An interview with Mr James Bainbridge

Mr James W B Bainbridge MA MB BChir PhD FRCOphth is a Consultant Retinal Surgeon at Moorfields Eye Hospital, London and Senior Researcher at UCL Institute of Ophthalmology. As a surgeon-scientist the aim of his work is to help prevent vision loss using translational research to develop effective new treatments for eye diseases.

Section 1:  About you:

What is your interest in and experience with the DVS condition?

I am interested in all disorders of the retina and vitreous that cause impairment of vision. Vitreous opacities are very common and often cause minimal or no impairment of sight. Once any associated sight-threatening condition (such as retinal tear or inflammation) has been excluded by an eye specialist, most people can be reassured and discover that over time the opacities become less noticeable. Only a small minority of people have persistently disabling vitreous opacities. Surgery to remove the opacities can help but the potential benefits must be carefully weighed against the associated risks of surgery for every individual.

Many surgeons are reluctant to treat floater patients, can you explain why you are prepared to?

The decision to treat any condition should be made jointly after appropriate discussion about the options, informed by expert judgement. The risks and potential benefits of available treatment options should be discussed with reference to the prognosis without treatment. I believe that the predicted benefit of surgical removal of vitreous opacities can occasionally justify the risk of sight-threatening side-effects.

Section 2:  About the condition:

Where do you see the future of floater research and treatment?

I anticipate that research and development to improve the design of surgical instruments will continue to improve the safety of vitreous surgery such that more people will be able to benefit.

Do any current projects show promise for the development of an effective treatment for vitreous degeneration?

I will be interested to see whether the injection of microplasmin into the eye will safely address vision impairment by vitreous opacities.

In your opinion, why hasn’t the ophthalmologic profession been more aggressive in the pursuit of a less invasive, complication free, treatment for floaters?

The development of safe new treatments for vitreous opacities is not seen as a high priority by many specialists because the majority of healthy people have floaters to some extent and severe impairment of vision is relatively uncommon.

Section 3:  About your approach to treatment:

How does your approach differ from other people working in this field, if it does?

I consider each person’s condition on an individual basis, and provide a balanced assessment of the likely benefits and risks depending on the degree of vitreous opacities evident on examination and the presence of any associated eye disease.

What kinds of patients and floaters do you feel are best suited to your treatment?

I believe that dense vitreous opacities causing disabling impairment of vision without associated eye disease are those best suited to surgical removal.

How many procedures on floaters have you carried out?

I have performed more than a thousand surgical procedures on the vitreous, of which only a small fraction are for simple vitreous opacities in the absence of other eye disease.

Can you describe your examination process, including any specialist equipment you use.

I use slit-lamp biomicroscopy and indirect ophthalmoscopy to assess the degree of vitreous opacities and the presence of any weakness of the retina.

Can you describe how you carry out the procedure, including the equipment you use.

I use 20 gauge or 23 gauge sutureless pars plana vitrectomy using the Alcon Accurus Surgical system.

What is the recovery period and follow-up process?

Most people are able to resume normal activities within 1 week of surgery.

What is your complication rate? How is this measured?

I maintain an ongoing audit of my success rates and have identified no serious side effects following surgery for simple vitreous opacities to date.

Have you experienced any patients reporting visual disturbances or a worsening of their condition as a result of treatment?

I know of people who have experienced worsening of sight as a result of laser and surgery but know of none in my own practice following surgery for isolated vitreous opacities to date.