Designing for patient empowerment: The application of multiple perspective problem framing in the development of Noctura 400 sleep mask

Medical technologies, especially self-administered interventions, have a critical role to play in addressing health service challenges: they can reduce the need for hospital-based surgical interventions and associated risk of infection, whilst also supporting patient empowerment (Cutler, 2007; García-Lizana & Sarría-Santamera, 2007). Additionally, during the Covid-19 pandemic, the burden on the NHS has been unprecedented (Willan et al., 2020), increasing the demand on limited resource leading to long waiting lists for hospital admissions (Smith et al., 2014).

This paper investigates a case study focussing on the design and ongoing development of the Noctura 400 sleep mask: a self-administered, non-invasive treatment for diabetic retinopathy (DR) and diabetic macular oedema (DMO) through the usage of a low level, controlled wavelength nocturnal light source. The mask, which has been developed by PolyPhotonix Ltd, can replace the need and eliminate the risk of regular surgical interventions involving laser treatment and injections into the patient’s eye. Scatter Laser Photocoagulation is associated with possible complications such as vision loss, diminished visual field and reduction in colour vision and contrast (Huamonte et al.,1976), whilst eye injections can lead to complications such as peripheral retinal tear, postoperative rhegmatogenous retinal detachment, hard exudates in the centre of the macula, and neovascular glaucoma haemorrhage (Yamamoto et al., 2003).

This paper explores the application of a Multiple Perspective Problem Framing (MPPF) method, which was used to analyse the relationship of factors influencing patient behaviour alongside technological and medical parameters. This method involved a synthesis of medical research, technological innovation, human factors and functional considerations, sleep patterns and habits, product/service requirements, stakeholder networks, and change factors particularly relating to diabetes. By modelling the interrelationship of these parameters, a novel configuration of factors was identified. This unique configuration is described in the claims of a patent (granted internationally) and underpins the development of the Noctura 400 treatment.

A recent study of the Noctura 400 sleep mask, from Ashford and St Peter’s NHS Hospital, saw 94% of patients achieve a beneficial outcome, with 66% enjoying stabilisation of their eyesight (preventing further degeneration) and 32% experiencing measurable improvement in their eyesight. The outcome of this study may lead to DR and DMO patients being supported to manage their own treatment whilst avoiding the burden and risks of surgical interventions. The study also validates the efficacy of a new self-administered treatment paradigm that frees health services of much of the clinical and financial burden of treating DR and DMO.