Determination and use of eye health index

Abstract

To provide a patient treatment system for determining an eye health index value representing the health or disease state of a patient's eye.SOLUTION: Various eye conditions can be treated, such as by monitoring a patient's eye health and using information about the patient's intraocular pressure (IOP) characteristics, information about the patient's blood pressure (BP) characteristics, and information about patient treatment, such as from a patient treatment system. In an example, a quantitative eye health index can be determined for a patient based on IOP characteristics, BP characteristics, and information about patient treatment.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] The present invention relates to the determination and use of an eye health index. [Background technology]

[0002] Glaucoma is a chronic condition that can lead to blindness and primarily affects older people in the population. Glaucoma is not reversible, but its progression can be stopped or slowed with treatment. Various existing glaucoma treatments include eye drops and surgery.

[0003] Eye drops (e.g., prostaglandins, beta-blockers, carboxylic anhydride inhibitors, or alpha-agonists) are typically the first treatment option because they can be effective for many patients and have a relatively low complication rate. Yet, eye drops can be ineffective for a significant number of patients. Patient compliance in regularly maintaining an eye drop regimen also presents significant challenges. Because glaucoma is a chronic condition, glaucoma patients generally require lifelong eye drop medication. It is estimated that up to 50% of glaucoma patients prescribed eye drops fail to administer the drops consistently and regularly. This failure can be attributed to forgetfulness, difficulty getting the drops into the eye, unwillingness to take the medication long-term, or unhappiness with certain side effects. Side effects may include, for example, eye redness, eyelash growth, inflammation, orbital fat atrophy, discoloration of the iris or surrounding periorbital tissue, exacerbation of COPD or asthma, inhibition of corneal endothelial pump function, exacerbation of corneal edema, or stinging upon instillation.

[0004] Various surgical options are available, such as laser trabeculoplasty, trabecular meshwork stent, suprachoroidal stent, subconjunctival stent, or trabeculectomy or glaucoma tube shunt. Such surgical treatment is typically the second treatment option for glaucoma patients. Compared with eye drop treatment, surgical options are more invasive and may have higher complications and morbidity. Summary of the Invention [Problem to be solved by the invention]

[0005] The inventors have recognized that the problem to be solved involves monitoring ocular disease progression and rapidly adapting treatment in response to disease progression. [Means for solving the problem]

[0006] The inventors have recognized that a solution can include an eye health management system for monitoring and treating ocular disease progression over time. In one example, the solution can include or use a system comprising an intraocular pressure (IOP) sensor, a blood pressure (BP) sensor, and a patient treatment system. One or more of the patient treatment system and the sensor can operate automatically or can be operated by the patient. In one example, the solution can further comprise a processor circuit configured to determine an eye health index for the patient based on IOP information from the IOP sensor, BP information from the BP sensor, and information related to treatment provided to the patient by the patient treatment system. In one example, the eye health index can represent a disease state or disease progression. The eye health index can be useful for clinicians and caregivers to monitor disease progression and patient response to treatment.

[0007] To easily identify the description of any particular element or function, the most significant digit(s) in a reference number refers to the figure number in which that element is first introduced. In the drawings (which are not necessarily drawn to scale), like numbers may describe like components in different figures. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments described in this document. [Brief explanation of the drawings]

[0008] [Figure 1] 1 illustrates an eye health management system according to one example. [Figure 2] 1 is a side cross-sectional view of an eye according to one example. [Figure 3]1 illustrates a goggle assembly according to one example. [Figure 4] FIG. 1 is a cross-sectional view according to one embodiment. [Figure 5] 1A-1C illustrate a first method for assessing a patient condition associated with a patient's ocular health according to one embodiment. [Figure 6] FIG. 10 illustrates a second method for assessing a patient condition associated with a patient's ocular health according to one embodiment. [Figure 7] FIG. 10 illustrates a third method for assessing a patient condition associated with a patient's ocular health according to one embodiment. [Figure 8] FIG. 10 illustrates a fourth method for assessing a patient condition associated with a patient's ocular health according to one embodiment. [Figure 9] FIG. 5 illustrates a fifth method according to one embodiment. [Figure 10] FIG. 1 is a schematic diagram of a machine in the form of a computer system upon which a set of instructions may be executed to cause the machine to perform any one or more of the methods described herein. DETAILED DESCRIPTION OF THE INVENTION

[0009] Ocular health can be monitored using various systems, methods, or techniques. Various eye-related diseases, such as glaucoma, can have a relatively long development period. If eye-related diseases, such as glaucoma, are identified early, it may be possible to monitor disease progression, such as allowing better decision-making by clinicians and patients regarding therapy. For example, although glaucoma is not reversible, its progression can be stopped or slowed by treatment aimed at reducing intraocular pressure (IOP). In one example, IOP treatment can include various non-invasive methods or methods that do not rely on drug therapy, such as eye drop medication. Non-drug therapy can be important due to patient compliance issues with drug therapy, the ineffectiveness of eye drop medication, or the actual or potential complications or morbidity associated with surgical solutions.

[0010] In one example, the systems and methods discussed herein can be used to include, use, or determine a patient's eye health index. The eye health index can be an objective measure or metric associated with the patient's condition and indicative of the patient's ocular or visual well-being. In one example, the eye health index can include or refer to a metric indicative of the physiological state of the eye, optic nerve, or other structure or feature associated with the eye or vision or visual processing.

[0011] In one example, the ocular health index can be based on the patient's IOP characteristics, such as at a particular moment or over a particular duration. In one example, the ocular health index can be based on changes in the patient's IOP characteristics over time. In one example, the ocular health index can be based on or used to inform the patient's therapy. For example, the ocular health index can indicate the patient's responsiveness or non-responsiveness to a particular therapy, such as a drug therapy, a non-invasive eye therapy, surgery, or other therapy.

[0012] In one example, the eye health index can be provided based at least in part on information from a patient treatment system. In one example, the patient treatment system can include or use goggles configured to fit over one or both of a patient's eyes, thereby providing a substantially airtight cavity partially bounded by the eye or eyes. The goggles can include means for varying pressure within one or more cavities of the goggles. The one or more goggles can be sealed against the patient's skin, such as at or around the periphery of the patient's eye sockets. When the means for varying pressure is activated, a pressure differential from atmospheric or gauge pressure can be generated and maintained within one or more goggle cavities, thus varying the effective pressure for the eye or eyes. Gauge pressure is positive for pressures above atmospheric pressure and negative for pressures below atmospheric pressure. Absolute pressure, such as within the goggles, is the sum of the gauge pressure and atmospheric pressure.

[0013] The cavity pressure can be increased or decreased relative to atmospheric pressure depending on the condition being treated (e.g., whether glaucoma or papilledema is being treated). Changes in pressure outside the eye can act to alter the pressure inside the eye (e.g., IOP) by driving changes in the drainage rate of ocular fluid through the trabecular meshwork through the resulting deflection of the eye's shape and / or from the pressure difference being translated directly to the eye. Pressure can be altered by using a small compressor or vacuum device (collectively "pump") in fluid communication with one or more cavities of the goggles.

[0014] In one example, the eye health index can be provided based in part on information from other physiological sensors or from subjective information received from the patient. For example, information from one or more of a cerebrospinal fluid (CSF) pressure sensor, a blood pressure sensor, an oxygen saturation sensor, an impedance sensor, a weight sensor, or other physiological sensors can be used. In one example, information received from a patient interface can be used. For example, information regarding the patient's visual field, well-being, mood, weight, body mass index, dietary habits, therapy compliance, or other patient-reported information can be used. In one example, the eye health index can be based in part on information from a treatment system about the patient's therapy compliance, such as medication compliance, CPAP therapy use or compliance, or other therapy titration information.

[0015] In one example, information regarding the eye health index can be reported to a clinician or an automated patient monitoring system. The eye health index can be reported with or without the underlying data or information on which the eye health index is based. For example, the eye health index can be reported with or without the patient's corresponding IOP, weight, medication compliance, or other information.

[0016] In one example, the ocular health index can be based in part on ocular perfusion pressure (OPP). OPP is generally defined as mean ocular perfusion pressure (MOPP), which is a function of diastolic blood pressure (DBP), systolic blood pressure (SBP), and IOP. For example, MOPP can be expressed as MOPP = 2 / 3 [DBP + 1 / 3 (SBP - DBP)] - IOP.

[0017] In one example, the systems and methods described herein can be used to ensure compliance with various Current Procedural Terminology (CPT) codes. CPT codes can be used to report various medical, surgical, or diagnostic services to physicians, health insurance companies, or accreditation agencies. In one example, the systems and methods described herein can be used for remote physiological monitoring or therapy management services, such as on a periodic basis (e.g., monthly, weekly, etc.). In one example, the systems and methods can be configured to facilitate two-way communication between a patient and a clinician (or other caregiver), such as at a frequency or interval specified for each CPT code. The two-way communication can include, for example, telephone, text, or email-based communication and can occur, for example, at least once per month, week, or day, as can be determined on a case-by-case basis.

[0018] 1 schematically illustrates an example of an eye health management system 100. The eye health management system 100 may include a patient system 102, which may be communicatively coupled to a remote patient monitoring system 116. In one example, the patient system 102 may be coupled to the remote patient monitoring system 116 using a wired or wireless data communication bus, which may include or use the Internet, a cellular network, or one or more other networks for communicating data unidirectionally or bidirectionally.

[0019] In the example of FIG. 1 , the patient system 102 can include an IOP sensor 104, a BP sensor 106, a physiological sensor 112, and a therapy system 108. The IOP sensor 104, the BP sensor 106, the physiological sensor 112, and the therapy system 108 can each have a dedicated processor or processor circuit, or can be coupled to a common central processor or processor circuit 110. For simplicity, the example of FIG. 1 shows an embodiment with the central processor circuit 110. The example of FIG. 1 further includes a patient interface 114, such as can be coupled to one or both of the therapy system 108 and the processor circuit 110. In one example, the processor circuit 110 can include or use one or more of the processors or processor circuits described herein in FIG. 10 . Other processors, ASICs, or circuits can be used as well.

[0020] The IOP sensor 104 may include a physiological sensor configured to measure intraocular pressure in a patient's eye, such as using tonometry, transpalpebral techniques, contact lens-based systems, or implanted devices. While tonometers are non-invasive, they are generally expensive, not portable, and require a skilled operator. Therefore, in practice, it may be difficult to effectively monitor the IOP of a patient's eye over time, such as over a day, a week, or longer, using a tonometer. Because IOP can fluctuate significantly over relatively short periods of time, sparse pressure measurements may not provide a complete or accurate view of a patient's risk for glaucoma. The implanted device or contact lens-based system, in some examples, may include other sensors, such as for monitoring glucose (e.g., measured from aqueous humor in the eye), heart rate, blood pressure, oxygen saturation, or other physiological condition information about the patient.

[0021] IOP sensor 104 can be configured to provide information regarding the patient's intraocular pressure (IOP) characteristics to processor circuit 110. The information can include, among other things, absolute pressure values ​​(e.g., in mmHg or other units), changes in pressure over time, pressure values ​​relative to a baseline, or other information regarding the patient's IOP.

[0022] In one example, the BP sensor 106 may include a physiological sensor configured to measure the patient's blood pressure. The BP sensor 106 may include an arm-cuff-based measurement system, an impedance-based system, or one or more other invasive, implantable, or non-invasive means for measuring diastolic and systolic pressures in the patient's blood vessels.

[0023] The BP sensor 106 can be configured to provide information regarding the patient's group pressure (BP) characteristics to the processor circuit 110. The information can include, among other things, absolute pressure values ​​(e.g., in mmHg or other units), changes in pressure over time, pressure values ​​relative to a baseline, or other information regarding the patient's BP.

[0024] The physiological sensors 112 may include sensors configured to sense one or more physiological parameters related to the patient or the patient's health. In one example, the physiological sensors 112 may include an invasive (e.g., implanted or partially implanted) or non-invasive system or device, or a wearable device. The physiological sensors 112 may be configured to monitor one or more of body impedance characteristics, blood chemical concentrations, temperature, pH level, sleep duration or quality, acoustic signals, blood oxygenation, airflow, or one or more other physiological aspects or indicators of the patient's physiological function.

[0025] In one example, one or more of the IOP sensor 104, the BP sensor 106, or the physiological sensor 112 can respond to instructions from the processor circuit 110. For example, the processor circuit 110 can be configured to coordinate physiological sensing or measurement activities by one or more of the sensors. The sensors can be configured to measure physiological information about the patient simultaneously or at different times. For example, the processor circuit 110 can coordinate the near-simultaneous receipt of IOP information from the IOP sensor 104 and BP information from the BP sensor 106, such as to provide a caregiver with a more comprehensive or complete physiological picture of the monitored patient.

[0026] In one example, the treatment system 108 can include various systems for treating one or more diseases or providing one or more therapies to a patient. In one example, the treatment system 108 can include or use a goggle-based glaucoma treatment or therapy system, such as one that can be configured to adjust the IOP of an eye by providing gauge pressure at or adjacent to the patient's eye. In one example, the treatment system 108 can include or use an automated or semi-automated drug delivery system, such as one that can be configured to provide drug or chemical therapy to a patient by delivering such drug or chemical directly to the patient's body (e.g., intravenously or otherwise), or by tracking the distribution of the drug or chemical. For example, the treatment system 108 can include an eye drop delivery system configured to count or track the number of droplets of a droplet volume dispensed from the treatment system 108. In one example, the treatment system 108 may include a system configured to treat obstructive sleep apnea or central sleep apnea, such as a continuous positive airway pressure (CPAP) system or a bilevel positive airway pressure (BiPAP) system, or other system. The treatment system 108 may be configured to provide information regarding treatment, therapy, patient response, or other information to the processor circuit 110.

[0027] The remote patient monitoring system 116 may include a system or network of systems of devices configured to enable clinicians, healthcare providers, patients, and others to remotely collect and review physiological or other health information from or about a patient. In some examples, one or more sensors associated with a patient may be in data communication with a remote system accessible by the patient's healthcare provider. In one example, a communicator or base station may be provided in the patient's home. The base station may include an interface configured to receive physiological data from the sensor and may include a network interface capable of uploading the physiological data to a remote server, such as one or more of the patient's healthcare providers. The network may include or use a data communications network, such as the Internet, and may be wired or wireless. In some examples, use of a remote patient monitoring system may be correlated with reduced healthcare costs and improved patient outcomes.

[0028] 2 schematically illustrates a cross-sectional side view of an eye 200. The cross-sectional side view of the eye 200 includes an anterior chamber 202, a ciliary muscle 204, a trabecular meshwork 206, a vitreous humor 208, a cerebrospinal fluid 210, an optic nerve 212, a lamina cribrosa 214, a lens 216, and a cornea 218.

[0029] The example in Figure 2 shows the cornea 218 and the anterior chamber 202, or aqueous humor, behind the cornea 218. The anterior chamber 202 is the main reservoir of aqueous humor inside the eye. Behind the anterior chamber 202 is the lens 216, and behind and around the lens 216 are the ciliary muscles 204, or ciliary processes, where aqueous humor is produced. The ciliary muscles 204 are approximately flush with the lens 216 and are located around the periphery of the lens 216. The trabecular meshwork 206, Schlemm's canal, and the anterior ciliary veins are all located below the anterior chamber 202 at the bottom of the cornea 218. This is the main pathway for aqueous humor to leave the eye.

[0030] Behind the lens 216 and ciliary muscle 204 is the posterior chamber, which is filled with vitreous humor 208. Although the vitreous humor 208 is different from the aqueous humor, the separation between the chambers holding these fluids is elastic, so the pressures of the two different humors can be equal or nearly equal. The optic nerve 212 connects to the back of the eye. The lamina cribrosa 214 is a membrane covering the junction of the optic nerve 212 with the eye. Cerebrospinal fluid 210 bathes the optic nerve 212 behind the lamina cribrosa 214, such that the lamina cribrosa 214 is affected by the pressure of the cerebrospinal fluid 210 on one side and the IOP on the other.

[0031] During normal eye function, aqueous humor is produced inside the eye by the ciliary body processes in the anterior segment of the eye. As aqueous humor is steadily produced, an equal amount of fluid must leave the anterior chamber 202 of the eye to maintain balanced intraocular pressure. Aqueous humor can exit the anterior chamber 202 through one or both of two main pathways. Some is reabsorbed by the uveoscleral outflow pathway around the ciliary muscle 204. Some exits the eye through the trabecular meshwork 206, a porous region at the front of the eye between the cornea 218 and the iris insertion. Aqueous humor exiting through the trabecular meshwork flows through Schlemm's canal and into the anterior ciliary veins. In one example, the systems and methods described herein can be used to change the IOP in one or both of a patient's eyes, for example, by altering the flow rate of aqueous humor through the trabecular meshwork 206, Schlemm's canal, and the anterior ciliary venous pathway.

[0032] FIG. 3 schematically illustrates a perspective view of an example goggle assembly 300. In one example, the treatment system 108 from the example of FIG. 1 may include or use goggle assembly 300. In the example of FIG. 3, goggle assembly 300 includes pump 302, battery 304, dial 306, switch 308, manifold 310, tubing 312, gasket 314, and goggle lenses 316. In one example, goggle assembly 300 may be used to change the IOP in one or both eyes of a patient.

[0033] The goggle assembly 300 may include one or more goggles that provide one or more eye cavities when the goggle assembly 300 is worn by a patient. The body of the goggle assembly 300 may be made of a relatively rigid, impermeable plastic to maintain a pressure differential within the one or more cavities. In one example, the goggle lens 316 portion of the goggle assembly 300 may be transparent to allow a patient wearing the one or more goggles to see through the cavities. In one example, the gasket 314 may comprise a compressible material provided around the periphery of the goggle body to create a seal between the edge of the one or more goggles and the patient's skin or other tissue around the eyes. The sealing material may be a foam, rubber, or plastic material held in intimate contact with the skin by a strap or headband configured to be worn around the head.

[0034] The example of FIG. 3 illustrates that a pressure control mechanism may be used with or attached to goggle assembly 300. The pressure control mechanism may include pump 302, which may be configured as a pressure or compression pump or a vacuum pump. Pump 302 may be reversibly configured so that the same goggle assembly 300 can be used to increase or decrease the pressure in the goggle cavity. Pump 302 may be in fluid communication with the cavity portion of goggle assembly 300 using manifold 310 and tubing 312. Pump 302 may be powered by battery 304. In one example, pump 302 may be activated by switch 308 (e.g., an on / off switch). A target goggle cavity pressure set point or range may be set or adjusted using dial 306 or other input means. An adjustable pressure set point or range may control pressure in a closed-loop manner, such as when a pressure sensor configured to monitor cavity pressure is used. Other means for controlling or regulating pressure can include a speed control for pump 302 or controls for one or more vents that may be provided in goggle assembly 300, such as in manifold 310 or in one or more cavities.

[0035] 4 schematically illustrates an example of a cross-section 400 of goggle assembly 300 fitted to a patient's eye 406. Cross-section 400 includes gasket 314, goggle lens 316, eyelid 402, cavity 404, and patient's eye 406. In the example of FIG. 4, cavity 404 can be provided between goggle lens 316 and patient's eye 406.

[0036] The body portion of goggle assembly 300 can be relatively rigid and made from an impermeable material, such as plastic or other polymer, so that goggle assembly 300 can achieve and maintain a differential or gauge pressure within cavity 404. Gasket 314 can be disposed around the periphery of the goggle body, which can be configured to provide a substantially airtight seal between the edge of the goggle and the patient's skin around the eye. In one example, gasket 314 is configured to contact a portion of the patient's face near or adjacent eyelid 402.

[0037] The pressure in the cavity 404 can be varied by various components of the assembly. The varied air pressure in the cavity 404 can act on an area in front of the patient's eye 406. In one example, the varied air pressure can be reduced for a patient with glaucoma or a patient with high IOP, so that the pressure acts to reduce the patient's IOP. In one example, the varied pressure can be increased for a patient with optic disc edema or swelling of the lamina cribrosa. In one example, the pressure in the cavity 404 can be changed or updated over time, such as to a different target pressure.

[0038] While the illustrated goggle assembly 300 is configured for use against a patient's eye 406, the assembly can be differently configured for wear elsewhere on the body, such as to provide a cavity and gauge pressure to various other tissue locations. For example, the assembly can be configured to provide a rectangular or oval cavity and be configured for placement against the back of a patient's neck. The assembly can thus be provided to apply gauge pressure to skin tissue in the neck, such as may be useful for treating headaches or other discomforts. The assembly can be configured to provide cavities of various different shapes and sizes, such as for use elsewhere on the body. In one example, the assembly can be configured to provide cupping therapy. Cupping therapy is used to alter blood flow or supply to a relatively small tissue area. This therapy is used by various athletes to aid in the recovery or healing of muscle tissue. In one example, the assembly can include or use an integrated heating mechanism to heat or cool the cavity or the air therein.

[0039] 5 generally illustrates an example of a first method 500 that may include determining an eye health index for a patient, such as using the eye health management system 100. At block 502, the first method 500 may comprise receiving information regarding a first IOP characteristic of the patient. Block 502 may include or use information from the IOP sensor 104. In one example, block 502 may include receiving, using the processor circuit 110, information regarding the first IOP characteristic of the patient.

[0040] At block 504, the first method 500 may comprise receiving information regarding a first BP characteristic of the same patient from which the first IOP characteristic was received at block 502. Block 504 may include or use information from a BP sensor 106. In one example, block 504 may include receiving, using the processor circuit 110, information regarding the patient's first BP characteristic.

[0041] At block 506, the first method 500 may comprise receiving information regarding a first patient therapy from a patient treatment system. In one example, block 506 may include receiving information regarding a therapy or treatment provided to the patient using the treatment system 108. The information regarding the first patient therapy may include, by way of example and not limitation, information regarding a glaucoma therapy, an apnea therapy, a dry eye therapy, a headache or migraine therapy, or other therapy configured to treat or cure a patient condition. The information regarding the therapy or treatment may include information regarding treatment duration, drug titration (e.g., delivered or prescribed amount of drug), treatment frequency, patient-reported or automatically-reported patient adherence to a therapy plan, information regarding the patient response to a particular therapy, or other information regarding the therapy.

[0042] In one example, information regarding the therapy or treatment can be received from the patient in block 506, such as using the patient interface 114. In one example, the patient interface 114 includes a graphical user interface through which the patient or user, or a clinician or other caregiver, can provide information regarding medication administration. In one example, the patient interface 114 can be configured to remind or prompt the patient to take a medication or perform a medication regimen, or to remind or prompt the patient to report a medication administration event.

[0043] At block 508, the first method 500 may comprise determining an eye health index for the patient. Block 508 may include processing information from at least the IOP sensor 104 and the BP sensor 106 using the processor circuit 110 and, in response, generating an eye health index. In one example, the processor circuit 110 may use information about both or the treatment, such as that received at block 506, to determine the eye health index.

[0044] In one example, the eye health index determined in block 508 may include a quantitative indicator of a disease state, disease progression, or risk of disease progression, such as glaucoma or dry eye progression. In one example, the eye health index may be a predictive index or metric associated with trends in eye patient health. In one example, block 508 may determine the eye health index using or including glaucoma-related data, such as may be obtained or determined using the eye health management system 100 or other systems or devices over time. In one example, block 508 includes using physiological information from the patient from daytime monitoring periods, nighttime monitoring periods, or both, to determine the eye health index.

[0045] In one example, clinician-generated data or information about the patient may be used to determine the eye health index in block 508. In one example, the clinician may provide the clinician-generated data or information to the remote patient monitoring system 116, and in response, the remote patient monitoring system 116 or processor circuit 110 may use the data or information to determine the eye health index.

[0046] In one example, determining the eye health index in block 508 may include or use information from the treatment system 108. For example, information from the goggle assembly 300 may be used. The information may include pressure information, such as information regarding the magnitude or duration of pressure applied to the patient's eye using the goggle assembly 300. The information from the treatment system 108 may include a typical or average pressure, such as a typical daily or nightly pressure, applied to the patient by or using the goggle assembly 300.

[0047] At block 510, the first method 500 may comprise reporting the eye health index to a remote system or device, such as the remote patient monitoring system 116. In one example, block 510 includes receiving the eye health index determined in block 508, such as using the processor circuit 110, and communicating the eye health index to the remote patient monitoring system 116 using a wired or wireless data communication system.

[0048] At block 512, the first method 500 may comprise generating a treatment recommendation for the patient based on the eye health index. In one example, block 512 includes receiving input or instructions indicating the treatment recommendation from a clinician at the remote patient monitoring system 116. In one example, block 512 includes automatically determining the treatment recommendation at the remote patient monitoring system 116 based on one or more algorithms or machine learning-based decision trees, which may use the eye health index information alone or in conjunction with other physiological condition information about the patient or patient population. For example, block 512 may include comparing the eye health index of the first patient with indices from a population of similar patients and providing a treatment recommendation determined to be most likely to successfully treat the first patient based on information about the outcomes of the similar patients. Similar patients or patient groups may be automatically identified by the remote patient monitoring system 116 or may be manually designated based on age, race, diet, gender, other health or disease state information, other patient attributes, or the like.

[0049] At block 514, the first method 500 may include updating therapy parameters used by a patient treatment system, such as treatment system 108. In one example, block 514 may include receiving the therapy recommendation generated in block 512 and, in response, updating or changing therapy parameters used by treatment system 108. The therapy parameters may affect, for example, the pressure or predetermined frequency of use of goggle assembly 300 on the patient. The therapy parameters may affect, for example, drug therapy, tissue pressure therapy, CPAP or BiPAP therapy, electrical stimulation therapy, or other patient therapy.

[0050] 6 schematically illustrates an example of a second method 600 that may comprise determining a patient's ocular health index using the patient's ocular perfusion pressure (OPP). The second method 600 may comprise or use the same or similar steps as those described in the first method 500 at blocks 502, 504, and 506. At block 602, the second method 600 may comprise determining the patient's ocular perfusion pressure (OPP) characteristic. The OPP characteristic may be based on at least an IOP characteristic and a BP characteristic.

[0051] For example, OPP or mean ocular perfusion pressure (MOPP) can be a function of diastolic blood pressure (DBP), systolic blood pressure (SBP), and IOP. For example, MOPP can be expressed as MOPP = 2 / 3 [DBP + 1 / 3 (SBP - DBP)] - IOP. In one example, standard or average information regarding IOP or BP can be used to provide an MOPP that is indicative of a patient's health over time rather than at a specific time or moment. For example, IOP and / or BP information can be obtained over a day, or over a specified daytime period (e.g., four hours or more, or longer or shorter), or over a specific nighttime period (e.g., one hour or more, or longer or shorter). In one example, the acquisition of IOP and / or BP information for use in determining MOPP can be triggered based on one or more conditions or events. For example, IOP or BP information can be obtained when REM sleep is detected, when CPAP therapy is activated or stopped, or at a specified time after drug therapy.

[0052] At block 604, the second method 600 may comprise determining an eye health index based on the OPP determined at block 602 and based on the information related to the patient therapy received at block 506. Block 604 may include using the processor circuit 110 to process the information related to the OPP along with the therapy information to generate the eye health index. In one example, the eye health index determined at block 604 may have one or more attributes of the eye health index described above in the description of block 508. For example, the eye health index determined at block 604 may include a quantitative indicator of a disease state, disease progression, or risk of disease progression. Following block 604, the eye health index determined using the OPP characteristics may be reported to a remote system or device, such as the remote patient monitoring system 116.

[0053] 7 illustrates generally an example of a third method 700 that may comprise using sensor information acquired over time to determine a patient's eye health index. The third method 700 may be performed using one or more components of the eye health management system 100.

[0054] In block 702, the third method 700 may comprise receiving information regarding a first IOP characteristic of a patient over time or a first duration. Receiving the first IOP characteristic over time may include measuring IOP at multiple separate instances and determining an average, running average, standard deviation, or other indicator of the patient's absolute or relative IOP over the specified duration. The duration may be specified to various lengths. For example, the duration may be several seconds, several minutes, several hours, or several days. In one example, the duration may represent several similar intervals, such as several minutes every hour, several minutes every day, several minutes during a daytime monitoring period, or several minutes during a nighttime monitoring period. Other durations may be used as well. Block 702 may include using the IOP sensor 104 to obtain IOP characteristic information and receiving the IOP characteristic information at the processor circuit 110.

[0055] In block 704, the third method 700 may comprise receiving information regarding the first BP characteristic over the same first duration. In other examples, the information regarding the first BP characteristic may be received over a different duration, such as a duration that at least partially overlaps with the first duration, or at a duration different from the first duration. Block 704 may include or use information from the BP sensor 106. In one example, block 704 may include using the BP sensor 106 to obtain the BP characteristic information and receiving the BP characteristic information at the processor circuit 110.

[0056] In block 706, the third method 700 may comprise receiving information regarding a therapy received by the patient over the same first duration. In other examples, information regarding a therapy received by the patient may be received over a different duration, such as a duration that at least partially overlaps with the first duration, or at a duration different from the first duration. In one example, block 706 may include receiving information regarding a therapy or treatment provided to the patient using the treatment system 108. Various types of information may be received in block 706, such as information regarding glaucoma therapy, apnea therapy, dry eye therapy, headache or migraine therapy, or other therapy configured to treat or cure the patient's condition. The information regarding both may include information regarding treatment duration, drug titration (e.g., delivered or prescribed amount of drug), treatment frequency, patient-reported or automatically-reported patient adherence to a therapy regimen (e.g., using a monitoring device configured to monitor and report drug administration), patient response to a particular therapy, or other information.

[0057] In one example, block 706 can include using information about the therapy to determine a relationship between therapy delivery and duration of therapy effectiveness. For example, block 706 can include cross-checking delivery times of medication (or other therapy) with expected or patient-reported effectiveness. In one example, efficacy information can be determined using patient-reported information, such as via the patient interface 114, or efficacy can be determined using more objective physiological information, such as IOP characteristic information (e.g., received in block 702) or BP characteristic information (e.g., received in block 704).

[0058] At block 708, the third method 700 may include determining an eye health index for the patient. Block 708 may include using the processor circuit 110 to process the information received from at least the IOP sensor 104 at block 702, the BP sensor 106 at block 704, and the information regarding therapy from block 706, and, in response, generate an eye health index. As also described elsewhere herein, the eye health index may include a quantitative indicator of a disease state, disease progression, or risk of disease progression, such as glaucoma or dry eye progression.

[0059] In one example, block 708 can include an indication of therapy effectiveness for the patient. For example, block 708 can include using efficacy information (actual or predicted) from block 706 along with information regarding IOP and BP characteristics from blocks 702 and 704 to determine an ocular health index. In one example, the ocular health index can have a value that depends at least in part on the measured physiological responsiveness to the therapy.

[0060] FIG. 8 schematically illustrates an example of a fourth method 800 that may include determining or updating an eye health index. For example, in block 802, the fourth method 800 may include receiving information from an interface or input device, such as the patient interface 114. In the example of FIG. 8, block 802 includes receiving information regarding a patient-reported visual field using the patient interface 114. In one example, the patient interface 114 includes a graphical user interface through which a patient or user, or a clinician or other caregiver, can provide information regarding the visual field available to or experienced by the patient. For example, the patient interface 114 may include means for taking a panoramic photograph and displaying the photograph on a screen for the patient. The patient may then indicate their visual field on the screen relative to the panoramic view. The patient's visual field may be quantitatively analyzed to provide an objective indicator of the patient's visual field or a change in the patient's visual field, etc.

[0061] In one example, block 802 may include displaying visual information to a patient, such as providing a visual field test to the patient, using a virtual reality (VR) headset or other head-mounted system. Patient-reported information regarding the displayed visual information may be received in block 802. In one example, the headset may include an inexpensive device such as Google Cardboard that may be used or paired with the patient's mobile device, tablet, or other computer. Using such a headset in block 802 may be useful in enabling patients to frequently self-administer their vision tests. Results may be delivered to the patient in real time or reported to a remote clinician. In one example, the information received in block 802 may be used to help facilitate the identification or treatment of eye disease or vision loss and may help reduce the incidence of irreversible damage due to untreated disease progression.

[0062] At block 804, the fourth method 800 may comprise determining or updating the patient's eye health index using the information received in block 802. That is, block 804 may include using one or more of the processor circuit 110 or the remote patient monitoring system 116 to receive information regarding the patient's visual field, such as that reported by the patient in block 802, and updating the patient's eye health index in response. The updated eye health index may then be provided to a clinician or other caregiver for monitoring or intervention purposes. For example, if the eye health index is trending negatively, indicating a narrower visual field experienced by the patient, the clinician or caregiver may change therapy parameters or update a drug therapy for the patient accordingly. In one example, one or more therapy parameters may be updated and implemented in response to a change in the eye health index, such as using the patient's treatment system 108.

[0063] 9 generally illustrates an example of a fifth method 900 that may include updating a therapy for a patient based on an eye health index for the patient. At block 902, the fifth method 900 may comprise reporting the eye health index to a remote system. For example, block 902 may include reporting or communicating the patient's eye health index to a remote patient monitoring system 116 using the processor circuit 110.

[0064] At block 904, information regarding the eye health index may be provided to a clinician or other caregiver at the remote patient monitoring system 116 using a clinician interface. Based on the eye health index, and optionally based on one or more other criteria, the clinician may provide input to the remote patient monitoring system 116 indicating an update on the patient receiving a therapy or treatment from the treatment system 108. At block 906, the fifth method 900 may comprise receiving instructions at the treatment system 108 to start, terminate, maintain, or change a patient therapy, such as may be provided to the patient using the treatment system 108. In one example, information regarding the therapy update may be provided to the patient using the patient interface 114. At block 908, the fifth method 900 may include providing a patient therapy to the patient using the treatment system 108 according to the instructions or parameters received at block 906.

[0065] Following block 908, the fifth method 900 may include providing therapy to the patient for at least a specified minimum duration or therapy interval. Following the therapy interval, the fifth method 900 may return to block 902 and report a new or updated eye health index to the remote patient monitoring system 116. In one example, the fifth method 900 may be performed according to a clinician-specified schedule or may be performed on-demand. For example, the fifth method 900 may be performed according to timing requirements specified by one or more CPT codes, such as being updated from time to time depending on the patient's disease state or best practices.

[0066] 10 is a schematic diagram of a machine 1000 capable of executing instructions 1008 (e.g., software, programs, applications, applets, apps, or other executable code) to cause the machine 1000 to perform any one or more of the methods described herein. For example, the instructions 1008 can cause the machine 1000 to perform any one or more of the methods described herein. The instructions 1008 can transform a general, unprogrammed machine 1000 into a specific machine 1000 that is programmed to perform the functions described and illustrated in the manner described. The machine 1000, or various instances of the machine 1000, can comprise or be used to implement one or more portions of the eye health management system 100.

[0067] In one example, the machine 1000 can operate as a standalone device or can be coupled (e.g., networked) to other machines or devices or processors. In a networked arrangement, the machine 1000 can operate as a server or client machine in a server-client network environment or as a peer machine in a peer-to-peer (or distributed) network environment. For example, one instance of the machine 1000 can comprise some or all of the patient systems 102, another instance of the machine 1000 can comprise the patient interface 114, and another instance of the machine 1000 can comprise the remote patient monitoring system 116, and the various instances can be networked together. The machine 1000 may include a server computer, a client computer, a personal computer (PC), a tablet computer, a laptop computer, a netbook, a set-top box (STB), a PDA, an entertainment media system, a mobile phone, a smartphone, a mobile device, a wearable device (e.g., a smart watch), a smart home device (e.g., a smart appliance), other smart devices, a web appliance, a network router, a network switch, a network bridge, or any machine capable of sequentially or otherwise executing instructions 1008 that specify actions to be taken by the machine 1000. Furthermore, although only a single machine 1000 is shown, the term “machine” may be interpreted to include a collection of machines that individually or jointly execute the instructions 1008 to perform any one or more of the methods described herein. In one example, the instructions 1008 may include instructions stored using a memory circuit, and the machine 1000 may include or use a processor circuit, such as processor circuit 110, which may be associated with any one or more of the various blocks, modules, processors, or other processing hardware or software described herein.

[0068] Machine 1000 may include various processors and processor circuits, represented in the example of FIG. 10 as processor 1002, memory 1004, and I / O components 1042, which may be configured to communicate with each other via bus 1044. In one example, processor 1002 (e.g., a central processing unit (CPU), a reduced instruction set computing (RISC) processor, a complex instruction set computing (CISC) processor, a graphics processing unit (GPU), a digital signal processor (DSP), an ASIC, a radio frequency integrated circuit (RFIC), another processor, or any suitable combination thereof) may include, for example, a first processor 1006 and a second processor 1010 that execute instructions 1008. The term “processor” is intended to include a multi-core processor, which may include two or more independent processors (sometimes referred to as “cores”) capable of simultaneously executing instructions. While FIG. 10 shows multiple processors, machine 1000 may include a single processor with a single core, a single processor with multiple cores (e.g., a multi-core processor), multiple processors with a single core, multiple processors with multiple cores, or any combination thereof.

[0069] The memory 1004 may include a main memory 1012, a static memory 1014, or a storage unit 1016, such as may be accessible to the processor 1002 via a bus 1044. The memory 1004, the static memory 1014, and the storage unit 1016 may store instructions 1008 that embody any one or more of the methods or functions or processes described herein. The instructions 1008 may also reside, completely or partially, within the main memory 1012, within the static memory 1014, within a machine-readable medium 1018 (e.g., including a non-transitory computer-readable storage medium) in the storage unit 1016, within one or more of the processors (e.g., within a processor's cache memory), or any suitable combination thereof during their execution by the machine 1000.

[0070] I / O components 1042 may include a wide variety of components for receiving input, providing output, generating output, transmitting information, exchanging information, capturing measurements, etc. The particular I / O components 1042 included in a particular machine will depend on the type of machine. For example, a portable machine such as a cell phone may be equipped with a touch input device or other such input mechanism, while a headless server machine is unlikely to be equipped with such a touch input device. It is understood that I / O components 1042 may include other components not shown in FIG. 10 . In various exemplary embodiments, I / O components 1042 may include output components 1028 and input components 1030. Output components 1028 may include visual components (e.g., a display such as a plasma display panel (PDP), a light-emitting diode (LED) display, a liquid crystal display (LCD), a projector, or a cathode ray tube (CRT)), acoustic components (e.g., speakers), haptic components (e.g., vibration motors, resistance mechanisms), other signal generators, etc. The input components 1030 may include an alphanumeric input component (e.g., a keyboard, a touchscreen configured to receive alphanumeric input, a photo-optical keyboard, or other alphanumeric input component), a point-based input component (e.g., a mouse, touchpad, trackball, joystick, motion sensor, or another pointing device), a tactile input component (e.g., a physical button, a touchscreen that provides the position and / or force of a touch or touch gesture, or other tactile input component), an audio input component (e.g., a microphone), a physiological sensor component, etc.

[0071] In one example, the I / O component 1042 can include, among other components, a biometric component 1032, a motion component 1034, an environmental component 1036, or a position component 1038. For example, the biometric component 1032 includes a component configured to detect the presence or absence of a human, pet, or other individual or object, or a component configured to detect facial expressions (e.g., hand expressions, facial expressions, vocal expressions, body gestures, or eye tracking), measure biosignals (e.g., intraocular pressure, cerebrospinal fluid pressure, blood pressure, heart rate, body temperature, sweating, or brain waves, among others), identify people (e.g., voice identification, retinal identification, face identification, fingerprint identification, or brainwave-based identification), etc. The motion component 1034 can include an acceleration sensor component (e.g., an accelerometer), a gravity sensor component, a rotation sensor component (e.g., a gyroscope), etc.

[0072] The environmental component 1036 may include, for example, an illumination sensor component (e.g., a light meter), a temperature sensor component (e.g., one or more thermometers that detect ambient temperature), a humidity sensor component, a pressure sensor component (e.g., a barometer), an acoustic sensor component (e.g., one or more microphones that detect background noise), a proximity sensor component (e.g., an infrared sensor that detects nearby objects), a gas sensor (e.g., a gas detection sensor that detects concentrations of harmful gases or measures pollutants in the air for safety purposes), or other components that can provide indicators, measurements, or signals corresponding to the surrounding physical environment. The location component 1038 includes a location sensor component (e.g., a GPS receiver component, an RFID tag, etc.), an altitude sensor component (e.g., an altimeter or barometer that detects air pressure from which altitude can be derived), a orientation sensor component (e.g., a magnetometer), etc. Information from any one or more of the I / O component 1042, the environmental component 1036, the location component 1038, and other components can be used to determine or update the patient's eye health index.

[0073] I / O component 1042 may include a communication component 1040 operable to couple machine 1000 to network 1020 or device 1022 via coupling 1024 and coupling 1026, respectively. For example, communication component 1040 may include a network interface component or another suitable device for interfacing with network 1020. In further examples, communication component 1040 may include a wired communication component, a wireless communication component, a cellular communication component, a near field communication (NFC) component, a Bluetooth® component (e.g., Bluetooth® Low Energy), a Wi-Fi® component, and other communication components that provide communication via other modalities. Device 1022 may be another machine or any of a wide variety of peripheral devices (e.g., a peripheral device coupled via USB).

[0074] Further, the communication component 1040 may include a component capable of detecting an identifier or operable to detect an identifier. For example, the communication component 1040 may include a radio frequency identification (RFID) tag reader component, an NFC smart tag detection component, an optical reader component (e.g., an optical sensor for detecting one-dimensional barcodes such as Universal Product Code (UPC) barcodes, multidimensional barcodes such as Quick Response (QR) codes, Aztec codes, Data Matrix codes, Dataglyph codes, MaxiCodes, PDF417, UltraCodes, UCC RSS-2D barcodes, and other optical codes), or an acoustic detection component (e.g., a microphone for identifying tagged audio signals) such as those that may be used to identify breathing patterns or apneas. Additionally, various information may be derived via the communication component 1040, such as location via Internet Protocol (IP) geolocation, location via Wi-Fi signal triangulation, or location via detecting NFC beacon signals that can indicate a specific location.

[0075] Various memories (e.g., memory 1004, main memory 1012, static memory 1014, and / or memory of processor 1002) and / or storage unit 1016 may store one or more instructions or data structures (e.g., software) that embody or are used by any one or more of the methods or functions described herein. These instructions (e.g., instructions 1008), when executed by a processor or processor circuitry, result in various operations for implementing the embodiments described herein.

[0076] The instructions 1008 may be transmitted or received over the network 1020 using a transmission medium via a network interface device (e.g., a network interface component included in the communications component 1040) using any one of many well-known transfer protocols (e.g., Hypertext Transfer Protocol (HTTP)). Similarly, the instructions 1008 may be transmitted or received using a transmission medium via a coupling 1026 (e.g., a peer-to-peer coupling) to the device 1022.

[0077] To further illustrate the methods and apparatus described herein, a non-limiting set of exemplary embodiments are set forth below as numerically identified examples. Example 1 includes a system comprising: an intraocular pressure (IOP) sensor; a blood pressure (BP) sensor; a patient treatment system; and a processor circuit configured to determine an eye health index (OHI) value for a patient based on IOP information from the IOP sensor, BP information from the BP sensor, and one or more of information regarding a therapy provided to the patient by the patient treatment system and information regarding the patient's response to the therapy provided by the patient treatment system.

[0078] In Example 2, the subject matter of Example 1 can optionally include the processor circuit configured to determine disease progression based on a trend in the OHI values, and in response to the disease progression corresponding to a worsening disease state for the patient, the processor circuit can be configured to change or update a gauge pressure parameter of the therapy provided to the patient by the patient treatment system.

[0079] In Example 3, the subject matter of Examples 1-2 can optionally include the patient treatment system configured to receive the OHI value from the processor circuit and, in response to the OHI value meeting specified threshold criteria, to vary a gauge pressure parameter of the therapy provided by the patient treatment system.

[0080] In Example 4, the subject matter of Example 3 can optionally include the patient treatment system configured to increase the frequency, duration, or intensity of administered gauge pressure therapy when the OHI value indicates deteriorating ocular health for the patient.

[0081] In Example 5, the subject matter of Examples 1-4 can optionally include a user interface configured to receive information regarding the OHI value from the processor circuit and to display the OHI value.

[0082] In Example 6, the subject matter of Examples 1-5 can optionally include a patient interface coupled to one or more of the patient treatment system and the processor circuit and configured to receive qualitative or quantitative health status information from the patient, and the processor circuit can be configured to determine the OHI value for the patient using the received health status information from the patient.

[0083] In Example 7, the subject matter of Examples 1-6 can optionally include the patient treatment system including a goggle-based treatment system configured to intermittently apply gauge pressure to the patient in conjunction with instructions from the processor circuit.

[0084] In Example 8, the subject matter of Examples 1-7 can optionally include the patient treatment system comprising a tissue interface system configured to intermittently apply a gauge pressure to a skin tissue surface of the patient.

[0085] In Example 9, the subject matter of Examples 1-8 can optionally include the patient treatment system including a glaucoma treatment system configured to intermittently deliver glaucoma therapy to the patient, wherein the processor circuitry is configured to determine a glaucoma disease progression index based on the OHI value.

[0086] In Example 10, the subject matter of Examples 1-9 can optionally include the patient treatment system comprising a drug delivery system, and the processor circuit can be configured to determine the OHI value based on information regarding a drug therapy provided to the patient using the drug delivery system.

[0087] In Example 11, the subject matter of Examples 1-10 can optionally include the IOP sensor comprising a contact lens, the contact lens configured to measure IOP information about the patient when worn by the patient.

[0088] In Example 12, the subject matter of Examples 1-11 can optionally include the processor circuit configured to determine a first ocular perfusion pressure (OPP) characteristic for the patient based on the IOP information and the BP information, and the processor circuit can optionally be further configured to determine the OHI value using the first OPP characteristic and the information regarding the therapy provided to the patient by the patient treatment system.

[0089] In Example 13, the subject matter of Examples 1-12 can optionally include the IOP sensor configured to measure IOP information for the patient over a first time interval, the BP sensor configured to measure BP information for the patient over the first time interval, the patient treatment system configured to record information related to patient therapy during the first time interval, and the processor circuit configured to determine the OHI value for the patient based on the IOP information measured over the first time interval, the BP information measured over the first time interval, and the information related to patient therapy during the first time interval.

[0090] In Example 14, the subject matter of Example 13 can optionally include the processor circuit being configured to determine the OHI value for the patient based on a change in the IOP information for the patient over the first time interval.

[0091] In Example 15, the subject matter of Examples 1-14 can optionally include the patient treatment system configured to provide nocturnal gauge pressure therapy to the patient. In Example 16, the subject matter of Examples 1-15 can optionally include using the processor circuitry to determine updated OHI values ​​for the patient at specified intervals, a minimum of every X days, where X is an integer number of days.

[0092] In Example 17, the subject matter of Examples 1-16 can optionally include the IOP sensor and the BP sensor configured to measure respective IOP and BP information about the patient substantially simultaneously.

[0093] In Example 18, the subject matter of Examples 1-17 can optionally include the processor circuitry configured to generate treatment parameters for use by the patient treatment system in providing a subsequent therapy to the patient based on the OHI value.

[0094] In Example 19, the subject matter of Examples 1-18 can optionally include a remote patient monitoring system and a communications circuit communicatively coupled to the processor circuit and the remote patient monitoring system. In Example 19, the processor circuit can be configured to periodically provide the OHI value to the remote patient monitoring system using the communications circuit.

[0095] In Example 20, the subject matter of Example 19 can optionally include the remote patient monitoring system being configured to provide instructions to the patient treatment system to update treatment parameters in response to receiving the OHI value.

[0096] In Example 21, the subject matter of Examples 19-20 can optionally include the remote patient monitoring system being configured to, in response to receiving the OHI value, request, via a patient interface, patient-reported status information regarding one or more of the patient's weight, the patient's body mass index (BMI), the patient's eating habits or changes in eating habits, the patient's medication regimen, and the patient's medication regimen compliance.

[0097] Example 22 is a non-transitory computer-readable storage medium comprising instructions that, when executed by a processor circuit, cause the processor circuit to perform: receiving information regarding a first intraocular pressure (IOP) characteristic of a patient from an IOP sensor; receiving information regarding a first blood pressure (BP) characteristic of the patient from a blood pressure sensor; a patient therapy information receiving step that receives information regarding a first patient therapy from a patient treatment system; and a health index determination step that determines a quantitative eye health index for the patient using the information regarding the received first IOP characteristic, using the information regarding the received first BP characteristic, and using the information regarding the first patient therapy received from the patient treatment system.

[0098] In Example 23, the subject matter of Example 22 includes instructions that, when executed by the processor circuit, cause the processor circuit to provide the quantitative eye health index to one or more of a remote patient monitoring system and a patient interface device. The instructions may further include instructions for displaying or communicating the quantitative eye health index to a patient or a caregiver.

[0099] In Example 24, the subject matter of Examples 22-23 can optionally include instructions that cause the processor circuit to perform the patient therapy information receiving step, including instructions that cause the processor circuit to perform a step of receiving information regarding gauge pressure therapy administered to the patient's eye by a goggle-based therapy system.

[0100] In Example 25, the subject matter of Examples 22-24 can optionally include instructions that cause the processor circuit to perform the patient therapy information receiving step, including instructions that cause the processor circuit to perform a step of receiving information regarding a gauge pressure therapy to be administered by a tissue interface system to a skin tissue surface area of ​​the patient, the skin tissue surface area excluding the patient's eye or eye cavity.

[0101] In Example 26, the subject matter of Examples 22-25 can optionally include instructions causing the processor circuit to perform the patient therapy information receiving step, which includes instructions to receive, from an eye treatment system, therapy information regarding an eye therapy provided to the patient by a goggle-based therapy system, and the instructions causing the processor circuit to perform the health index determining step include instructions causing the processor to determine a quantitative glaucoma health index for the patient based on the first IOP characteristic, the first BP characteristic, and the information regarding the eye therapy.

[0102] In Example 27, the subject matter of Examples 22-26 can optionally include instructions that cause the processor circuit to perform the patient therapy information receiving step, including instructions to receive information regarding a drug therapy to be provided to the patient from a drug delivery system.

[0103] In Example 28, the subject matter of Examples 22-27 can optionally include instructions that cause the processor circuit to perform the health index determination step, including instructions that cause the processor circuit to determine a first ocular perfusion pressure (OPP) characteristic of the patient based on the first IOP characteristic and the first BP characteristic, and determine the ocular health index based on the information regarding the first OPP and the first patient therapy.

[0104] In Example 29, the subject matter of Examples 22-28 can optionally include instructions further configuring the processor circuit to receive information regarding a subsequent second IOP characteristic of the patient, receive information regarding a subsequent second BP characteristic of the patient, and determine the eye health index using information regarding a difference between the first IOP characteristic and the second IOP characteristic and using information regarding a difference between the first BP characteristic and the second BP characteristic.

[0105] In Example 30, the subject matter of Example 29 can optionally include information regarding the first IOP characteristic corresponding to a first IOP measurement event and the information regarding the second IOP characteristic corresponding to a subsequent second IOP measurement event, and the instructions configuring the processor circuit to perform a patient therapy information receiving step include instructions configuring the processor circuit to receive information regarding a therapy provided to the patient between the first IOP measurement event and the second IOP measurement event.

[0106] In Example 31, the subject matter of Examples 29-30 can optionally include the information regarding the first IOP characteristic and the second IOP characteristic being received over one or more nighttime monitoring periods.

[0107] In Example 32, the subject matter of Examples 29-31 can optionally include the information regarding the first IOP characteristic and the second IOP characteristic being received over one or more daytime monitoring periods.

[0108] In Example 33, the subject matter of Examples 22-32 can optionally include the information regarding the first IOP characteristic indicating IOP information for the patient over a first interval, the information regarding the first BP characteristic indicating BP information for the patient over the same first interval, and the information regarding the first patient therapy indicating therapy information corresponding to the same first interval.

[0109] In Example 34, the subject matter of Examples 22-33 can further include instructions for further configuring the processor circuit to receive information regarding the patient-reported visual field from a patient interface, and the instructions for configuring the processor circuit to perform the health index determination step can include using the information regarding the patient-reported visual field.

[0110] In Example 35, the subject matter of Examples 22-34 can optionally include instructions that further configure the processor circuit to substantially simultaneously measure the first IOP characteristic and the first BP characteristic of the patient.

[0111] In Example 36, the subject matter of Examples 22-35 can optionally include instructions further configuring the processor circuitry to generate a treatment recommendation for the patient based on the eye health index.

[0112] In Example 37, the subject matter of Examples 22-36 can optionally include instructions that further configure the processor circuit to update treatment parameters used by the patient treatment system to provide subsequent therapy to the patient.

[0113] In Example 38, the subject matter of Example 37 can optionally include instructions to update the treatment parameters, including instructions to update a glaucoma therapy frequency or a glaucoma therapy duration provided to the patient using a goggle-based treatment system.

[0114] In Example 39, the subject matter of Examples 22-38 can optionally include instructions further configuring the processor circuit to receive, from a patient interface, patient-reported status information regarding one or more of the patient's weight, the patient's body mass index (BMI), the patient's dietary habits or changes in dietary habits, the patient's medication regimen, or the patient's medication regimen compliance. In Example 39, the instructions configuring the processor circuit to perform the health index determining step include instructions for determining the eye health index using the patient-reported status information.

[0115] In Example 40, the subject matter of Examples 22-39 can optionally include instructions further configuring the processor circuit to receive, from a remote patient monitoring system, instructions that enable the patient treatment system to initiate a new therapy for the patient, instructions to continue a previous therapy for the patient, or instructions to inhibit delivery of a therapy to the patient, in response to information regarding the eye health index.

[0116] In Example 41, the subject matter of Examples 22-40 can optionally include instructions that further configure the processor circuit to request patient-reported status information regarding one or more of the patient's weight, the patient's body mass index (BMI), the patient's eating habits or changes in eating habits, the patient's medication regimen, and the patient's medication regimen compliance.

[0117] Example 42 may include a method for assessing a patient status associated with a patient's ocular health, the method comprising: receiving information regarding a first intraocular pressure (IOP) characteristic of the patient; receiving information regarding a first blood pressure (BP) characteristic of the patient; receiving information regarding a first patient therapy from a patient treatment system; and determining a health index for the patient using the received information regarding the first IOP characteristic, the received information regarding the first BP characteristic, and the received information regarding the first patient therapy from the patient treatment system. Example 42 may further comprise providing the quantitative eye health index to one or more of a remote patient monitoring system and a patient interface device, and displaying the quantitative eye health index using the remote patient monitoring system or the patient interface device.

[0118] In Example 43, the subject matter of Example 42 can optionally include the patient therapy information receiving step including a gauge pressure therapy information receiving step that receives information regarding a gauge pressure therapy administered to the patient by a treatment system.

[0119] In Example 44, the subject matter of Example 43 can optionally include receiving information about a gauge pressure therapy administered to the patient's eye by a goggle-based therapy system, wherein the receiving information about the gauge pressure therapy can optionally include receiving information about a gauge pressure therapy administered to the patient's eye by a goggle-based therapy system.

[0120] In Example 45, the subject matter of Examples 43-44 can optionally include receiving information regarding a gauge pressure therapy administered by a tissue interface system to a skin tissue surface area of ​​the patient, the skin tissue surface area excluding the patient's eye or eye cavity.

[0121] In Example 46, the subject matter of Examples 43-45 can optionally include receiving the patient therapy information including receiving, from an eye treatment system, therapy information regarding an eye therapy provided to the patient by the system. In Example 46, the health index determining step can include determining a quantitative Glaucoma Health Index for the patient based on the first IOP characteristic, the first BP characteristic, and the information regarding the eye therapy.

[0122] In Example 47, the subject matter of Examples 42-46 can optionally include the health index determining step including determining the patient's visual health. In Example 48, the subject matter of Examples 42-47 can optionally include receiving the patient therapy information including receiving information regarding a drug therapy provided to the patient from a drug delivery system.

[0123] In Example 49, the subject matter of Examples 42-48 can optionally include the health index determination step including determining a first ocular perfusion pressure (OPP) characteristic of the patient based on the first IOP characteristic and the first BP characteristic, and determining the ocular health index based on the information regarding the first OPP and the first patient therapy.

[0124] In Example 50, the subject matter of Examples 42-49 can optionally include determining the health index using information regarding the patient's cerebrospinal fluid pressure characteristics. In Example 51, Examples 42-50 can optionally include receiving the BP characteristic information including receiving the blood pressure information from a sensor on a contact lens worn by the patient.

[0125] In Example 52, the subject matter of Examples 42-51 can optionally include a second IOP characteristic information receiving step receiving information regarding a subsequent second IOP characteristic of the patient, and the health index determining step including a step of receiving information regarding a subsequent second BP characteristic of the patient, and a step of using information regarding a difference between the first IOP characteristic and the second IOP characteristic and a step of using information regarding a difference between the first BP characteristic and the second BP characteristic.

[0126] In Example 53, the subject matter of Example 52 can optionally include the information regarding the first IOP characteristic corresponding to a first IOP measurement event and the information regarding the second IOP characteristic corresponding to a subsequent second IOP measurement event, and the patient therapy information receiving step includes receiving information regarding a therapy provided to the patient between the first IOP measurement event and the second IOP measurement event.

[0127] In Example 54, the subject matter of Examples 52-53 can optionally include the first IOP characteristic information receiving step and the second IOP characteristic information receiving step including receiving the information over one or more nighttime monitoring periods.

[0128] In Example 55, the subject matter of Examples 52-54 can optionally include the first IOP characteristic information receiving step and the second IOP characteristic information receiving step including receiving the information over one or more daytime monitoring periods.

[0129] In Example 56, the subject matter of Examples 52-55 can optionally include said health index determining step including determining a new index value at least every 30 days. In Example 57, the subject matter of Examples 42-56 can optionally include the information regarding the first IOP characteristic indicating IOP information for the patient over a first interval, the information regarding the first BP characteristic indicating BP information for the patient over the same first interval, and the information regarding the first patient therapy indicating therapy information corresponding to the same first interval.

[0130] In Example 58, the subject matter of Examples 42-57 can optionally include receiving information regarding patient-reported visual field from a patient interface and determining the health index using the information regarding the patient-reported visual field.

[0131] In Example 59, the subject matter of Examples 42-58 can optionally include substantially simultaneously measuring the first IOP characteristic and the first BP characteristic of the patient. In Example 60, the subject matter of Examples 42-59 can optionally include generating treatment recommendations for the patient based on the eye health index, and the treatment recommendations can be implemented at least in part by the patient treatment system.

[0132] In Example 61, the subject matter of Examples 42-60 can optionally include a treatment parameter updating step that updates treatment parameters used by the patient treatment system to provide subsequent therapy to the patient.

[0133] In Example 62, the subject matter of Example 61 can optionally include updating the treatment parameters including updating a glaucoma therapy frequency or duration for the patient.

[0134] In Example 63, the subject matter of Examples 42-62 can optionally include a step of communicating a therapy plan to the patient based on the eye health index, the therapy plan comprising or using the patient treatment system or one or more sensors coupled to the patient treatment system.

[0135] In Example 64, the subject matter of Examples 42-63 can optionally include receiving patient-reported status information from a patient interface regarding one or more of the patient's weight, the patient's body mass index (BMI), the patient's eating habits or changes in eating habits, the patient's medication regimen, and the patient's medication regimen compliance, and the health index determination step includes using the patient-reported status information.

[0136] In Example 65, the subject matter of Examples 42-64 can optionally include automatically reporting the eye health index to a remote patient monitoring system. In Example 66, the subject matter of Example 65 can optionally include receiving from the remote patient monitoring system, in response to the reported eye health index, instructions that enable the patient treatment system to initiate a new therapy for the patient, instructions to continue a previous therapy for the patient, or instructions to inhibit delivery of a therapy to the patient.

[0137] In Example 67, the subject matter of Examples 65-66 can optionally include a step of requesting patient-reported status information regarding one or more of the patient's weight, the patient's body mass index (BMI), the patient's dietary habits or changes in dietary habits, the patient's medication regimen, and the patient's medication regimen compliance in response to the reported eye health index.

[0138] Example 68 is one or more machine-readable media comprising instructions that, when executed by a processor circuit, cause the processor circuit to perform operations to implement any of Examples 1-21 or 42-67.

[0139] Example 69 is an apparatus comprising means for implementing any of Examples 1-67. Example 70 is a system that implements any of Examples 1-67. Each of these non-limiting examples can exist alone or can be combined in various permutations or combinations with one or more of the other examples.

[0140] The above description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention may be practiced. These embodiments are also referred to herein as "examples." Such examples may include elements in addition to those shown or described. However, the inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the inventors also contemplate examples that use any combination or permutation of those elements (or one or more aspects thereof) shown or described with respect to a particular example (or one or more aspects thereof), or with respect to any other example (or one or more aspects thereof) shown or described herein.

[0141] In the event of a conflict of usage between this document and any document so incorporated by reference, the usage in this document shall prevail. As used herein, the terms "a" or "an" are used, as is common in patent documents, to include one or more, independent of any other instance or use of "one or more" or "one or more." As used herein, the term "or" is used to refer to non-exclusion, such that, unless otherwise indicated, "A or B" includes "A but not B," "B but not A," and "A and B." As used herein, the terms "including" and "in which" are used as the plain-English equivalents of the respective terms "comprising" and "wherein." Also, in the following claims, the terms "including" and "comprising" are open-ended, i.e., systems, devices, articles, compositions, formulations, or processes that include elements in addition to the elements recited after such terms in a claim are still considered to be within the scope of that claim. Moreover, in the following claims, the terms "first," "second," and "third," etc., are used as labels only and are not intended to impose numerical requirements on their objects.

[0142] The above description is intended to be illustrative, not limiting. For example, the above examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments may be utilized, for example, by those of ordinary skill in the art who review the above description. The Abstract is provided in accordance with 37 C.F.R. §1.72(b) to allow the reader to quickly ascertain the nature of the technical disclosure. The Abstract is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be construed as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in fewer than all features of a particular disclosed embodiment. Accordingly, the following claims are hereby incorporated into the Detailed Description as an example or embodiment, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention is to be determined with reference to the appended claims, along with the full range of equivalents to which such claims are entitled.

Claims

1. 1. A patient treatment system for determining an Ocular Health Index (OHI) value representative of a patient's ocular health or disease state, comprising: a processor circuit, the processor circuit comprising: receiving a first indication of intraocular pressure (IOP) in the patient's eye over a first time interval and a first indication of systemic blood pressure (BP) from the patient over the first time interval, the first time interval occurring prior to administering a therapy to the patient's eye; receiving a second indication of IOP in the patient's eye over a second time interval and a second indication of systemic BP from the patient over the second time interval, the second time interval occurring after administering the therapy to the patient's eye; determining an IOP difference between the received first indicator of IOP and the received second indicator of IOP; determining a BP difference between the received first indicator of systemic BP and the received second indicator of systemic BP; generating the OHI value based at least in part on the determined IOP difference and the determined BP difference to determine an effect of the therapy on the patient's eye.

2. The patient treatment system of claim 1 , wherein the processor circuitry is configured to determine an indicator of glaucoma disease progression based on the OHI value.

3. The patient treatment system of claim 1 , wherein the OHI value is an index of ocular perfusion pressure (OPP).

4. The patient treatment system of claim 1 , wherein the processor circuitry is configured to determine the OHI value based at least in part on information related to the therapy provided to the patient.

5. 10. The patient treatment system of claim 1, wherein the therapy administered to the patient's eye includes one or more of a goggle-based therapy and a drug delivery therapy.

6. The patient treatment system of claim 5 , wherein the therapy administered to the patient's eye is the goggle-based therapy.

7. 7. The patient treatment system of claim 6, wherein the processor circuitry is configured to determine the OHI value based at least in part on information related to the goggle-based therapy provided to the patient.

8. The patient treatment system of claim 5 , wherein the therapy administered to the patient's eye is the drug delivery therapy.

9. 10. The patient care system of claim 1, further comprising a patient interface configured to identify a field of view of the patient, the patient interface comprising one or more of a virtual reality (VR) headset and other head-mounted system.

10. goggles configured to fit over the patient's eyes to form cavities over the patient's eyes; 10. The patient treatment system of claim 1, further comprising: a pump in communication with the cavity and configured to affect fluid pressure in the cavity.

11. 10. The patient care system of claim 9, wherein the patient interface is the VR headset.

12. 10. The patient care system of claim 9, wherein the patient interface is a head-mounted system other than a VR headset.

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