The I-TRAC Study
Research type
Research Study
Full title
In-home Tracking of glaucoma: Reliability, Acceptability, and Cost: the I-TRAC Study
IRAS ID
285641
Contact name
Katie Gillies
Contact email
Sponsor organisation
University of Aberdeen/NHS Grampian
Duration of Study in the UK
1 years, 11 months, 31 days
Research summary
Summary of Research
Glaucoma is the second commonest cause of blindness in the UK and is typically influenced by the pressure in the eye (intraocular pressure) being too high. Treatments reduce eye pressure to delay or stop glaucoma getting worse. However, in some glaucoma may still progress, so patients need regular monitoring at hospital eye services where they have their eye pressure and the visual field measured. Patients need these check-ups for the rest of their lives. Glaucoma patients represent a significant part of all NHS outpatient visits, in England alone over 1 million visits per year are for glaucoma patients.Recent advances in technology mean it is now possible for glaucoma patients to monitor eye pressure and visual fields in their own home. Home monitoring could mean patients requiring fewer hospital check-ups, whilst increasing convenience and potentially reducing costs and increase capacity for the NHS.
Currently though, we do not know if home monitoring is acceptable to people with glaucoma, or if home monitoring in the general glaucoma population is feasible. The main aim of our study is to assess acceptability and feasibility of home monitoring, and to make recommendations about future research to test how the NHS could use home monitoring.
In our project, 45 patients with glaucoma (15 each from Northern Ireland, Scotland and England) will get home monitoring equipment, an iPad tablet and a home tonometer to do home monitoring tests weekly for 4 months. We have chosen a visual field test and eye pressure test that previous research has shown is suitable for home monitoring use. We’ll also interview patients about their experiences of performing the tests, focusing on the difficulties experienced and what could be done to make the home tests more acceptable. We will also discuss the use of home monitoring with clinical care team, research teams, and NHS IT staff to identify the barriers and facilitators to evaluating and implementing technology of this type.
This research fits one of the top five research recommendations by the James Lind Alliance, i.e., “What can be done to improve early diagnosis of sight-threatening glaucoma”?
Summary of Results
What is this research about?
The I-TRAC study explored whether glaucoma patients who would normally be monitored in hospital could do some monitoring themselves at home, and if self-monitoring at home would be acceptable or possible for them.How was the research done?
We delivered I-TRAC in four phases by:
1. Surveying expert glaucoma specialists to understand which patients would benefit the 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 three 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 help us understand the main challenges.
4. Reviewing other researchers’ work and comparing it with what we did and to help us understand if 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 glaucoma. Most patient participants were able to use the technologies and half told us they would prefer home monitoring. Most clinicians recognised the potential advantages of glaucoma home monitoring but had several concerns about the technologies and how they would fit into routine care. Plans for how to evaluate value for money in a future study were identified. I-TRAC did not aim to identify if the digital technology was better than what happens currently, a different study design with many more patients would be required to answer that question many more patients. However, it has identified several questions that are important to answer before designing a future larger study. These questions should be the focus of future research in this area.REC name
East Midlands - Derby Research Ethics Committee
REC reference
20/EM/0244
Date of REC Opinion
20 Oct 2020
REC opinion
Further Information Favourable Opinion