Polarization Perception in Health and Disease. Testing a New Sight Test (TaNSiT)

Polarization Perception in Health and Disease. Testing a New Sight Test: The TaNSiT Study

A study to assess the utility of human polarization pattern perception for the detection, diagnosis and monitoring of eye disease

Study Overview

• Status: Unknown
• Conditions: Diabetic Retinopathy; Cataract; Age Related Macular Degeneration; Macular Disease; Pseudophakia; Retinal Disease
• Intervention / Treatment: Diagnostic test: polarization sensitivity

Detailed Description

The recently described high sensitivity of the human eye to differentiate small angular differences in linear polarization and evidence supporting its macular origin (Misson, Anderson; 2017) suggests that human polarization sensitivity might be a useful diagnostic tool for macular disease. This augments a previous study in which we demonstrated the ability of the human visual system to detect isochromatic isoluminant polarization modulated pattern stimuli (Misson et al 2015).

This is an exploratory 'proof-of-concept' study to determine the clinical value of polarization pattern perception, PPP, in health and disease. We further propose that PPP might be valuable for the diagnosis, monitoring and early detection of macular disease. The latter includes common blinding conditions such as age related macular degeneration and diabetic retinopathy. It is also intended to investigate the effect of cataracts and cataract surgery on PPP: cataract surgery modifies the optics of the eye so might also modify PPP.

PPP is measured using a modification of the methodology described in (Misson et al 2015) and (Misson, Anderson; 2017) whereby polarization modulated patterns are presented on a modified LCD display. The observer's task is to report if they see an image and to describe the image. Images comprise simple patterns or traditional optotypes. A standard set of images are presented in pseudorandom order and the response recorded. A total score, the polarization pattern perception score PPP is then determined from the number of images seen/identified. A more refined metric, the polarization visual acuity pVA, will be derived from the response to the optotype stimuli. These data are then compared to conventional tests of visual structure and function including logMAR visual acuity, ocular examination and OCT scan data.

The study in anticipated to comprise:

Phase 1. Normative Evaluation: observational prospective cross-sectional.. A preliminary normative study will be undertaken on staff members. The aim is to quantify normative values in preparation for the clinical studies.

Hypotheses to be tested:

1. that healthy subjects can perceive polarization stimuli
2. that there is a threshold of polarization image resolution (pVA) analogous to visual acuity. Normative PPP and pVA data will be collected.

Phase 2 Patient Group: observational Prospective cross-sectional / case-control.

Phase 2 subjects will comprise normals and patients with cataracts/pseudophakia and/or AMD, other macular pathology, diabetic retinopathy..

The aim of this phase is to determine the effect, if any, of particular eye conditions on pVA/PPP alone and in comparison with other test parameters.

Hypotheses to be tested:

1. that eye conditions affect pVA/PPP
2. that specific eye conditions have a selective effect on pVA/PPP
3. that pseudophakia affects pVA/PPP

Phase 3: Cataract pre-op v post op pVA/PPP: prospective interventional case-control.

Timescale:concurrent with Phase 2 A subset of the phase 2 cataract patients will undergo cataract surgery according to clinical need. These patients are routinely reviewed 4 - 8 weeks post-op when the opportunity will arise to repeat pVA/PPP measurement. The fellow eye will serve as a control / provide data for repeatability assessment.

The aims of this phase are

1. to determine the repeatability of pVA/PPP testing in a heterogeneous patient group
2. to determine the effect of cataract surgery on the pre-operative pVA/PPP results
3. to determine if pVA/PPP is a useful determinant of post-operative visual outcome.

Hypotheses:

1. that pVA/PPP testing is repeatable
2. that there is a difference in pVA/PPP pre and post cataract surgery

• Study Type: Observational
• Enrollment (Anticipated): 300

Contacts and Locations

Study Locations

• United Kingdom
  • Warwickshire
    • Warwick, Warwickshire, United Kingdom, CV37 0PZ
      • Recruiting
      • South Warwickshire NHS Foundation Trust
      • Contact: Gary P Misson, PhD FRCOphth; Phone Number: +44 01926495321; Email: gary.misson@swft.nhs.uk
      • Contact: Jo Williams; Phone Number: +44 01926495321; Email: jo.williams@swft.nhs.uk
      • Sub-Investigator: Stephen J Anderson, PhD FRCOptom

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients and staff of the Eye Department of South Warwickshire NHS Trust

Description

Inclusion Criteria:

- willing and able to provide informed consent

Exclusion Criteria:

• unwilling or unable to provide informed consent
• individuals wishing to exit the study

Study Plan

How is the study designed?

Number of groups / cohorts

6

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Normal; phakic participants with no evidence of eye disorders	Diagnostic test: polarization sensitivity; test of polarization vision as described in Study Description
Cataract; participants with cataract	Diagnostic test: polarization sensitivity; test of polarization vision as described in Study Description
AMD; participants with age related macular degeneration	Diagnostic test: polarization sensitivity; test of polarization vision as described in Study Description
Pseudophakic; particpiants who have had cataract surgery with intraocular lens implant	Diagnostic test: polarization sensitivity; test of polarization vision as described in Study Description
other macula; participants with macular ddisorders other than AMD	Diagnostic test: polarization sensitivity; test of polarization vision as described in Study Description
DR; participants with diabetic retinopathy	Diagnostic test: polarization sensitivity; test of polarization vision as described in Study Description

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
polarization sensitivity	determine and compare polarization sensitivity between groups	18 month

Collaborators and Investigators

• Sponsor: South Warwickshire NHS Foundation Trust
• Collaborators: Aston University

Publications and helpful links

General Publications

• Misson GP, Timmerman BH, Bryanston-Cross PJ. Human perception of visual stimuli modulated by direction of linear polarization. Vision Res. 2015 Oct;115(Pt A):48-57. doi: 10.1016/j.visres.2015.08.004. Epub 2015 Aug 28.
• Misson GP, Anderson SJ. The spectral, spatial and contrast sensitivity of human polarization pattern perception. Sci Rep. 2017 Nov 29;7(1):16571. doi: 10.1038/s41598-017-16873-6.

Study record dates

Study Major Dates

• Study Start (ACTUAL): November 9, 2017
• Primary Completion (ANTICIPATED): April 1, 2019
• Study Completion (ANTICIPATED): July 1, 2019

Study Registration Dates

• First Submitted: January 28, 2019
• First Submitted That Met QC Criteria: January 28, 2019
• First Posted (ACTUAL): January 30, 2019

Study Record Updates

• Last Update Posted (ACTUAL): January 30, 2019
• Last Update Submitted That Met QC Criteria: January 28, 2019
• Last Verified: January 1, 2019

More Information

Terms related to this study

• Keywords: cataract; vision testing; age related macular degeneration; retinal disease; macular disease; pseudophakia; macular function; polarization perception; Haidinger's brush
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Eye Diseases; Endocrine System Diseases; Diabetic Angiopathies; Diabetes Complications; Diabetes Mellitus; Retinal Degeneration; Lens Diseases; Macular Degeneration; Retinal Diseases; Diabetic Retinopathy; Cataract; Pseudophakia
• Other Study ID Numbers: 17/WA/0180

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No