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Comment
. 2024 Jun 1;142(6):512-520.
doi: 10.1001/jamaophthalmol.2024.0918.

Home-Monitoring Vision Tests to Detect Active Neovascular Age-Related Macular Degeneration

Ruth E Hogg  1 , Sobha Sivaprasad  2 , Robin Wickens  3 , Sean O'Connor  1 , Eleanor Gidman  3 , Elizabeth Ward  3 , Charlene Treanor  1 , Tunde Peto  1 , Ben J L Burton  4 , Paul Knox  5 , Andrew J Lotery  6 , Michael Donnelly  1 , Chris A Rogers  3 , Barnaby C Reeves  3
Affiliations
Comment

Home-Monitoring Vision Tests to Detect Active Neovascular Age-Related Macular Degeneration

Ruth E Hogg et al. JAMA Ophthalmol. .

Abstract

Importance: Most neovascular age-related macular degeneration (nAMD) treatments involve long-term follow-up of disease activity. Home-monitoring would reduce the burden on patients and their caregivers and release clinic capacity.

Objective: To evaluate 3 vision home-monitoring tests for patients to use to detect active nAMD compared with diagnosing active nAMD at hospital follow-up during the after-treatment monitoring phase.

Design, setting, and participants: This was a diagnostic test accuracy study wherein the reference standard was detection of active nAMD by an ophthalmologist at hospital follow-up. The 3 home-monitoring tests evaluated included the following: (1) the KeepSight Journal (KSJ [International Macular and Retinal Foundation]), which contains paper-based near-vision tests presented as word puzzles, (2) the MyVisionTrack (mVT [Genentech]) vision-monitoring mobile app, viewed on an Apple mobile operating system-based device, and (3) the MultiBit (MBT [Visumetrics]) app, viewed on an Apple mobile operating system-based device. Participants were asked to test weekly; mVT and MBT scores were transmitted automatically, and KSJ scores were returned to the research office every 6 months. Raw scores between hospital follow-ups were summarized as averages. Patients were recruited from 6 UK hospital eye clinics and were 50 years and older with at least 1 eye first treated for active nAMD for at least 6 months or longer to a maximum of 42 months before approach. Participants were stratified by time since starting treatment. Study data were analyzed from May to September 2021.

Exposures: The KSJ, mVT, and MBT were compared with the reference standard (in-hospital ophthalmologist examination).

Main outcomes and measures: Estimated area under receiver operating characteristic curve (AUROC). The study had 90% power to detect a difference of 0.06, or 80% power to detect a difference of 0.05, if the AUROC for 2 tests was 0.75.

Results: A total of 297 patients (mean [SD] age, 74.9 [6.6] years; 174 female [58.6%]) were included in the study. At least 1 hospital follow-up was available for 312 study eyes in 259 participants (1549 complete visits). Median (IQR) home-monitoring testing frequency was 3 (1-4) times per month. Estimated AUROC was less than 0.6 for all home-monitoring tests, and only the KSJ summary score was associated with lesion activity (odds ratio, 3.48; 95% CI, 1.09-11.13; P = .04).

Conclusions and relevance: Results suggest that no home-monitoring vision test evaluated provided satisfactory diagnostic accuracy to identify active nAMD diagnosed in hospital eye service follow-up clinics. Implementing any of these evaluated tests, with ophthalmologists only reviewing test positives, would mean most active lesions were missed, risking unnecessary sight loss.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Hogg reported receiving advisory board fees from Roche and grants from Okko Health outside the submitted work. Dr Sivaprasad reported receiving advisory board and/or data safety monitoring committee fees from Bayer, AbbVie, Novartis, Roche, Apellis, Biogen, Eyebiotech, Kriya Therapeutics, Sanofi, Ocular Therapeutics, Eyepoint, Johnson & Johnson, Amgen, Stealth Biotherapeutics, and OcuTerra and grants from Boehringer Ingelheim outside the submitted work. Dr Peto reported receiving grants from Novartis and Boehringer Ingelheim; consulting fees from Boehringer Ingelheim, Novartis, Apellis, Bayer, Oxurion, Roche, and Sandoz; and speaker/advisory board fees from Boehringer Ingelheim, Bayer, Roche, Apellis, Sandoz, Heidelberg, Zeiss, and Optos during the conduct of the study. Dr Burton reported receiving funding from Lumithera; consultant/travel fees from Bayer and Roche;, advisory board fees from Bayer and Roche; and serving as president of the Royal College of Ophthalmologists and adviser to the National Institute for Clinical Excellence during the conduct of the study. Dr Knox reported receiving software support from Vital Art & Science Inc during the conduct of the study. Dr Lotery reported receiving equity from Gyroscope Therapeutics outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Example of a Page From the KeepSight Journal (KSJ [International Macular and Retinal Foundation])
A page in the KSJ contains a near visual acuity puzzle (A) and an environmental Amsler test including a modified Amsler grid (B).
Figure 2.
Figure 2.. Example of the Content of Electronic Visual Games
A, At-home vision monitoring mobile app, MyVisionTrack (mVT [Genentech]). B, Electronic software application, MultiBit Test (MBT [Visumetrics]).
Figure 3.
Figure 3.. Chart Showing the Flow of Patients Through the Study
Figure 4.
Figure 4.. Diagnostic Accuracy Receiver Operating Characteristic Curves and Area Under the Receiver Operating Characteristic Curve (AUROC)
A, Primary reference standard, using all test data available between visits (primary analysis). B, Primary reference standard, using test data from previous 4 weeks only (sensitivity analysis 1). C, Alternative reference standard (reading center–graded optical coherence tomography scans). The parentheses include the lower and upper range of the 95% CIs. KSJ indicates KeepSight Journal; MBT, MultiBit Test; mVT, MyVisionTrack.
See this image and copyright information in PMC

Comment on

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