In a postcode lottery, many patients are denied a vital eye drug writes Helen Puttick

Dr William Matheson, a former GP, says if he had refused a patient treatment they needed he could have faced a malpractice hearing.

Now he is a patient himself, however, and he has repeatedly been told he can't have the drug his consultant recommends.

For the past 18 months or more, the 78-year-old has been losing his eyesight. Reading newspapers has become much more difficult, so has tying his fishing flies and recognising friends.

Yet he has not been able to obtain the only drug which could reverse some of the devastating decline.

Dr Matheson, from Blanefield near Glasgow, suffers from a condition called wet age-related macular degeneration. It's not painful, but it blights the central field of vision and experts say it needs swift intervention.

The drug Dr Matheson has been waiting for since last Christmas is called Lucentis. It has been hailed as a breakthrough because, unlike the alternatives, research has shown it does not just stop deterioration of eyesight but can improve vision.

Finally, on June 11, the Scottish Medicines Consortium, which advises NHS Scotland on new treatments, approved it for prescription.

Dr Matheson, who had long anticipated the SMC announcement, had an appointment almost a fortnight later ready to receive his first injection. Then he got a phone call.

He recalls: "My consultant said it wasn't available. The finances had to be put in place. We delayed it for another fortnight. I got another appointment still expecting to get Lucentis. Again a phone call to say I could not get it.

"It seems to me to be absolutely ridiculous. The thing has been approved and the treatment is well-known."

Now eight weeks have gone by, and still he is waiting.

Despite more than 30 years working as a GP in Bearsden, Dr Matheson remembers seeing few patients with AMD and says he had never given much thought to losing his own eyesight. He first faced the possibility during a routine visit to his optician to get new glasses last year.

His optician detected a problem with his right eye and he was referred to an ophthalmologist who confirmed he had the gradual, "dry" variety of AMD.

Initially, the problem caused him little inconvenience. Then in December 2006, Dr Matheson's eyesight suddenly declined. He describes struggling to follow the lines of text in a newspaper column and failing to recognise friends until they were very near.

The sudden shift suggested he had developed the more aggressive wet AMD.

Dr Matheson says his consultant confirmed the diagnosis and told him he would be a "good candidate" for Lucentis.

However, at that time the drug had not been approved for use in NHS Scotland.

"It seems the condition will get worse and worse without Lucentis," he says. "I do not think I will ever go completely blind, but I will be able to do less and less."

He admits the prospect frightens him.

While his peripheral vision allows him independence at home - he can still make cups of tea - he admits he could not read a destination board at a train station or check-in at an airport.

"I feel very annoyed," he says, adding that he blames financial constraints. "They are trying to meet targets, they do not want to go into the red," he says of health board, but adds spending thousands now could save hundreds of thousands in the long term.

Lucentis is not cheap. It costs £761 per dose, so if sufferers need an injection every month the bill is more than £9000 a year, though the drugs company Novartis Pharmaceuticals UK Ltd say such an intensive regime is unusual.

The treatment is given as an injection into the eye. Patients tend to receive one shot a month for three months and then further shots according to need.

Making the therapy available is not necessarily just a question of consultants prescribing the drug - health boards also have to set up a service to deliver the treatment.

A spokesman for the Royal National Institute of Blind People Scotland said the same explanation was given last year when another treatment injected straight into the eye, Macugen, was approved for prescription.

The spokesman said: "We understand that Macugen treatment is now widely available. It is therefore surprising to hear the same excuses being rolled out for the failure to provide Lucentis."

Both Macugen and Lucentis work to switch off the signal at the back of the eye which causes the problems associated with wet AMD. Dr Matheson along with other patients across Scotland have received Macugen.

However, in 2006, the Royal College of Ophthalmologists published recommendations which said although there had been no direct comparisons, Lucentis "is the more efficacious of the two products."

Trials have found a significant improvement in the vision of 30% to 40% of patients and some improvement in up to 70% .

Dr Mike Gavin, consultant ophthalmologist at Gartnavel General in Glasgow, says: "It is the first drug which really has been shown to significantly reverse visual loss in a significant percentage of patients.

"There is a need for rapid access and delivery of the treatment because otherwise that window of opportunity is missed."

What is age-related macular degeneration?
The macula is an important part of the eye, found at the centre of the retina. It is responsible for vision straight in front. It allows us to see fine detail for activities such as reading and to see colour.

However, the delicate cells of the macula can become damaged and stop working. If this occurs later in life it is known as age-related macular degeneration, or AMD. It is the most common cause of poor eyesight in people over the age of 60.

There are two types of AMD, called "wet" and "dry", referring to what ophthalmologists can see when looking at the macula.

Dry AMD, the most common form, develops slowly, causing the gradual loss of central vision. Some people compare it to colours fading from an old photograph. There is no medical treatment for this condition although aids such as magnifiers can be used to help with reading.

Wet AMD results in new blood vessels growing behind the retina, triggering bleeding and scarring which can ultimately cause sight loss. It can develop rapidly.

Both eyes are usually affected by AMD, although one may start to deteriorate long before the other. However, the condition almost never leads to complete blindness because only the central vision is affected. Peripheral vision can help people maintain their independence.

Lucentis works by stopping the alarm signal at the back of the eye which triggers the growth of new blood vessels. The vessels are permeable and leak. Lucentis also works to address this, potentially reducing damage.

Where the drug has been made available
SOME boards have made Lucentis available to patients since its use was approved and some have not.

Ayrshire and Arran Yes. Treatment started in June.

Borders No. Looking to develop a new sterile room or find more theatre time.

Dumfries and Galloway Yes.

Fife No. Currently prescribes Macugen and hopes to move on to Lucentis in "the near future."

Forth Valley Yes.

Grampian No. Treatment is being assessed.

Greater Glasgow and Clyde No. Says it should be offered to eligible patients "within the next two weeks".

Highland Approved for use, patients identified, but none has received it yet.

Lanarkshire Yes. 12 patients already undergoing treatment, five due to start.

Lothian Say they have prescribed the treatment where clinically appropriate since early July. Lucentis manager for Novartis Pharmaceuticals UK Ltd said no patients had been treated with Lucentis at Princess Alexandra Eye Pavilion in Edinburgh.

Orkney Due to discuss the matter next week.

Shetland Yes.

Tayside Yes. Started 10 days ago.

Western Isles Yes.