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Prevention of blindness caused by glaucoma requires an early diagnosis, for which we have developed new clinical techniques. The Moorfields Regression Analysis (MRA) is an algorithm that we developed for the Heidelberg Retina Tomograph, an imaging device for glaucoma diagnostics. The MRA made it possible, for the first time, to accurately quantify structural damage caused by glaucoma. The MRA allows earlier diagnosis of glaucoma, and has been adopted worldwide.
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.
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 is the commonest cause of irreversible blindness world-wide and, in many parts of the world, surgery to create a new drainage channel is the only practical treatment. The commonest cause of surgical failure is scarring, and the use of injections of cytotoxic agents prevents scarring but has many complications. Our research identified how convenient single 5-minute treatments with cytotoxic drugs work and led us to carry out pilot and randomised trials, which showed they reduced post-operative scarring. Combined with other refinements of surgical technique (named the Moorfields Safer Surgery System) this has improved outcomes of glaucoma surgery world-wide.
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.
Our research into the epidemiology of childhood visual impairment has transformed understanding of the epidemiology, outcomes and impact of childhood visual impairment in the UK. As a result, changes have been made to the Newborn and Infant Physical Examination Programme and the National Vision Screening Programme. Our work has underpinned the development of new quality standards for paediatric ophthalmology services issued by the Royal College of Ophthalmologists. Our studies on congenital cataract have improved the management of this condition nationally. We have involved visually impaired service users and patient groups directly in our research to improve quality of life measures and patient engagement.
Research at the University of Nottingham has defined the clinical phenotype and management of lymphangioleiomyomatosis, a rare and often fatal multisystem disease affecting 1 in 200,000 women worldwide. The group has led the development and evaluation of new therapies and diagnostic strategies which are now part of routine clinical care. The research has underpinned the transformation of this previously under recognised and untreatable disease into a condition recognised by respiratory physicians, with international clinical guidelines, patient registries, clinical trials, specific treatments and a UK specialist clinical service.
Research at Strathclyde has brought about a change in eye surgery practice throughout Europe and worldwide. A four-year cross-Europe study in collaboration with the European Society of Cataract and Refractive Surgery (ESCRS) investigated antibiotic treatment to prevent endophthalmitis, a complication arising during cataract operations which typically results in loss of sight. The findings showed that when the treatment is given at the start of surgery it leads to a 5-fold reduction in the risk of endophthalmitis. The European Society of Cataract and Refractive Surgery has endorsed the discovery and widely promoted the uptake of the treatment through publications and guidelines, which over the last 6 years has led to the prevention of loss of sight in thousands of patients. In Europe alone it is estimated that each year there have been 7500 fewer cases of blindness following cataract surgery as a result of the ESCRS guidelines.
Impact: Health and welfare; the GRACE risk score (derived using data from 102,000 patients with acute coronary syndrome (ACS) in 30 countries) identifies high-risk ACS patients more effectively than do alternative methods.
Significance: GRACE is now a reference standard and has resulted in international guideline changes. It is estimated to save 30-80 lives for every 10,000 patients presenting with non-ST elevation ACS.
Beneficiaries: Patients with ACS; the NHS and healthcare delivery organisations.
Attribution: All work was led by Fox (UoE) with co-chair Gore (University of Massachusetts) and was developed from Edinburgh-based studies.
Reach: Worldwide: guidelines adopted in more than 55 countries; >10,000 downloads of app.
Research led by Pardhan has enhanced the healthcare offered to diabetic patients of South Asian origin in the UK and overseas (Pakistan, East Africa). Prevalence of diabetes within this ethnic group is six times higher than in Caucasians. Our research into this group, which demonstrated an increased risk of sight-threatening eye disease and poor engagement with screening/treatment regimes, has impacted upon both patients and healthcare practitioners. Ophthalmologists, general practitioners and other clinicians have used our findings to target various physiological and cultural factors that influence diabetic control and eye health in the South Asian population.
Our research also provided the underpinning data that informed reports commissioned by the Royal National Institute of Blind People (RNIB). These reports demonstrate the increased prevalence of eye problems in patients of South Asian origin, and highlight the barriers that affect patients' access to primary and secondary eye-care across the UK. The reports evaluate the effectiveness of current management, and suggest strategies to improve the eye health of this group of patients.
These reports have led directly to the creation of dedicated community-based eye-care programmes. Funded by the Royal National Institute of Blind People (£400,000) and Innovation, Excellence and Strategic Development Fund (Department of Health), the programmes are designed to reduce diabetic-related complications through improved self care by patients in Bradford and Glasgow, regions that have significant Asian diabetic populations.