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Hogg RE, Sivaprasad S, Wickens R, O’Connor S, Gidman E, Ward E, Treanor C, Peto T, Burton BJL, Knox P, Lotery AJ, Donnelly M, Rogers CA, Reeves BC. Home-Monitoring Vision Tests to Detect Active Neovascular Age-Related Macular Degeneration. JAMA Ophthalmol 2024:2817623. [PMID: 38662399 PMCID: PMC11046404 DOI: 10.1001/jamaophthalmol.2024.0918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/20/2024] [Indexed: 04/26/2024]
Abstract
Importance Most neovascular age-related macular degeneration (nAMD) treatments involve long-term follow-up of disease activity. Home-monitoring would reduce the burden on patients and their caregivers and release clinic capacity. Objective To evaluate 3 vision home-monitoring tests for patients to use to detect active nAMD compared with diagnosing active nAMD at hospital follow-up during the after-treatment monitoring phase. Design, Setting, and Participants This was a diagnostic test accuracy study wherein the reference standard was detection of active nAMD by an ophthalmologist at hospital follow-up. The 3 home-monitoring tests evaluated included the following: (1) the KeepSight Journal (KSJ [International Macular and Retinal Foundation]), which contains paper-based near-vision tests presented as word puzzles, (2) the MyVisionTrack (mVT [Genentech]) vision-monitoring mobile app, viewed on an Apple mobile operating system-based device, and (3) the MultiBit (MBT [Visumetrics]) app, viewed on an Apple mobile operating system-based device. Participants were asked to test weekly; mVT and MBT scores were transmitted automatically, and KSJ scores were returned to the research office every 6 months. Raw scores between hospital follow-ups were summarized as averages. Patients were recruited from 6 UK hospital eye clinics and were 50 years and older with at least 1 eye first treated for active nAMD for at least 6 months or longer to a maximum of 42 months before approach. Participants were stratified by time since starting treatment. Study data were analyzed from May to September 2021. Exposures The KSJ, mVT, and MBT were compared with the reference standard (in-hospital ophthalmologist examination). Main Outcomes and Measures Estimated area under receiver operating characteristic curve (AUROC). The study had 90% power to detect a difference of 0.06, or 80% power to detect a difference of 0.05, if the AUROC for 2 tests was 0.75. Results A total of 297 patients (mean [SD] age, 74.9 [6.6] years; 174 female [58.6%]) were included in the study. At least 1 hospital follow-up was available for 312 study eyes in 259 participants (1549 complete visits). Median (IQR) home-monitoring testing frequency was 3 (1-4) times per month. Estimated AUROC was less than 0.6 for all home-monitoring tests, and only the KSJ summary score was associated with lesion activity (odds ratio, 3.48; 95% CI, 1.09-11.13; P = .04). Conclusions and Relevance Results suggest that no home-monitoring vision test evaluated provided satisfactory diagnostic accuracy to identify active nAMD diagnosed in hospital eye service follow-up clinics. Implementing any of these evaluated tests, with ophthalmologists only reviewing test positives, would mean most active lesions were missed, risking unnecessary sight loss.
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Affiliation(s)
- Ruth E. Hogg
- Center for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Center, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Robin Wickens
- Bristol Trials Center, University of Bristol, Bristol, United Kingdom
| | - Sean O’Connor
- Center for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Eleanor Gidman
- Bristol Trials Center, University of Bristol, Bristol, United Kingdom
| | - Elizabeth Ward
- Bristol Trials Center, University of Bristol, Bristol, United Kingdom
| | - Charlene Treanor
- Center for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Tunde Peto
- Center for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Ben J. L. Burton
- James Paget University Hospitals NHS Trust, Great Yarmouth, United Kingdom
| | - Paul Knox
- University of Liverpool, Liverpool, United Kingdom
| | - Andrew J. Lotery
- Department of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Michael Donnelly
- Center for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Chris A. Rogers
- Bristol Trials Center, University of Bristol, Bristol, United Kingdom
| | - Barnaby C. Reeves
- Bristol Trials Center, University of Bristol, Bristol, United Kingdom
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Gidman EA, Reeves B. Uncertain Diagnostic Accuracy of Self-Monitoring Vision at Home. JAMA Ophthalmol 2024; 142:391-392. [PMID: 38358774 DOI: 10.1001/jamaophthalmol.2023.6717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Eleanor A Gidman
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Barnaby Reeves
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Balaskas K, Zhang G. Uncertain Diagnostic Accuracy of Self-Monitoring Vision at Home-Reply. JAMA Ophthalmol 2024; 142:392. [PMID: 38358776 DOI: 10.1001/jamaophthalmol.2023.6714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Konstantinos Balaskas
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Gongyu Zhang
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Reeves BC, Wickens R, O'Connor SR, Gidman EA, Ward E, Treanor C, Peto T, Burton BJL, Knox PC, Lotery A, Sivaprasad S, Donnelly M, Rogers CA, Hogg RE. Descriptive study of the challenges when implementing an app for patients with neovascular age-related macular degeneration to monitor their vision at home. BMJ Open 2024; 14:e077196. [PMID: 38453199 PMCID: PMC10921518 DOI: 10.1136/bmjopen-2023-077196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES Remote monitoring of health has the potential to reduce the burden to patients of face-to-face appointments and make healthcare more efficient. Apps are available for patients to self-monitor vision at home, for example, to detect reactivation of age-related macular degeneration (AMD). Describing the challenges when implementing apps for self-monitoring of vision at home was an objective of the MONARCH study to evaluate two vision-monitoring apps on an iPod Touch (Multibit and MyVisionTrack). DESIGN Diagnostic Test Accuracy study. SETTING Six UK hospitals. METHODS The study provides an example of the real-world implementation of such apps across health sectors in an older population. Challenges described include the following: (1) frequency and reason for incoming calls made to a helpline and outgoing calls made to participants; (2) frequency and duration of events responsible for the tests being unavailable; and (3) other technical and logistical challenges. RESULTS Patients (n=297) in the study were familiar with technology; 252/296 (85%) had internet at home and 197/296 (67%) had used a smartphone. Nevertheless, 141 (46%) called the study helpline, more often than anticipated. Of 435 reasons for calling, all but 42 (10%) related to testing with the apps or hardware, which contributed to reduced adherence. The team made at least one call to 133 patients (44%) to investigate why data had not been transmitted. Multibit and MyVisionTrack apps were unavailable for 15 and 30 of 1318 testing days for reasons which were the responsibility of the app providers. Researchers also experienced technical challenges with a multiple device management system. Logistical challenges included regulations for transporting lithium-ion batteries and malfunctioning chargers. CONCLUSIONS Implementation of similar technologies should incorporate a well-resourced helpline and build in additional training time for participants and troubleshooting time for staff. There should also be robust evidence that chosen technologies are fit for the intended purpose. TRIAL REGISTRATION NUMBER ISRCTN79058224.
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Affiliation(s)
- Barnaby C Reeves
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Robin Wickens
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sean R O'Connor
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Eleanor Alma Gidman
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - E Ward
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Charlene Treanor
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Tunde Peto
- Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, UK
| | - Ben J L Burton
- James Paget University Hospitals NHS Trust, Liverpool, UK
| | | | | | | | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Chris A Rogers
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ruth E Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Hogg RE, Wickens R, O'Connor S, Gidman E, Ward E, Peto T, Burton BJL, Knox P, Lotery AJ, Sivaprasad S, Donnelly M, Rogers CA, Reeves BC. Inequalities in Uptake and Use of Digital Applications for Home-Monitoring of Neovascular Age-Related Macular Degeneration in an Elderly Visually Impaired Population: The MONARCH Study. Transl Vis Sci Technol 2024; 13:2. [PMID: 38427348 PMCID: PMC10913936 DOI: 10.1167/tvst.13.3.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/08/2024] [Indexed: 03/02/2024] Open
Abstract
Purpose To describe inequalities in the Monitoring for Neovascular Age-related Macular Degeneration Reactivation at Home (MONARCH) diagnostic test accuracy study for: recruitment; participants' ability to self-test; and adherence to testing using digital applications during follow-up. Methods Home-monitoring vision tests included two tests implemented as software applications (apps: MyVisionTrack and MultiBit) on an iPod Touch device. Patients were provided with all hardware required to participate (iPod and MIFI device) and trained to use the apps. Regression models estimated associations of age, sex, Index of Multiple Deprivation, strata of time since first diagnosis, and baseline visual acuity at study entry on outcomes of willingness to participate, ability to perform tests, and adherence to weekly testing. Results A minority of patients who were approached were willing-in-principle to participate. Increasing age was associated with being unwilling-in-principle to participate. Patients from the most deprived areas had a 47% decrease in odds of being willing compared to those from the middle quintile deprived areas (odds ratio, 0.53; 95% confidence interval = 0.32, 0.88). Increasing age and worse deprivation were not consistently associated either with ability to self-monitor with the index tests, or adherence to weekly testing. Conclusions Associations of increasing age and worse deprivation index were associated with unwillingness-in-principle to participate despite the provision of hardware' highlighting the potential for inequality with interventions of the kind evaluated. Translational Relevance The clear evidence of inequalities in participation should prompt future research on ways to encourage adoption of mobile health technologies by underserved populations.
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Affiliation(s)
- Ruth E. Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Robin Wickens
- Bristol Trials Centre, University of Bristol, Bristol, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sean O'Connor
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Institute of Nursing and Health Research, Ulster University, Londonderry, UK
| | - Eleanor Gidman
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Elizabeth Ward
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Paul Knox
- University of Liverpool, Liverpool, UK
| | - Andrew J. Lotery
- Department of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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O'Connor AR, Warburton A, Farrelly-Waters M, England L, Clarke R, Kay H. Evaluation of the Amblyopia tracker app. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06413-0. [PMID: 38413448 DOI: 10.1007/s00417-024-06413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/29/2024] Open
Abstract
PURPOSE The Amblyopia tracker app has been developed to be a tool for parents to monitor changes in vision at home during amblyopia treatment. The aims of this study were to evaluate the feasibility and repeatability of parents testing their children at home and to compare home test results to an assessment in clinic by an orthoptist. METHODS Children (age < 18 years) with amblyopia (interocular acuity difference of ≥ 0.2logMAR) were recruited. Parents were asked to test their child with the app three times during a two week period followed by an online questionnaire about the usability. Participants also tested within 48 h of their appointment where the measurement was repeated by an orthoptist. RESULTS Out of 277 potential participants contacted, 37 completed three home measurements, mean age 6.8 years (SD 2.94). Home tests comparisons were made between test two and three to ensure familiarity with the process. Paired t-tests showed no statistically significant difference for either eye or the interocular acuity difference (IAD). However, 29% had a difference in IAD of more than 0.1logMAR on repeated testing, with a maximum of 0.4logMAR difference in the IAD. Questionnaire responses from the parents who participated were predominantly positive with 97% of respondents saying they would use it if were available. Comparison of home and clinical measurements (n = 23, mean age 6.72 SD 2.60) showed no statistically significant differences for either eye or interocular acuity difference (paired t-test, p > 0.3 in all cases). CONCLUSION Results show no statistically significant differences for the Amblyopia tracker app when used by parents at home on repeated testing, or between the home test by a parent and the test by a clinician. However, variability in the results does indicate that further improvements are required to ensure the results can be used as a reliable clinical tool.
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Affiliation(s)
- Anna R O'Connor
- School of Health Sciences, University of Liverpool, Thompson Yates Building, Brownlow Hill, Liverpool, L69 3GB, UK.
| | - Ashli Warburton
- School of Health Sciences, University of Liverpool, Thompson Yates Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | | | - Laura England
- Orthoptic Department, Manchester Royal Eye Hospital, Manchester, UK
| | - Rachel Clarke
- Orthoptic Department, Manchester Royal Eye Hospital, Manchester, UK
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Papaioannou C. Advancements in the treatment of age-related macular degeneration: a comprehensive review. Postgrad Med J 2024:qgae016. [PMID: 38330506 DOI: 10.1093/postmj/qgae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 02/10/2024]
Abstract
Age-related macular degeneration (AMD) stands as a leading cause of irreversible blindness, particularly affecting central vision and impeding daily tasks. This paper provides a thorough exploration of AMD, distinguishing between its two main subtypes-Wet and Dry AMD-while shedding light on the prevalence and risk factors, including age, genetics, and smoking. The focus shifts to the current and future treatment landscape, examining both Dry and Wet AMD. Regarding Dry AMD, interventions such as antioxidant supplementation and ongoing clinical trials offer hope. Notable among these is Pegcetacoplan which is the only Food and Drug Administration (FDA)-approved medication, displaying promising results in reducing geographic atrophy lesions. For Wet AMD, anti-Vascular Endothelial Growth Factor therapies like Ranibizumab (Lucentis®) have been instrumental, and newer drugs like Faricimab and OPT-302 show comparable efficacy with extended dosing intervals. Additionally, gene therapies such as RGX-314 present a potential paradigm shift, reducing or eliminating the need for frequent injections. Biosimilars offer cost-effective alternatives. The paper also delves into the integration of technology and artificial intelligence in AMD management, highlighting the role of smartphone apps for patient monitoring and artificial intelligence algorithms for diagnosis and surveillance. Furthermore, patient perspectives on artificial intelligence demonstrate a positive correlation between understanding and trust. The narrative concludes with a glimpse into ground-breaking technologies, including retinal implants and bionic chips, offering hope for vision restoration. Overall, this paper underscores the multifaceted approach in addressing AMD, combining traditional and innovative strategies, paving the way for a more promising future in AMD treatment.
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Affiliation(s)
- Christos Papaioannou
- Department of Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, TW7 6AF, London, United Kingdom
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Nagino K, Sung J, Midorikawa-Inomata A, Eguchi A, Fujimoto K, Okumura Y, Miura M, Yee A, Hurramhon S, Fujio K, Akasaki Y, Hirosawa K, Huang T, Ohno M, Morooka Y, Zou X, Kobayashi H, Inomata T. Clinical Utility of Smartphone Applications in Ophthalmology: A Systematic Review. OPHTHALMOLOGY SCIENCE 2024; 4:100342. [PMID: 37869018 PMCID: PMC10587618 DOI: 10.1016/j.xops.2023.100342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 10/24/2023]
Abstract
Topic Numerous smartphone applications have been devised for diagnosis, treatment, and symptom management in ophthalmology. Despite the importance of systematic evaluation of the purpose, target disease, effectiveness, and utility of smartphone applications to their effective utilization, few studies have formally evaluated their validity, reliability, and clinical utility. Clinical Relevance This report identifies smartphone applications with potential for clinical implementation in ophthalmology and summarizes the evidence on their practical utility. Methods We searched PubMed and EMBASE on July 28, 2022, for articles reporting original data on the effectiveness of treatment, disease detection, diagnostic accuracy, disease monitoring, and usability of smartphone applications in ophthalmology published between January 1, 1987, and July 25, 2022. Their quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Results The initial search yielded 510 articles. After removing 115 duplicates and 285 articles based on inclusion and exclusion criteria, the full texts of the remaining 110 articles were reviewed. Furthermore, 71 articles were included in the final qualitative synthesis. All studies were determined to be of high (87.3%) or moderate (12.7%) quality. In terms of respective application of interest, 24 (33.8%) studies assessed diagnostic accuracy, 17 (23.9%) assessed disease detection, and 3 (4.2%) assessed intervention efficacy. A total of 48 smartphone applications were identified, of which 27 (56.3%) were publicly available. Seventeen (35.4%) applications included functions for ophthalmic examinations, 13 (27.1%) included functions aimed at disease detection, 10 (20.8%) included functions to support medical personnel, five (10.4%) included functions related to disease education, and three (6.3%) included functions to promote treatment adherence for patients. The largest number of applications targeted amblyopia (18.8%), followed by retinal disease (10.4%). Two (4.2%) smartphone applications reported significant efficacy in treating diseases. Conclusion In this systematic review, a comprehensive appraisal is presented on studies related to diagnostic accuracy, disease detectability, and efficacy of smartphone applications in ophthalmology. Forty-eight applications with potential clinical utility are identified. Appropriate smartphone applications are expected to enable early detection of undiagnosed diseases via telemedicine and prevent visual dysfunction via remote monitoring of chronic diseases. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Ken Nagino
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jaemyoung Sung
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akie Midorikawa-Inomata
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsuko Eguchi
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Keiichi Fujimoto
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuichi Okumura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Maria Miura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Alan Yee
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shokirova Hurramhon
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenta Fujio
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasutsugu Akasaki
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kunihiko Hirosawa
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tianxiang Huang
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mizu Ohno
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Morooka
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Xinrong Zou
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Ophthalmology, Fengcheng Hospital, Shanghai, China
| | - Hiroyuki Kobayashi
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takenori Inomata
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- AI Incubation Farm, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Joseph A, Bullimore M, Drawnel F, Miranda M, Morgan Z, Wang YZ. Remote Monitoring of Visual Function in Patients with Maculopathy: The Aphelion Study. Ophthalmol Ther 2024; 13:409-422. [PMID: 38015309 PMCID: PMC10776523 DOI: 10.1007/s40123-023-00854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Remote monitoring of vision, using tools such as the shape discrimination hyperacuity (SDH) test, can detect disease activity in patients with maculopathy. We determined the in-clinic accuracy and repeatability of three myVisionTrack expanded version (mVTx) tests for self-testing of visual acuity (VA) and contrast sensitivity. METHODS Aphelion, a single-arm, prospective study conducted at two sites in the USA, included adults with any maculopathy and a baseline VA of 0.7 log of minimum angle of resolution (logMAR) (Snellen 20/100) or better. Participants completed the mVTx tests (tumbling E, Landolt C, contrast sensitivity, and SDH) and standard clinical tests (near and distance Early Treatment Diabetic Retinopathy Study [ETDRS] charts and the Pelli-Robson contrast sensitivity chart). Test-retest repeatability and agreement between the mVTx tests and the corresponding clinical test were assessed by Bland-Altman analyses. Participants also completed a usability survey. RESULTS The mean age of the 122 participants was 67 years. The most common diagnosis was age-related macular degeneration (42% of patients). The tumbling E test had a test-retest 95% limit of agreement (LoA) of ± 0.18 logMAR; the Landolt C test, ± 0.23 logMAR; the SDH test, ± 0.24 logMAR; and the contrast sensitivity test, ± 0.32 log contrast threshold (logCT). Compared with the distance ETDRS chart, the LoA was ± 0.35 logMAR for the tumbling E test (mean difference, - 0.07 logMAR) and ± 0.39 logMAR for the Landolt C test (mean difference, 0.03 logMAR). For the contrast sensitivity test, the LoA compared with the Pelli-Robson chart was ± 0.30 logCT (mean difference, - 0.25 logCT). Most participants (85%) reported that they learned the tests quickly. The tumbling E test scored the highest on ease of use. CONCLUSION The mVTx tests of VA are accurate and repeatable, supporting their potential use alongside the SDH test to detect disease progression remotely between clinic visits.
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Affiliation(s)
| | - Mark Bullimore
- University of Houston College of Optometry, Houston, TX, USA
| | | | - Marco Miranda
- Roche Products, Ltd., Welwyn Garden City, UK
- University College London Institute of Ophthalmology, London, UK
| | - Zoe Morgan
- F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Yi-Zhong Wang
- Retina Foundation of the Southwest, 9600 N. Central Expressway, Suite 200, Dallas, TX, 75321, USA.
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, USA.
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Than J, Sim PY, Muttuvelu D, Ferraz D, Koh V, Kang S, Huemer J. Teleophthalmology and retina: a review of current tools, pathways and services. Int J Retina Vitreous 2023; 9:76. [PMID: 38053188 DOI: 10.1186/s40942-023-00502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/02/2023] [Indexed: 12/07/2023] Open
Abstract
Telemedicine, the use of telecommunication and information technology to deliver healthcare remotely, has evolved beyond recognition since its inception in the 1970s. Advances in telecommunication infrastructure, the advent of the Internet, exponential growth in computing power and associated computer-aided diagnosis, and medical imaging developments have created an environment where telemedicine is more accessible and capable than ever before, particularly in the field of ophthalmology. Ever-increasing global demand for ophthalmic services due to population growth and ageing together with insufficient supply of ophthalmologists requires new models of healthcare provision integrating telemedicine to meet present day challenges, with the recent COVID-19 pandemic providing the catalyst for the widespread adoption and acceptance of teleophthalmology. In this review we discuss the history, present and future application of telemedicine within the field of ophthalmology, and specifically retinal disease. We consider the strengths and limitations of teleophthalmology, its role in screening, community and hospital management of retinal disease, patient and clinician attitudes, and barriers to its adoption.
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Affiliation(s)
- Jonathan Than
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
| | - Peng Y Sim
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
| | - Danson Muttuvelu
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- MitØje ApS/Danske Speciallaeger Aps, Aarhus, Denmark
| | - Daniel Ferraz
- D'Or Institute for Research and Education (IDOR), São Paulo, Brazil
- Institute of Ophthalmology, University College London, London, UK
| | - Victor Koh
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Swan Kang
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
| | - Josef Huemer
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK.
- Department of Ophthalmology and Optometry, Kepler University Hospital, Johannes Kepler University, Linz, Austria.
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Balaskas K, Drawnel F, Khanani AM, Knox PC, Mavromaras G, Wang YZ. Home vision monitoring in patients with maculopathy: current and future options for digital technologies. Eye (Lond) 2023; 37:3108-3120. [PMID: 36973405 PMCID: PMC10042418 DOI: 10.1038/s41433-023-02479-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/25/2023] [Accepted: 02/28/2023] [Indexed: 03/29/2023] Open
Abstract
Patients with macular pathology, including that caused by age-related macular degeneration and diabetic macular oedema, must attend frequent in-clinic monitoring appointments to detect onset of disease activity requiring treatment and to monitor progression of existing disease. In-person clinical monitoring places a significant burden on patients, caregivers and healthcare systems and is limited in that it only provides clinicians with a snapshot of the patient's disease status. The advent of remote monitoring technologies offers the potential for patients to test their own retinal health at home in collaboration with clinicians, reducing the need for in-clinic appointments. In this review we discuss visual function tests, both existing and novel, that have the potential for remote use and consider their suitability for discriminating the presence of disease and progression of disease. We then review the clinical evidence supporting the use of mobile applications for monitoring of visual function from clinical development through to validation studies and real-world implementation. This review identified seven app-based visual function tests: four that have already received some form of regulatory clearance and three under development. The evidence included in this review shows that remote monitoring offers great potential for patients with macular pathology to monitor their condition from home, reducing the need for burdensome clinic visits and expanding clinicians' understanding of patients' retinal health beyond traditional clinical monitoring. In order to instil confidence in the use of remote monitoring in both patients and clinicians further longitudinal real-world studies are now warranted.
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Affiliation(s)
- Konstantinos Balaskas
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- Institute of Ophthalmology, University College London, London, UK.
| | | | - Arshad M Khanani
- The University of Nevada, Reno School of Medicine, Reno, NV, USA
- Sierra Eye Associates, Reno, NV, USA
| | - Paul C Knox
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | | | - Yi-Zhong Wang
- Retina Foundation of the Southwest, Dallas, TX, USA
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, USA
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12
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Keenan TDL, Loewenstein A. Artificial intelligence for home monitoring devices. Curr Opin Ophthalmol 2023; 34:441-448. [PMID: 37527207 DOI: 10.1097/icu.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW Home monitoring in ophthalmology is appropriate for disease stages requiring frequent monitoring or rapid intervention, for example, neovascular age-related macular degeneration (AMD) and glaucoma, where the balance between frequent hospital attendance versus risk of late detection is a constant challenge. Artificial intelligence approaches are well suited to address some challenges of home monitoring. RECENT FINDINGS Ophthalmic data collected at home have included functional (e.g. perimetry), biometric (e.g. intraocular pressure), and imaging [e.g. optical coherence tomography (OCT)] data. Potential advantages include early detection/intervention, convenience, cost, and visual outcomes. Artificial intelligence can assist with home monitoring workflows by handling large data volumes from frequent testing, compensating for test quality, and extracting useful metrics from complex data. Important use cases include machine learning applied to hyperacuity self-testing for detecting neovascular AMD and deep learning applied to OCT data for quantifying retinal fluid. SUMMARY Home monitoring of health conditions is useful for chronic diseases requiring rapid intervention or frequent data sampling to decrease risk of irreversible vision loss. Artificial intelligence may facilitate accurate, frequent, large-scale home monitoring, if algorithms are integrated safely into workflows. Clinical trials and economic evaluations are important to demonstrate the value of artificial intelligence-based home monitoring, towards improved visual outcomes.
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Affiliation(s)
- Tiarnan D L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Anat Loewenstein
- Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Faes L, Maloca PM, Hatz K, Wolfensberger TJ, Munk MR, Sim DA, Bachmann LM, Schmid MK. Transforming ophthalmology in the digital century-new care models with added value for patients. Eye (Lond) 2023; 37:2172-2175. [PMID: 36460858 PMCID: PMC9735073 DOI: 10.1038/s41433-022-02313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/31/2022] [Accepted: 11/10/2022] [Indexed: 12/04/2022] Open
Abstract
Ophthalmology faces many challenges in providing effective and meaningful eye care to an ever-increasing group of people. Even health systems that have so far been able to cope with the quantitative patient increase, due to their funding and the availability of highly qualified professionals, and improvements in practice routine efficiency, will be pushed to their limits. Further pressure on care will also be caused by new active substances for the largest group of patients with AMD, the so-called dry form. Treatment availability for this so far untreated group will increase the volume of patients 2-3 times. Without the adaptation of the care structures, this quantitative and qualitative expansion in therapy will inevitably lead to an undersupply.There is increasing scientific evidence that significant efficiency gains in the care of chronic diseases can be achieved through better networking of stakeholders in the healthcare system and greater patient involvement. Digitalization can make an important contribution here. Many technological solutions have been developed in recent years and the time is now ready to exploit this potential. The exceptional setting during the SARS-CoV-2 pandemic has shown many that new technology is available safely, quickly, and effectively. The emergency has catalyzed innovation processes and shown for post-pandemic time after that we are equipped to tackle the challenges in ophthalmic healthcare - ultimately for the benefit of patients and society.
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Affiliation(s)
- Livia Faes
- Moorfields Eye Hospital, 162 City Rd, London, EC1V 2PD, UK
| | - Peter M Maloca
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
- Institute of Molecular and Clinical Ophthalmology (IOB), Basel, Switzerland
- OCTlab, University Basel, Mittlere Strasse 91, CH-4056, Basel, Switzerland
- Hirslanden St. Anna im Bahnhof Luzern, Lucerne, Switzerland
| | - Katja Hatz
- Vista Eye Clinic Binningen, Hauptstrasse 55, CH-4102, Binningen, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | - Marion R Munk
- Ophthalmology, Inselspital, University Hospital Bern, Bern, Switzerland
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Dawn A Sim
- Moorfields Ophthalmic Reading Centre and Artificial Intelligence Lab, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, England
| | - Lucas M Bachmann
- Medignition AG, Engelstrasse 6, 8004, Zurich, Switzerland.
- University of Zurich, CH-8091, Zurich, Switzerland.
| | - Martin K Schmid
- Eye Clinic, Lucerne Cantonal Hospital LUKS, 6000 16, Lucerne, Switzerland
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14
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Khavandi S, Lim E, Higham A, de Pennington N, Bindra M, Maling S, Adams M, Mole G. User-acceptability of an automated telephone call for post-operative follow-up after uncomplicated cataract surgery. Eye (Lond) 2023; 37:2069-2076. [PMID: 36274084 PMCID: PMC10333311 DOI: 10.1038/s41433-022-02289-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 09/18/2022] [Accepted: 10/10/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Innovative technology is recommended to address the current capacity challenges facing the NHS. This study evaluates the patient acceptability of automated telephone follow-up after routine cataract surgery using Dora (Ufonia Limited, Oxford, United Kingdom), which to our knowledge is the first AI-powered clinical assistant to be used in the NHS. Dora has a natural-language, phone conversation with patients about their symptoms after cataract surgery. METHODS This is a prospective mixed-methods cohort study that was conducted at Buckinghamshire Healthcare NHS Foundation Trust. All patients who were followed up using Dora were asked to give a Net Promoter Score (NPS), and 24 patients were randomly selected to complete the validated Telephone Usability Questionnaire (TUQ) as well as extended semi-structured interviews that underwent thematic analysis. RESULTS A total of 170 autonomous calls were completed. The median NPS score was 9 out of 10. The TUQ (scored out of 5) showed high rates of acceptability, with an overall mean score of 4.0. Simplicity, time saving, and ease of use scored the highest with a median of 5, whilst 'speaking to Dora feels the same as speaking to a clinician' scored a median of 3. The main themes extracted from the qualitative data were 'I can see why you're doing it', 'It went quite well actually', 'I just trust human beings I suppose'. CONCLUSION We found high levels of patient acceptability when using Dora across three acceptability measures. Dora provides a potential solution to reduce pressure on hospital capacity whilst also providing a convenient service for patients.
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Affiliation(s)
- Sarah Khavandi
- Imperial College School of Medicine, Imperial College London, London, UK
- Ufonia Limited, 3-5 Hythe Bridge Street, Oxford, UK
| | - Ernest Lim
- Ufonia Limited, 3-5 Hythe Bridge Street, Oxford, UK.
- Imperial College Healthcare NHS Trust, London, UK.
| | - Aisling Higham
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | | | - Mandeep Bindra
- Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - Sarah Maling
- Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - Mike Adams
- Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
- Royal College of Ophthalmology, London, UK
- United Kingdom & Ireland Society of Cataract & Refractive Surgeons, Wirral, UK
| | - Guy Mole
- Ufonia Limited, 3-5 Hythe Bridge Street, Oxford, UK
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
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15
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Thirunavukarasu AJ, Hassan R, Limonard A, Savant SV. Accuracy and reliability of self-administered visual acuity tests: Systematic review of pragmatic trials. PLoS One 2023; 18:e0281847. [PMID: 37347757 PMCID: PMC10286971 DOI: 10.1371/journal.pone.0281847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Remote self-administered visual acuity (VA) tests have the potential to allow patients and non-specialists to assess vision without eye health professional input. Validation in pragmatic trials is necessary to demonstrate the accuracy and reliability of tests in relevant settings to justify deployment. Here, published pragmatic trials of these tests were synthesised to summarise the effectiveness of available options and appraise the quality of their supporting evidence. METHODS A systematic review was undertaken in accordance with a preregistered protocol (CRD42022385045). The Cochrane Library, Embase, MEDLINE, and Scopus were searched. Screening was conducted according to the following criteria: (1) English language; (2) primary research article; (3) visual acuity test conducted out of eye clinic; (4) no clinical administration of remote test; (5) accuracy or reliability of remote test analysed. There were no restrictions on trial participants. Quality assessment was conducted with QUADAS-2. RESULTS Of 1227 identified reports, 10 studies were ultimately included. One study was at high risk of bias and two studies exhibited concerning features of bias; all studies were applicable. Three trials-of DigiVis, iSight Professional, and Peek Acuity-from two studies suggested that accuracy of the remote tests is comparable to clinical assessment. All other trials exhibited inferior accuracy, including conflicting results from a pooled study of iSight Professional and Peek Acuity. Two studies evaluated test-retest agreement-one trial provided evidence that DigiVis is as reliable as clinical assessment. The three most accurate tests required access to digital devices. Reporting was inconsistent and often incomplete, particularly with regards to describing methods and conducting statistical analysis. CONCLUSIONS Remote self-administered VA tests appear promising, but further pragmatic trials are indicated to justify deployment in carefully defined contexts to facilitate patient or non-specialist led assessment. Deployment could augment teleophthalmology, non-specialist eye assessment, pre-consultation triage, and autonomous long-term monitoring of vision.
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Affiliation(s)
- Arun James Thirunavukarasu
- School of Clinical Medicine, University of Cambridge, Camybridge, United Kingdom
- Corpus Christi College, University of Cambridge, Cambridge, United Kingdom
| | - Refaat Hassan
- School of Clinical Medicine, University of Cambridge, Camybridge, United Kingdom
- Sidney Sussex College, University of Cambridge, Cambridge, United Kingdom
| | - Aaron Limonard
- School of Clinical Medicine, University of Cambridge, Camybridge, United Kingdom
- St John’s College, University of Cambridge, Cambridge, United Kingdom
| | - Shalom Vitreous Savant
- School of Clinical Medicine, University of Cambridge, Camybridge, United Kingdom
- St John’s College, University of Cambridge, Cambridge, United Kingdom
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16
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Bjerager J, Schneider M, Potapenko I, van Dijk EHC, Faber C, Grauslund J, Pfau K, Huemer J, Muttuvelu DV, Rasmussen MLR, Sabaner MC, Subhi Y. Diagnostic Accuracy of the Amsler Grid Test for Detecting Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-analysis. JAMA Ophthalmol 2023; 141:315-323. [PMID: 36795396 DOI: 10.1001/jamaophthalmol.2022.6396] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Importance Patients with nonneovascular age-related macular degeneration (AMD) are encouraged to use the Amsler grid test for self-assessment to facilitate early diagnosis. The test is widely recommended, suggesting a belief that it signals worsening AMD, warranting its use in home monitoring. Objective To systematically review studies of the diagnostic test accuracy of the Amsler grid in the diagnosis of neovascular AMD and to perform diagnostic test accuracy meta-analyses. Data Sources A systematic literature search was conducted in 12 databases for relevant titles from database inception until May 7, 2022. Study Selection Studies included those with groups defined as having (1) neovascular AMD and (2) either healthy eyes or eyes with nonneovascular AMD. The index test was the Amsler grid. The reference standard was ophthalmic examination. After removal of obviously irrelevant reports, 2 authors (J.B. and M.S.) independently screened the remaining references in full text for potential eligibility. Disagreements were resolved by a third author (Y.S.). Data Extraction and Synthesis Two authors (J.B. and I.P.) independently extracted all data and evaluated quality and applicability of eligible studies using the Quality Assessment of Diagnostic Accuracy Studies 2. Disagreements were resolved by a third author (Y.S.). Main Outcomes and Measures Sensitivity and specificity of the Amsler grid for detecting neovascular AMD with comparators being either healthy control participants or patients with nonneovascular AMD. Results Of 523 records screened, 10 studies were included with a total of 1890 eyes (mean participant age ranging from 62 to 83 years). Sensitivity and specificity to diagnose neovascular AMD were 67% (95% CI, 51%-79%) and 99% (95% CI, 85%-100%), respectively, when comparators were healthy control participants and 71% (95% CI, 60%-80%) and 63% (95% CI, 49%-51%), respectively, when control participants were patients with nonneovascular AMD. Overall, potential sources of bias were low across studies. Conclusions and Relevance Although the Amsler grid is easy and inexpensive to use for detection of metamorphopsia, its sensitivity may be at levels typically not recommended for monitoring. Coupling this lower sensitivity with only moderate specificity to identify neovascular AMD in a population at risk, these findings suggest that such patients typically should be encouraged to undergo ophthalmic examination regularly, regardless of any results of Amsler grid self-assessment.
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Affiliation(s)
- Jakob Bjerager
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Miklos Schneider
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Ivan Potapenko
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Ophthalmology, Haga Hospital, The Hague, the Netherlands
| | - Carsten Faber
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Kristina Pfau
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany.,Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Josef Huemer
- National Institute for Health and Care Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
| | - Danson V Muttuvelu
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,MitØje Aps, Skive, Denmark
| | - Marie L R Rasmussen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M Cem Sabaner
- Department of Ophthalmology, Kütahya Health Sciences University, Evliya Celebi Training and Research Hospital, Kütahya, Turkey
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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17
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Mathai M, Reddy S, Elman MJ, Garfinkel RA, Ladd B, Wagner AL, Sanborn GE, Jacobs JH, Busquets MA, Chew EY. Analysis of the Long-term Visual Outcomes of ForeseeHome Remote Telemonitoring: The ALOFT Study. Ophthalmol Retina 2022; 6:922-929. [PMID: 35483614 DOI: 10.1016/j.oret.2022.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To evaluate long-term visual acuity (VA) and performance of a monitoring strategy with a self-operated artificial-intelligence-enabled home monitoring system in conjunction with standard care for early detection of neovascular age-related macular degeneration (nAMD). DESIGN Retrospective review. SUBJECTS Patients with dry-age-related macular degeneration from 5 referral clinics. METHODS Clinical data of patients monitored with ForeseeHome (FSH) device from August 2010 to July 2020 were reviewed. MAIN OUTCOME MEASURES Visual acuity at baseline, VA at diagnosis of nAMD for eyes that converted while monitored, and 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 since conversion to final study follow-up were collected. RESULTS We reviewed 3334 eyes of 2123 patients with a mean (standard deviation [SD]) age of 74(8) years, monitored for a mean (SD) duration of 3.1 (2.4) years, with a total of 1 706 433 tests in 10 474 eye-monitoring years. The mean (SD) weekly use per patient was 5.2 (3.4), and it was persistent over the usage period. Two hundred eighty-five eyes converted while monitored at an annual rate of 2.72% and were treated with a mean (SD) 17.3 (16.5) injections over a mean (SD) 2.7 (2.0) years, with 6.4 (3.1) injections per year for eyes treated for > 1 year. The median VAs at baseline and at final follow-up for eyes that did not convert were 20/27 and 20/34 with a median change of 0.0 letters. The median VAs at baseline, conversion, and final follow-up for eyes that converted during the monitoring period 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. Fifty-two percent of conversions detected had a system alert before conversion. Forty-eight percent of patients were detected by symptoms or routine visit. Patients experienced a non-nAMD alert on average every 4.6 years. At conversion and at final follow-up, the proportion (95% CI) of eyes that maintained ≥ 20/40 was 84% (78% to 88%) and 82% (76% to 86%), respectively. CONCLUSIONS Patients in the FSH monitoring program showed excellent long-term VA years after conversion to nAMD.
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Affiliation(s)
| | | | | | | | - Byron Ladd
- Virginia Eye Institute, Richmond, Virginia
| | - Alan L Wagner
- Wagner Macula & Retina Center, Virginia Beach, Virginia
| | | | | | | | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
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18
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Li JPO, Keane PA, Thomas P. Valid but Undervalued. JAMA Ophthalmol 2022; 140:471. [PMID: 35357424 DOI: 10.1001/jamaophthalmol.2022.0549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, London, England
| | - Peter Thomas
- Moorfields Eye Hospital NHS Foundation Trust, London, England
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