Q&A: Clear vision: Roche's developments in ophthalmology
Med-Tech Innovation spoke to Sukh Tatla, marketing community lead at Roche, about its work in ophthalmology, which includes a collaboration with Moorfields Eye Hospital.
Tell us about the work that Roche has been doing in ophthalmology.
At Roche, we’re dedicated to saving people’s eyesight from the leading causes of vision loss using pioneering therapies and ground-breaking technology. This makes ophthalmology one of the most exciting areas in which to work. We have a broad ophthalmology pipeline, covering early and late-stage treatments for conditions including neovascular age-related macular degeneration, diabetic macular oedema and diabetic retinopathy.
In the UK, we’re working with the NHS to use technology and innovation that helps maximise the current capacity within the ophthalmology healthcare system. Our objective is to ensure patients are seen and treated quickly to limit the deterioration of their eyesight, and so they aren’t worried about a decline in vision while they’re waiting for their next appointment.
We’re also partnering with many different organisations across the UK, including Health Data Research UK (HDRUK)on the INSIGHT Hub and Moorfields Eye Hospital on the Home Vision Monitor app. These collaborations help us to ensure we’re listening to and learning from patients and their experiences, and the insights feed into everything we do.
You have worked together with Moorfields Eye Hospital on the Home Vision Monitor. Tell us about this collaboration.
The Home Vision Monitor allows patients to track their vision at home using a simple, interactive app on their smartphone or tablet. The app features a shape discrimination test designed to detect early vision changes in patients with retinal diseases, such as neovascular age-related macular degeneration (nAMD) and diabetic eye disease.
In April 2020, during the early stages of the COVID-19 pandemic, Moorfields Eye Hospital was searching for a solution to help minimise the time patients had to attend in-person hospital appointments. This was critical for patients with nAMD who were typically older than 65 and considered highly vulnerable to the effects of COVID-19. As a response to this urgent need, a global project team was set up to collaborate with Moorfields and introduce the Home Vison Monitor as a service enhancement.
The app was set up within four weeks and received a CE mark in Europe. So far, the app has been used by over 400 patients and the insights we’ve gained from Moorfields into what patients need has been critical in further developing the app, including securing an FDA 510k clearance in the USA. The industry needs these real-life insights because ophthalmology is an area where clinical trial settings don’t always translate perfectly to the real world.
Why did you choose to use a shape discrimination test?
We wanted to make the process as simple as possible for patients. Patients are asked to take the test twice a week, which is a big commitment, so it had to be a test that didn’t take up too much time. The shape discrimination hyperacuity (SDH) test, the specific test featured in the app, measures the threshold at which changes in certain types of patterns can be detected. These tests are better at picking up some visual issues. They also provide a more quantitative measure of how patients are doing than the more commonly available methods like the Amsler grid (a tool that eye doctors use to detect vision problems resulting from damage to the macula or the optic nerve).
Does using this have advantages compared to using a smartphone camera as a medical device to check on eye health?
The smartphone display technology available for shape discrimination hyperacuity tests is more robust than using a smartphone camera to check eye health. The SDH test that is displayed on the Home Vision Monitor has 20 years of research in over 1650 participants supporting its use. It also relies a lot less on training the user as there’s much less room for error, and there’s no need to attach any additional equipment to your smartphone.
What is the potential of technology that can be developed in ophthalmology?
Technology has huge potential to help solve the problem of NHS capacity, not only in helping doctors to monitor patients remotely and prioritise those who need care most urgently, but also in providing people with reassurance that their condition is being managed. The real challenge is finding ways to effectively analyse data to get to the information that’s most important and translates into meaningful clinical insights, plus, making sure the technology is accessible for everyone affected by eye conditions.
The Roche Ophthalmology Personalised Healthcare Initiative is exploring the potential to develop artificial intelligence and machine learning tools that can analyse huge data sets to predict treatment response and disease progression.
You have been involved in developing an AI algorithm for eye care. Can you give us some insight into how this was developed?
In September 2019, Roche entered into a multi-party collaboration agreement to establish INSIGHT for Eye health. Together with Google, Moorfields Eye Hospital and Birmingham NHS Trusts, INSIGHT aims to build the first-of-its-kind holistic data-record in eye disease. It will use anonymised, large-scale data and advanced analytics, including AI algorithms, to develop new insights into disease detection, diagnosis, treatments and personalised healthcare.
What are your future plans in this space?
Our future plans centre around bringing innovative medicines to patients. AI is one part of this and partnerships with the NHS and other organisations outside of the industry are also key.
Is there anything else you'd like to add?
It’s clear that people’s sight will have deteriorated because of the delay in diagnosis and treatment created by the pandemic. The use of technology to look after and monitor patients remotely has become more important than ever, but it’s also important that we don’t lose momentum in innovating in this space and that this progress is not seen as a short-term fix to help the NHS recover from the pandemic.