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Use of a home monitoring device to monitor patients at high risk for wet age-related macular degeneration may have a considerable public health impact over time.
Take-home message: Use of a home monitoring device to monitor patients at high risk for wet age-related macular degeneration may have a considerable public health impact over time.
By Lynda Charters: Reviewed by Carl Regillo, MD
Philadelphia-Early identification of individuals at risk of developing neovascular age-related macular degeneration (AMD) is key to preventing and minimizing vision loss from the disease, urged Carl Regillo, MD.
Thanks to use of a home monitoring device (ForeseeHome AMD Monitor with Preferential Hyperacuity Perimetry, Notal Vision), monitoring patients at high risk for wet AMD may have a substantial public health impact over time, with more patients able to maintain functional vision as a result of early intervention and treatment in the disease process, said Dr. Regillo, chief, Wills Eye Hospital Retina Service, and professor of ophthalmology, Thomas Jefferson University, Philadelphia.
In the Age-Related Eye Disease Study 2 (AREDS2) HOme Monitoring of the Eye (HOME) study, AREDS data were used to identify the U.S. population at risk, apply the HOME study findings with the device and known epidemiologic data to the target population, and estimate the potential public health effect of home monitoring with the device.
Next: Combined strategy
Dr. Regillo and other study investigators theorized that by using the device, patients would be able to identify the presence of choroid neovascularization (CNV) early and take advantage of appropriate treatment to arrest disease progression at an early stage when visual acuity is often good.
The importance of this early identification is underscored by the AREDS results (the AREDS 11 Report) that determined of about 8 million patients with intermediate- to high-risk AMD, about 670,000 will progress to CNV over a period of 5 years after treatment was started.
Of those patients, about 77% may qualify to use the home monitoring device. When patient noncompliance is factored in-estimated to account for about 10% of patients-more than 400,000 patients may use home monitoring over a period of 5 years, with a resultant additional 100,000 maintaining 20/40 or better visual acuity at the time of neovascular AMD detection.
The combination strategy of a home monitoring device and the Amsler grid-considered the standard of care-resulted in a larger proportion of study eyes with intermediate AMD maintaining vision of 20/40 or better, i.e., 87%, at diagnosis of CNV compared with study eyes evaluated with only the Amsler grid, 62%.
These results were applied to estimates of the U.S. population at high risk of developing late AMD to estimate the potential public health effect of home monitoring with the device.
Next: Home monitoring's impact
“Comparing such estimates from the community, home device monitoring may result in another approximately 200,000 people retaining good functional vision,” Dr. Regillo said.
When an estimation of those who are at high risk for developing CNV and can use the device, between 100,000 to 300,000 additional patients in the United States would be detected at 20/40 or better over the next 5 years. The potential impact on public health in the United States may be considerable with more than 60% of patients likely to maintain 20/40 or better for at least 2 years on anti-vascular endothelial growth factor therapy, Dr. Regillo noted.
The usability of the device by older patients is a consideration. A recent study from the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, supported use of the device in this study population and showed that usability was high, i.e., more than 80% and not associated with age (Chaikitmongkol V et al. Retin Cases Brief Rep. 2015;9:33-37).
Carl Regillo, MD
This article was adapted from Dr. Regillo’s presentation at the 2015 meeting of the American Society of Retina Specialists. Dr. Regillo received research grant support from Notal Vision. The study was performed by the AREDS2 investigators and sponsored by Notal Vision, in collaboration with the National Eye Institute.