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

Background

The Scottish government Chief Scientist Office are investing £250,000 including VAT, in a Small Business Research Initiative (SBRI) focused on Home Glaucoma Monitoring.

The innovation 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.

Priority Areas:

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

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

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

• 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.

The challenge was launched in 2022 and attracted a high number of excellent applications. Three companies successfully completed their 4-month Phase 1 feasibility projects in June. Following a competitive application, 2 companies have embarked on their 12-month Phase 2 prototyping and validation projects. Project details are provided below.

Irida Health, working with Health Innovation South East Scotland

Eyecatcher: Enabling glaucoma assessments directly within domiciliary care settings – a real-world feasibility study

By 2050, 1 million people will reside in UK care-homes. One in 10 will have glaucoma, and many will struggle to attend regular eye assessments, owing to the high prevalence of complex-care-needs, and various financial and logistical complexities. What is needed is a way of assessing these individuals at home, without requiring them to attend lengthy outpatient appointments.

The problem will be felt particularly acutely in Scotland, where, due to a number of factors (including geography and long-term investments in service provision) roughly 2% of all eye examinations are already performed via home visits: a number which is likely to grow significantly over the coming decades as Scotland’s population ages.

One of the cornerstones of a glaucoma assessment is a visual field (VF) examination: An eye test that attempts to map out “blind spots” across the retina. Currently, VF examinations can only be performed using bulky and expensive specialist clinical equipment. However, Irida Health Ltd, working in partnership with NHS Health Innovation South East Scotland, have developed Eyecatcher: A low cost, portable smartphone device, which allows “clinical grade” VF assessments to be performed at home.

With this support from the SBRI, Irida will now assess the accuracy and feasibility of using Eyecatcher to perform portable VF assessments directly within care homes and private residences (“domiciliary care”). By integrating Eyecatcher into already ongoing domiciliary care programs, we shall evidence the possibility of a smarter, more convenient approach to glaucoma management, and help to empower Scottish optometrists to better cope with Scotland’s ageing population.

With the data thus collected, a health economic assessment will also be performed, to establish the potential utility of managing patients outside of hospitals: both in terms of the health benefit to the patient, and the potential cost saving to the NHS.

PeriVision, working with the West of Scotland Innovation Hub

Validation of remote perimetry workflow for glaucoma monitoring

In November 2022, PeriVision was selected to participate in a national procurement challenge for glaucoma monitoring by NHS Scotland funded by the Scottish Government Chief Scientist Office. The aim is to develop and implement remote patient monitoring (RPM) concepts to ease pressure on the NHS and prepare for national procurement in two phases.

Glaucoma is the UK's leading cause of irreversible blindness. It affects 2% of the population over the age of 40. According to a 2022 report on the UK’s state of eye health, there are more than 2 million people at risk of vision loss due to glaucoma. Patients require lifelong monitoring, placing significant strain on NHS resources. Due to the vast number of patients, clinics are oversubscribed, leading to delays in assessment and vision loss. Across NHS trusts more than 633K patients wait for ophthalmology appointments – 64% of which are delayed. Demand for glaucoma services is projected to increase by 44% by 2035, requiring innovative solutions and efficient care pathways.

PeriVision combines Artificial Intelligence (AI), Virtual Reality (VR) and the cloud to build the next generation systems to understand visual function. Patients perform eye tests on VR headsets. Doctors configure tests and analyse results on a cloud platform. Across the workflow, AI algorithms are deployed to make tests faster and more reliable, autonomously assist patients, control quality and provide deeper insights.

In phase 1, the company implemented its patented VR perimetry test for glaucoma patients which drastically reduces test time, improves patient comfort and increases clinic productivity and patient access. This allows early detection and efficient monitoring. In phase 2, the company will validate its technology and RPM concept in a study with NHS Forth Valley and Glasgow Caledonian University’s School of Optometry (GCU) in terms of reliability, time savings / capacity increases and patient comfort.