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Researchers assess whether AMD patients could self-test vision

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A study is investigating whether home eye tests will benefit patients with wet age-related macular degeneration and, as a result, significantly reduce the burden on the NHS.

Researchers from Queen’s University Belfast, in collaboration with the University of Bristol, are leading a cutting-edge project, named the MONARCH study.

“We urgently need to rethink how services are offered as the current setup isn’t sustainable”

Ruth Hogg

The MONARCH study aims to investigate if patients with the eye condition wet AMD could test their vision at home, rather than attend a hospital appointment.

The most serious type of the condition, wet AMD develops when abnormal blood vessels form underneath the macula stops functioning as well as it used to.

Current treatment for wet AMD is a series of monthly injections which reduce the growth of new vessels which limit vision loss.

Patients then 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% do need them in order to prevent further loss of vision, noted the researchers.

However, they said check-up appointments put a huge strain on already-stretched resources and limited the capacity for seeing new patients who, if not seen urgently, were at high risk of site loss.

The study aims to find out whether monitoring vision by patients at home could potentially alleviate some of the burden of AMD on the NHS, as well as be more convenient for patients.

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.

Dr Ruth Hogg, from the Centre of Public Health at Queen’s University and co-chief investigator of the MONARCH study, said: “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,” she said. “In Belfast, evening and weekend clinics have been added, yet it’s still not enough.

She added: “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,” noted Dr Hogg.

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 “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.

“We are excited to be collecting data from the apps automatically, via the internet”

Barney Reeves

Professor Barney Reeves, from the Bristol Medical School and co-chief investigator of the 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,” he said.

Throughout the study participants will attend their normal hospital check-up appointments and the results of the tests done during them will be compared with the results from the home eye tests.

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.

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