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02 August 2018

STAR Study

A clinical trial using a robotically-controlled system to deliver highly-targeted, low-dose radiotherapy to treat patients with Wet Age-Related Macular Degeneration (AMD) in the hope of eradicating or reducing eye injections is now available to patients attending the eye department at Bristol Eye Hospital.

The nationwide study, funded by an NIHR & MRC partnership and initiated by clinicians at King's College Hospital in London, is giving new hope to patients with the condition who until now have faced regular eye injections to preserve their vision.

In the one-off, non-invasive treatment, three rays of radiotherapy are beamed through the white of the eye to overlap at the macula. The therapy is delivered by an eye doctor using a robotically-controlled machine to ensure precision treatment. The total dose of radiation received by the body is about the same as a mammogram.

AMD, of which there are two main types (Wet and Dry), affects patients over 50 and is the leading cause of sight loss in the UK. The condition develops when the part of the eye responsible for central vision (the macula) is unable to function as effectively as it used to. Wet AMD, which usually affects the vision more rapidly, occurs when abnormal blood vessels grow underneath the macula and leak fluid. Without treatment, vision can deteriorate rapidly (within days or weeks).

The standard treatment for Wet AMD involves the injection of drugs into the eye targeting a chemical called vascular endothelial growth factor known as VEGF. VEGF causes abnormal blood vessels to grow and leak fluid under the retina. The injections do not cure Wet AMD, they just reduce the leakage of fluid from the abnormal blood vessels. The injections do not make the abnormal blood vessels go away and unfortunately they often start leaking fluid again, when the injection wears off after a month or so.

It is anticipated that the new radiotherapy treatment may actually make the abnormal blood vessels shrink or go away in some patients and thereby reduce the number of injections required. Studies have already shown that in carefully selected patients stereotactic radiotherapy can reduce the number of eye injections by about half, with many patients needing no further injections at all, and vision was better than in those who only received eye injections.

If proved successful, the new treatment will not only be more convenient for patients, who currently have to visit an eye clinic on a regular basis, but it will also be more cost-effective for the NHS. Each dose of the injection costs around £800 and may need to be repeated multiple times each year, whereas the radiotherapy treatment costs £1,250 but is required only once.

Mr Richard Haynes, Consultant Ophthalmic Surgeon and Mr Martin Bennett, Associate Specialist, who are leading the study in Bristol have said:  "We are very excited to be offering this study to patients under the care of the Bristol Eye Hospital team.  Whilst not all of our patients are suitable for the study, it is a promising prospect for those that are, with the hope that it may reduce the number of injections required, thus improving patient experience.  We have already exceeded our target recruitment, but we are keeping recruitment to the study open for additional participants to become involved should they meet the criteria and wish to take part". 

"Patients have their initial assessment at Bristol Eye Hospital before travelling to King's College Hospital for a one-off visit for treatment with stereotactic radiotherapy.  They return to Bristol for monthly assessments and injections if required, for the duration of the trial."

The randomised trial treats two-thirds of participants with the active treatment and one-third with a placebo. The standard treatment of eye injections is continued on patients throughout the trial, if they need it.

We recommend that patients visit the STAR website ( and  discuss the study with their local ophthalmologist.  Following this if they may be suitable, contact the Clinical Research Unit at Bristol Eye Hospital (tel: 0117 342 4770, email: BEHCRUAppointments

Patients are encouraged to ask their doctor about research opportunities and view trials seeking volunteers at The UK Clinical Trials Gateway at