EDiMaD

Early Detection in Macular Disease - EDiMaD actually turns out to be a family of projects.  The macula is the small area at the back of the eye responsible for our high acuity vision. It accounts for only the central few degrees of our visual field, but is critical for what we normally think of as "seeing".  Damage to the macula therefore has a big impact on what we can do (drive, read, knit, hit a golf ball etc). For a long time there wan't much that could be done for patients suffering from important diseases affecting the macula like neovascular age-related macular degeneration (nAMD) and diabetic macular oedema (DMO). But a few years ago, drugs were introduced that could not only stop these diseases damaging the macula, but actually reverse some of the damage done, restoring at least some vision in many patients. Identifying these patients early and starting treatment has much better outcomes than identifying and treating them later on. So we've been investigating tests that might enable this, particularly tests that could be used away from the hospital, and even in patients' own homes.

In EDiMaD I  we investigated a test developed by Vital Art & Science Inc and presented on an Apple Ipod Touch (an inexpensive device about the size of a mobile phone). The handheld radial shape discrimination test (hRSD) measures our ability  to detect increasingly subtle distortions in a circle, an ability that is affected by the development of macular disease (see Ku et al, 2016) . We wished to find out if the hRSD test was sufficiently sensitive to be used to detect wet AMD in its earliest stages. So we recruited a group of about 200 patients being treated for wet AMD in their first eye and followed their second eye knowing that a number of them would develop disease. At least in our studies the hRSD test does much better than some familiar alternatives, and patients find it very easy to use. You can read the results here.

In EDDMO we're investigating how useful the hRSD test is detecting DMO. Screening for diabetic eye disease in the UK has been a great success and is reducing the levels of visual disability caused by diabetes in the UK population. But lots of patients are sent in to hospital clinics unnecessarily because it's suspected that they have DMO. A simple additional test at the screening stage (like the hRSD test) might prevent this, reducing the inconvenience to patients, and reducing the workload in busy hospital eye departments.

In EDiMaD II (a PhD project) we are looking at the relationship between hRSD results and Contour Integration Perimetry, a new test developed by Yi-Zong Wang and colleagues in Dallas.

We are investigating the hRSD test (along with other tests) in the MONARCH project.