In June 2023, we launched a call for research proposals aimed at testing and scaling up healthcare technologies specifically designed to address age-related hearing and vision challenges.
Our goal was to support projects that move beyond understanding the biological mechanisms of age-related hearing and vision conditions, and seek to develop new technologies or scale-up promising pilot technologies to make a real-world impact. As with all of our funding opportunities, we were also looking for proposals which aligned with our key principles for research. This scheme followed our previous themed calls on developing suitable living environments for older adults and addressing the social determinants of healthy older age.
We received 27 expression of interest applications in total. Following assessment, 12 of these were invited to submit a full application (a success rate of 44% at this stage). You can read our earlier blog post for general feedback on the applications received at this stage.
Full applications were externally peer reviewed, and applicants then had the chance to respond to reviewers’ key points of feedback. The full applications, along with applicants’ responses, were then assessed by a panel comprising independent experts and suitably qualified members of our Research Grants Committee. The panel members were:
- Professor Carmel Hughes, Queen’s University Belfast (Chair of the Expert Panel and Dunhill Medical Trust Research Grants Committee)
- Professor Ala Szczepura, Coventry University
- Professor Augusto Azuara-Blanco, Queen’s University Belfast
- Professor Doris-Eva Bamiou, University College London
- Professor Gabrielle Saunders, University of Manchester
- Dr Helen Henshaw, University of Nottingham
- Professor Louise Robinson, Newcastle University
- Dr Siobhán O’Connor, King’s College London
- Professor Stuart Gray, University of Glasgow
- Dr Tony Redmond, Cardiff University
The Expert Panel, along with the remaining members of our Research Grants Committee, came together to make decisions on funding in early February 2024. Also present at this meeting were two early career researchers, Barbara Balocating Dunn and Tim Whitfield, who had been given the opportunity to observe a Research Grants Committee meeting. You can read about their experience in our blog post.
Thank you to everyone who applied to the call – we appreciate the time and effort that goes into making an application. We also appreciate the large amount of work involved in reviewing grant applications, which is crucial to good decision-making. We’d therefore like to take this opportunity to extend a huge ‘thank you’ to all those who contributed to the assessment of these proposals.
Of the 12 full applications, we are delighted to announce that four projects were selected for funding (a success rate of 33% at this stage). More details on the funded proposals are provided below.
Please expand any of the project titles below to read more information, including the lay summary:
Lead applicant: Dr Keir Yong (University College London)
Award amount: £453,877
Duration: 60 months
Award type: Post-doctoral fellowship
Summary: When dementia affects the back of the brain, it causes dementia-related visual impairment (‘brainsight’ not eyesight loss). Dementia-related visual impairment makes everyday tasks we take for granted harder: reading, perceiving faces, balancing and mobility. For some, brainsight loss is the earliest sign of dementia. These people have posterior cortical atrophy (‘back of the brain shrinkage’), in whom vulnerability of the brain’s visual rather than memory networks causes ‘visual-led’ dementia. Dementia-related visual loss is commonly misinterpreted or overlooked, delaying diagnosis for years. Many people who experience such loss have repeated visits with eye professionals and/or have eye or psychiatric misdiagnoses. They may have changes to glasses or even eye surgery which are unsuccessful as these do not address the cause of sight loss. Existing tests are insensitive to dementia-related visual loss and/or used almost entirely by highly specialised professionals.
Work Plan: I will investigate ‘brainsight’ tests in patients with different dementia diagnoses, eye conditions and UK-wide ageing studies. Rather than standard eye tests (e.g. smallest letter that can be read), these assess perceiving what or where things are, and how this may be affected by brain damage. Work packages will involve:
•Participants with visual-led (169) or memory-led dementia (135) who have undergone detailed visual and thinking tests. I will investigate how well-suited tests are for diagnosis by evaluating associations with brainsight loss, the integrity of visual networks on brain scans and non-visual tests of memory, attention and language. I will evaluate how well tests diagnose other people with visual-led dementia (50 at UCL, >149 from international centres) and develop a digital test battery to diagnose dementia-related visual impairment in specialist dementia and eye clinics.
•Participants from ageing studies (UK Biobank: 35,000; Insight 46: 502), eye clinics (150) and neurology clinics (150; 50 with visual-led dementia). I will develop a brainsight test I developed using brain scans and clinical tests and develop a digital vision chart to detect and distinguish brainsight from eyesight loss in opticians and eye clinics.
This work will benefit: Patients through accurate diagnosis enabling early treatment, symptom understanding and putting in place home adaptations, assistive technology and support tailored to visual loss. Staff through evidence-based brainsight tests and training improving sight assessment for people with dementia. Services through reducing diagnostic delays and misdiagnoses: in particular, avoiding repeated visits with eye professionals, unsuccessful surgery and psychiatric referrals.
Lead applicant: Dr Helen Nuttall (Lancaster University)
Award amount: £325,660
Duration: 36 months
Award type: Project grant
Summary: By the age of 70 years, 71% of people experience some degree of hearing loss, which can reduce quality of life. Older adults with hearing loss usually have a problem with how the ear processes sounds. This means that a degraded sound signal is then sent to the brain. Our brains then have to work extra hard and use additional brain resources to understand the message. The main option for hearing loss rehabilitation is to be fitted with a hearing aid. However, adjusting to hearing aids can take some time, as the brain works even harder to ‘relearn’ the noisy auditory world after not having fully heard it for some time. The effort of adjusting and relearning drains the brain’s resources, which are already depleted due to extra listening effort. This period of adjustment is frustrating and time-consuming, and is one reason why people with hearing aids decide not to use them, as wearing them feels like a different problem as opposed to a solution.
Work plan: Our research aims to find out whether we can boost the brain resources that are responsible for processing sound so that adapting to hearing aids is faster and more effective. Knowing whether we can boost the brain resources is important because if we can boost them, it could represent an improved rehabilitation option for age-related hearing loss as we could seek to boost brain resources straight after people are fitted with hearing aids to help the brain adapt. To meet this aim, we will combine three major lines of enquiry. We will use brain stimulation to manipulate how the brain is working by increasing activity in auditory brain areas after people receive a hearing aid. Brain stimulation works by applying magnetic pulses to the brain, which can temporarily, and safely, affect how the brain cells work together in a particular area of the brain. We will use brain imaging to understand how brain structure and function have been affected by the brain stimulation. We will further use behavioural tasks to record hearing, listening, and thinking ability after the brain stimulation. By comparing brain imaging and behaviour before and after the stimulation, we will be able to 1) tell if stimulation of brain areas affects brain structure and function (using brain imaging), and behaviour (using hearing, listening, and thinking tests) in people with age-related hearing loss.
This work will benefit: This project will bring new knowledge of whether the positive impact of hearing aids on the brain can be accelerated by brain stimulation. The project would bring significant benefit to hearing aid users who could potentially experience a greater quality of life sooner. If successful, the project has the potential to positively impact hearing aid usage, uptake, and stigma, by supporting the positive framing of hearing aids and the brain’s lifelong capacity for neuroplasticity.
Lead applicant: Professor Anya Hurlbert (Newcastle University)
Award amount: £386,254
Duration: 36 months
Award type: Project grant
Summary: Glaucoma is the leading cause of irreversible blindness worldwide. In the UK, it affects about 2 of every 50 people over 50 years old. The damage glaucoma causes to the eye at first goes unnoticed in many people, yet it is irreversible. Blindness can be prevented with appropriate treatment if detected early. In the UK’s rapidly ageing population, glaucoma numbers are steeply rising, and the NHS cannot keep up. Eye doctors need urgent help to improve the care they give.
Work Plan: We aim to create an AI-based computer program that helps physicians take better care of people with glaucoma. We will harness the power of optical coherence tomography (OCT), a non-invasive imaging technique which provides detailed 3D pictures of the eye’s retina and the damage glaucoma causes there. We will train the computer program to extract information from OCT images and to combine this with other important information to diagnose glaucoma and its chances of worsening, thereby helping doctors decide how urgently patients need treatment and check-ups. To achieve this, we will create a database of eye scans and other medical information for thousands of patients with glaucoma. This database will include all the information doctors use to understand how glaucoma progresses and how to treat it. Unlike other existing AI programs, ours will use changes in each patient’s OCT scans over time, plus additional clinical information to predict how an individual patient may progress. To make sure the tool works well, we will test it on data not used for training and compare its predictions to what actually happened to the patients. Beyond the immediate benefits for treatment of glaucoma, our work will also help build trust in AI. Our program will be designed to reveal the AI’s reasoning so that doctors can understand it. We will also test the tool on images collected with different medical devices and from people with different ethnicities, sex, and histories to make sure the tool works for a diverse population. We will engage patients and the public in workshops, panel meetings, and community events, to understand better their concerns over the use of AI in health care, and to gain views on how this AI-based tool will help them.
This work will benefit: Ultimately, our AI will enable better care of people with glaucoma. The program will help decide who needs to be seen urgently, and how quickly to treat individuals to reduce the risk of blindness.
Lead applicant: Dr Peter Jones (City, University of London)
Award amount: £381,590
Duration: 36 months
Award type: Project grant
Summary: By 2050, 1M people will live in UK care-homes. One-in-ten will have glaucoma: an eye disease that currently requires regular, lifelong hospital assessments. Many individuals will struggle to attend these appointments, and the hospitals themselves will face increasing strain.Recently, we have developed a collaborative eyecare model at Guy’s and St Thomas’ [GSTT], in which care-homes, optometrists, GPs, and hospital eyecare specialists all work together to perform eye assessments directly within care-homes. Such in-home assessments have proven effective for other eye conditions (cataracts, age related macular degeneration): allowing for better patient experience, faster assessments, fewer follow-up appointments, and reduced costs. However, glaucoma still remains difficult to assess outside of hospitals. This is particularly unfortunate as glaucoma requires lifelong monitoring, yet patients often remain stable for many years at a time. It is simply not sensible or sustainable for all glaucomatous care-home residents to keep having to travel to hospital, only to be told that no change in treatment is required. Meanwhile, applicants at City, University of London [CITY], together with industry partners Irida Health, have assembled a set of portable tests for assessing glaucoma. This includes low-cost devices for assessing eyesight, as well as third-party devices for measuring the physical health of the eye. Additional software allows measurement to be automatically uploaded to a secure cloud-server for review by a consultant.
Work Plan: The present grant shall combine these two strands of inquiry: integrating the glaucoma assessment tools developed by CITY/Irida Health, into the collaborative, in-home eye care model developed at GSTT. The long-term goal is to develop a glaucoma care-home model that maintains vision while minimising unnecessary hospital visits. In addition, we shall also investigate whether these same portable tests can be used proactively to identify older individuals (both existing care-home residents and also the wider public) at risk of falls, as part of South East London’s ongoing falls prevention program. With this grant we shall quantify the feasibility, acceptability, reliability, and value-for-money of (1) a novel, care-home based glaucoma assessment pathway, and (2) an enhanced fall-risk assessment program.
This work will benefit: This work shall evidence more efficient and effective methods of glaucoma management & fall prevention. For the 100,000 UK care-home residents with glaucoma expected by 2050, such changes will allow for more frequent and convenient glaucoma monitoring, while simultaneously reducing the strain on overstretched hospital services.
In addition, we were glad to be able to fund a PhD fellowship proposal from Aishah Baig of Nottingham University Hospitals NHS Trust, whose proposal to another scheme aligned thematically with this call. Please expand Aishah’s project title below to read more about her fellowship:
Lead applicant: Aishah Baig (Nottingham University Hospitals NHS Trust)
Award amount: £216,304.46
Duration: 36 months
Award type: PhD fellowship
Summary: Falling is common in older adults and can negatively impact their lives in several ways. Falling can lead to pain, injuries and fractures, difficulty doing normal daily activities, feeling isolated, losing independence and confidence, living in fear of falling, depression, frailty, complex health problems and increased risk of death. Globally, falls are a major public health problem with high costs to health and social services. The NHS alone spends more than £2 billion per year on caring for older adults who fall. National and international guidelines have been produced for health services to help prevent falls. Scientific research has shown that poor vision can affect the likelihood of falling, therefore the guidelines recommend assessing vision in older adults who attend hospital following a fall. Despite these recommendations, previous surveys showed that this was only being done in a small number of hospitals. The reasons for this need to be investigated. Developing an easy-to-use vision assessment tool can also encourage hospitals to assess vision in these patients. The tool will help identify and manage vision problems promptly to reduce falls due to poor vision. However, older adults who fall may be less likely to seek treatment for vision problems. The reasons for this and ways in which this can be improved need to be investigated to help reduce falls due to treatable vision problems.
Work Plan: This study aims to improve the assessment and management of vision problems in adults ≥65 years of age, who attend hospital following a fall. This study will have five parts:
1. A review of the existing research on this topic. 2. A survey asking hospital-based health professionals about assessing vision in falls patients. 3. Focus groups collecting the views of patients and carers on eye services. 4. Development of a vision assessment tool used on falls patients in hospitals. 5. A trial of this tool.
This work will benefit: The development of an evidence-based intervention will enable the implementation of national falls prevention guidance and bridge health inequalities in the management of vision impairment in this population. This could help reduce the prevalence of visual impairment and the incidence of falls with lasting individual and population level improvement in health.
Congratulations to the successful applicants and we very much look forward to working with you. We hope that the unsuccessful applicants found the detailed feedback provided to each of them helpful.
Feel free to explore our other funding opportunities and take a look at the stories from our award-holders. To stay informed about our future activities and funding calls, join our mailing list by adding your details to the ‘Join our community’ section of our “Contact us” page.