Glaucoma researchers tackle COVID-19 eye care challenges

The COVID-19 pandemic has made research to discover new ways of diagnosing and monitoring glaucoma more important than ever.

Around the world, the pandemic has had a devastating impact on eye care services. It has exacerbated the dilemma of already scarce resources in many developing nations. In wealthier countries, it has led to predictions of massive backlog in untreated and undiagnosed eye conditions caused by cancelled and delayed appointments.

Writing for the IAPB on the eve of World Glaucoma Week in 2020, I reflected on the exciting times ahead for glaucoma research and the great potential in this decade to make real inroads into developing new treatments that could combat the disease and save sight.

Despite the enormous challenges of the past year, and those that lie ahead, we can continue to be optimistic about the future of glaucoma research.

In an incredibly tough year, scientists continued to advance their research. Protracted lockdowns and restrictions on face-to-face medical appointments added impetus to research to develop new technologies that enable glaucoma to be diagnosed and monitored remotely.

And as the world emerges from this difficult period, health services research will come to the fore to help us determine how we can best utilise these new technologies to increase access to screening services, and early treatment.

AI for early diagnosis

Glaucoma is known as the silent thief of sight because often by the time someone notices they have the disease; irreversible damage has occurred.

But with early detection there is a lot we can do to manage the disease and save people’s sight.

At the Centre for Eye Research Australia, our ophthalmic epidemiology team and World Health Organization Collaborating Centre for the Prevention of Blindness led by Professor Mingguang He is at the forefront of utilising AI to increase access to eye screenings.

Professor He’s team is leading research trialling the use of an artificial intelligence tool to identify people at early risk of blinding eye diseases including glaucoma.

The technology has been trialled in real-world settings, including remote Indigenous communities in the APY Lands in Central Australia in a collaboration with the Nganampa Health Council and The Fred Hollows Foundation.

The next step will be to compare it to current telehealth models and measure accuracy, cost-effectiveness, ease of use and patient and clinician acceptance.

The team is also further developing the technology so that it can predict disease progression and prognosis.

And, as face-to-face consultations become increasingly challenging in a post-pandemic world, the team hopes to develop a virtual clinic as a new model of care, ensuring critical eye screenings can be delivered to everyone who needs them.

Monitoring vision at home

The pandemic has also shown the great potential to develop technologies that help patients monitor their vision at home.

CERA is supporting Australian ophthalmologist Dr George Kong to develop a smartphone visual field test using artificial intelligence to check for early changes and allow patients to monitor their vision from home between eye examinations.

During the COVID-19 lockdowns many patients could not visit their optometrist or ophthalmologist and a test like this will enable them to monitor their vision in an objective way.

The proposed test could be a real game changer in remote regions and developing countries – because even when specialist equipment or trained professionals are scarce, the smartphone is ubiquitous.

Health services research

As the pandemic continues to unfold, its full impact on eye health is yet to be determined.

Around the world, cancelled elective surgeries, restrictions of optometry services to only the most urgent cases and patients delaying treatment for conditions like glaucoma have led to predictions of a surge in serious vision problems.

To understand how to best address this problem, CERA has established a new Health Services Research Unit led by former Specsavers executive Peter Larsen.

Although the team will initially examine backlogs experienced in Australia, its findings will have global significance and help us understand the systems we need to have in place for new eye care technologies to be delivered effectively.

The Health Service Research Unit will also have a strong focus on helping our eye care sector detect the currently undiagnosed 50% of glaucoma cases around the world.

Gene and cell therapy

Finally, last year I wrote about my research with colleagues from the University of Cambridge to investigate the use of gene therapy strengthen and repair damage to the optic nerve and potentially restore sight.

A highlight of 2020 for me was the publication of our team’s research demonstrating that we could repair damaged optic nerve cells by using gene therapy to stimulate the production of a protein known as protrudin.

The research demonstrated the strongest regeneration of any technique we’ve used before and raises hopes of new treatments for glaucoma.

In the past it seemed impossible we would be able to regenerate the optic nerve, but this research shows the potential of gene therapy to do this bringing hope for new treatments in the future.

Professor Keith Martin is the Managing Director of the Centre for Eye Research Australia and the Ringland Anderson Chair of Ophthalmology at the University of Melbourne. He was president of the World Glaucoma Association from 2018-20.