Sight Loss and Vision

Nicotinamide in Glaucoma (NAMinG): a randomised, placebo-controlled, multicentre, Phase III trial

Addressing a range of priorities in the Glaucoma Top 10: NIHR Research in progress.

This trial aims to answer the question: Does NAM treatment protect against people losing sight because of glaucoma getting worse?

Glaucoma Risk Prediction in ocular hypertension (GRIP): a cohort study using electronic medical records to validate a risk predictor and determine the cost-effectiveness of different monitoring schemes according to risk of conversion to glaucoma

Addressing Priority 4 in the Glaucoma Top 10: NIHR Research in progress.

In the UK around 1.3 million adults have ocular hypertension, and although many of these people will not develop glaucoma, treatment may be required to stop this happening. Those with the condition are typically monitored in hospital eye services, which are costly to the NHS and can be inconvenient for patients. Current guidance in the UK recommends treatment with eye drops if the eye pressure is greater than 24 mmHg, but it is not known if people with mild elevation of eye pressure (22-23 mmHg) may benefit from treatment. For patients, treatment means having laser treatment and/or using eye drops on a daily and lifelong basis, which patient engagement work performed by the research team revealed to be 'inconvenient and impractical without knowing if it stops the progression to glaucoma'. Having a tool that can help doctors identify those at the greatest risk of progressing from ocular hypertension to glaucoma would both support clinical decision-making, and improve information that can be given to patients regarding the status of their condition.

Study of technologies for the diagnosis of angle closure glaucoma (ACE)

Addressing priorities 4 and 7 in the Glaucoma Top 10: NIHR Research in progress.

Current NHS NICE guidance requires that patients who are referred to hospital eye services with possible glaucoma should have a test called 'gonioscopy' to examine the angle to rule out angle closure. This test needs to be done by an expert clinician with a special contact lens that touches the front of the eye. If there was an accurate non-contact assessment of the angle, gonioscopy by an expert clinician might not be needed for all individuals. These tests will reduce unnecessary hospital referrals and demand for clinician examination. The ACE will evaluate two different tests: (1) anterior-segment OCT, which is a sophisticated imaging technology that can be easily interpreted. This test is user friendly, easy to learn, fast, and provides consistent and high-resolution measurements of the angle structures. This device is widely available in NHS Trusts. (2) limbal anterior chamber depth test, that estimates indirectly if the angle is open or closed; it is simple and quick, and is done routinely by optometrists. If one or both of the non-contact tests done by non-ophthalmologists are as accurate as gonioscopy, this would free up doctors time and NHS resources to treat more patients with eye diseases.

Digital technologies for home monitoring glaucoma: a feasibility study

Addressing Priority 6 in the Glaucoma Top 10: NIHR Research in progress.

Demand for glaucoma care is increasing (and will continue to do so) due to our aging population. Recent advances in technology mean it is now possible for glaucoma patients to monitor eye pressure and visual fields in their own home. The main aim of this study is assess acceptability and feasibility of home monitoring, and to make recommendations about future research to test how the NHS could use home monitoring.

A Randomised, single masked, non-inferiority trial of Femtosecond Laser Assisted vs Manual Phacoemulsification Cataract Surgery for Adults with Visually Significant Cataract: The FACT trial

Addressing Priority 7 in the Cataract Top 10: NIHR Research published.

Read more information about this study. Mark Wilkins, consultant ophthalmologist at Moorfields Eye Hospital, is leading a team comparing two forms of cataract surgery. The trial will include more than 800 people, from Moorfields Eye Unit at St Ann’s Hospital in North London, and Wolverhampton Infirmary. They’re looking at the benefits of making some of the steps of surgery more robotic.

Efficacy of the Telescopic Mirror Implant for Age-related Macular Degeneration: The MIRROR Trial

Addressing Priority 4 in the Age-Related Macular Degeneration (AMD) Top 10: NIHR Research complete.

AMD typically leads to loss of central vision and low vision aids can be successful in some users however limitations include small field of view and difficulties with hand-eye co-ordination. Recently a novel approach has been the use of an implantable magnifying lens into the eye. This is often described as an intraocular telescope. The aim of this trial is to provide good quality evidence around the use of this.

The following are Macular Society research grants awarded against the priorities highlighted in the Sight Loss and Vision PSP:

Assessing retinal structure and function in Stargardt’s disease using advanced phenotyping in preparation for planned therapeutic intervention

Dr Michel Michaelides from University College London Institute of Ophthalmology, and colleagues, were awarded funding to look at the observable characteristics of eyes with Stargardt’s to determine how retinal pigment epithelium (RPE) cells and photoreceptor cells are involved in various forms of Stargardt’s disease.

Does higher macular pigment density preserve visual function in intermediate AMD?

Dr Raymond Beirne from the University of Ulster was awarded funding to research the relationship between macular pigment density and visual function in AMD to understand the role that the macular pigment plays in keeping retinal rods healthy and maintaining dark adaption.

How eccentric viewing training may help wayfinding and outdoor mobility in the built environment for people with AMD

Josie Grant at Heriot Watt University was awarded funding to look at how we navigate the built environment and whether eccentric viewing training (Skills for seeing) makes this easier for people with AMD. The research also measures whether the training improves people’s self-confidence and has a positive impact on physical activity levels and quality of life.

Establishment of a national eye tissue archive for AMD research

Professor Paul Bishop from the University of Manchester was awarded funding to retrieve tissue from 1,000 pairs of eyes and make it available to researchers in the UK for at least the next 10 years to provide a unique and important resource for future research into new treatments for AMD.

Using induced pluripotent stem cells to investigate Best’s associated macular degeneration

Dr Amanda Carr from University College London Institute of Ophthalmology was awarded funding to create models of Best’s disease using induced pluripotent stem cells (iPSCs) to define the role of the gene BEST1 in the progression of Best’s disease, and potentially identify new treatment pathways. The Macular Society have funded the first year of this study.

Read more here about the research funded by Fight for Sight as a result of the Sight Loss and Vision PSP.

Binocular OCT Reinventing the Eye Examination

Addressing Priority 6 in the Age-Related Macular Degeneration (AMD) Top 10: NIHR Research completed.

Read more information about this study. Chronic eye diseases are a major cause of visual impairment and blindness in the UK. The need for long-term monitoring of these diseases, with frequent, time-consuming visits to hospital eye clinics, places a huge burden on both patients and the NHS. A new form of medical imaging device, termed binocular optical coherence tomography (OCT) has the potential to reinvent the eye examination for the 21st Century, and thus greatly improve the care of patients with these conditions. This research tests the effectiveness of this device in hospital eye clinics in the NHS.

KERALINK: Efficacy and safety of cross-linking in children with Keratoconus

Addressing priority 6 in Corneal and External eye conditions: NIHR Research in progress.

Read more information about this study. Keratoconus is a long term eye disorder that impairs the ability of the eye to focus and reduces vision. Frank Larkin, a consultant at Moorfields Eye Hospital, and his co-investigators will test a treatment known as ‘collagen cross-linking to find out if it’s safe and whether it works in children and young people.

Horizon scanning review

Addressing priority 1 in Inherited Retinal Disease: In June 2014, the NIHR published the results of its 'horizon scanning review', which looked for any new and emerging technologies for inherited retinal disease. The review found 40 new and emerging technologies.

Horizon scanning review

Addressing priority 1 in Corneal and external eye conditions: In September 2016, the NIHR published the results of its horizon scanning review, which looked for any new and emerging technologies for the treatment of corneal disorders. The review identified 130 new and emerging technologies and procedures.

The effect of light therapy on birdshot uveitis

Addressing ocular inflammatory priority 1: Participants in this study are given a course of experimental light therapy in one eye only, in addition to their existing treatment, to see if this can reduce inflammation in the eye caused by auto-immune activity.

The world’s first birdshot uveitis database

Addressing ocular inflammatory priority 5: This biobank of samples from patients with birdshot will ultimately enable a great variety of statistically-valid studies to be performed on large numbers of patient samples.

Can we develop a fast, reliable and cheap way to monitor Birdshot’s progress?

Addressing ocular inflammatory priority 7: Omar Mahroo and colleagues test a portable device that measures electroretinogram activity to find out whether it can reliably monitor Birdshot’s progress.

Can supercell analysis diagnose Birdshot uveitis

Addressing ocular inflammatory priority 3 and 5: In this project, a research team from Birmingham explores a machine learning method known as ‘supercell analysis’ to see if it can help speed up diagnosis and ultimately lead to a reliable diagnostic test.

Are there any early signs or symptoms that can predict Birdshot’s course?

Addressing ocular inflammatory priority 3: In this project, Mark Westcott and team at Moorfields Eye Hospital look for which clinical signs that appear early in the condition are good predictors of poor prognosis later on.

A patient-friendly way to measure flare-ups of birdshot uveitis

Addressing ocular inflammatory priority 3 and 5: This team based at Queen Elizabeth Hospital Birmingham tests a light-based imaging device to see how good it is at detecting ‘flare-ups’.

How many new cases of birdshot are there each year?

Addressing ocular inflammatory priority 7: This project is a 2-year national survey of the demographics, signs and symptoms of each new case of birdshot in the UK.

Studying birdshot using stem cells from patients

Addressing ocular inflammatory priority 1 and 5: It would help our understanding of birdshot to study cells and tissue from patients, but donor tissue is in short supply. This team aims to develop a suitable layer of tissue from certain stem cells that come from patients.

Are the genetics of birdshot related to iron overload in the eye?

Addressing ocular inflammatory priority 5: This research team studies genes to find out whetheriron overload is related to birdshot and can therefore be helped by standard therapy for iron overload.