Authors (including presenting author) :
Lee A (1)(2), Ko PYE(3) ,Kan HSA(1), Singh HG(4)
Affiliation :
(1) Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong
(2) Department of Ophthalmology, Hong Kong West Cluster (Queen Mary Hospital, Grantham Hospital)
(3) LKS Faculty of Medicine, The University of Hong Kong
(4) Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong
Introduction :
Bone marrow transplantation (“transplant”) is the only hope of cure for many blood cancers and disorders. While advances in transplant improves survival, more patients are facing long-term debilitating complications from transplant.
Graft-versus-host disease (GvHD) is one important complication that occurs when donor blood cells attack healthy tissues of the recipient. The eyes are commonly affected in up to 60% of patients. Ocular GvHD commonly presents as dry eyes and red eyes that significantly affect patients’ quality of life. Severe forms include non-healing corneal ulcers, infections, perforations and even permanent visual loss.
There exist important service gaps in the eye care of transplant patients in Hong Kong:
1) Lack of surveillance programme: Regular eye assessments for monitoring has been suggested internationally but this has not been adopted in our locality yet.
2) Lack of dedicated expertise: It is known that ocular GvHD outcomes are better in cancer centers with dedicated eye expertise. However, there is no such expertise in Hong Kong yet.
3) Long waiting time: At time of arrival at ocular GvHD specialists, some patient already developed severe complications with visual loss.
Objectives :
Our new service aims to:
1. Address critical service gaps: Establish the first territory-wide eye health service dedicated to all cancer survivors following bone marrow transplant in Hong Kong, thereby serving as a safety net for all bone marrow transplant cancer survivors and providing universal coverage throughout Hong Kong.
2. Comprehensive eye care model: Implement a model comprising a designated clinic with specialized expertise, multidisciplinary care, fast-track referral system, surveillance programme and patient education
3. Ensure early diagnosis and treatment: Prevent progression to severe sight-threatening transplant-related eye diseases and safeguard vision
4. Enhance cancer survivorship: Improve the quality of life for cancer survivors and their families, aiding their return to regular daily life and productivity
5. Empower patients: Strengthen patient education to improve eye health literacy, change help-seeking behaviours, and empower them in their long-term eye care
6. Align with Government cancer strategy: Enhance cancer survivorship in alignment with the directions of the Government’s Hong Kong Cancer Strategy
Methodology :
A novel, multidisciplinary service for the eye care of all ocular GvHD patients in Hong Kong has been set up since 2020 as a collaboration between specialists from the Department of Ophthalmology, LKS Faculty of Medicine, the University of Hong Kong, the Department of Ophthalmology, Hong Kong West Cluster (Queen Mary Hospital and Grantham Hospital) as well as the Bone Marrow Transplant Centre at Queen Mary Hospital.
It has two key components:
1) Direct referral pathway: It is set up between the Bone Marrow Transplant Centre and the ocular GvHD specialists at Department of Ophthalmology, Grantham Hospital. Transplant patients will be seen before transplant, and monitored at regular intervals after transplant.
2) Fast-track joint clinic: It is set up in the Bone Marrow Transplant Centre to provide easy access of eye care to transplant patients. It also provides a platform for ophthalmologists and haematologists to manage a patient together.
3) Health education: To improve eye health literacy in transplant patients to raise their awareness of disease and to enhance home eye care.
In this abstract we would like to evaluate the effectiveness of the new ocular GvHD serve, we compare the rate of severe eye complications before and after establishment of service, and with international literature. We evaluated waiting time and percentage of severe disease at diagnosis.
Result & Outcome :
Since establishment of the ocular GvHD service in 2020, we have served over 300 bone marrow transplant patients.
Before establishment of the service, in transplant patients from 2018 to 2019, 6.4% developed non-healing ulcers and 1.8% developed corneal perforation. This number was comparable with international literature with 3.9-6.2% for non-healing ulcers and 0.7-3.7% for corneal perforation. Since introduction of our service, none of our patients under surveillance developed non-healing ulcer or corneal perforation.
In the international literature, there was a median delay of 6.3 months from eye symptom onset to diagnosis of ocular GvHD. 76% presented with severe disease with long-term complication at diagnosis. Since introduction of our service, the waiting time was reduced to within 1 to 2 months. At diagnosis, only 20% patient had severe disease.
For patient education, before the introduction of our electronic eyecare materials, 65% transplant patients had no prior knowledge of home eye care. After being introduced to the materials, 96% showed correct understanding.
