Editor’s Note: Welcome to “Eye Catching: Let's Chat,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The views expressed in these blogs are those of their respective contributors and do not represent the views of Ophthalmology Times or UBM Medica. This is part two of a three-part Clinical Innovations series discussing the benefits of incorporating an at-home monitoring system for patients with AMD. Joshua Mali, MD, is a vitreoretinal surgeon at The Eye Associates, a private multispecialty ophthalmology practice in Sarasota, FL.
Early detection, followed by immediate treatment, is key to achieving the best possible outcomes for patients with wet age-related macular degeneration (AMD).i
Therefore, monitoring these patients to detect the progression from dry to wet AMD is integral to preserving their vision. Due to the fact that patients are more likely to convert to wet AMD between scheduled follow-up appointments with their primary eye-care physician, home monitoring is a valuable extension of in-office clinical care that allows us to detect wet AMD at the earliest possible moment.
This permits earlier treatment of a less-aggressive disease, potentially reducing the intravitreal injection treatment burden and dramatically improving visual outcomes. Aside from the obvious visual acuity benefit, at-home monitoring can also alleviate patients’ anxiety about their disease, as they find comfort knowing that I am watching and monitoring their AMD on a daily basis.
There are currently two methods to monitor vision outside the clinic. One is the Amsler grid, the current standard of care, that is essentially a straight-lined piece of paper with a fixation point in the center. The efficacy of the Amsler grid has been called into question often, given that its sensitivity varies from patient to patient and even from test to test.ii
Given all our 21st-century advances in technology and medicine, it is time for our technology to revolutionize the way we monitor a disease like AMD. Therefore, a more advanced technology, preferential hyperacuity perimetry (PHP), is now available in a device (ForeseeHome, Notal Vision).
The device was found to be so effective that the clinical trial to demonstrate its efficacy ended early given such a positive impact on visual outcomes in AMD patients.iii
In addition, the device can relieve patients’ anxiety as they find comfort knowing that an objective, highly sensitive device is monitoring their vision regularly and will detect changes in their vision and alert me directly if needed.
Dr. Mali is currently a consultant and speaker for Notal Vision, Inc.
iHo AC, Albini TA, Brown DM, et al. The potential importance of detection of neovascular age-related macular degeneration when visual acuity is relatively good. JAMA Ophthalmol. 20171;135:268-273.
iiAchard OA, et al. Role of the Completion Phenomenon in the Evaluation of Amsler Grid Results. Am Journal of Ophthalmol. 1995;120:322-329.
iiiAREDS2-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;121:535-44.