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Abstract

This programme of work comprises five studies exploring new ways of examining age-related eye conditions in England.

The first study in this thesis estimated the impact of neighbourhood deprivation on the time of presentation of advanced visual field loss to the hospital eye services. It showed that glaucoma severity at presentation to English HES is associated with levels of multiple deprivation. However, the likelihood of rapid VF progression during follow-up was not found to be associated with IMD, hinting at equity of glaucoma care and outcomes once patients are in English HES. The disparities identified in this study provide the broader context to empirically assess novel approaches to testing, as explored in the forthcoming studies.

My second study assessed the feasibility of using “wasted” waiting time to perform self-administered contrast sensitivity assessments on glaucoma patients within the waiting area. Potential environmental confounds and patient feedback were recorded. Vision self-assessments took 2.5-3.0 minutes to complete each time, and most patients (97%) completed the test. Both tests were highly acceptable to most patients and suggested that the approach may enable additional data collection, potentially improving patient management, clinic flow, and/or improving patient satisfaction.

My third study assessed the use of head-mounted visual field glasses to monitor visual fields in glaucoma patients from their home environment, and to assess normally sighted adults in simulated home-like environments. All patients completed the tests, and the results showed reasonable correlation with the HFA MD (r=0.78, P=0.008). The results suggested the test may provide a feasible way to monitor glaucoma patients though unanswered questions and opportunities for further improvement were identified. My fourth study evaluated the resilience of novel contrast sensitivity tests to different environmental conditions encountered in a home setting. Normally sighted individuals (n=107) performed two contrast sensitivity tests, Spotchecks and PopCSF, in a simulated home-like environment. Illumination and seating position showed no impact on the test performance, suggesting that regular home-like environmental factors may not substantially impede home-based testing.

The fifth and final study in this thesis reported the views, expectations, and concerns of patients living with glaucoma and age-related macular degeneration regarding vision home-monitoring. The participants graded six home-monitoring devices and rated them highly for usability. However, several practical improvements were suggested. The results suggest that patients view vision home-monitoring as being likely beneficial but have significant concerns about its potential implementation.

Collectively, these five studies suggest that novel visual function assessments can be feasibly administered outside traditional clinical settings, though not without some important limitations. Possible future work is suggested in the discussion to address these limitations.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RE Ophthalmology
Departments:	School of Health & Medical Sciences > Department of Optometry & Visual Science School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

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