GATE

GATE: Glaucoma Automated Tests Evaluation: comparative study of new imaging technologies for the diagnosis of glaucoma

Glaucoma describes a group of eye diseases in which there is progressive damage of the optic nerve and loss of visual field leading to impaired vision and sometimes blindness. The estimated prevalence of glaucoma in the UK is 2% of the adult population with approximately 4,000 new cases of severe visual impairment due to glaucoma every year. Currently, a definitive glaucoma diagnosis is based on the expertise of an ophthalmologist interpreting a visual field test. New imaging techniques have emerged and this within-patient, multicentre, comparative study compared these new techniques between themselves and with current practice. We assessed the cost-effectiveness of adopting individual tests or combination of tests as triage tests compared with the current practice of diagnostic examination by an ophthalmologist in a secondary care setting.

Outcome and Translation

Considerable NHS resources are required to assess all patients referred to secondary eye-care services with suspected glaucoma. Furthermore, there is considerable strain on secondary eye-care services through the increase in false positive referrals from optometrists.

Automated imaging can be effective in aiding glaucoma diagnosis among individuals referred from the community to HES. A model of care using a triage composite test appears to be cost-effective. NICE supported its decision to review the glaucoma clinical guidelines in 2016 based on the evidence provided by this and other studies  (see OHT project).

Future work is needed as there are uncertainties about glaucoma progression under routine care, and the cost of providing healthcare. Acceptability of implementing a triage test needs to be explored.

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HERU researchers involved in this research project: Rodolfo Hernández

External collaborators: A Azuara-Blanco (NHS Grampian); C Ramsay, J Cook, K McCormack (HSRU, University of Aberdeen); J Burr (University of St. Andrews); D Garway-Heath (Moorfield Eye Hospital NHS Foundation Trust); R Bourne (Hinchingbrooke Hospital/Moorfield Eye Hospital/Addenbrooke’s Hospital) and M Batterbury (Royal Liverpool University Hospital)

Publications

Azuara-Blanco, A., Banister, K., Boachie, C., McMeekin, P., Gray, J., Burr, J., Bourne, R., Garway-Heath, D., Batterbury, M., Hernández, R., McPherson, G., Ramsay, C. and Cook, J. (2014) Comparative study of automated imaging technologies for the diagnosis of glaucoma (GATE study). Diagnostic accuracy, performance as triage tests, and cost-effectiveness. Report submitted to the NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC), Aberdeen: University of Aberdeen.

Azuara-Blanco, A., Banister, K., Boachie, C., McMeekin, P., Gray, J., Burr, J., Bourne, R., Garway-Heath, D., Batterbury, M., Hernández, R., McPherson, G., Ramsay, C. and Cook, J. (2016) 'Automated imaging technologies for the diagnosis of glaucoma: a comparative diagnostic study for the evaluation of the diagnostic accuracy, performance as triage tests and cost-effectiveness (GATE study)', Health Technology Assessment, 20(8).

Banister, K., Boachie, C., Bourne, R., Cook, J., Burr, J. M., Ramsay, C., Garway-Heath, D., Gray, J., McMeekin, P., Hernández, R. and Azuara-Blanco, A. (2016) 'Can automated imaging for optic disc and retinal nerve fiber layer analysis aid glaucoma detection?', Ophthalmology, 123(5), 930-938.

Presentations

Azuara-Blanco, A., Banister, K., Boachie, C., Batterbury, M., Burr, J. M., Bourne, R., Garway-Heath, D., Hernández, R., McPherson, G., Ramsay, C. and Cook, J. (2014) 'Patterns of glaucoma referrals from the community to hospital eye services in the UK. Description of participants of the GATE study [poster]', European Glaucoma Society Annual Congress, NICE, France, 7-11 June 2014.

Banister, K., Cook, J., Burr, J., Hernández, R., McCormack, K., Bourne, R., Batterbury, M., Garway-Heath, D. and Azuara-Blanco, A. (2012) 'Comparative study of new imaging technologies for the diagnosis of glaucoma (GATE): design and conduct of a multicentre diagnostic study', European Glaucoma Society meeting, Copenhagen, 17-22 June 2012.

Banister, K., Cook, J., Ramsay, C. R., Burr, J. M., Hernandez, R., McCormack, K., Bourne, R., Batterbury, M., Garway-Heath, D. and Azuara-Blanco, A. (2013) 'Comparative study of new imaging technologies for the diagnosis of glaucoma: design and conduct of a multi-centre diagnostic accuracy study (the GATE study)' [Poster Presentation], SINAPSE (Scottish Imaging Network: a Platform for Scientific Excellence), 5th Annual Scientific Meeting, Aberdeen, 15 May 2013.

Banister, K., Cook, J., Ramsay, C.R., Burr, J.M., Hernandez, R., McCormack, K., Bourne, R., Batterbury, M., Garway-Heath, D. and Azuara-Blanco, A. (2013) 'Comparative study of new imaging technologies for the diagnosis of glaucoma: design and conduct of a multi-centre diagnostic accuracy study', 2nd UK Clinical Trials Methodology Conference, Edinburgh, 18-19 November 2013.

Banister, K., Boachie, C., Cook, J., Batterbury, M., Burr, J. M., Bourne, R., Garway-Heath, D., Hernández, R., McPherson, G., Ramsay, C. and Azuara-Blanco, A. (2014) 'The diagnostic accuracy of new imaging technologies for the diagnosis of glaucoma: results from the GATE study [poster]', European Glaucoma Society Annual Congress, Nice, France, 7-11 June 2014.

Banister, K., McMeekin, P., Gray, J., Hernández, R., Boachie, C., Cook, C., Burr, J. M., McCormack, K., McPherson, G., Ramsay, C., Bourne, R., Garway-Heath, D., Batterbury, M. and Azuara-Blanco, A. (2014) 'Cost-effectiveness evaluation of novel care pathways in glaucoma diagnosis using imaging technologies', 11th Annual Meeting of Health Technology Assessment International Society (HTAi), Wasington DC, USA, 15-18 June 2014.