Risk stratification in glaucoma
Dr Hari Jayaram | GR001214
There is currently no nationally agreed, evidence-based risk stratification model for glaucoma care. We are funding an innovation grant which will evaluate a risk stratification tool to identify patients with glaucoma at higher risk of vision loss.
Glaucoma is the leading cause of preventable sight loss in the United Kingdom and is responsible for almost a third of new vision impairment certifications. The Covid-19 pandemic has re-emphasised the need for a safe and practical risk algorithm to help ensure timely monitoring of glaucoma care during both normal and extraordinary times.
Over 1 million
glaucoma related visits occur yearly in the NHS
Learn more about glaucoma
Glaucoma is when damage to the optic nerve causes sight loss. This is usually due to pressure in your eye rising too high which can develop gradually over the years.
The fluid inside our eyes helps it to keep its shape and function properly. If too much fluid builds up inside the eye, the pressure squeezes the optic nerve at the back of the eye. This can damage the optic nerve made up of million fibres which send signals from the eye to the brain, helping us to see.
Pressure can build in the eye when:
- fluid is no longer able to drain
- extra fluid is produced due to an eye injury or infection – this is referred as ‘secondary glaucoma’
- an abnormality in the shape of the eye in children – this is referred as ‘congenital glaucoma’
It is currently not possible to repair the damage to the optic nerve, therefore any vision lost to glaucoma cannot be recovered. If left untreated, glaucoma can progress to further sight loss.
As there is no cure for glaucoma, current approaches rely on careful monitoring and regular treatment to retain useful sight. There are usually no symptoms of rising pressure in the eye until some vision loss occurs, therefore frequent eye tests are imperative to early onset of glaucoma.
Finding a solution
Along with colleagues, Moorfields consultant Dr Hari Jayaram aims to validate the “Glauc-Strat 4” glaucoma risk stratification tool. This system was developed by UK and international specialists but has yet to be validated. This project will take advantage of available data from the Laser in Glaucoma and Ocular Hypertension (LiGHT) trial by using six years of comprehensive clinical follow up-data from 700 patients with glaucoma.
Specifically, the project aims to:
- compare “Glauc-Strat 4” stratification using baseline data to actual clinical outcomes after six years of follow-up
- evaluate whether mobility of individual patient’s stratified risk correlates with other objective measures of clinical deterioration
- refine and re-validate the stratification tool in order to optimise its correlation with long-term outcomes
Assessing the performance of “Glauc-Strat 4” to stratify patients could help support the delivery of safe and timely glaucoma care. As a result, this system has the potential to shape the future delivery of glaucoma care at a national level.
Dr Hari Jayaram
Glaucoma, Service improvement, Patient experience