In the first part of his Clinical Innovation series, Josh Mali, MD, shares how this novel home-use device is the new standard of care for AMD monitoring. Future blogs in the series will discuss the increased efficacy of patient monitoring and present case examples.
Additionally, patients who triggered an alert between office visits lost a mean of three letters of vision compared with an average of nine letters of vision lost in the control group. Finally, patients in the standard-of-care group had CNV lesions that were about 300% larger than the cohorts. As healthcare providers, our plan for monitoring these patients’ progression needs to be more regimented than sending them home with a lined piece of paper and instructing them to call us if they notice a vision change in either eye. Although the Amsler grid has certainly helped many patients, its sensitivity fluctuates based on individual patient variability, leaving its true ability to detect visual changes at somewhere between 34% and 56%.IV,V
Preferential hyperacuity perimetry (PHP) is a newer technology that detects minute changes in the central visual field with a sensitivity of 80%. The device uses PHP and was cleared by the FDA as a home- monitoring device in 2009.
Even with relatively frequent visits, the greatest probability remains that dry AMD patients will convert to wet AMD between routinely scheduled visits. Thus, frequent and regular home-screenings with highly sensitive technology is a necessary component in protecting our patients’ vision.
The device provides at-home monitoring and takes the pressure off the patient since it acts as a safety net to detect vision changes between regularly scheduled visits. My patients can feel confident that the machine will automatically detect significant changes in metamorphopsia and will alert me electronically, allowing me to have a significantly better chance of preserving their vision and their quality of life. Ultimately, patients who are reassured that they are being monitored consistently feel better about their disease, and I truly believe this results in a happy patient.
Joshua Mali, MD, is a board-certified ophthalmologist and award-winning vitreoretinal surgeon at The Eye Associates, a private multispecialty ophthalmology practice in Sarasota, FL. He can be reached at 941-923-2020.
Dr. Mali is currently a consultant and speaker for Notal Vision, Inc.
I Wong WL, Su X1, Li X, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. Lancet Glob Health. 2014;2(2):e106-16.
II Cheung LK, Eaton A. Age-related macular degeneration. Pharmacotherapy. 201;33:838-855.
III AREDS2-HOME Study Research Group, Chew EY, Clemons TE, Bressler SB, et al. Randomized trial of a home monitoring system for early detection of choroidal neovascularization home monitoring of the Eye (HOME) study. Ophthalmology. 2014;121:535-544.
IV Schuchard RA. Validity and interpretation of Amsler grid reports. Arch Ophthalmol. 1993;111:776-780.
V Loewenstein A, Malach R, Goldstein M, et al. Replacing the Amsler grid: a new method for monitoring patients with age-related macular degeneration. Ophthalmology. 2003;110:966-970.