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15 July 2026

Digital twins and personalised medicine: A peek into the future of healthcare

We previously introduced Dr Giovanni Montesano, the recipient of our first ever Pitts Crick Career Development Fellowship. He spoke at a recent digital glaucoma support group, describing his research and the difference it might make to glaucoma care. It was a fascinating session, so we thought we’d write up a summary of the key points covered.

Giovanni is a glaucoma consultant at Moorfields Eye Hospital with a strong research background. He began his medical training in Italy, but moved to the UK to complete his PhD and specialist clinical and surgical training. His main research interests are finding and building better ways to predict glaucoma change over time and how patients respond to different treatments.

We’ve supported Giovanni with two grants so far. In 2023 we awarded him a Royal College of Ophthalmologists project grant (worth just under £100,000), called A path to personalised glaucoma care: mapping clinical trial and real-world outcomes to individuals.

And in 2024, he became the first recipient of our Pitts Crick Career Development Fellowship. The aim of that grant, worth £425,000 over three years, is to support him to build his research team and tools needed to take this work forward. His project is called Digital Twins in Glaucoma: advanced modelling for personalised medicine.

A virtual you

Think of a digital twin as a really detailed “virtual version” of you (or your eye) on a computer. It pulls together your own test results—like visual field tests, scans and clinic information—and combines that with what scientists know about how glaucoma works. The goal is to use that mix to make sensible predictions about what might happen next, and what different treatment choices could mean for you.

In a typical glaucoma appointment, the advice given to you has to be based on the best available evidence, which is currently based on what happens, on average, in big clinical studies. A digital twin could help make that conversation much more personal. For example, it could help you explore questions like:

  • “What if I don’t have any treatment for now?”
  • “What if I start drops?”
  • “What if I choose laser or surgery?”

It could also help with practical things like how often you might need your appointments, based on how likely you are to lose vision. And because it can learn from what actually happens over time, it could become more accurate as your glaucoma journey continues. It wouldn’t replace the consultation with your specialist, but it would help them give more personalised advice and answers to your questions.

The two projects we’re funding have significant overlaps, and some of Giovanni’s findings from the first grant are being fed directly into the development of digital twin models, as well as generating significant interest in their own right.

Some highlights are:

  • The relationship between eye pressure and glaucoma getting worse isn’t a linear one. The risk of losing vision doubles for every 10 mmHg increase in pressure. What that means is decreasing someone’s eye pressure from 40 mmHg to 30 mmHg has four times the benefit compared to reducing from 20 mmHg to 10 mmHg.
  • Different treatments appear to protect vision differently, even when they end up with similar pressures.
    • The LiGHT trial investigated whether laser treatment or eye drops were better as a first treatment for glaucoma. The original findings showed that they both resulted in similar eye pressures and quality of life. However, vision loss was almost 30% slower on average in the group who received laser treatment, compared to the group who used eye drops.
    • The TAGS trial investigated whether eye drops or trabeculectomy (surgery) were better for people newly diagnosed with advanced glaucoma. Even though both groups attained the same eye pressure, people who had surgery lost vision almost 40% more slowly than people using drops.
  • The reason for these findings is still being investigated, but it may be that non-drop treatments provide more consistent pressure lowering compared to eye drops. This reduces fluctuations in eye pressure, which may protect the optic nerve.
  • Treatments for other diseases might also be having an effect on glaucoma. For example, real-world clinic data from over 14,000 patients suggest that patients taking calcium channel blockers (a blood pressure medicine) may show slower progression of their glaucoma. This is surprising, as previous findings suggested the opposite – that there may be a link between calcium channel blockers and a higher risk of developing glaucoma. Digital twin models might help investigate these discrepancies.
  • These findings show why “one-size-fits-all” glaucoma care doesn’t work well for everyone. Some people don’t get worse for a long time, even without treatment, while others can still progress despite treatment. It also suggests that it’s not just about one pressure reading. Things like how pressure changes during the day and night, how consistent the pressure control is, the type of treatment, and other health factors (including other medicines) may all matter. A digital twin is a way of bringing all those pieces together, so care and monitoring can be more tailored to the individual.

Giovanni told us that since starting his project, he has got even more enthusiastic about digital twins. “There are challenges in tackling such a complex project. But we’re building it in a modular way, adding components and data as we go. That helps keep the momentum and the motivation because we are getting exciting results each step of the way. I am really looking forward to seeing the first implementations being tested.”

Giovanni’s research is very exciting. His findings are already having an impact, and we believe digital twins could improve your glaucoma care in future. However, this kind of research is based on clinical data, such as eye pressures and visual field test results. Currently, we don’t capture enough data on your experiences, and how it feels to navigate the glaucoma care system. That’s the gap we’re working to fill through the Glaucoma UK National Patient Voices Survey. By gathering experiences at scale, we can give researchers, decision‑makers and care providers the insight they need to help build a glaucoma care system that works better for you. We hope you’ll take part.

This work is still in the research stage. A “digital twin” isn’t something that’s used in routine glaucoma clinics yet, and it will only support, not replace, your clinician’s advice. The examples shared here are from research studies and large datasets and need further testing before they can guide individual care. It’s likely to be at least 10 years until digital twins might be used in routine glaucoma appointments.

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