Patient self-testing at home for macular oedema 

With support of an innovation grant, Associate Professor Dawn Sim will investigate the use of a patient self-test smartphone-based app for patients with macular oedema to monitor their vision from home.

Macular oedema is a common sight-threatening condition caused by abnormal build-up of fluid and swelling at the back of the eye. It is associated with a number of conditions such as wet age-related macular degeneration and diabetes. Treatment options include eye drops, medication or injections. 

Ophthalmology is the busiest outpatient speciality in the NHS and was under significant strain even before the Covid 19 pandemic. Many patients, already within Moorfields’ system on injection treatment, have multiple annual follow up appointments. These stable reviews will add to the volume of patients being seen, some of whom will be more urgent cases than others. 

The challenge is to establish a safe and effective approach for risk stratification and minimise the number of patients asked to attend in-person hospital reviews.

The opportunity to monitor vision remotely through a smartphone will be offered to patients from the relevant medical retinal clinics. The training and installation for using the app will be provided by telephone or video conferencing depending on what the patient prefers.

Patients will be asked to perform tests three times a week. The data is relayed to the eye care professionals remotely as well as to the patient. The scores will help identify patients who may need an earlier repeat consultation with the eye care team. 

There is great potential in providing patients with a means to monitor their own eye health. It can help with alleviating health anxiety through the provision of immediate feedback. It can also provide direct means of addressing vision deterioration, should it occur. This means healthcare professionals could have more time to prioritise face to face visits for those who need to be urgently seen. 

As a result, this could potentially minimise avoidable sight loss, lessen the strain on clinical services and reduce the number of appointments and waiting times. 

The use of digital tools may support the ultimate aim - for the right patient to be seen at the right time.