Researchers from the University of Bristol, in collaboration with Queen’s University Belfast, are leading a cutting-edge project, named the "MONARCH" study, that could benefit eye disease patients whilst saving both time and money within the NHS.
The MONARCH study aims to investigate if patients with an eye condition called wet age-related macular degeneration (AMD) could test their vision at home rather than attend a hospital appointment.
The most serious type of AMD, known as wet AMD, develops when abnormal blood vessels form underneath the macula stops functioning as well as it used to. AMD patients experience blurred distorted vision, difficulty seeing in dim lighting and problems reading.
Current treatment for wet AMD is a series of monthly injections which reduce the growth of new vessels which limit vision loss. Following treatment, patients attend regular hospital check-ups where clinical staff monitor the macula by taking photographs and doing vision tests, checking whether any follow-up treatment is needed.
Most patients will not require follow-up treatment, but about 30 per cent do. Hospital check-up appointments are important for preventing further loss of vision. However, these check-up appointments put a huge strain on already-stretched resources, and limit the capacity for seeing new patients who, if not seen urgently, are at high risk of losing their vision. Check-up visits are also very inconvenient for patients and their friends or family members who may have to take time off work to provide transport to these appointments.
Barnaby Reeves , Professorial Research Fellow in Health Services Research from the Bristol Medical School: Translational Health Sciences and co-chief investigator of the MONARCH study, said: "We are excited to be collecting data from the apps automatically, via the internet. These kinds of methods, with data flowing directly from the data source to the study database, should increase both the accuracy of the data and the efficiency of their capture."
Dr Ruth Hogg , from the Centre of Public Health at Queen’s University Belfast and co-chief investigator of the MONARCH study, explained: "Injections for AMD have been very successful, with about half of patients retaining vision sufficiently good for driving. However, the burden on the NHS and patients has been considerable due to the need for frequent injections and intensive monitoring throughout the follow-up period. In Belfast, evening and weekend clinics have been added, yet it’s still not enough.
"We urgently need to rethink how services are offered as the current setup isn’t sustainable. AMD is a huge burden to the NHS through time spent by clinical staff monitoring patients of whom the majority do not require treatment."
The study aims to find out whether monitoring vision by patients themselves at home could potentially alleviate some of the burden of AMD on the NHS, as well as be more convenient for patients, without compromising their safety or wellbeing. If home eye tests can detect when treatment is needed, it would mean that patients might only need to attend hospital appointments to have treatment.
Patients participating in the study will be provided with three different eye tests for them to do at home, comprising a paper-based booklet of reading tests and two tests ("apps") that run on an iPodtouch. Patients will be asked to do all three tests weekly at home. The results of the tests are sent automatically via the internet to the Study Management Centre in Bristol.
Throughout the study participants will attend their normal hospital check-up appointments and the results of the tests done at these appointments will be compared with the results from the home eye tests.
Patricia Strong, an AMD patient, added: "Since completing a course of treatment for wet AMD, I’ve had regular appointments to check my vision and get photographs taken and I’ve occasionally needed further injections. I spend quite a lot of time getting to the hospital and the cost of transport does add up so being able to check for myself at home would make a real difference for me, saving time and money."
The study aims to recruit 400 participants from five different hospitals around the UK. Patients will be provided with equipment and support to do the three home eye tests weekly over a period of one to two years. It is hoped that the data gathered will lead to a shift in services provided to AMD patients, so that only those who require treatment will be required to attend hospital appointments.
The MONARCH study is funded by National Institute of Health Research (NIHR) Health Technology Assessment Programme and is currently recruiting participants who have AMD.