Dr Jennifer Acton

(she/her)

Publication

• Date
• Type

Research

I have a strong desire to undertake research that has a direct impact on society. I am involved in a number of projects in the area of public health and in clinical projects related to retinal diseases, such as age-related macular degeneration (AMD). I am a member of the Ophthalmic Public Health Group and the Macular Research Group.

Acute eye care project

This project represents a multidisciplinary collaboration with Prof Barbara Ryan, Prof Rachel North, Dr Angharad Hobby, Dr Andrew Carson-Stevens from the School of Medicine, Dr Mat Smith from the School of Pharmacy, and Dr Nik Sheen from HEIW, and is internally funded. We are investigating the acute eye conditions that present to optometrists, pharmacists, GPs and to A&E. The project is also part of a collaboration with SAIL (Secure Anonymised Information Linkage), in which we are undertaking a Wales-wide data analysis of prescribing for acute eye conditions. For further details and to take part in the study as a participant, please follow this link.

Evaluation of errors in the delivery of care to patients with eye-related problems

Funded by KESS2 East, the co-supervisor of this PhD Studentship is Dr Andrew Carson-Stevens and the industrial partner is Optometry Wales. This project aims to evaluate eye-related patient safety. The main work packages within the project are: The development and testing of a patient safety incident reporting system for optometry in Wales; A mixed methods analysis of patient safety incident reports describing unsafe eye care in England and Wales; Stakeholder consensus on the nature of avoidable unsafe eye care.

A preventative approach for Access to a Sustainable, whole System pathway for older people with vISion impairmenT (ASSIST)

The project will address the need for more sustainable care and support for older people with vision impairment to help them live happier and more fulfilling lives. The problem for many older people with vision impairment can be getting access to and finding the right type of support for their individual needs. Social Prescribing means “connecting people to community support to better manage their health and wellbeing”, in which professionals (e.g. doctors, optometrists, social workers, housing officers) can refer people to community services and activities.

The project aims to find out what the current provision of care and support for older people with vision impairment is, to uncover gaps in access and identify areas of best practice. We will recommend how improvements can be made to support better, joined up working and more efficient ways of using existing resources. The project will involve mixed methods, using a realist approach to hear the views of individuals with vision impairment and their carers, as well as staff and other stakeholders.

Investigation of pain and discomfort associated with anti-VEGF injections  

With Dr Ashley Wood, and funded by Abbeyfield Research Foundation, we are using mixed methods research to evaluate the experience of pain in patients undergoing anti-VEGF injections for AMD, as part of a collaboration with Prof Heather Waterman, in the School of Healthcare.

Transforming eye care services Wales  

This project aims to evaluate the enhanced eye care services delivered by optometrists in primary care, using patient reported experience measures. It is funded by the Accelerate scheme, supported by the Welsh European Funding Office (WEFO) and European Regional Development Fund (ERDF). We are collaborating on the ERDF award of £103K, and the total project value is £1.3M. A validation of the patient reported experience measures is being undertaken in collaboration with Swansea University. With Prof Barbara Ryan, and Dr Angharad Hobby, we are collaborating with Cardiff and Vale University Health Board, and the Accelerate team.

Independent prescribing in optometry  

In collaboration with Prof Molly Courtenay, Angela Whitaker and researchers from the University of Bedfordshire and Bristol Medical School, we recently undertook a qualitative study on the factors affecting prescribing by independent prescriber optometrists, based on the Theoretical Domains Framework. Ongoing work in collaboration with Dr Nik Sheen from HEIW will develop support for independent prescribing by optometrists.

Other projects

My research interests also involve the examination of visual function in AMD, which was established during my PhD and developed during international postdoctoral research fellowships.  Past work involved the topographical assessment of the retina using multimodal imaging in relation to visual function measured by microperimetry and other visual field techniques in AMD and in other retinal diseases. Recent studies have evaluated the application of normative data in microperimetry, using the Macular Integrity Assessment (Centervue; Figure 1) and MP-1 (Nidek) instruments, to enable robust interpretation of results in those with visual system disorders.  Another ongoing study is the evaluation of the relationship of microperimetry with vision-related and health-related quality of life instruments in individuals with AMD.

In other research, we have determined the agreement between low vision optometrists and consultant ophthalmologists in the process of certification for vision impairment.  We have also estimated the impact of vision rehabilitation on quality of life outcomes in individuals with low vision.  Our findings provide support for the effectiveness of the vision rehabilitation service.

Images

• Figure 1. Microperimetry results in a healthy eye.
• Figure 2. Microperimetry results in early AMD.

Summary of findings

• Low vision optometrists and consultant ophthalmologists demonstrated equivalent performance in the certification of vision impairment, when classifying abridged cases for certification.
• Vision rehabilitation has a positive influence on vision-related quality of life.
• In early AMD, thinning of the outer segment layer, measured using retinal layer segmentation of spectral-domain optical coherence tomography images, was significantly associated with reduced microperimetry sensitivity (Fig 1.).
• Commercial microperimetry is limited by the lack of robust probability analyses. A normative database and robust model of analysis to detect abnormality have been developed.
• Despite similarities in stimuli and threshold procedures between microperimetry and conventional perimetry, there are important differences between instruments that need to be taken into account when interpreting visual field results. These include the difference in dynamic range, normative data and background luminance levels. The amount of visual loss detected, differed between instruments and this was dependent upon adaptation level and type of retinal disease.

Funding

R Reynolds (PI), J Acton, B Ryan, C Wallace, M Davies, M Jones, B Molik, S Wallace, P Anderson, F Verity, R North, Hospital to Community: The value to stakeholders of community Low Vision Optometrists providing certification of visual impairment in cases of Dry Age Related Macular Degeneration, Health & Care Research Wales, RfPPB, £230,000

Acton JH (PI), Anderson P, Ryan B, North R, Wallace C, Davies M, Jones M, Verity F. A preventative approach for Access to a Sustainable, whole System pathway for older people with vISion impairmenT (ASSIST), Health & Care Research Wales, Social Care Grant, £288,548

Acton JH (PI), Carson-Stevens A, Evaluation of errors in the delivery of care to patients with eye-related problems, KESS2 PhD studentship, 2019, £57,802

Acton JH (PI), Ryan B, Morgan J, GCRF fellowship, 2018, £4,500

Redmond T (PI), Acton JH, Greenwood J, Glaucoma, visual psychophysics, visual fields, quality of life, College of Optometrists Studentship, 2018, £58,611

John R (PI), Acton JH, Evidencing the potential role of Low Vision Service Wales Optometrists in the certification of vision impairment, Sight Cymru 2017, £16,636

Thomas N (PI), Dunn M, Acton JH, Erichsen JT, Retinal predictors of visual performance in nystagmus, Nystagmus Network, 2017, £1,387

Wood A (PI), Acton JH, Waterman H, Investigation of pain and discomfort associated with anti-VEGF injections, Abbeyfield Research Foundation, 2016, £72,663

Dunn M (PI), Acton JH, Erichsen JT,  Retinal predictors of visual performance in infantile nystagmus, College of Optometrists Studentship, 2016, £55,827

Acton JH (PI), Margrain T, Effectiveness of vision rehabilitation, Sight Cymru, Cardiff Council, Welsh Government, 2015, £5,122

Acton JH (PI), Redmond T, Cassels N, Prediction of the integrated visual field in age-related macular degeneration, CUROP, 2015, £1,440

Acton JH, A microperimetric evaluation of age-related macular degeneration and polypoidal choroidal vasculopathy, JSPS, 2015, £3,000

Acton JH (PI), Binns AM, Margrain TH, Does rehabilitation officer input improve quality of life in individuals with low vision?, Sight Cymru, Cardiff Council, Welsh Government, 2014, £38,481

Acton JH (PI), The application of spatial filtering to microperimetry in age-related macular degeneration, College of Optometrists, 2014, £2,000

Acton JH (PI) & Margrain TH, Evaluation of the Macular Integrity Assessment microperimeter, Fight for Sight, 2013, £15,000

Biography

Qualifications

• 2010- PhD (Vision Sciences) Aston University, Birmingham, UK
• 2001- BSc Optometry, Cardiff University, Cardiff, Wales, UK

Professional memberships

• 2002- present     Member of the College of Optometrists (MCOptom), College of Optometrists, London, UK
• 2002- present     GOC registered optometrist
• 2014- present     Fellow of the Higher Education Academy (FHEA)

Academic positions

• 2020- present    Senior Lecturer, Cardiff University, Cardiff, Wales UK
• 2012-2020         Lecturer, Cardiff University, Cardiff, Wales, UK
• 2012-2012         Postdoctoral Research Fellowship, Department of Ophthalmology, New York University, New York, USA
• 2010-2012         Postdoctoral Research Fellowship, Department of Ophthalmology, Columbia University, New York, USA
• 2006-2010         Postgraduate Clinical Demonstrator & PhD student, Aston University, Birmingham, UK

Committees and reviewing

School committees

• 2018-present: Director of Recruitment and Admissions
• 2017-2018:     Senior Admissions Tutor
• 2012-2016:     Associate Admissions Tutor
• 2022-present: Member of the Senior Management Team
• 2017-present: Member of the Postgraduate Student Staff Panel
• 2014-present: Member of the Postgraduate Research Committee
• 2013-present: Member of the Teaching and Learning Committee
• 2012-present: Member of the Board of Studies
• 2016-2020:     Senior Personal Tutor

University committees

• College of Biomedical & Life Sciences Admissions & Recruitment Group

External committees

• 2014-present   Member of Guide Dogs Research Ethics Committee
• 2018-present   Member of Megafocus (Minority Ethnic Groups Association for Ophthalmic Care Uptake and Service Improvement) Advisory Group

Supervisions

I am interested in supervising PhD students in the areas of: Public health and eye care; and Visual function.

Current supervision

Elinor Macfarlane

Research student

Aysenur Kilic

Research student