Can 3D facial imaging help manage a disfiguring cause of sight loss?

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 give 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."