Home-monitoring device may advance diagnostics, detection of AMD

Take-home message: An ophthalmologist shares the clinical benefits he has experienced with a home vision-monitoring device for his patients with age-related macular degeneration.

By Richard Garfinkel, MD, Special to Ophthalmology Times

Damage to the macula caused by age-related macular degeneration (AMD) can develop slowly or quickly, and the early and intermediate stages often pass without symptoms.

While a complete dilated eye examination will allow an ophthalmologist to detect the disease earlier, a patient often does not notice disease progression until central vision is significantly deteriorated.

Unfortunately, outcomes of AMD treatment are correlated to baseline visual acuity, area, and characteristics of choroidal neovascularization (CNV).¹ Though new pharmaceutical treatment options have made strides in terms of maintaining patients’ vision, restoration of significant vision loss is rare.

This shifts the burden of disease management to the earliest detection of CNV, so that patients can preserve the best vision possible. While there are known risk factors, there is no true predictive model for determining who will progress from dry to wet AMD and when. A typical 6-month interval between appointments could allow an alarming amount of disease progression and visual loss.

Understanding the necessity of self-monitoring of disease by patients, the practice of providing Amsler grids to patients was made common in the 1960s. Although it has been the standard of care for more than half a decade, it has known limitations, such as perceptual completion and lack of compliance, that make the overall sensitivity of detecting macular disease less than 50%.^2,3

Hyperacuity is the ability to perceive minute differences in the relative spatial localization of two objects‑a human skill that remains despite aging and cataract development.^4,5,6

However, changes in retinal morphology will lead to an incorrect perception of the location of the objects. Preferential hyperacuity perimetry (PHP) assesses and records perceived shifts in object location that correlate to metamorphopsia.⁷

When compared with a patient’s baseline and normative data for an AMD population, it becomes an effective test for detecting the development of CNV.⁸

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