Current status of home monitoring technology for age-related macular degeneration

Abstract

Purpose of review: Evidence suggests that patients present with exudative age-related macular degeneration (AMD) in a delayed fashion. Increased lesion size associated with this delay directly impacts visual acuity. Upon treatment initiation, patients are monitored largely with optical coherence tomography (OCT) technology to determine the need for treatment. Home-monitoring systems using preferential hyperacuity perimetry (PHP) and OCT may optimize management.

Recent findings: Comparison of Age-related Macular Degeneration Treatment Trials study and American Academy of Ophthalmology's Intelligent Research in Sight registry data suggest smaller lesion size and better visual acuity upon choroidal neovascularization (CNV) capture are associated with better final visual acuity with therapy. The HOME study and recent PHP-based ForeseeHome data indicate that this modality leads to earlier detection of CNV. Results of a real-world data analysis demonstrate 82% retention of ≥20/40 vision with median visual acuity of 20/40 at time of CNV detection using PHP home-monitoring. Home OCT data suggests excellent patient useability, with >90% of patients obtaining analyzable images. The Notal OCT Analyzer demonstrates superiority over human interpreters regarding the ability to detect intraretinal and subretinal fluid (82% vs. 47% sensitivity).

Summary: PHP may improve treatment outcomes for exudative AMD by allowing for earlier detection of lesions. Home OCT platforms could allow for more convenient monitoring of patients undergoing treatment for exudative AMD and better enable true PRN models.