Fight for Sight and BTF Co-Fund New Research

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

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Fight for Sight/British Thyroid Foundation award winner 2014

The winner of the Fight for Sight/British Thyroid Foundation Small Grant Award 2014 is Mr Daniel Ezra, Consultant Ophthalmologist at Moorfields Eye Hospital and lecturer at the UCL Institute of Ophthalmology. Here he explains his research study on Application of 3D facial imaging system in the management of Thyroid Eye Disease:

Thyroid Eye Disease (TED) is a condition in which the immune system attacks tissues surrounding the eyes, producing inflammation and swelling. Double vision, protruding eyes, discomfort, redness and reduced vision are common features. The disease is variable and can have both blinding and immense psychosocial consequences.

Disfigurement is a particular burden to TED patients and there are currently limited ways of measuring this.
The Vectra M3 3D Imaging system (Canfield Imaging, Fairfield, NJ, USA) is a sophisticated tool that has been used in the fields of reconstructive breast and facial surgery as well as cosmetic surgery. This system can capture 3D images of patients to enable more accurate measurement of changes in contour and shape.This could be an invaluable way detecting progression of disease and response to treatment and could also help doctors to measure the effect of different treatments and compare new with existing treatments to decide which is better. The system can also act as a simulator to show predicted changes which could help patients understand the potential benefits in appearance which surgical treatment can bring. No systematic work to investigate the use of this system has ever been performed in TED patients. Our research aims to help answer the question: Is the Vectra M3 3D imaging system a useful and reliable tool for managing TED?

We aim to conduct a series of studies to investigate this system. Firstly, a study to image TED patients before and after surgical treatment aimed at reducing 'protrusion' of the eyes. Secondly, a study to assess TED patients during the course of their disease to analyse how good 3D imaging is compared to the tools/measures of disease that doctors already use. Thirdly, a study to investigate the effect of eye drops on reducing eye protrusion, which has been suggested by several laboratory studies.

This work could help bridge the gap in research exploring measures of appearance in disfiguring orbital diseases and the results could therefore be far-reaching and relevant for doctors and patients.

Mr Ezra added: 'I am delighted to win this award and am very grateful to the BTF and the FFS for making it possible to conduct this important research'.



The winner of the Fight for Sight/British Thyroid Foundation and Thyroid Eye Disease Charitable Trust Small Grant Award 2013 was Mr Matt Edmunds, University of Birmingham.


Digital Infrared Thermal Imaging for Early Diagnosis and Disease Monitoring in Thyroid Eye Disease

With this study we are interested in establishing a method of diagnosing Thyroid Eye Disease (TED) at the earliest possible stage and in more effectively monitoring TED progress, using a technique called thermal imaging.

TED is a condition involving inflammation of the tissues inside the eye socket and may be associated with distressing symptoms such as staring or bulging eyes, pain, grittiness, light sensitivity or double vision. Some develop sight-threatening complications and many have an altered physical appearance. TED occurs in up to half of people with the form of thyroid gland over-activity called Graves' Disease (GD). Unfortunately, there is no current way of telling which of those with GD will go on to develop TED and it is often the case that people are diagnosed with TED too late, when the damaging effects of the eye socket inflammation are already well-established. If it were possible to diagnose TED at an earlier stage then doctors could intervene to prevent matters from deteriorating.

In people who already have TED there are other difficulties. It is often a great challenge to decide whether a person with TED has active problems which are definitely getting worse, and therefore need treatment, or has TED that has run its course and "burnt out". This is a really important decision, as those with active TED require treatment with medications to control the immune system, whereas those with stable TED do not. Likewise, those with stable TED may want to consider surgery to return their facial features to as close as possible an appearance as before TED, whereas those with active TED may not necessarily benefit from surgery.

We aim to use thermal imaging to address these difficult problems. When any body tissue is inflamed it becomes swollen, red, painful and hot. Thermal imaging involves using an advanced digital camera to take photographs of how hot different areas of the body are. This is a rapid way of assessing the eyes and eye socket, essentially the same as having a photo taken . Thermal imaging has been used before to assess people for diabetic foot problems, burns and some cancers. This technique is portable, quick, painless and easy to understand. The doctor taking the photo will be able to show each patient what the picture looks like, will be able to compare it with previous photos and will be able to decide if there have been changes between one clinic appointment and another.

The aim of our study is to perform thermal imaging in people with GD and TED attending a specialist thyroid clinic over the course of 12 months. We believe that it will be possible to take thermal pictures on each occasion that a person with GD or TED attends clinic, allowing us to recognise at an extremely early stage when problems inside the eye socket may be beginning in a patient with GD, or to decide whether the eye socket of patient with known TED is actively inflamed or not.