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IN TOUCH 鈥� Glaucoma Treatments; Driverless Cars

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TX:听 22.09.20听 2040-2100

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PRESENTER:听 听听听听听听听 PETER WHITE

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PRODUCER:听 听听听听听听听听听 MIKE YOUNG

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White

Good evening.听 Well you have definitely set the agenda for tonight鈥檚 programme.听 Prompted by your questions we鈥檙e going to be investigating the role laser treatments can play in controlling glaucoma 鈥� the advances and when caution is advisable.听 And the latest on driverless cars.

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I think it鈥檒l be great for independence.听 The day one of us, you know, totally blind jump in a car and get dropped off at the place you actually want to be at, instead of having to learn the route from a bus stop, yeah, fantastic.

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White

So, an eventual route to greater freedom for visually impaired people or just another hazard on the road?听 And we鈥檒l be fitting in a few more of your emails as well.听 Like the one which was prompted by the item we did recently on the fears of drug shortages when we leave the EU at the end of this year.

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It prompted a query from Linda Dickson from Cottingham near Hull.听 Now Linda wanted to know more about a laser treatment that she鈥檇 been offered by her consultant, which, she鈥檇 been told, could end the need for her to take eye drops to control her glaucoma.

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Dickson

Living with glaucoma, it can be very painful, it鈥檚 like a hot needle sometimes stuck in the eye.听 I was diagnosed about 30 years ago now.听 Apart from having laser treatment in the early stages I鈥檝e been taking drops for all that time.听 When I put the drops in my eye it reduces the pressure, which makes the pain go away.听 Oh, it鈥檚 a massive relief.听 Originally, I was given xalatan drops, they had to be kept in a fridge, so my consultant changed the prescription to monopost, which don鈥檛 need to be kept in a fridge, it鈥檚 a much easier performance.听 The last time I saw my consultant he mentioned this new laser treatment.听 It鈥檚 only done privately; it鈥檚 done under local anaesthetic and it鈥檚 supposed to stop having to use drops at all.听 I鈥檓 seriously considering applying to have it actually, I know it鈥檚 quite expensive, about 拢1,500 per eye but it would be very useful not to have to take drops every evening.听 It would be wonderful to think that it would sort this problem out once and for all.

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White

Well, Linda wanted to know about laser treatments, she actually mentioned, in her email to us, a micropulse transscleral cyclophotocoagulation, which I鈥檝e been practising saying.听 To tackle Linda鈥檚 enquiry and matters arising from it we鈥檝e gone to the top.听 I鈥檓 joined by consultant ophthalmic surgeon Professor Gus Gazzard who is Director of the glaucoma service at Moorfields Eye Hospital and we鈥檒l also be joined by Karen Osborn, who鈥檚 Chief Executive of the support organisation Glaucoma UK.

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Professor Gazzard, if I can come to you first, we鈥檒l come to Linda鈥檚 specific enquiry in a moment but could you just give us a bit of background first?听 What is the significance of laser in treating glaucoma because I think there are several possible treatments aren鈥檛 there?

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Gazzard

The primary treatment for glaucoma, the only really proven treatments, are all to lower the eye pressure and to lower eye pressure we can use laser, eye drops or surgery and surgery鈥檚 reserved for when the other things don鈥檛 work.听 And so, there鈥檚 often a lot of confusion about which sort of laser we鈥檙e dealing with, so we have to be clear what鈥檚 being offered and that the rumours or the advice that somebody鈥檚 been given applies to the particular type of laser we鈥檙e dealing with.

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White

So, perhaps at this point, I should ask you about what Linda is talking about.听 She was offered it, she鈥檚 thinking of spending quite a lot of money on it, what would you tell her?

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Gazzard

Well I would tell her to balance the risks against the benefits, to find out very, very clearly what the risks of any treatment are, whether those are the eye drops or one of the many lasers available and then to try and balance those, as you would do for any medical treatment, even taking paracetamol for a headache or antibiotics for an infection, balance those risks against the benefits that you鈥檙e getting from it.

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White

So, what are the risks?

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Gazzard

Some lasers 鈥� Selective Laser Trabeculoplasty 鈥� SLT is a very safe laser that鈥檚 done on the NHS in the clinic and works as well as one or two eyedrops and we鈥檝e proven that very nicely over the last year or so.听 The micropulse diode laser is a different kettle of fish really, that鈥檚 a more invasive laser that actually seeks to destroy some of the organ that makes fluid inside the eye and pumps water, aqueous humour, inside the eye and turn the tap off, if you like, to reduce the pressure that way.听 But because it destroys tissue it can cause quite a bit of inflammation.听 It doesn鈥檛 necessarily work permanently, it can wear off over time, so it鈥檚 more of a surgical procedure that, at Moorfields, we tend to reserve for patients who鈥檝e got very high pressure and haven鈥檛 responded to other treatments.

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White

Clearly if there are risks there must be advantages too, otherwise you would assume people wouldn鈥檛 even want to consider those risks, so, what are the advantages?

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Gazzard

The advantage is that it lowers the eye pressure, it鈥檚 not an incisional surgery so it鈥檚 not a traditional surgery with scalpels and sutures, stitches, but it does come with a degree of risk.听 So, micropulse cyclodiode as described is quite an invasive technique, I would view, in the circumstances that we鈥檙e hearing here, where the drops are working well but they are uncomfortable and inconvenient.听 And also, I always a slight concern if someone鈥檚 saying that a treatment is only available privately in that area because we know that those treatments are available elsewhere on the NHS and you always have to question whether it would be possible to go somewhere else for that same treatment.

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White

So, it sounds as if there are a lot of questions a patient needs to ask, especially if you鈥檙e being asked for reasonably large sums of money?

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Gazzard

The questions that I would ask in this situation would be what can go wrong and how frequently, how often does it work and perhaps, lastly, how long does it last.听 Many of these laser treatments don鈥檛 last that long.听 I think Linda did exactly the right thing to reach out to the programme for help and advice because it鈥檚 such a great resource and opportunity to get in touch with a specialist and also be able to put her in touch with Glaucoma UK who are a great resource for patients.

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White

Let me bring in Karen, Karen Osborne, Chief Executive of Glaucoma UK.听 Karen, what are you hearing from glaucoma patients about their concerns and how typical is Linda鈥檚 case?

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Osborne

I think Linda鈥檚 case is fairly typical.听 We have a telephone helpline and laser and surgery calls are always absolutely top of the list there, we get more calls about surgery and laser than any other topics.听 It鈥檚 quite complicated and there are so many different treatments available, I鈥檓 not surprised that people are confused really and need extra advice and support.

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White

The trouble is you really have to trust your consultant to give you the options that are right for you, don鈥檛 you?

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Osborne

Yeah, have trust in them and feel that it is actually 鈥� it鈥檚 a joint process of making a decision together and it鈥檚 really hard to remember what questions you were going to ask.听 We often recommend that people take in a list, a written list, take somebody with you and they can help you ask the questions, make sure you don鈥檛 forget anything and help you recall things afterwards.听 Don鈥檛 be rushed in a decision, it鈥檚 complicated and to get all the facts can take a little while.听 We鈥檝e all done it 鈥� you come out of the clinic and you think 鈥� oh blimey, you know, I wish I asked that.听 Call the helpline, they are a really good source of sound impartial advice and they can fill in the gaps.

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White

Presumably then, there are still cases where however fiddly and slightly irritating they may be, drops are still the answer?

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Osborne

Definitely.听 I mean for years and years they鈥檝e been the first line treatment.听 It was really interesting that Linda said she found it difficult keeping them in the fridge but a lot of people do that on purpose, as long as the drop, it won鈥檛 be harmed by cooler temperatures, because they鈥檙e actually quite hard to get in the eye and if you keep them in the fridge the drops are a little bit cooler, so you can feel whether it鈥檚 gone in or not.听 But you鈥檙e right, I mean there are a lot of side effects and it鈥檚 an interruption to the day if you鈥檙e having to do it morning and evening and you鈥檝e got two or three different kinds of drops.

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White

Now just one more thing, because what first made Linda email us was the concerns over potential drug shortages after the Brexit transition period ends, as we enter the New Year.听 Now Chris Kennet emailed us from Dunstable and he says: 鈥淓ven before Brexit there have been recurrent shortages of my glaucoma medication, iopidine, over the past few years.鈥澨� And I think you鈥檝e been looking into this general issue of possible drug shortages.听 What鈥檚 the situation as you understand it?

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Osborne

I think initially, this time last year, what we were being told by the pharmaceutical companies was don鈥檛 worry, we鈥檝e kind of got it under control.听 The messages that we鈥檙e getting now are not quite so optimistic.听 I think covid has had some impact on supply chains and because there鈥檚 still the uncertainty from the government in terms of Northern Ireland, what鈥檚 happening there, I think they, themselves, are getting more worried than previously about supplies.听 But there鈥檚 an enormous amount of planning gone in, on the part of the pharma companies, to make sure that they鈥檙e doing everything they can from their perspective.

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White

Well, this is something we鈥檙e going to be keeping a very close ear and eye on.听 Karen Osborne, Professor Gus Gazzard, thank you both very much indeed.听 And there will be a link on our website which will give you details of how to get to the Glaucoma UK helpline.

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Now, the prospect of autonomous or driverless cars always gets a mixed reception amongst visually impaired people.听 The idea of one day being able to drive around independently is very seductive, I mean we know that driving is one of the losses that newly blind people feel most keenly.听 But the concerns remain over the safety for users and pedestrians.听 The government has now launched a consultation on the evolution in the next phase of driverless cars taking to our roads.听 It鈥檚 assessing automated lane keeping systems that can take over control of a vehicle, at low speeds, keeping it in lane on motorways.听 Well, we鈥檒l talk more about that in a moment but first, you may recall that in April of last year, when we reported on a trial of small driverless vehicles at the Blind Veterans UK centre near Brighton.听

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Mark Threadgold served for 17 years in the Royal Signals, he鈥檚 now in his early 50s and is totally blind.听 He gave these driverless pods the once over.

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Threadgold

It was interesting, very quiet being electric, and a bit disconcerting because the two seats are facing each other, so, you know, you haven鈥檛 got a front and back, so to speak.听 I think it鈥檒l be great for independence.听 The day one of us could, totally blind, jump in a car and get dropped off at the place you actually want to be at, instead of having to learn the route from a bus stop, yeah, fantastic.听 Speaking to the guys about the design, the way they described it was, if you can make it work for the most difficult person, for want of a better word, then it鈥檒l work for everybody else.听 So, for me, I鈥檓 looking at things like audio tags to tell you where you are, what you鈥檙e passing, how long it鈥檚 going to be until you get there.听 The feedback, when you鈥檙e totally blind, is hugely important.

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White

Well, the company that makes those pods that Mark was trying out is called Aurrigo.听 Dr Richard Fairchild is Director of their autonomous vehicles programme and he joins me.听

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Richard, your pods and shuttles aren鈥檛 ever intended for use on things like motorways, are they, you describe them as first and last mile vehicles.听 What do you mean by that?

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Fairchild

That鈥檚 right.听 So, we mean that the pods and shuttles that we鈥檙e producing would be used to complete the journey.听 So, if you think about a journey to a city like, for example, Milton Keynes, you might get the train up from London, you get to the train station and then you鈥檝e got that last mile or so to go.听 There are a number of choices there available to you and we want autonomous vehicles to be one of those choices.

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White

So, that trial in Brighton last year, that went on for six months, what were the main lessons that you took away from it, specifically with regard to visually impaired users?

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Fairchild

Mark made me chuckle when I heard that back again, he said if you design for the most difficult person you design for all and that鈥檚 kind of how we thought about it, is that people who are blind or partially sighted are the gold standard for accessibility, when it comes to how you interact with things like this vehicle.听 It was really simple things like are the buttons bright enough so there鈥檚 enough contrast between the button surface that you press and the background that the button鈥檚 in; is there enough tactile surfaces so you know what a handle is compared to just a piece of trim; if you don鈥檛 know where you are it鈥檚 difficult to know when to get ready and so, having audio cues just, for example, taking a left turn onto Main Street, that enable the person in the vehicle to have that mental map of where they are was a really important finding.

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Another great finding was about how the vehicles are audible to people in the environment.听 So, we know that audible electric vehicles is a new regulation that鈥檚 coming into place next year but what鈥檚 interesting is that it鈥檚 not just about hearing them coming, it鈥檚 about actually how close they are, so, we developed a system where the vehicle beeps, a little bit like an industrial forklift, for example, but that time between the beeps changed depending on how close the vehicle was, so, you actually got a sense of the vehicle moving towards you even if you couldn鈥檛 see it coming or even hear it.

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White

Well, actually, you鈥檝e brought up an issue I wanted to put to you anyway because we鈥檝e had a couple of emails from In Touch listeners.听 I mean what would you say to another Mark, actually, who writes: 鈥淚鈥檓 now severely sight impaired and use two hearing aids, in the past few years we鈥檝e not been informed that these driverless vehicles will be able to identify blind, deafblind and partially sighted people using guide canes, guide dogs, etc., to cross the streets in safety.听 The vehicles must be able to make the necessary manoeuvres to enable us to cross roads and especially side streets without fear of an accident.鈥澨� In other words, he鈥檚 talking about actually identifying visually impaired people.听 What do you say to that, is that practical?

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Fairchild

Well, I don鈥檛 think that it鈥檚 necessary to distinguish between a pedestrian who鈥檚 sighted and a pedestrian who isn鈥檛 sighted because our vehicles are programmed to be super cautious, so any kind of obstacle that鈥檚 in the road, whether that be a cat or a dog or a person, the vehicle will identify as an obstacle and stop.听 We鈥檙e moving into more efficient driving but at the same time we鈥檙e being absolutely super cautious about everything.

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White

Right.听 Can I also bring in a point made by Kevin Satizabal.听 He鈥檚 been in touch after our item on e-scooters because he says, representatives from sight loss councils attended the scooter operator tiers official UK launch on 25th August and it committed 鈥� and you鈥檝e mentioned this 鈥� to installing an acoustic vehicle alert system to provide warnings to blind and partially sighted pedestrians.听 So, what is your take on that?

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Fairchild

I think they鈥檙e absolutely essential.听 Electric vehicles, they鈥檙e all so quiet at low speeds, and our pods are quite low speed.听 Scooters are obviously the same, they鈥檙e a low speed vehicle.听 So, tyre noise, you can鈥檛 hear them.听 The new regulations that are coming in for road vehicles, which is going to be in force in September next year, I think it鈥檚 necessary that all electric powered vehicles that occupy space on our streets or in the way scooters are going, on shared spaces like pavements and pedestrianised areas, need to make a noise.听 It鈥檚 not just about blind and partially sighted people, there鈥檚 a lot of people that have temporary issues caused by things like looking at their mobile phones or listening to music loudly.

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White

Just before we end, I mean what every visually impaired person wants to know is when are we going to get a vehicle that we can actually drive, that will give us some level of real independence.听 Now the government鈥檚 opened a call for evidence on new technology, allowing a vehicle to take over the responsibility of driving.听 In this case it鈥檚 the automated lane keeping system on motorways that鈥檚 being looked at.听 But how close are we to all these various technologies coming together and there being a proper driverless vehicle on the UK鈥檚 roads?

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Fairchild

My point of view is that freight will be the first beneficiary of autonomous driving.听 A large proportion of that journey is on a motorway from one hub to the next.听 The skills bit of a freight journey is the driver navigating round those difficult city streets in a very large vehicle.听 So, I think we鈥檒l end up seeing that the hub to hub journey will become autonomous fully, without the driver in the cab at all.听 When you get to the passenger car in the urban city street, I think we鈥檙e still maybe 10 years away from that.

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White

And for visually impaired drivers then, if you鈥檙e still saying even then you still need somebody to be able to take over in a real emergency, we鈥檙e actually a long way away still aren鈥檛 we?

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Fairchild

Well I think that the pods and shuttles that we鈥檙e building fill that gap.听 Because they鈥檙e running at much lower speed it means our environment we鈥檙e in is much less complicated and therefore we鈥檙e able to get on the streets and roads much sooner.

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White

Richard Fairchild, thank you very much indeed.

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And that鈥檚 it for today.听 Your comments, please, on anything you鈥檝e heard on the programme today.听 Email intouch@bbc.co.uk or go to our website bbc.co.uk/intouch and from there you can download tonight鈥檚 and many previous editions of the programme.

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From me, Peter White, producer Mike Young and studio managers Phil Booth and Tom Parnell, goodbye.

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