In-home Tracking of glaucoma: Reliability, Acceptability, and Cost: the I-TRAC Study

The research outlined in our proposal will determine the feasibility and acceptability of digital technologies to monitor glaucoma at home and inform the possible need and design of a definitive evaluative study.

Resource constraints resulting in delays in patients’ access to glaucoma services have resulted in vision loss due to glaucoma [1]. Glaucoma services are overwhelmed and struggling to accommodate current demands [2]. Reducing the need for hospital based services will improve the ability to see those most at risk of vision loss, which could alleviate both demand on the service and improve patient outcomes.

Digital technologies that provide opportunities for home monitoring of glaucoma progression have potential to contribute to solve these challenges and, potentially, improve outcomes. However, understanding which patients could benefit most, the acceptability of the technologies, and the implications for the service need to be resolved before a definitive evaluative study can be conducted. The feasibility study outlined in this application will address these uncertainties.

Specifically, we will:

1. Identify which glaucoma patients are most appropriate for home monitoring (e.g. all patients, or those with stable disease, or those with severe glaucoma?);

2. Understand the views of key stakeholders (patients, clinicians, IT personnel, researchers) on whether home monitoring is feasible and acceptable; 3. Identification of key elements for an economic evaluation for home monitoring for glaucoma;

4. Explore the need for and provide evidence on the optimal design of a future study to evaluate the use of digital technologies for home monitoring of glaucoma.

We will utilise a mixed-methods sequential explanatory design feasibility study with key components informed by theoretical (i.e. the Consolidated Framework for Implementation Research and Theoretical Framework of Acceptability) and conceptual (ADePT) frameworks. In brief the interlinked phases of work will survey Ophthalmologists to determine which patients would be appropriate for home monitoring of glaucoma; interview key stakeholders to determine acceptability of the technology and explore key features and feasibility of a future definitive study; and identify the key cost drivers from a range of stakeholders involved in service provision to inform development of an economic model for future evaluation.

The findings from all phases will provide evidence to support a statement on feasibility and acceptability of an evaluative study (e.g. trial, longitudinal study, economic modelling) comparing current standard NHS glaucoma care with home monitoring. The projected timetable start date for the study is 1st June 2020: the study duration will be 20 months

All study participants will have the opportunity to receive feedback on the overall results of the study in the form of a newsletter. We will work with the PPI partners during the study to explore options for broader patient feedback. Publication of a methods paper is anticipated to raise awareness of the feasibility study.

Presentation at the largest UK ophthalmic congress is planned, along with an international congress to reach an international audience. In terms of direct impact from this study, we will provide evidence to support a statement on feasibility and acceptability of an evaluative study comparing current standard NHS glaucoma care with home monitoring.