Spikes in eye pressure in glaucoma patients are thought to be pivotal in understanding the progression of this potentially blinding disease. Currently, however, measuring a patient’s eye pressure is primarily done during clinic hours, making it an inadequate assessment of a patient’s condition.
A new device is being trialled for patients to measure intra-ocular eye pressure at home. Partly funded through an Avant Foundation Grant, this trial will provide a more accurate picture of fluctuations in eye pressure in patients treated for glaucoma.
This world-first study is a collaboration between Professor Minas Coroneo AO at the Look for Life Foundation and Dr Barbara Zangerl from the Centre for Eye Health, University of New South Wales.
Dr Penny Browne, Chair of the Avant Foundation Board, commends the work of Professor Coroneo and Dr Zangerl, “This device delivers on a number of important benefits for glaucoma patients, not least its focus on patient-centred care. I’m thrilled the Avant Foundation can contribute with this grant”.
Meeting of minds
For Professor Coroneo, who trained with and eventually took over from Fred Hollows, ophthalmology is rewarding and good fun. As he says, “You get to have a big impact on people’s lives”.
Of the three core components of his career – teaching, clinical practice and research – Professor Coroneo says, “The interesting part comes when you can solve a problem that has implications for how you treat patients and you distill something out of it, such as a device or a treatment. You then go from treating thousands of patients, to a lot more across the planet”.
While their backgrounds may be different, Professor Coroneo and Dr Zangerl share a passion for research and improving people’s lives.
A veterinarian who also holds a PhD in genetics, Dr Zangerl knew she wanted a career that combined both research and practice. In 1999, she undertook a post-doc in the US studying inherent blindnesses, learning that our companion animals share our problems. By examining how dogs go blind, she learnt how it similarly affects humans.
The opportunity came to translate this research into the clinical realm when Dr Zangerl relocated to the Centre for Eye Health, Sydney, in 2011. It was here the two joined forces to conduct this study.
The stakes are high, Professor Coroneo points out, “When you lose sight from glaucoma, that’s it, you can’t get it back.” He explains that in any given ophthalmic practice, roughly half the workload relates to glaucoma. It’s a big cohort of patients needing regular visits and monitoring. Early diagnosis is critical and then it’s all about treatment.
Dr Zangerl heads up the team researching ways to make the diagnosis and treatment process more efficient, while Professor Coroneo is providing clinical and basic research expertise.
The study will trial a device to measure intra-ocular pressure (IOP) called Icare HOME.
Coroneo explains why, “There is a notion that pressure spikes are happening in some patients for reasons we don’t understand and it’s the dynamics of these spikes that are damaging the optic nerve”.
“By having patients monitoring their own pressure”, Dr Zangerl continues, “we’ll have a better view of what is going on over extended periods of time”.
“The device we’re using is quite pragmatic, it’s not that expensive and it works in a good percentage of patients,” Professor Coroneo enthuses. “This is a real-world first study where we will see how well home monitoring works and whether or not it’s going to change how we intervene”.
Patients with ongoing glaucoma treatment at risk of disease progression will be selected to participate, and then randomised into either the control or intervention group.
Those in the intervention group will be asked to measure their IOP four times during the day, for 14 days. They will continuously upload these measurements into a cloud-based database using an enabled device, such as a smartphone.
Patients will visit the clinic at the end of the initial measurement period, then again in six months to discuss outcomes and implications to ongoing clinical care. While the control group will receive the same state-of-the-art clinical care, their management will not be supported by the Icare HOME monitoring during the study period.
The two groups will be compared to see who fared better.
Compliance and satisfaction
Involving patients in their own management has been shown to improve compliance, as well as outcomes, for those with chronic disorders.
The team hopes it will be the same for their glaucoma patients, “Compliance is a real problem, but I think giving patients some ownership of their condition may help”.
Additionally, this home monitoring is a move towards a better patient-centred and patient-driven model of care. To evaluate this, participants will be asked to complete a satisfaction and modified quality-of-life questionnaire to see whether home monitoring is associated with a change in satisfaction and quality of life.
According to Dr Zangerl, “Including quality-of-life feedback from the participants is important to determine out of all the outcomes we can get, which are actually relevant to our patients”.
Sights set on preventing blindness
Professor Coroneo believes the outcomes will mean tremendous things for patients, “Particularly because it coincides with a time where interventions for treating glaucoma are improving rapidly,” he says.
Dr Zangerl is pleased to report the preliminary results are looking good, “So far, it looks like we probably would integrate this technology to improve disease management”.
Complete results will be available later this year.