Aims and objectives:
Within a strategic contest, this project has allowed integration of research into clinical practice and is linked into our orthoptic departmental action plan. It is also relevant to the NHS plan by 'using new ways of working' and the NHS Improvement Plan (2004) supporting the principle of 'flexible services shaped around individual's needs and preferences other than an expectation that people will fit the system'. In addition Queens Medical Centre NHS Trust aims to be 'the hospital of choice' and hopefully in the future, our centre could be the first to offer this novel treatment within the NHS. In addition we have linked into the expertise provided by the East Midlands Innovation Hub. Exploitation of intellectual property generated by the NHS is being promoted.
Support for the change:
The change has been supported by identification of an orthoptist as research lead and liaison link between orthoptic department and University of Nottingham. Orthoptic colleagues have also been supportive by assisting with collection of appropriate patients from their clinical workload. The head orthoptist was a champion for change within the project by providing flexible opportunities for staff to develop new approaches to clinical intervention and so was one of our ophthalmologists, who allowed his patients to be treated with this system.
Patient and public influence:
Feedback on the prototype and treatment from both parents and children have allowed the development of the research system into the manufactured prototype. This has meant issues, such as child comfort whilst sat at the system. In addition difficulties using the game have lead to improvements, such as differing game levels, more interactive elements within the game and lap scores. We have canvassed orthoptic colleagues, both within the department, and at recent clinical study day meetings for comments on development and market research.
Impact on the workforce:
Opportunities to introduce orthoptic colleagues to research and registration of one orthoptist for a higher degree to develop this project. University colleagues have taken on board requirements of clinicians, children and parents both within a clinical trial setting and with adaptations to the system. Also, exposure to the business world and the differing objectives of business has meant flexibility and adaptation of the research trials.
Measuring the results:
Results measured by ergonomic assessment of the new manufactured prototype, using formal assessment in the ergonomic lab, University of Nottingham and providing photographic evidence to enable the manufacturer to address the modifications. We have involved stakeholders by closely liaising with Carlton Optical Ltd (Ophthalmic distribution company), Gatehouse (the prototype manufacturer), the hospital, the university and East Midlands Innovation Hub.
Improved performance:
Outstanding performance was demonstrated on the experimental system with 22 patients at this centre and a further 12 at another centre being treated. Increases in vision were rapid, sometimes following the first treatment. Most of the improvement occurred after 2 hours of treatment. Two hours is often the daily recommended amount of patching, which can be continued for several months. To date the children have had a 60% improvement in their vision. Traditional thinking within our profession is that vision cannot be improved in children over the age of 8 years. We have treated children older than this; one was over the age of 11 years.
Other data collected from the usability studies have enabled us to create an impressive manufactured system, which now looks like a piece of state of the art ophthalmic equipment, from a basic in-house produced system.
Reflecting diversity:
This system has been developed for use by children of differing ages and for future use by adults. Modifications to the game include automated and semi-automated 'play' mode to allow for diverse gaming skills of children. We also aimed to have a user-friendly clinician interface to enable ease of treatment mode selection.
Sharing the learning:
The original prototype was presented as a poster and won a prize at the East Midlands Innovation Day, April 2004. Oral presentations, from both Nottingham and the other research centre Glasgow, were selected to be presented at the British Isles Strabismological Association (BISA), October 2004. The audience being leading ophthalmologists and orthoptists. Oral presentation given at the 3rd Nottingham Orthoptic Symposium, October 2004, the audience being essentially clinical orthoptists. Accepted for oral presentation at 'Making a difference in practice through research' February 2005. Article written for monthly orthoptic newsletter. Papers in preparation for an ophthalmology journal.
Outstanding features:
This represents a novel innovative idea to treat amblyopia with both eyes open and using virtual reality (VR). Using both eyes open for amblyopia treatment and VR is something that has not been previously used. To treat amblyopia in a fun and interactive way for children and we have taken into consideration children's views when developing the prototype. We are also treated children who were thought to be too old for treatment. Energy has been required to keep this project going for 4 years, despite non-continuous funding and no member of the team has been able to work full time on the project. We are currently in a funding gap but hope our energy will enable us to apply for more money from appropriate grant bodies.
