title: The Health Of Patients' Eyes (HOPE) Glaucoma study. The effectiveness of a 'glaucoma personal record' for newly diagnosed glaucoma patients: study protocol for a randomised controlled trial.
abstract: BACKGROUND
  Glaucoma involves progressive optic nerve fibre loss, subsequently leading to irreversible and disabling visual field defects. In Europe, the prevalence of glaucoma is approximately 2.2 % of all people aged over 40 years; this equates to 12 million people. Glaucoma patients require regular lifelong follow-up, contributing to a large financial and resource burden for the National Health Service (NHS) in the UK. This study aims to determine whether providing newly diagnosed glaucoma patients with a personalised client-held eye health summary ('glaucoma personal record'), improves patients' knowledge of their glaucoma condition. A potential long-term benefit could be improved self-management and henceforth a slower rate of deterioration.
  
  
  METHODS
  HOPE Glaucoma is a 3-year, prospective, parallel-group, pragmatic, single-centred, randomised controlled trial. An anticipated 122 adults, newly diagnosed with glaucoma (including ocular hypertension, suspected glaucoma and/or chronic open-angle glaucoma) will be recruited from a nurse-led ophthalmology outpatient clinic at a medium-sized NHS Trust. Participants will be randomly allocated to receive standard clinical care (control arm) or standard care plus a glaucoma personal record, detailing the current state of their condition (interventional arm). Participant assessments are designed to test whether provision of a glaucoma personal record 1) improves patient knowledge of glaucoma and 2) contributes to improvements in clinical outcomes, i.e. delay of visual field loss. The primary outcome measure is better client knowledge of glaucoma at the 9-12 month follow-up visit. Secondary outcome measures include the rate of visual field loss and patient-reported outcome measures on visual function (National Eye Institute VFQ - 25) measured at baseline, 9-12 months, 24 months and 36 months. Estimating a 20 % drop-out rate, the study will have 90 % power to detect a mean two-point difference in glaucoma knowledge score between groups at 5 % significance - based on two-sided Mann-Whitney U test.
  
  
  CONCLUSIONS
  If a glaucoma personal record is found to significantly improve glaucoma patients' knowledge of their condition, this intervention could potentially provide a low-cost, straightforward tool to educate and engage glaucoma patients. Subsequently, this could have the potential to increase patient self-management and therefore allow glaucoma patients to prolong their sight functionality for longer.
  
  
  BACKGROUND
  ISRCTN41306818 , registered on 22 August 2013.
authors.affiliation: Clinical Nurse Specialist Ophthalmology, North Cumbria University Hospitals NHS Trust, Cumberland Infirmary, Ophthalmology Department, Newtown Road, Carlisle, CA2 7HY, UK. Marina.Forbes@ncuh.nhs.uk.
authors.forename: Marina
authors.initials: M
authors.lastname: Forbes
authors.affiliation: Cumberland Infirmary, R&D Department, North Cumbria University Hospitals NHS Trust, Newtown Road, Carlisle, CA2 7HY, UK. Helen.Fairlamb@ncuh.nhs.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Fairlamb
authors.affiliation: Cumberland Infirmary, R&D Department, North Cumbria University Hospitals NHS Trust, Newtown Road, Carlisle, CA2 7HY, UK. Leon.Jonker@ncuh.nhs.uk.
authors.forename: Leon
authors.initials: L
authors.lastname: Jonker
mesh_terms: D018450:Disease Progression; D004739:England; D005123:Eye / Q000503:physiopathology*; D005901:Glaucoma / Q000175:diagnosis / Q000451:nursing* / Q000503:physiopathology / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D055991:Health Records, Personal; D006801:Humans; D010044:Outpatient Clinics, Hospital; D010353:Patient Education as Topic; D011446:Prospective Studies; D012107:Research Design; D012648:Self Care; D013222:State Medicine; D011795:Surveys and Questionnaires; D013997:Time Factors; D014794:Visual Fields