Home monitoring for glaucoma to better identify patients at risk of losing vision, and to reduce the individual and societal costs of sight loss.

Introduction

Glaucoma affects half a million individuals in the UK, a figure that is projected to rise by 44% over the next 15 years [1]. Ophthalmology accounts for more outpatient visits than any other speciality in NHS hospital care and glaucoma is the most prevalent condition among those attending [2].

Patients with glaucoma consume considerable resources due to the large number of follow up visits and lifelong monitoring required. Key tests for glaucoma diagnosis and monitoring include measurement of intraocular pressure (IOP), visual field test using automated perimetry, and assessment of the optic disc and retinal nerve fibre layer (RNFL). Regular assessment is required to detect and quantify possible disease progression, estimate risk of visual loss, and determine responses to treatment. For example, it is recommended that newly diagnosed patients have at least 6 visits in the first 2 years to determine whether vision is declining [3]. Hospital eye services are struggling to meet these intervals, with some patients reported have lost sight due to appointment delays [4].

There is a UK shortage of ophthalmologists [6], which has been exacerbated by nursing staff shortages due to the COVID-19 pandemic, presenting a challenge to the delivery of care.

Glaucoma patients waiting in NHS Forth Valley, May 2022

Waiting Patient Type = New 69

Returning = 3133

Overdue return = 1159 ( 37% of returning patients)

NHS Forth Valley represents approximately 5% of the patient population of NHS Scotland. An approximate extrapolation of NHS Forth Valley data suggests there are over 60,000 returning Glaucoma patients waiting in NHS Scotland.

Innovative and sustainable methods of glaucoma monitoring are required to better identify patients at risk of losing vision, and to reduce the individual and societal costs of sight loss. In Scotland alone, sight loss costs the NHS and public sector at least £194 million per year, plus an estimated £434 million in broader costs to the economy [7].

The challenge

The challenge is to develop and validate the tools needed for home (or near-patient) glaucoma assessment, including home tonometry and home assessment of visual function, and potentially even optic disc imaging. It is also important to develop methods of securely storing, transferring, and analysing the likely large number home measurements obtained.

The themes and priority areas below are for illustrative purposes and are not exhaustive.

Priority Areas:

1. Development and validation of an affordable tool for home perimetry for monitoring glaucoma.

2. Development and validation of an affordable tool for home perimetry for detecting glaucoma.

3. Development of method of secure data storage, analysis, and transfer (or integration) with NHS electronic patient records.

4. Development of tools for home tonometry and /or home optic disc / retinal imaging, in addition to methods for integrating results from these tests with NHS electronic patient records.

Long Term Vision

The goal of innovation and development of initiatives is to develop and validate an affordable tool for home visual field assessment, that provides a method for detecting glaucoma progression. The goal is that the ability to detect progression should be as accurate as the current clinical standard of standard automated perimetry (SAP). While a single test administered at home may be less accurate than SAP, the ability to take multiple tests at home, may provide greater ability to distinguish genuine change from visit-to-visit fluctuation.

If the challenge is successful, it has the potential for patients with glaucoma to monitor their own visual function in between clinic visits. This would allow clinicians to safely lengthen the duration between visits for stable patients and enable more patients to be managed in the community. Conversely, patients at higher risk of visual loss would be identified more quickly and could be monitored more closely, through a combination of home and hospital-based testing. As Scotland moves towards a shared electronic patient record for hospital eye services and primary care optometry, there is also the potential for home tests to be integrated into this record.

The long-term vision is that home tonometry and home optic disc/retina imaging might also be used, to further improve the ability of patients and their healthcare providers to monitor this potentially blinding chronic disease. Self-monitoring also has the potential to improve adherence to treatment, and boost patients’ engagement with management of their condition.

The combination of intra-ocular pressure and visual field data could allow an asynchronous data review that would obviate hospital reviews and also allow remote decisions around treatment changes without necessity for face-to-face review. These are the two major pieces of information that inform management. How a blended service combining asynchronous data collection and face-to-face appointments would be the subject of a pragmatic trial.

This is a Pre-Commercial Procurement Challenge competition funded by The Scottish Health Industry Partnership (SHIP), Scottish Government. Successful applicants receive 100% funding and access to advice from the NHS Scotland innovation hubs.

The programme will be delivered in up to 2 phases. This is phase 1.

A decision to proceed with phase 2 will depend on the outcomes from phase 1. Only successful applicants from phase 1 will be able to apply to take part in phase 2.

SHIP are investing up to £210,000 including VAT, split across 2 innovative challenge areas.

There is a preference for projects at an advanced stage of development, near ready to be deployed in a real world situation for use evaluation. For projects with advanced prototypes, where possible we would like to see evidence of certification of the appropriate EN or ISO standard, or plans to achieve this. This detail forms part of the Gateway assessment.

Projects showing high potential but at an earlier stage of development may also be considered.

Eligibility

To lead a project, you can:

Be any type of organisation of any size Work in conjunction with one of the NHS Scotland and Social Care Innovation Test Beds to deliver R&D services Work alone or with other organisations as subcontractors Application Process:

All applications for this challenge will be managed through the Innovate UK website:

Link to Challenge

DO NOT SUBMIT YOUR SOLUTION TO SCOTLAND INNOVATES WEBSITE. THIS CHALLENGE IS BEING ADMINISTERED VIA IUK.

Applicants will be expected to engage with the test beds to identify one to work with that can provide the relevant expertise to support your project, and evidence this in your application.

The innovation test beds are uniquely placed to support your project, providing access to relevant systems and supporting testing in a healthcare environment. In order to do this, the test beds will need to know what and how you are going to answer the challenge, including what support and access you will need.

This information will enable the test bed to provide information on expected timelines in accessing certain support which will need to be included in the project plan section of your application. It will also enable the test bed to confirm they are able to support your project with the relevant required expertise.

How to contact the NHS Test Beds:

North of Scotland Test Bed

gram.innovation-hub@nhs.scot

West of Scotland

Website: https://www.woshealthinnovation.scot/ Contact FV Innovation: fv.innovation@nhs.scot

Health Innovation South East Scotland

Website: NHS Health Innovation South East Scotland: https://hises.edinburghbioquarter.com/

Contact: innovations@nhslothian.scot.nhs.uk

Support for Applicants:

To support potential applicants there is a launch event with the Test Beds.

Link to Launch Event resources and recording originally published on Wednesday 25th August 2022:

Link to Launch Event Resources

References

1. Royal College of Ophthalmologists (RCOphth) (2016). The Way Forward. Options to help meet demand for the current and future care of patients with eye disease.

2. NHS Digital (2020). Hospital Outpatient Activity 2019-20.

3. European Glaucoma Society Guidelines, 5th edition, 2020.

4. Foot B, MacEwen C. Surveillance of sight loss due to delay in ophthalmic treatment or review: frequency, cause and outcome. Eye (Lond). 2017;31(5):771-775.

5. Ting DSJ, et al. The impact of COVID-19 pandemic on ophthalmology services: are we ready for the aftermath? Ther Adv Ophthalmol. 2020 Oct 20;12:1-3.

6. Royal College of Ophthalmologists (RCOphth). (2018) Workforce Census 2018. RCOphth.

7. RNIB Scotland (2010). The cost of sight loss Scotland 2010-2020.