Background:

Glaucoma is a chronic disease of the optic nerve and a leading cause of severe visual loss in the UK. Once patients have been diagnosed, they need regular monitoring at hospital eye services. Recent advances in technology mean patients with glaucoma can now monitor their disease at home. This could be more convenient for patients and potentially reduce costs and increase capacity for the NHS. However, it is uncertain whether self-monitoring would be acceptable or possible for patients with glaucoma.

Objectives:

The objectives were to: identify which patients are most appropriate for home monitoring; understand views of key stakeholders (patients, clinicians, researchers) on whether home glaucoma monitoring is feasible and acceptable; develop a conceptual framework for the economic evaluation of home glaucoma monitoring; and explore the need for and provide evidence on the design of a future study to evaluate the clinical and cost-effectiveness of digital technologies for home monitoring of glaucoma.

Design:

In-home Tracking of glaucoma: Reliability, Acceptability, and Cost (I-TRAC) was a multiphase mixed-methods feasibility study with key components informed by theoretical and conceptual frameworks.

Setting:

Expert glaucoma specialists in the UK recruited through professional glaucoma societies; study site staff and patient participants recruited through three UK hospital eye services (England, Scotland, Northern Ireland); and UK research teams recruited though existing networks.

Intervention:

Home tonometer that measures intraocular pressure and a tablet computer with a visual function application. Patients were asked to use the technology weekly for 12 weeks.

Results:

Forty-two patients were recruited. Retention and completion of follow-up procedures was successful, with 95% (n = 40) completing the 3-month follow-up clinic visits. Adherence to the interventions was generally high [adherence to both devices (i.e. ≥ 80% adherence) was 55%]. Overall, patients and healthcare professionals were cautiously optimistic about the acceptability of digital technologies for home monitoring of patients with glaucoma. While most clinicians were supportive of the potential advantages glaucoma home monitoring could offer, concerns about the technologies (e.g. reliability and potential to miss disease progression) and how they would fit into routine care need to be addressed. Additionally, clarity is required on defining the ideal population for this intervention. Plans for how to evaluate value for money in a future study were also identified. However, the study also highlighted several unknowns relating to core components of a future evaluative study that require addressing before progression to a definitive effectiveness trial.

Limitations:

The main limitation relates to our sample and its generalisability, for example, the over-representation of educated persons of white ethnicity who were generally experienced with technology and research motivated.

Conclusions:

The In-home Tracking of glaucoma: Reliability, Acceptability, and Cost study has demonstrated ‘cautious optimism’ when considering patients’ and healthcare professionals’ views on the acceptability of digital technologies for home monitoring of patients with glaucoma. However, the study also highlighted several unknowns relating to the research question and design of a future evaluative study that require addressing before progression to a randomised controlled trial.

Future work:

Further research is required to determine the appropriate population (i.e. low vs. high risk of progression) and further refine the intervention components and delivery for planning of future evaluation studies.

Study registration:

This study is registered as Research Registry #6213.

Funding:

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR129248) and is published in full in Health Technology Assessment; Vol. 28, No. 44. See the NIHR Funding and Awards website for further award information.

What is this research about?:

The In-home Tracking of glaucoma: Reliability, Acceptability, and Cost study explored whether glaucoma patients who would normally be monitored in hospital could do some monitoring themselves at home, and whether self-monitoring at home would be acceptable or possible for them.

How was the research done?:

We delivered In-home Tracking of glaucoma: Reliability, Acceptability, and Cost in four phases by:

1. Surveying expert glaucoma specialists to understand which patients would benefit most from home monitoring.
2. Providing glaucoma patients with an iPad tablet and a device which measures eye pressure to use once a week for 3 months. The patients who participated and the clinical staff delivering the study were interviewed about their experiences.
3. Interviewing researchers with experience of running large studies testing digital technologies to monitor patients’ health at home to understand challenges.
4. Reviewing other researchers’ work and comparing it with ours to help us understand whether home monitoring of glaucoma could be good value for money.

What did the research find out?:

Overall, patients and healthcare professionals were cautiously optimistic about the digital technologies for home monitoring of glaucoma. Most patient participants were able to use the technologies, and half told us they preferred home monitoring. Most clinicians recognised the potential advantages of glaucoma home monitoring but had concerns about the technologies (specifically reliability and the risk of missing disease progression) and how they would fit into routine care. Plans for how to evaluate value for money in a future study were identified. The study did not aim to identify whether the digital technology was better than what happens currently; a different study design with many more patients would be required to answer that question. The study did identify several important questions to answer before designing a future larger study; for example, how to ensure diverse patient participation. These questions should be the focus of future research in this area.

Article history

The research reported in this issue of the journal was funded by the HTA programme as award number NIHR129248. The contractual start date was in January 2021. The draft manuscript began editorial review in March 2023 and was accepted for publication in January 2024. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors’ manuscript and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this article.