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Article History

Received: 26 October 2025

Revised: 27 April 2026

Accepted: 7 May 2026

First Online: 19 May 2026

Conflict of interest

: Angus IG Ramsay is a trustee at Health Services Research UK and supported by the NIHR Central London Patient Safety Research Collaboration. Juan Carlos Bazo-Alvarez reports salary support from the National Institute for Health and Care Research (NIHR) Three Research Schools Mental Health Programme (grant reference number: MHF012). Helen Baker is employed by the National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. Jocelyn Cammack is employed by the NIHR BRC at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. Caroline S Clarke has an honorary research associate contract with Moorfields Eye Hospital NHS Foundation Trust (required for receiving data for another aspect of the HERCULES project). Sir Peng Tee Khaw is Co-Director of the NIHR BRC at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology; he has an honorary contract with Moorfields Eye Hospital NHS Foundation Trust; he is also supported by the Helen Hamlyn Trust, the Nolan Family, the Katz Foundation and reports consulting and lecturing at Aerie Pharmaceuticals and consulting for Novartis, Thea, Glaukos, Santen, Genentech, CMER Hospital Group, Hong Kong Alcon, ISA RNA Therapeutics GmbH; he was also on the Advisory Boards for Novartis, DrugTech, Santen, CRICK Institute Translational Advisory Group, and Decisions on health Care to Introduce or Diffuse innovations using Evidence (DECIDE). Steve Napier is a patient and public involvement and engagement (PPIE) volunteer at the NIHR BRC at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. At the time of drafting this manuscript, Steve Napier was affiliated with Janes, a global open-source intelligence company specialising in military, national security, aerospace and transport. This relationship had no influence on the design, conduct, analysis, or reporting of this study; all PPIE activities were conducted independently and transparently with appropriate safeguards to ensure the integrity of public involvement. Siyabonga Ndwandwe has an honorary research associate contract with Moorfields Eye Hospital NHS Foundation Trust (required for receiving data for another aspect of the HERCULES project). Hari Jayaram is employed by Moorfields Eye Hospital NHS Foundation Trust; he has consulted for Allergan, Alcon, Ivantis, Scope Ophthalmics, and Rebio; received honoraria for lectures and educational events from Allergan, Laboratoires Théa, and Santen; received support to attend meetings from Allergan; participated on an Advisory Board for Allergan; receives research funding via UCL from Santen. Sobha Sivaprasad is employed by Moorfields Eye Hospital NHS Foundation Trust; she reports receiving research grants from Novartis, Bayer, Allergan, Roche, Boehringer, Ingelheim and Optos plc, travel grants from Novartis, Bayer, speaker fees from Novartis, Bayer and Optos plc, and attending advisory board meetings for Novartis, Bayer, Allergan, Roche, Boehringer, Ingelheim, Optos plc, Apellis, Oculis and Eyebiotech. Paul J Foster has an honorary contract with Moorfields Eye Hospital NHS Foundation Trust, and reports personal fees from Abbvie, Allergan, AlphaSights, Carl Zeiss, DeepMind, Google Health, GLG, Guidepoint, PwC and Santen, as well as a grant from Alcon, all outside the submitted work. Naomi J Fulop is an NIHR Senior Investigator, a Non-Executive Director at Covid-19 Bereaved Families for Justice UK (August 2022 - present), and a Member of National Emergencies Trust Advisory Board (September 2025 - present). She was a Non-Executive Director at Whittington Health NHS Trust until October 2024, a trustee at Health Services Research UK until 2022, a member of the UKRI and NIHR College of Experts for Covid-19 Research Funding (2020), the NIHR Health Services and Delivery Research (HS&DR) Programme Funding Committee (2013-2018), and the HS&DR Evidence Synthesis Sub Board (2016). All other authors report no conflicts.