A research grant co-funded by Fight for Sight and the British Thyroid Foundation has been awarded to researchers at London's NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (the "NIHR Moorfields BRC"). Mr Daniel Ezra and co-investigator Mrs Anjana Haridas will study whether a new tool for 3D facial imaging can help improve management of a distressing cause of sight loss which can also cause significant facial disfigurement. This research helps to address the top unanswered question established by our Priority Setting Partnership for Sight Loss and Vision for ocular inflammatory diseases.

Thyroid eye disease or 'TED' is an inflammatory disease of the fat and muscle at the back of the eye which sometimes compresses the optic nerve which sends visual signals from eye to brain. If the optic nerve becomes compressed, people can experience sight loss. Loss of function of the muscles around the eye can also cause debilitating double vision. The swelling also pushes the eye forward, causing facial disfigurement and causing the cornea – the transparent front surface of the eye – to become exposed and damaged.

Current treatments for TED include 'orbital decompression surgery' to increase the space around the eye by removing tissue or bone. However, it is hard to predict what result the operation will have, either for the soft tissues around the eye or for reversing the facial disfigurement of the person undergoing surgery. This in turn makes it hard to provide appropriate counselling to the patient on the potential benefits of surgery in reversing the disfigurement caused by the disease.

In three pilot studies, the researchers will test a sophisticated 3D imaging system that has been used in breast reconstruction and reconstructive craniofacial surgery. It captures 3D images of patients and uses software to analyse changes in volume, contour and shape or to simulate the change in appearance that could be achieved by having surgery.

Mr Ezra, Consultant Ophthalmologist, NIHR investigator, and research lead for the Oculoplastics Service at Moorfields Eye Hospital said:
"We expect our results to help quantify the 3D changes around the eye in thyroid eye disease. This could provide outcome measures which 1) are better correlated with what the patients want; and 2) generate an index measure of 'disfigurement' to classify/characterise disease severity, predict and monitor disease course or analyse treatment outcomes."

In study 1, the team will compare pre- and post-op 3D imaging of TED patients undergoing orbital decompression surgery. Study 2 will compare imaging data to the current standard measurement for predicting treatment outcomes in TED (the "clinical activity score") gathered over a number of visits from people with TED that is actively progressing. The third study will use 3D facial imaging of people with glaucoma to find out whether a common glaucoma treatment known as 'topical prostaglandin analogues' (PGAs) can reduce the soft tissue volume of the eye socket,

"We're delighted to team up again with British Thyroid Foundation for the first study of this nature in TED," said Dr Dolores M Conroy, Director of Research at Fight for Sight. "The research will address the clear, unmet need for a tool to take the management of TED from initial assessment through to reliable monitoring of the condition, peri-operative counselling and post-treatment assessment."

Janis Hickey, Director of the British Thyroid Foundation said, "Seeking improvements for patients with TED is very important to us and joining forces with Fight for Sight has allowed this research to be funded. The study is innovative and deals with an issue that is often overlooked – that of psychological impact arising from facial disfigurement – an aspect that is very important for people with TED."

The study will be further supported by the infrastructure available through the NIHR Moorfields BRC. Patients will undergo testing and monitoring in the NIHR Clinical Research Facility at Moorfields Eye Hospital. Professor Sir Peng Tee Khaw, Fight for Sight Ambassador and Director of the NIHR Moorfields BRC, said:

"We are very pleased to support a study arising from discussions at a research day involving Fight for Sight and the British Thyroid Foundation and organised by our NIHR Biomedical Research Centre. This day brought together clinicians, surgeons, patients, family members, scientists and support charities to discuss priorities for TED research. It is tremendous that a research project addressing patient needs has been funded."

Fast facts

• Thyroid eye disease (TED) affects around 400,000 people in the UK.
• Every year 16 in 100,000 women and 3 in 100,000 men are diagnosed with TED.
• Glaucoma is a group of eye conditions that if left untreated can lead to irreversible sight loss.
• Topical prostaglandin analogues (PGAs) are currently used to treat glaucoma by reducing high pressure within the eye. They are taken as eye drops.

About Fight for Sight

1. Fight for Sight is the leading UK charity dedicated to funding pioneering research to prevent sight loss and treat eye disease.

2. Fight for Sight is funding research at leading universities and hospitals throughout the UK. Major achievements to date include:

• saving the sight of thousands of premature babies through understanding and controlling levels of oxygen delivery
• restoring sight by establishing the UK Corneal Transplant Service enabling over 52,000 corneal transplants to take place
• providing the funding for the research leading to the world's first clinical trial for choroideremia
• bringing hope to children with inherited eye disease by co-funding the team responsible for the world's first gene therapy clinical trial
• identifying new genes responsible for keratoconus and Nance-Horan syndrome

3. Fight for Sight's current research programme is focusing on preventing and treating age-related macular degeneration, diabetic retinopathy, glaucoma, cataract and corneal disease. We are also funding research into the causes of childhood blindness and a large number of rare eye diseases.
For more information or images please contact:
Ade Deane-Pratt, Research Communications Officer, Fight for Sight. T: 020 7264 3906. E: [email protected]
W: www.fightforsight.org.uk. Twitter: @fightforsightUK. Facebook: https://www.facebook.com/fightforsightuk

About the British Thyroid Foundation
1. The British Thyroid Foundation (BTF) was set up in 1991 to help people with thyroid disorders
2. Staff, medical professionals, volunteers and people with thyroid disorders work together to provide quality information and support based on reliable medical evidence and personal experiences.
3. The BTF is involved in projects and campaigns to improve the patient experience.
4. The BTF is a member of TEAMeD (Thyroid Eye Disease Amsterdam Declaration Implementation Group UK) whose mission is:

• To raise awareness of TED
• To establish pathways for referral and care
• To reduce the impact of TED
• To assure quality of care

For information about our TED project visit our TEAMeD page
T: 01423 810093
E: [email protected]
W: www.btf-thyroid.org

About the NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology:

Established in April 2007 and awarded a second five-year term by the NIHR from April 2012, its purpose is to conduct 'translational research' that is designed to take advances in basic medical research from the laboratory to the clinic, enabling patients to benefit more quickly from new scientific breakthroughs. Our centre is currently one of 11 Biomedical Research Centres that were awarded in 2012 to NHS/university partnerships with an outstanding international reputation for medical research and expertise, and experience of translating that research into the clinical setting. For further information, please visit www.brcophthalmology.org.

Moorfields Eye Hospital NHS Foundation Trust is one of the world's leading eye hospitals, providing expertise in clinical care, research and education. We have provided excellence in eye care for more than 200 years and we continue to be at the forefront of new breakthroughs and developments. We are an integral part of one of the UK's first academic health science centres, UCL Partners, and now we are part of one of the first science health networks. We were one of the first organisations to become an NHS foundation trust in 2004. For further information, please visit www.moorfields.nhs.uk. Press contact: Julia Jones – 020 7566 2628, [email protected]

UCL Institute of Ophthalmology is one of a number of specialised research centres within UCL (University College London) and is, together with Moorfields Eye Hospital, one of the leading centres for eye research worldwide. The combination of the Institute's research resource with the resources of Moorfields Eye Hospital, which has the largest ophthalmic patient population in the Western World, opens the way for advances at the forefront of vision research. For further information, please visit www.ucl.ac.uk.

About the NIHR The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence, and systems represent the most integrated health research system in the world. For further information, visit the NIHR website www.nihr.ac.uk