Researchers use health data to tackle a growing challenge in glaucoma care

Glaucoma is one of the leading causes of irreversible blindness worldwide, and detecting it in short-sighted (myopic) patients can be significantly more difficult. Myopic eyes face a higher risk of developing glaucoma, and the structure of these eyes can also make glaucoma considerably harder to accurately detect in a timely manner. 

Both myopia and glaucoma have been identified as governmental public health priorities, but their combined influence on clinical services is underexplored, despite rising rates of both conditions. 

Projections suggest that by 2050, half the world's population will be short-sighted, compared with around 36% today. Glaucoma cases, meanwhile, are increasing in line with an ageing population.

A new health data study aims to inform how services plan for this increasing demand and support the development of more accurate tools for glaucoma detection in myopic patients. 

The research is led by Caitlin Campbell, a clinical optometrist and PhD researcher at Ulster University and Honorary Research Fellow at Moorfields Eye Hospital NHS Foundation Trust. Working with colleagues in Moorfields Eye Hospital NHS Foundation Trust, Ulster University, UCL, and Cardiff University, Caitlin is analysing a decade of NHS health data curated through the INSIGHT Eye and Oculomics Health Data Research Hub at Moorfields, which is the world’s largest ophthalmic bioresource.

The data for the study covers more than 200,000 eyes from patients attending glaucoma services across Moorfields' London sites over ten years. It includes appointment records, visual field test results, intraocular pressure measurements, visual acuity data, demographic information, referral details, and records of imaging and clinical investigations.

Mapping the patient journey

Caitlin says: "Myopic eyes are at two to three times greater risk of developing glaucoma compared with non-myopic eyes, and that risk rises up to six-fold in people with high levels of short-sightedness. The problem is not just one of prevalence. The very structure of a myopic eye being longer than average, complicates  the standard tests used to detect  glaucoma.”

Caitlin Campbell is a clinical optometrist and PhD research fellow at Ulster University, working with Moorfields Eye Hospital, UCL Institute of Ophthalmology and Cardiff University.

The optic nerve measurements  and visual field tests that clinicians rely on are both affected by myopia. In a short-sighted eye, the optic nerve may appear unusual even in the absence of glaucoma, and visual field results can either mimic or mask the characteristic patterns of glaucomatous damage. 

"This can result in a situation where a myopic patient is suspected of having glaucoma and undergoes unnecessary referral and monitoring," explains Caitlin. "You can also have the opposite scenario, where the signs of glaucoma may be missed or delayed because the effects of myopia make it so hard to interpret the tests."

Caitlin's research approaches the problem in two ways. The first is to map the patient journey: comparing the timeline between myopic and non-myopic patients, from referral into glaucoma services to eventual diagnosis and treatment. The aim is to establish, for the first time using real-world data, whether myopia is genuinely associated with longer diagnostic pathways, more clinic visits, and delayed treatment, and to understand what that means for patients and services.

The second strand of research focuses on the nature of vision loss itself. By examining visual field data in detail, Caitlin hopes to identify whether the patterns of vision change in glaucoma differ between myopic and non-myopic eyes in ways that could improve diagnostic accuracy, and potentially support risk stratification for disease progression.

Working securely with sensitive data

By providing access to a large dataset of health-record information for patients attending glaucoma clinics, INSIGHT is enabling Caitlin to examine how patients are referred and cared for, extracting information that is directly applicable to current clinical practice.

All of Caitlin's data analysis is carried out within INSIGHT's Secure Research Environment (SRE), which allows researchers to work with anonymised datasets without any patient data leaving the secure system. "Within the SRE I'm using R to analyse and visualise the data, and it is very intuitive,” says Caitlin. “The INSIGHT team has also been on hand to help if there are ever any technical queries. It feels very accessible."

Dr Pádraig Mulholland, who supervises the project, underlines the importance of the data. "This kind of research requires real-world evidence at scale. INSIGHT has provided secure access to a depth of longitudinal clinical data that cannot be replicated in a traditional research study setting. Being able to examine how myopia shapes the glaucoma care pathway, across thousands of patients over a decade, means we can move from clinical suspicion to robust, evidence-based answers."

"Glaucoma cases are rising, the population is ageing, and we're increasingly more myopic,” highlights Caitlin. “The number of patients this will affect, and the public health implications, are going to be significant. When we publish our research later this year, we anticipate it will give us a clearer picture of how myopia currently impacts glaucoma care and how new clinical tests under development may be used to address this problem."

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Caitlin Campbell's PhD is funded by the Department for the Economy in Northern Ireland. Her research is conducted in collaboration with Moorfields Eye Hospital NHS Foundation Trust, UCL, and Cardiff University.