FLORetina 2025: Remotely managing patients with neovascular age-related macular degeneration

The ability to remotely monitor patients with age-related macular degeneration (AMD) is a real boon for practitioners and patients alike. Remote management has filled a gap in the care of patients with neovascular AMD arising from the heavy treatment burden imposed on these patients and the healthcare system, explained Anat Loewenstein, MD, speaking at the FLOretina 2025 annual meeting in Florence, Italy.

She is professor and head of retina, Division of Ophthalmology, and vice president of Ambulatory Services, Tel Aviv Medical Center, and the Sidney A. Fix Chair in Ophthalmology, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

“The treatment burden has been quantified in multiple studies and indeed poses a very heavy burden on patients and caregivers, creating significant societal costs,” she commented.

Because of this heavy burden, the real-world management of this patient population has not been as successful as seen in large-scale clinical trials. Dr. Loewenstein reported that patients have barely maintained the vision at which they were detected at conversion.

Home monitoring

The Home OCT Monitoring Program from Notal Vision begins with a prescription sent to the monitoring center that manages the remote care and provides patients with the device. The images from the patient are analyzed by artificial intelligence (AI) looking for specific biomarkers. The physician can then review the AI data to make management decisions for the patient. decision.

The advantage of this self-imaging device is that it can be patient-operated without assistance. The successful imaging has been validated in large-scale studies. The device comes with cellular and wi-fi connectivity that facilitates data transmission to the cloud.

For the physician, the Home OCT portal facilitates review of dense OCT volume scans; the segmented areas are overlaid on B-scans and spatially localized over a 3x3-mm grid. The quantitative estimates are plotted longitudinally. Physicians can set thresholds related to relevant biomarkers and based on time, she explained.

Clinical studies of the device

Loewenstein cited studies on the feasibility of using the home monitoring device for patient care.

In a study¹ of treatment-naïve patients with nAMD, they monitored themselves on the Home OCT but were managed via the standard of care. The factors recorded were the weekly scan frequency over 6 months, time/scan, and the number of scans eligible for fluid quantification. The accuracy of the AI-based quantification for detection of retinal fluid was evaluated, and the fluid trajectories for these patients for the first 6 months of the study were explored.

The study found that for these patients, the frequency/quality of scanning and accuracy of fluid detection were sufficient to assess fluid monitoring at home. Accommodations for travel and Wi-Fi connectivity could improve uptake of the Home OCT device.

A second study² investigated treatment-experienced patients with the device. Patients with nAMD in at least one eye were switched to home OCT-based management. The patients went into the office only when home OCT-based alerts were received. The factor recorded was the change in treatment intervals and visual acuity between the standard of care management and home OCT-based management. The adherence to the use of the Home OCT based on the scans/week was recorded.

The study found both that remote patient monitoring with Home OCT allowed personalized management of nAMD and a significant reduction in treatment burden while maintaining the visual acuity.

In another study,³ retina specialists were presented data from patient monitoring with Home OCT but were managed with in-office OCT and were asked to make decisions about treatment timing. The study concluded that home OCT-based decision-making differed substantially from actual clinical care. Home OCT has the potential to facilitate personalized care in nAMD.

Loewenstein summarized the key points.

• Home OCT monitoring provides granular insights in disease dynamics.
• Trajectories of AI-based image analysis biomarkers represent a new phenotyping tool.
• Home OCT allows objective data-driven patient management with physician set notification criteria impacting the course of the disease.
• In the coming years, we will learn a lot more on how short-term temporal changes impact long-term outcomes.
• Digital healthcare providers of remote monitoring devices, data analytics, and patient support services enable retina specialists to improve personalized care.

References

1. Blinder KJ, Calhoun C, Maguire MG, et al. Home OCT Imaging for newly diagnosed neovascular age-related macular degeneration. A feasibility study. Ophthalmol Retina.2024;8:376-387. doi: 10.1016/j.oret.2023.10.012.

2. Holekamp NM, De Beus AM, Clark WL, Heier JS. Prospective trial of home optical coherence tomography guided management of treatment experienced neovascular age-related macular degeneration patients. Retina. 2024;44:1714-31.doi: 10.1097/IAE.0000000000004167

3. Heier JS, Liu Y, Holekamp NM, et al. Clinical use of home OCT data to manage neovascular age-related macular degeneration. J Vitreoretin Dis. 2024; published online ahead of print. doi: 10.1177/24741264241302858