Clinical Use of Home OCT Data to Manage Neovascular Age-Related Macular Degeneration

Jeffrey S Heier¹, Yingna Liu^{1

2}, Nancy M Holekamp³, Mohsin H Ali⁴, Konstantin Astafurov⁵, Kevin J Blinder⁶, Miguel A Busquets⁷, Moises A Chica⁸, Michael J Elman⁹, Jordana G Fein⁴, Paul Hahn¹⁰, Nikolas London¹¹, Thomas Margolis¹², Yasha S Modi¹³, Aleksandra Rachitskaya¹⁴, Eric W Schneider¹⁵, Glenn L Stoller¹⁶, Jay C Wang¹⁷, Ankoor R Shah¹⁸

Affiliations

¹ Ophthalmic Consultants of Boston, Boston, MA, USA.
² New England Eye Center, Tufts Medical Center, Boston, MA, USA.
³ Pepose Vision Institute, St. Louis, MO, USA.
⁴ Retina Group of Washington, Washington, DC, USA.
⁵ Monmouth Retina Consultants, Belleville, NJ, USA.
⁶ The Retina Institute, St. Louis, MO, USA.
⁷ Retina Associates of Kentucky, Lexington, KY, USA.
⁸ Retina Consultants of Texas, San Antonio, TX, USA.
⁹ Elman Retina Group P.A., Rosedale, MD, USA.
¹⁰ NJ Retina, Belleville, NJ, USA.
¹¹ Retina Consultants San Diego, Poway, CA, USA.
¹² Retinal and Ophthalmic Consultants, Northfield, NJ, USA.
¹³ New York University Langone Health, New York, NY, USA.
¹⁴ Cleveland Clinic Cole Eye Institute, Cleveland, OH, USA.
¹⁵ Tennessee Retina, Nashville, TN, USA.
¹⁶ Ophthalmic Consultants of Long Island, Long Island, NY, USA.
¹⁷ Northern California Retina Vitreous Associates, Mountain View, CA, USA.
¹⁸ Retina Consultants of Texas, Houston, TX, USA.

PMID: 39654701
PMCID: PMC11625398
DOI: 10.1177/24741264241302858

Clinical Use of Home OCT Data to Manage Neovascular Age-Related Macular Degeneration

Jeffrey S Heier et al. J Vitreoretin Dis. 2024.

. 2024 Dec 7:24741264241302858.

doi: 10.1177/24741264241302858. Online ahead of print.

Authors

Affiliations

¹ Ophthalmic Consultants of Boston, Boston, MA, USA.
² New England Eye Center, Tufts Medical Center, Boston, MA, USA.
³ Pepose Vision Institute, St. Louis, MO, USA.
⁴ Retina Group of Washington, Washington, DC, USA.
⁵ Monmouth Retina Consultants, Belleville, NJ, USA.
⁶ The Retina Institute, St. Louis, MO, USA.
⁷ Retina Associates of Kentucky, Lexington, KY, USA.
⁸ Retina Consultants of Texas, San Antonio, TX, USA.
⁹ Elman Retina Group P.A., Rosedale, MD, USA.
¹⁰ NJ Retina, Belleville, NJ, USA.
¹¹ Retina Consultants San Diego, Poway, CA, USA.
¹² Retinal and Ophthalmic Consultants, Northfield, NJ, USA.
¹³ New York University Langone Health, New York, NY, USA.
¹⁴ Cleveland Clinic Cole Eye Institute, Cleveland, OH, USA.
¹⁵ Tennessee Retina, Nashville, TN, USA.
¹⁶ Ophthalmic Consultants of Long Island, Long Island, NY, USA.
¹⁷ Northern California Retina Vitreous Associates, Mountain View, CA, USA.
¹⁸ Retina Consultants of Texas, Houston, TX, USA.

PMID: 39654701
PMCID: PMC11625398
DOI: 10.1177/24741264241302858

Abstract

Purpose: To investigate how home optical coherence tomography (OCT) influences the clinical decision-making of retina specialists for the management of neovascular age-related macular degeneration (nAMD). Methods: In this retrospective imaging review, 15 retina specialists each evaluated 10 home OCT data segments from 29 eyes being treated for nAMD. Based on OCT data, indications were identified for when eyes should be treated, which antivascular endothelial growth factor should be used, and the specific retinal fluid and time thresholds for notification. Results: Withholding treatment was recommended in 64 (42.7%) of 150 data segments (95% CI, 34.7-50.6), whereas 100% of eyes received treatment on the last day of each data segment. Treatment was recommended in 86 cases (57.3%), with treatment occurring 7 or more days before the actual treatment was advised in 52 (60.5%) of 86 data segments. This earlier treatment would have prevented the accumulation of intraretinal fluid (IRF), subretinal fluid (SRF), and total retinal fluid for 69.1 nL, 162.2 nL, and 231.2 nL days. Retina specialists chose a different type of treatment agent in 35 (40%) of 86 cases. The following notification values were set: IRF, mean 9.8 ± 14.9 nL (median, 5; IQR, 5); SRF, mean 10.2 ± 16.1 nL (median, 5.5; IQR, 5); total retinal fluid, mean 15.2 ± 24.0 nL (median, 10; IQR, 5). The time-based notification interval was set at a mean of 34.7 ± 21.9 days (median, 30; IQR, 2). Conclusions: Home OCT-based decision-making by retina specialists differed substantially from actual clinical care. Home OCT has the potential to facilitate personalized care in nAMD.

Keywords: artificial intelligence; home OCT; imaging review; neovascular age-related macular degeneration; optical coherence tomography; overtreatment; remote monitoring; retina specialists; telemedicine; undertreatment.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: G: Grant, C: Consultant, H: Honorarium, T: Travel Support, S: Shareholder: A: Advisory or Safety Board Member, L: Leadership. JSH: 4D Molecular Therapuetics (G,C,S), Annexon (G,C), Apellis (G,C), AsclepiX Therapeutics (G,C), Ashvattha (G), Bayer (G), Cognition Therapeutics (G), Curacle (G,C), Genentech/Roche (G,C), Gyroscope Therapeutics (G,C), Iveric Bio (G,C), Janssen R&D (G,C), Kodiak (G), NGM (G,C), Novartis (G,C), OcuTerra (G,C), Perceive Bio (G), Regeneron Pharmaceuticals (G,C), RegenexBio (G,C), Abpro (C), Adverum (C,S), AffaMed Therapeutics (C), Applied Genetics Technologies Corporation (C), Akouos (C), Aviceda (C,S), Bausch + Lomb (C), Biovisics (C), Clearside (C), DTx Pharma (C,S), Exegenesis (C), Glaukos (C), Gyroscope Therapeutics (C), Immunogen (C), jCyte (C,S), Kriya (C), Nanoscope (C), Notal Vision (C), Ocular Therapeutix (C,L), Ocuphire (C,S), OliX (C), ONL Therapeutics (C), Outlook Therapeutics (C), Palatin Technologies (C), Perceive Biotherapeutics (C), Ray Therapeutics (C), RetinAI (C), RevOpsis Therapeutics (C,S), Stealth BioTherapeutics (C), Théa Pharmaceuticals (C), Vanotech (C), Aldeyra Therapeutics (S), Allegro (S), Vinci Pharmaceuticals (S), Vitranu (S); YL: Genentech (H), Horizon Therapeutics (H), Apellis Pharmaceuticals (H), Regeneron Healthcare Solutions (H), Notal Vision (T), Center for Eye Research and Education (T); NMH: Notal Vision (G,A,S);MHA: Notal (M), Alimera Science (C), Abbvie (C); KJB: Notal Vision (M), Regeneron (C,H), Genentech (C,H), Bausch & Lomb (C,H), Biogen (C); MAB: Notal Vision (M,C,H,T); MAC: Notal Vision (M,C); MJE: Notal Vision (G, T); JGF: Notal Vision (M), Roche (C, A, H), Regeneron (C, A, H); PH: Notal Vision (M), Adverum (G,C), Apellis (G,C,A), Eyepoint (G,C,H,A), Genentech (G,C,H,A), Regeneron (G), RegenxBio (G), Samsara (G), Alcon (C,A), DORC (C,A), ASRS (L); NL: Notal Vision (M), Roche (C), Regeneron (C,A), RegenxBio, (C), Ionis (C), Apellis (C,H), Annexon (C), Genentech (H,A), Iveric Bio (H), EyePoint Pharmaceuticals (A), Opthea (A); TM: Notal Vision (M); YSM: Notal Vision (C), Alimera (C), Allergan (C), Genentech (C), DORC (C), Thea (C), Zeiss (C), Iveric Bio (C), Apellis, Regeneron (C); AR: AGTC (G), Apellis Pharmaceuticals (G,C,), DRCR Retina Network (G), Roche/Genentech (G,C), Abbvie/Allergan (C), Alcon (C), Regeneron (C), Iveric Bio (C), Ocular Therapeutix (C); EWS: Notal Vision (M,C), Carl Zeiss (C); JCW: Genetech (C,A), Carl Zeiss (C); ARS: Notal Vision (M,C), RegenxBio (C), Regeneron (C), Apellis (S). The sponsor of the study is a provider of home OCT monitoring services.

Figures

**Figure 1.**
Home optical coherence tomography (OCT) web viewer interface for data review. An example of a home OCT data segment is shown. Day 0 is the day the patient received the last treatment. Day 43 is the day the patient received the next treatment. The retina specialists were asked to determine whether they would offer a treatment during this time period and if so, which day and what treatment. They were only allowed to offer a treatment at least 28 days from the previous one.

**Figure 2.**
The number and percentage of times when a retina specialist decided not to treat the patient based on the home optical coherence tomography (OCT) data but the patient did receive treatment in actual care based on in-clinic OCT data alone.

**Figure 3.**
The time difference between home OCT–guided treatment and the actual treatment in cases in which retina specialists decided to treat the patient earlier, as shown by each individual retina specialist. Abbreviations: LQ, lower quartile; OCT, optical coherence tomography; UQ, upper quartile.

**Figure 4.**
The distribution of retinal fluid notification thresholds for volume of intraretinal fluid (IRF), subretinal fluid (SRF), and total retinal fluid (TRF) as determined by 15 retina specialists across 6 different eyes.

See this image and copyright information in PMC

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Clinical Use of Home OCT Data to Manage Neovascular Age-Related Macular Degeneration

Affiliations

Clinical Use of Home OCT Data to Manage Neovascular Age-Related Macular Degeneration

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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