Glaucoma is the world's leading cause of irreversible blindness and will affect >110 million people by 2040. Early detection and treatment are critical, as symptoms typically do not present until the disease is advanced. A data-driven precision medicine approach is needed to better identify individuals who are at greatest risk of developing the disease and who are at greatest risk of progressing quickly to vision loss. While there has been considerable progress in eye imaging and testing to improve glaucoma monitoring, precision management of glaucoma is incomplete without accounting for patients' co-existing systemic conditions, concurrent systemic medications and treatments, and adherence with prescribed glaucoma treatment. Understanding how systemic conditions, and specifically vascular conditions such as hypertension, impact glaucoma presents growing public health importance given the increasing co-morbidities facing aging populations. Preliminary studies have demonstrated the predictive value of systemic data, even without ophthalmic endpoints. Similarly, measuring medication adherence is important for guiding patient counseling and engagement and avoiding downstream interventions such as surgeries, which carry high cost and morbidity. These factors are important for providing a more comprehensive perspective of glaucoma management and for improving patient outcomes, yet they are relatively understudied. I propose applying multi-modal advancements in health information technology (IT) to address these gaps and achieve the following specific aims: (1) Develop machine learning-based predictive models classifying patients at risk for glaucoma progression using systemic electronic health record (EHR) data from a diverse nationwide patient cohort; (2) evaluate how integrating blood pressure (BP) data from novel smartwatch-based home BP monitors enhance predictive models for risk stratification in glaucoma, and (3) measure glaucoma medication adherence using innovative flexible electronic sensors to validate their use for future interventions aimed at improving adherence and clinical outcomes in glaucoma. These studies would leverage state- of-the-art methods in big-data predictive modeling as well as cutting-edge advancements in sensor technologies. This multi-faceted approach will build a foundation for a health IT framework geared toward improving risk stratification and generating novel therapeutic targets for glaucoma patients.
A precision medicine approach is critical for early detection and treatment of glaucoma, an insidious chronic eye disease that can lead to blindness and severely decreased quality of life. The relationship between systemic conditions and treatments with glaucoma progression, as well as methods for monitoring and promoting glaucoma medication adherence, represent areas of glaucoma management that are not well-understood and are thus critical opportunities for technology-driven interventions. This study proposes the development and application of multi- modal health information technology innovations ? such as machine learning-based predictive modeling, massive electronic datasets, wearable devices, and flexible sensor electronics ? to enhance understanding of glaucoma pathophysiology and identify new potential therapeutic strategies.
