Study could benefit eye disease patients whilst saving NHS both time and money

Press release issued: 20 December 2018

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.

For more information about MONARCH, please contact the MONARCH study coordination team on tel 0117 342 2526 or email MONARCH-study@bristol.ac.uk

Further information

The MONARCH study is funded by National Institute of Health Research (NIHR) Health Technology Assessment Programme (HTA) (15/97/02).

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health and Social Care. The study is sponsored by Queen's University of Belfast and is managed by the Clinical Trials and Evaluation Unit at the University of Bristol.

About the National Institute for Health Research (NIHR)
The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:

Funds, supports and delivers high quality research that benefits the NHS, public health and social care
Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
Partners with other public funders, charities and industry to maximise the value of research to patients and the economy

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.

The NIHR Health Technology Assessment (HTA) Programme funds research about the clinical and cost effectiveness and broader impact of healthcare treatments and tests for those who plan, provide or receive care from NHS and social care services. HTA research is undertaken where some evidence already exists to show that a technology can be effective and this needs to be compared to the current standard intervention to see which works best.

This study is kindly supported by Visumetrics AB in collaboration with Novartis Sverige AB have provided use of the MultiBit vision test software application free of charge for the duration of the study; Vital Art and Science LLC have provided use of the MyVisionTrack® vision test software appplication free of charge for the duration of the study, and KeepSight have provided access to KeepSight branded vision monitoring and education tools and use of the KeepSight Journal, adapted for UK use for the duration of the study.