Ophthalmologists typically see patients with neovascular age-related macular degeneration (nAMD) every few weeks, capturing the needed optical coherence tomography (OCT) scans. However, if physicians had access to imaging that showed fluid patterns through the full interval between visits, they might be able to see how an individual is responding to a specific biologic, or gauge when retinal fluid volume tends to rise and fall — allowing for refinement of time between injections.
A study published in Ophthalmology Retina reviewed just such an at-home OCT imaging system. The trial (ClinicalTrials.gov Identifier: NCT04650672) evaluated the cases of 15 patients at 2 US retina clinics. Patients had a mean age of 73.4±6.5 years and all were undergoing anti-vascular endothelial growth factor (VEGF) therapy for nAMD in at least 1 eye. They were asked to self-image with the at-home OCT instrument.
Self-imaging was to be performed every day for each eye with nAMD during the 3-month period, and the scans were automatically evaluated by a deep learning algorithm. They were also graded by human specialists. Participants underwent standard care during the investigation, with self-operated tests not influencing clinical treatment.
The participants completed the scans of at least 1 eye at a mean rate of 5.7±0.9 each week, with 2380 successful images achieved among the 15. Of this total, 93% were qualified for examination to quantify intraretinal fluid (IRF) and subretinal fluid (SRF). Concerning reliability, the human graders agreed with the device on fluid shown in the home images 83% of the time, with most in the remaining 17% involving borderline or trace amounts of fluid. When comparing the instrument’s scoring with in-office scans graded by clinicians, agreement on retinal fluid status reached 96%. All participants completed the study and a questionnaire. Participant reports show 97% strongly agreed or agreed that self-imaging was easy and convenient, and 67% who wanted to continue daily monitoring.
The instrument also assessed central subfield thickness (CST). “CST and retinal fluid volume measurements from home OCT and in-office OCT scans demonstrated Pearson correlation coefficients of r =0.90 and r =0.92, respectively,” according to the investigators.
Analysis limitations comprised inclusion in the data for both eyes of a number of patients, and the relatively short study period. Strengths included a high level of weekly scans performed and consistent image quality returned. Researchers added that regular home imaging may spot conversion from dry to wet AMD in a contralateral fellow eye, noting that one participant converted during the 3-month period, with increased IRF volume found by the home system 2 weeks before the individual’s next regular appointment at the clinic.
Disclosures: The study was sponsored by Notal Vision, Ltd. and supported by Genentech, Inc. Study authors have disclosed affiliations with the biotech and pharmaceutical industries, including Notal Vision. Please see the original reference for a full list of authors disclosures.
Liu Y, Holekamp NL, Heier JS. Prospective, longitudinal study: daily self-imaging with home OCT in neovascular age-related macular degeneration. Ophthalmol Retina. Published online Feb. 28, 2022. doi:10.1016/j.oret.2022.02.011