Transforming outlooks

31 October 2019
Autumn 2019

One of our biggest challenges, both clinically and psychologically, is the patient with degenerative eye disease for which there is no cure.

Patients with inherited eye disease can be offered support through local sensory services (see Acuity Summer 2018), access to work schemes, and low vision assessments. But now, new avenues of hope are emerging: gene therapy is an area of medicine that is beginning to make its way from the world of research into the clinical realm. 

Eyes are particularly amenable to gene therapy, with a selection of well-understood genetic eye diseases, lower risk of immune reaction, and easy-to-measure treatment outcomes compared with other organs. Gene therapy itself involves modifying a patient’s own faulty DNA, using a viral vector to insert new genes or replace faulty ones. Some gene therapies inactivate a faulty gene instead. Approaching disease at the genetic level removes the root cause and allows tissue to function correctly again.

In this issue, Becky McCall explores the latest advancements and the involvement of optometrists such as Jasleen Jolly in the development of ocular gene therapy. This is an exciting time in the treatment of many devastating eye diseases, and will transform the future for those suffering from them, although it may still be some years before they are clinically available.

As research steams ahead with genetic eye disease, other areas of practice still need more investigation. Implicit, or unconscious, bias is something that affects everyone. These terms essentially refer to subconscious stereotyping. Forming categories can be helpful in many situations, and helps us understand the world around us, but we are not always right in the categorisations we make. 

Put simply, not everyone who wears a stripy top, beret and onions around their neck is French, and not all French people sport this fashionable look. 

However, most of the stereotypes we make are not so obvious. Our own subtle internal stereotypes develop from a lifetime of experiences and social interactions, and are assimilated from the opinion of our families, friends and wider society, as well as our personal experiences of dealing with certain groups.

Unconscious bias can have a damaging effect on our social interactions, and society at large. The first step in overcoming our unconscious biases is identifying them and being mindful about the way we think about certain groups. Once we are able to do this, it is easier to change our outlook and treat everyone as an individual, rather than making assumptions based on their sex, gender, age, skin colour, sexuality, creed, job, political opinions, appearance... the list of potential biases goes on. Kathy Oxtoby explores how unconscious bias can influence healthcare, and highlights the sparsity of research into this fascinating aspect of optometric care. 

By being aware of ourselves, we can treat others better, and by being aware of new developments, we can offer the latest interventions to our patients. 


Kieran RG Loft MSc BSc (Hons) MCOptom DipTp (IP)


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