Patients monitored at home with a self-operated artificial intelligence system, in conjunction with standard care for early detection of neovascular age-related macular degeneration (nAMD), can maintain excellent long-term visual acuity (VA) years after conversion to nAMD, according to research published in Ophthalmology Retina.

The investigators conducted a retrospective study to evaluate the performance of a monitoring strategy with a self-operated artificial intelligence enabled home monitoring system in conjunction with standard care for early detection of nAMD and to assess long-term VA among patients after conversion to nAMD.

They used clinical data from medical records of patients with dry AMD from 5 referral clinics who were monitored with the ForeseeHome device (Notal Vision Inc) between August 2010 and July 2020. The main outcome measures were VA at baseline, VA at diagnosis of nAMD for eyes that converted while monitored, VA from the final study follow up, weekly frequency of use, duration of monitoring, modality of conversion diagnosis (system alert vs detection by other standard care means), and duration and number of treatments from conversion to final study follow up.


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The researchers reviewed data from 3334 eyes of 2123 patients (61% women and 39% men) with a mean age of 74 ± 8 years. Patient eyes were monitored for a mean duration of 3.1±2.4 years, resulting in a total of 1,706,433 tests in 10,474 eye-monitoring years. Device use was persistent over the usage period, with a mean weekly use per patient of 5.2±3.4 times. 

The researchers observed that 285 eyes converted to nAMD while monitored, an annual rate of 2.72%. These eyes were treated with an average of 17.3±16.5 injections for a mean of 2.7±2.0 years and 6.4±3.1 injections per year for eyes treated for more than 1 year. 

The team found that the median VA at baseline and final follow up for eyes that did not convert were 20/27 and 20/34 with a median change of 0.0 letters. For eyes that converted during the monitoring period, they observed that the median VA at baseline, conversion, and final follow up were 20/30, 20/39 and 20/32 with a median change from baseline to conversion, baseline to recent, and conversion to recent of -4, -4 and 0 letters, respectively. 

The researchers also found that 52% of conversions detected had a system alert prior to conversion, whereas 48% of conversions were detected by symptoms or routine visit. At conversion and final follow up, the team found that the proportion of eyes that maintained at least 20/40 vision was 84% (95% CI, 78-88%) and 82% (95% CI, 76-86%), respectively.

Limitations of the study included the retrospective design, no collection of prequalification information about the number of prescriptions that were filled by the patients, lack of VA data for eyes that did not convert, and lack of information about drugs used for treatment and management scheme.

Disclosure: This research was supported by Notal Vision Inc. Please see the original reference for a full list of disclosures.

Reference

Mathai M, Reddy S, Elman MJ, et al. Analysis of the Long-term visual outcomes of ForeseeHome remote telemonitoring – the ALOFT study. Ophthalmol Retina. Published online April 25, 2022. doi:10.1016/j.oret.2022.04.016