin. Coalexin is set to begin clinical trials in the next two years.

Alongside his cutting-edge research, Dr Clark has been praised for his editorial and scientific contributions to a number of respected scientific journals, as well as his close collaboration with other universities throughout the world, including in Denmark, the Netherlands and the United States. In addition, he has been helping inspire budding scientists by regularly hosting students at his laboratory, enabling them to learn more about macular disease.

Dr Clark said: “Although I knew I’d been shortlisted for the award, I really wasn’t expecting to win, so it was a lovely surprise when the Macular Society rang to tell me.

“I’ve been nominated for awards before, but this is the first time I’ve won anything like this, and it’s very humbling. It’s taken a little while to sink in, but I’m so pleased to have been chosen. Alongside going to collect the award next month, I’m hoping to do something with my family to celebrate too.”

Dr Clark will receive his award at the Macular Society’s national annual conference, which takes place at the Grange Tower Bridge Hotel in London, on 22 September. He will also be speaking at the conference, providing guests with an overview of current research into age-related macular degeneration (AMD).

Now in its 10th year, the Macular Society Awards for Excellence is run by the charity to celebrate the inspirational work done to provide services and care for people with macular disease all over the UK.

Rising Star of the Year is one of five honours handed out by the charity as part of the awards. There are also prizes for Clinical Service of the Year; Optician / Optometrist of the Year; a Chairman’s Award for Volunteering, and Chairman’s Award for Fundraising.

The Macular Society is the national charity for anyone affected by central vision loss. It has more than 400 support groups across the UK, which help to increase the confidence and independence of people affected by macular disease. AMD is the most common cause of sight loss in the UK, affecting more than 600,000 people. More people are affected as our population ages, and it is estimated that by 2050, around 1.3 million people will have AMD.

Cathy Yelf, chief executive of the Macular Society, said: “Our annual awards are our chance to recognise and reward professionals like Dr Clark for their incredible commitment and dedication in the fight against macular disease. It’s thanks to them that potential new treatments for macular conditions continue to be discovered.

“The work Dr Clark undertakes is truly pioneering and it’s only right that his efforts should be rewarded in this way. On behalf of everyone at the Macular Society, I’d like to add our thanks, and congratulate him on this excellent achievement.”

Highly effective current treatments for vision loss need to be allied with careful counselling to ensure patients maintain good psychological health as well as good vision, new research recommends.

wAMD is the commonest cause of vision loss in the western world, but modern treatments have dramatically improved the level of vision patients can expect to retain. These treatments involve regular injection of vascular endothelial growth factor inhibitors (anti-VEGF) into the eye.

However, a new study conducted at 91直播 Royal Eye Hospital and published in the , demonstrates high levels of undiagnosed anxiety and depression persisting in patients receiving treatment, despite their improved visual outcomes.

91直播 researchers say that the study findings demonstrate the value of human interaction between clinician and patient in offering reassurance around the efficacy and safety associated with anti-VEGF injections.

, Senior Lecturer in Ophthalmology at The University of Manchester, Consultant Ophthalmologist, at Central 91直播 University Hospitals NHS Foundation Trust (CMFT), and lead author of the study, said: “There have been amazing scientific achievements in diagnosing and treating serious eye diseases, such as wAMD, which have revolutionised our ability to reverse life-changing vision loss. However, we must not forget the human element when applying all this to ensure all our patients can reap the full benefits of this cutting-edge science.

“This study represents one of the largest and most detailed examinations of patients undergoing anti-VEGF therapy to date. It helps us understand how factors such as patients’ understanding and building strong relationships with healthcare professionals may help alleviate anxiety around receiving injections.”

The report suggests that patients may benefit from additional assurances from clinical staff regarding; success rates in halting disease progression with anti-VEGF therapy, how it can reduce the risk of becoming blind in the future, and the low likelihood of serious problems occurring following the injections.

Dr Hugo Senra, the Clinical Psychologist who conducted the study, said: “This study also highlights the importance of considering specialised counselling for certain wAMD patients. Literature has shown that tailored psychological and psychosocial interventions can be effective to reduce anxiety and depression in wAMD patients, and contribute to their adjustment to illness and medical treatments.”

The research found as many as 89% of patients who showed anxiety, and 91% who showed depression were not receiving appropriate psychological and psychiatric treatment.

Although levels of depression reduce once anti-VEGF therapy is established, doctors should be vigilant to such symptoms and their potential to impair quality-of-life. Use of standardised tools to screen wAMD patients for symptoms of anxiety and depression in the macular treatment unit could better help identify patients at risk. Further research and controlled trials will be needed to better understand anxiety and depression in wAMD patients and develop new intervention tools at patient and clinical level to reduce symptoms and improve quality-of-life.

This study was supported by the National Institute for Health Research (). It was also funded by a grant from , in order to support the ophthalmology community in transforming care and supporting people living with retinal conditions.

Dr Jackie Napier, Medical Director for Ophthalmology at Bayer, said "At Bayer we are dedicated to working in partnership with the ophthalmology community to help transform lives, and an important element of this is working together to improve the holistic support that is provided to patients, carers and their families. We are proud to support this study, which is one of the first of its kind in the UK to investigate the experience of patients with wet AMD receiving anti-VEGF therapy. This type of research can help shape improvements in patient education and support, and thus enable people with wet AMD to get the most from their treatment."

The article 'Experience of Anti-VEGF Treatment and Clinical Levels of Depression and Anxiety in Patients With Wet Age-Related Macular Degeneration', by Hugo Senra, Konstantinos Balaskas, Neda Mahmoodi, Tariq Aslam (), appears online at , published by .

Five blind 91直播 patients will be among the first in the country to receive revolutionary bionic eye implants funded by the NHS.

NHS England will provide funding for further testing of the Argus II, also known as the Bionic Eye, for ten patients with Retinitis Pigmentosa (RP), an inherited disease that causes blindness.

Five of these procedures will take place at the 91直播 Royal Eye Hospital (MREH) from 2017, with the other half at Moorfields Eye Hospital in London.

Surgeons at 91直播 and Moorfields made history by delivering the world’s first trial of the Argus II bionic eye implants in RP . MREH surgeons also performed the first ever bionic eye implant on a patient with age-related macular degeneration (AMD) in 2015.

NHS England will fund this through its Commissioning through Evaluation (CtE) scheme, designed to gather vital evidence for treatments that show significant promise for the future. NHS England will assess how the Bionic Eye helps patients function with everyday tasks.

One of the first implanting surgeons was Professor Paulo Stanga from 91直播 Royal Eye Hospital, University of Manchester and 91直播 Vision Regeneration (MVR) Lab at NIHR/Wellcome Trust 91直播 Clinical Research Facility. Prof. Stanga, who has played a crucial role bringing the bionic eye to patients on the NHS, says: “I’m delighted that our pioneering research has provided the evidence to support NHS England’s decision to fund the bionic eye for the first time for patients. It surpassed all of our expectations when we realised that one of the RP patients in 91直播 using the bionic eye could identify large letters for the first time in his adult life.”

This news comes just weeks after the Department of Health announced a £12.5m investment into 91直播’s clinical research facilities.  The NIHR/Wellcome Trust 91直播 Clinical Research Facility has provided the dedicated space, specialist staff and equipment to support the Bionic Eye studies, which demonstrated that the bionic eye device restores a degree of visual function to patients who have suffered complete vision loss due to RP. 

“Our work also has the potential to improve the lives of thousands of other patients with the more common condition, age-related macular degeneration – 91直播 is currently the only site in the world to be trialing the bionic eye in AMD”, added Prof. Stanga.

Patients using the system, developed by American company Second Sight Medical Products, are given an implant into their retina and a camera mounted on a pair of glasses sends wireless signals direct to the nerves which control sight. The signals are then ‘decoded’ by the brain as flashes of light.

Grandfather-of-five from Lancashire, Keith Hayman, 68, was one of three people who had been fitted with the bionic eye at 91直播 Eye Hospital by Professor Stanga during a trial for Retinitis Pigmentosa in 2009. He has been blind for 25 years having been diagnosed in his 20s while working as a butcher and was forced to give up work in 1981 when he was registered blind. He says; "Having spent half my life in darkness, I can now tell when my grandchildren run towards me and make out lights twinkling on Christmas trees. When I used to go to the pub, I would be talking to a friend, who might have walked off and I couldn't tell and kept talking to myself. This doesn't happen anymore because I can tell when they have gone. These little things make all the difference to me."

Grégoire Cosendai, VP of Europe for Second Sight Medical Products Inc, said: “Second Sight wishes to congratulate NHS England for this decision to make this truly revolutionary and life-changing technology available for patients. Argus II makes a real difference to blind people. It may be, for some patients, the difference between staying at home alone, or being able to find your way outside. Now this treatment is to be offered free of charge to blind patients in the UK. This is a major victory for blind people in the UK who have supported us in our six-year mission to fund Argus II in England.”

Dr Jonathan Fielden, Director of Specialised Commissioning and Deputy National Medical Director, NHS England said: “This highly innovative NHS-funded procedure shows real promise and could change lives. The NHS has given the world medical innovations ranging from modern cataract surgery, new vaccines and hip replacements. Now once again the NHS is at the forefront of harnessing ground-breaking science for the benefit patients in this country."

Procedures will take place during 2017 and patients will then be monitored for a period of one year, during which they will be assessed on how the implants improve their everyday lives.
 

Two gene mutations that trigger a retinal disease that causes blindness in one in 5,000 males have been mapped, leading to the potential for new therapeutic treatments.

Researchers from The University of Manchester undertook a structural analysis of X-linked Retinoschisis (XLRS), a genetic disease leading to a type of macular degeneration in which the inner layers of the retina split causing severe loss of vision and gradual blindness. Currently, there is no effective treatment for XLRS, with research focused on understanding how the disease occurs in the retina.

XLRS is caused by mutations in the retinal protein retinoschisin. The protein plays a crucial role in the cellular organisation of the retina, assembling itself to form paired octameric (consisting of eight retinoschisin) rings. The rings each resemble an 8-bladed propeller. This new structural insight yielded important clues into how retinoschisin performs its crucial role in the retina and spurred efforts to investigate what happens to this structure when it is mutated in XLRS.

Using a cryo-electron microscope, the team examined the paired rings as well as the effects on the rings of two XLRS-causing mutations. The effects of these mutations, despite being reported to cause the disease, were unknown and may offer explanations on how the normal protein functions in the retina.

, Professor of Biochemistry at The University of Manchester and lead author of the research team’s resulting paper, said the cryo-electron microscopy allowed them to identify the location of the mutations on the rings.

“We found that one disease-causing mutation sits in the interface between the octamer rings, causing retinoschisin to be less stable. The other mutation is on the propeller tip which we think is a novel interaction site for other binding proteins in the retina.”

As well as identifying the mutations and precisely mapping their locations, the research team held out the possibility that future work could lead to genetic interventions and treatments, which could limit or prevent the damage caused by XLRS.

“XLRS is a promising candidate for gene therapy, so our findings on these two different classes of mutations will be informative for future therapeutic strategies,” concluded Professor Baldock.

The paper, entitled ‘’, was published in the journal Human Molecular Genetics. doi: 10.1093/hmg/ddw345

A unique art project showing how artificial and natural sight have been combined for the first time in history has is launched at 91直播 Science Festival.

An exciting new project is exploring the damage of sight loss caused by Age Related Macular Degeneration (AMD) and the use of the ground-breaking bionic eye for vision restoration.

Artist, Lucy Burscough is bringing the pioneering work of Paulo Stanga, Professor of Ophthalmology and Retinal Regeneration, to life with Ocular Bionica, an exquisitely painted stop-frame animated film made in a hospital setting with support from Arts Council England’s National Lottery funded Grants for the Arts programme.

, Consultant Ophthalmologist and Vitreoretinal Surgeon for the 91直播 Vision Regeneration (MVR) Lab at 91直播 Royal Eye Hospital (MREH) and NIHR/Wellcome Trust 91直播 Clinical Research Facility, , Ray Flynn, with the Argus® II ‘bionic eye’. Ray is the first person in the world to have combined artificial and natural vision.

The art project, part of , tells the story of Ray, who underwent the four-hour operation to have the bionic eye implanted in June 2015. With the Argus II system switched on, Ray is able to make out the outline of people and objects even with his eyes closed. With his eyes open, Ray successfully combines vision from his artificial vision with his remaining natural vision. Lucy’s film is a world first – because it shows what this looks like for Ray.

Lucy spent time interviewing Ray about how he got involved in the clinical research trial and his experiences of taking part. She has painted detailed and vivid pictures including Ray, Professor Stanga and his team, to illustrate the development of the study and how it came to change Ray’s life.

Lucy said: “This work has been inspired by remarkable, cutting-edge technologies that hint at a future of biomedical bionics and the hacking of humanity. The film seeks to show viewers the world through Ray’s eyes, both before and after the device was fitted.

”The film was created in Lime Arts Studios, actually on site in CMFT and follows my previous work including celebrating 91直播 Royal Eye Hospital’s 200^th anniversary in 2014.

“I am intrigued by perception and the differences between how different people see the same things. I am also interested in finding narratives in biomedical science and showcasing clinical research to a wider audience. I hope that the film inspires people to find out more about research here at Central 91直播 University Hospitals NHS Foundation Trust.”

Professor Stanga, who is also Professor of Ophthalmology & Retinal Regeneration at The University of Manchester and Principal Investigator on the trial to test the usefulness of the Argus II in patients with total central vision loss due to AMD, said: “Lucy’s work depicts two unique aspects of sight loss for the very first time, which greatly adds to our understanding – and empathy with – a blind patient’s experience.

“The first is that Lucy has interpreted Ray’s ability to successfully combine artificial vision from the Argus II in his central visual field with his remaining natural vision, which is at the periphery of his sight.

“On a personal level, this is a very moving as well as an exciting experience, to literally see through Ray’s eyes and experience the real visual function benefits Ray has gained from his artificial vision. The film clearly shows how the Argus II system provides basic shapes and outlines of objects (or people) to fill in a gap in the centre of Ray’s sight destroyed by AMD, while he is still able to discern detail and colour using his natural vision, not affected by the AMD, at the corners of his eye.

“Ray is only one of five people in the world who have been implanted with the Argus II on the current AMD trial at 91直播 Royal Eye Hospital, to have combined natural and artificial vision. Ray is a very special bionic man, and thanks to Lucy, to be able to see through his eyes, will help people to understand more fully, the real impact that artificial vision can make to blind individuals.”

Audenshaw resident Ray (aged 81), who once had dinner with LS Lowry at the Grand Hotel in 91直播 said: “I was delighted to be asked to take part in the film. I very much enjoyed working with Lucy, who visited me on two occasions to take photos and recordings. Art’s an excellent way of explaining medicine and research, and I’m looking forward to seeing the film for the first time.”

The film will be on exhibition at the 91直播 Museum 27–30 October 2016. Further information is available on , and the project’s and feeds.

Details are also on .

The research study is now closed for recruitment and is currently not looking for patients to take part. However, if you are interested in taking part in research conducted by Professor Stanga, please email MVR.lab@cmft.nhs.uk and/or visit: .

The combined impact of dementia, age-related hearing and vision impairment is to be investigated by a new multi-million European research consortium led by The University of Manchester.

Seven in ten Europeans over the age of 65 suffer from either sight or hearing problems and over two thirds suffer from depression or dementia. When combined together the cumulative impact of these dual or triple impairments is far greater than the individual conditions. The scale of combined sensory and cognitive problems is substantial but poorly understood.

The five year project, led by The University of Manchester, has been funded with €6.5m from the European Commission’s research programme. The project aims to investigate this combined impact and develop new tools that could improve quality of life and optimise health and social care budgets across Europe.

, an academic psychiatrist from The University of Manchester, who is the lead researcher on the project, said: “In combination these problems have a much greater effect than each one individually. Imagine if you have dementia which affects your memory or interferes with your recognition of familiar people. When you add visual impairment to that, you can understand why those affected may experience even greater cognitive difficulty or even experience altered behaviour such as agitation or hallucinations.

“The burden on carers – often family members – is also increased as they are required to do much more on a daily basis and we see a greater number of these suffering from burn-out.”

The project seeks to define the scale of the challenges so that authorities across the continent can allocate resources more optimally. At the same time, researchers will also develop online tests, guides and multi-lingual training manuals to help medical professionals diagnose and treat the combined problems more effectively.

Minority groups are particularly disadvantaged with respect to diagnosis and treatment of mental and sensory problems, so researchers will be seeking out people from these groups to participate in the research.

The programme will also trial an intervention of at-home support for people with dual- and triple-impairments. This will be supported by specialist sensory therapists based at and will focus around pragmatic solutions to support both the affected person and their carer.

, a University of Manchester audiologist and co-lead of the SENSE-Cog project said: “Millions of people in the UK and wider EU are affected by this combination of problems and it’s only going to get more prevalent as the population ages. That’s why we have to understand the scale of the problem and then equip the public, carers and health care workers with the tools they need to deal with it. If we could reduce disability due to hearing and vision impairment, there is huge potential to improve mental well-being and even delay the deterioration of dementia.”

A study of up to 433,390 UK adults, led by The University of Manchester, has linked being under and overweight at birth with poorer hearing, vision and cognition in middle age.

Researchers in 91直播, Nottingham, Cincinnati and Madison, Wisconsin analysed data from up to 433,390 UK adults from study.

Associations with birth weight – an index of prenatal growth – were complex.  Larger babies falling within the 10^th and 90^th percentile of weight had better hearing, vision and cognition in adulthood.

But very small and very large babies had the poorest hearing, vision and cognitive function.  Better growth during childhood (as indexed by adult height) was associated with better hearing, vision and cognition in adulthood.

Dr Piers Dawes, a lecturer in audiology at The University of Manchester’s led the study.  He said: “Sensory problems and illness such as dementia are an increasing problem but these findings suggest that issues begin to develop right from early life.

“While interventions in adulthood may only have a small effect, concentrating on making small improvements to birth size and child development could have a much greater impact on numbers of people with hearing, vision and cognitive impairment.”

The data was taken from the UK Biobank study which contains detailed information on UK adults aged between 40-69 years in 2006-2010 from across the country. The researchers used statistical techniques to correct for other sources of impairment such as smoking, economic deprivation and other existing health decisions.

As a result they suggest in the research paper that under-nutrition may impact on development of the brain and sensory systems. Alternatively, growth hormones and changes in genetic regulation may be affected by experiences early in life and impact on neurosensory development.

The paper, ‘’ was published in the journal PLOS One.  The study was facilitated by the 91直播 Biomedical Research Centre.

The world’s first implant of a bionic eye has been carried out by a University of Manchester academic.

led the four hour operation on pensioner Ray Flynn at the which implanted a device to convert video images from a miniature camera installed in his glasses.

Mr Flynn, 80, has age related macular degeneration, a condition which affects over 500,000 people in the UK. The condition is not painful but it means that central vision is impaired resulting in people being unable to read or drive and having difficulty recognising faces.

For Mr Flynn this meant he was unable to watch his beloved 91直播 United on television or do gardening. He was fitted with the device in June which was activated on 1 July and Professor Stanga is delighted with the results.

“Mr Flynn’s progress is truly remarkable,” said Professor Stanga. “He is seeing the outline of people and objects very effectively.

“The dry form of AMD is a common, but untreatable condition. In the western world, it is the leading cause of sight loss. Unfortunately, with an ageing population, it is becoming more common."

The technology works by turning the images captured by the camera into small electrical pulses.  These are transmitted wirelessly to electrodes on the retina surface where they stimulate the remaining cells and replicate the patterns of light for the brain.  Over time Mr Flynn will learn to interpret these patterns and regain vision.

“This technology is revolutionary and changes patients’ lives – restoring some functional vision and helping them to live more independently,” said Professor Stanga, who works in the University’s as Professor of & Retinal Regeneration.

“As far as I am concerned, the first results of the trial are a total success, and I look forward to treating more dry AMD patients.”

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Clinical vision scientist, Dr Neil Parry, sheds some light on why millions around the world are confused about the colour of a dress in a photo circulating on the Internet.

“This is an example of a bistable image, like the famous and illusions. 

“These illusions are ambiguous and so the brain tries to build a model of the likeliest interpretation.  Sometimes it has prior information, sometimes not.

“This photo is ambiguous because there are clues about the ambient light which may be wrong.  In fact we know it's a badly exposed picture because the original dress is deep blue.

“The washed out background of the image gives the impression that it was taken outside on a bright day.  White reflects the ambient light and so when we are outside, white is actually quite blue when measured by a machine that just reports reflected wavelengths. 

“But the visual system isn't a dumb machine.  There is a phenomenon called colour constancy, which helps keeps our perception constant under widely varying illumination, for example the huge change in the colour of daylight from the  morning (blue) to the evening (red). 

“Because of colour constancy, the bus you get to work in  the morning appears the same colour as the one you take home, even though its physical colour can be changed dramatically by the illuminant.   Colour constancy needs context and the context here is ambiguous. 

“Going back to the dress, if you take the context away (by showing a naive observer a small section of the dress), most people say it’s blue if they haven't already seen the whole picture. 

“When I first saw it I wasn't sure and swayed between blue and white.  But now I know that the dress is definitely deep blue and  the photo is overexposed, I no longer ever perceive it as white. 

“So there is another factor at play and that is prior knowledge.  The visual brain uses models of the world whenever it can to help make sense of what it is seeing. 

“If, instead of a dress, it had been a banana, then, regardless of the illuminant and photographic inaccuracy, it’s more likely to be perceived as yellow, because we all know that that a ripe banana is supposed to be yellow.”

Read more about the University’s vision research .