Home OCT Monitoring Cuts Treatment Burden for Macular Degeneration

Nancy M. Holekamp, MD

Credit: The American Society of Retina Specialists

A home-based optical coherence tomography (OCT) allowed for personalized care for people with neovascular age-related macular degeneration (nAMD) for the first time. The study, published in The Journal of Retinal and Vitreous Diseases, showed that remote monitoring significantly reduced the number of eye treatments needed while keeping vision stable.

“Personalized treatment algorithms have the potential to reduce the burden on patients, their caregivers, retinal clinics and health care systems,” wrote a team of investigators led by Nancy M. Holekamp, MD, director of Retina Services at the Pepose Vision Institute in St. Louis, Missouri. “Personalized health care in nAMD would require a treatment regimen based on each individual's unique disease pattern per eye, treatment response per eye, and medication durability per eye. Currently, OCT is only available at each clinic visit, with clinicians making treatment decisions based on sparse data points weeks to months apart.”

Although AMD is the leading cause of legal blindness in the United States, nAMD is now treatable with the use of anti–vascular endothelial growth factor (VEGF) agents in conjunction with OCT imaging.

To determine the effects of home OCT-guided patient management on both visual outcomes and treatment burden, an interventional trial (the Home OCT Guided Management Study of Subjects Diagnosed with nAMD) was performed to compare visual acuity and treatment frequency among a cohort of patients with nAMD. Eligible patients had at least one eye with active nAMD, were receiving anti-VEGF treatments, had the ability to give consent and undergo OCT imaging and exhibited Snellen visual acuity of 20/320 or better in the eye with nAMD.

Data were assessed both before and during use of the OCT over a 6-month period. The adherence to regular scanning was determined using the number of scans performed on a weekly basis. Additionally, the classification of typical fluid volume trajectories as well as the characteristics of episodes of fluid recurrence were determined. Information from the daily, remote self-imaging was used to manage nAMD and make decisions about the need for office visits.

Among 15 patients, 27 eyes were monitored (21 of which had a diagnosis of nAMD at baseline). The mean age of patients was 75.1 years and 53% of participants were female. All patients were able to self-install the device at home and self-image for the six-month duration.

Over the course of the trial, patients were able to scan their eyes at home approximately six times a week, culminating in 4,435 scans. These scans were analyzed by artificial intelligence, and 91.2% of them were useful for monitoring fluid changes in the eye.

With the home-based OCT, the need for injections was cut nearly in half, from every 8 weeks to every 15 weeks, without a noticeable impact on vision. This shows that remote OCT monitoring is not only feasible but also effective in reducing the treatment burden for patients with AMD. This reduction in treatment could also translate to significant savings for the health care systems, as therapies for nAMD currently cost more than four billion dollars per year in the United States.

The mean change in visual acuity before and during home-based OCT was 3.5 letters and 0.0 letters, respectively, which indicates no significant impact on visual acuity.

“This study demonstrated that near daily self-imaging with the Notal Vision Home OCT System (NVHO) enabled the successful management of eyes with nAMD,” investigators concluded.