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Anglia Ruskin University's Professor Bourne leads the Vision Loss Experts Group (VLEG) which is part of the Global Burden of Disease Study (GBD. Comprising 79 leading ophthalmic epidemiologists from around the world, and carried out in partnership with the World Health Organization (WHO), VLEG compiled the most up-to-date statistics ever generated on the prevalence of global blindness, facilitating the analysis of trends and risk factors, and producing detailed future projections.
VLEG data have been described as "a critical contribution to our understanding of present and future health priorities for countries and the global community" (Editor-in-Chief, The Lancet, Dec 2012). The findings have directly impacted on healthcare policymakers and professionals, charities and economic analysts, both in the UK and overseas, increasing their awareness of global eye care issues. These users have applied this increased awareness at a:
a. Global level where the data have become a significant resource in health analyses by economists and healthcare planners such as PricewaterhouseCoopers and the World Economic Forum (WEF), enabling these organisations to provide recommendations for eye-health policies and practices. These reports predict the socio-economic impact of visual impairment in the world and provide an insight into the economic return from investments in eye-health treatment programmes. These in turn have informed the development of healthcare planning nationally and internationally, including the Eye Health Strategy by Vision2020 Australia. In addition, the research findings were used by NGOs and opinion leaders in ophthalmology at the Congress of the International Agency for the Prevention of Blindness (IAPB), informing discussion of blindness prevention strategies. This led directly to the development of an Action Plan for the Prevention of Avoidable Blindness and Visual Impairment (2014-2019) by the WHO, which was endorsed by the 66th World Health Assembly. Furthermore, the World Bank, as part of its mission to alleviate poverty, has adopted the data to inform funding priorities for health care projects in developing countries.
b. National level where VLEG findings drew attention to the absence of reliable data, subsequently leading to the commissioning of a detailed countrywide National Eye Survey of Trinidad and Tobago (NESTT), worth £350,000, in order to identify and address eye-health priorities.
Research carried out at the University of Aberdeen has directly resulted in a new therapy for stroke patients who have suffered partial sight loss. The sight rehabilitation device developed through the research has so far been used to treat around 300 UK stroke patients, who reported significant improvements in their quality of life. The therapy has been publicized by the UK Stroke Association and at national and international events. The research also led to commercial impacts through the creation of a spin-out company, Sight Science Ltd, which was later acquired by its only worldwide competitor, NovaVision Inc, protecting jobs and forging a long-term commercial partnership.
The specific impacts on commerce have been: substantial industrial investment in research and development, job creation and protection within UK industry, commercialisation of a new product, and long term partnership contract with industry with provisions for commercialisation of future products.
The most frequent surgical procedure undertaken in the NHS is cataract surgery and it improves vision and quality of life (QoL). In the 1990's there were long waiting times for cataract surgery with rationing most frequently restricting surgery on the 2nd eye. A randomised controlled trial undertaken at the University of Bristol (UoB) demonstrated clear QoL benefits from 2nd eye cataract surgery, followed by a population study quantifying population requirements for 1st and 2nd eye surgery and the surgical backlog. Government policy, announced in `Action on Cataracts — Good Practice Guidance, 2000', advised that the volume cataract surgery, including on the 2nd eye, should be increased. This policy ensured timely access to surgery becoming routine practice in the NHS, thus improving the lives of thousands of people. Second-eye surgery rates rose from ~25% of operations to 35-40%, with overall increases in operations for patients needing surgery (e.g. in England up from 201,682 operations in 1998-1999 to 332,625 in 2009-2010) and reduced waiting times. These improvements were sustained through to the end of the 2000's. The research has become highly relevant again as the NHS enters another period of constrained expenditure.
Glaucoma is one of the major causes of blindness world-wide and is characterised by visual loss arising from death of retinal ganglion cells. One important form, angle-closure glaucoma, is particularly prevalent in Asia. Based on experience of large-scale epidemiological surveys, UCL researchers devised a classification for angle-closure glaucoma that has become the international standard for this condition. The research been used as the basis for the development of the current framework for the management of angle-closure glaucoma, informing the development of both new and revised guidelines used around the world.
Fundus autofluorescence imaging has transformed understanding of retinal disease and brought enormous benefit to millions of patients world-wide. By visualising what is predominantly a lipofuscin signal from the retinal pigment epithelium, retinal diagnosis is now much more sophisticated, therapy can be better targeted to an individual patient's needs and clinical trials can use area of loss of autofluorescence as an outcome measure. Certain inherited retinal disorders have distinctive patterns of altered fluorescence and ageing changes can be followed with much greater precision. A global industry has built up around the devices required to image retinal autofluorescence safely.
Research at the UCL Institute of Ophthalmology over the last 15 years has developed new treatments for management of uveitis and its sight-threatening complications, which have subsequently become standard practice. Our work, in previously untreatable disease, has allowed restoration of vision in many patients and prevention of further visual loss in others. Many patients have been able to reduce systemic medication, limiting adverse effects of treatment.
Glaucoma affects around 2% of people over 40 years of age and almost 10% of those over 75. There are more than one million glaucoma-related outpatient visits to hospital eye services annually. Once lost through glaucoma, sight cannot be restored. Therefore early detection (mainly by optometrists) and appropriate management of the condition are crucial to maintaining a sighted lifetime. Uncertainty and variation exist in clinical practice and service delivery. Research undertaken by academic staff at City University London has led to:
In addition, City research on the scope of therapeutic practice by optometrists and the development of clinical management guidelines (CMGs) strongly influenced the decision to extend independent prescribing to optometrists. CMGs developed at City were incorporated into the Map of Medicine and other national ophthalmology primary care pathways. Research on a repeat-measurement-enhanced glaucoma scheme generated a National Institute for Health and Care Excellence (NICE) Quality, Innovation, Productivity and Prevention (QIPP) Case Study and informed Joint College Commissioning Guidance on Glaucoma and Local Optical Committee Support Unit (LOCSU) schemes. City's Standardised Patient research, where actors play the role of patients to collect evidence on actual clinical practice, is unique in optometric research and has been referred to by experts and relied upon in the defence of optometrists' actions in several clinico-legal cases before the General Optical Council.
(1) Enhancing the awareness of (i) women of childbearing age suffering from epilepsy and prescribed new and/or older generation AEDs, and (ii) their healthcare professionals. Empowering both to make informed decisions through evidence-based practice that will reduce/prevent the risk of harm to unborn children potentially exposed to AEDs in early pregnancy.
(2) A change in the process by which GlaxoSmithKline (GSK) practices post-marketing epidemiological surveillance of the new generation AED `lamotrigine' in pregnancy.
(3) Benefit to the methodological practice of other researchers in Europe involved with AEDs and epidemiological surveillance
(4) Contribution to building European system for reproductive safety evaluation
Impact: New business, intellectual property, employment and clinical diagnostic capability resulting from the invention, development, validation and manufacture of a peripheral vision-measuring device.
Significance: A new technology, Saccadic Vector Optokinetic Perimetry (SVOP) has been developed and commercialised. SVOP enables the testing of visual fields in patients who previously could not be tested. A spin-out company, i2eye Diagnostics Ltd., raised £900K to commercialise the technology, employs five people and has made sales internationally.
Beneficiaries: Commerce; ophthalmologists, opticians and optometrists; previously untestable patients.
Attribution: UoE team comprising Professor Bob Minns, Professor Brian Fleck, Dr Ian Murray and Dr Harry Brash are inventors on the granted patent for SVOP. The UoE BioQuarter commercialisation team formed the spin-out company and recruited the management team.
Reach: Worldwide: SVOP instruments are now in use in the US, EU and Australia. The technology is suitable for the 30% of patients worldwide whose visual field could previously not be measured.