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Monitoring critical to preserve visual acuity in patients before and after CNV detection
Patients who use a home monitoring system may have a better chance of retaining 20/40 or better vision with anti-VEGF therapy.
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Wider use of a home monitoring system for detecting wet age-related macular degeneration in patients at high risk for developing the disease may have a positive effect on public health in the U.S., according to an expert.
At the American Society of Retina Specialists meeting in Vienna, OSN Retina/Vitreous Board Member Carl D. Regillo, MD, discussed the potential public health impact of the ForeseeHome AMD monitoring program (Notal Vision), which uses preferential hyperacuity perimetry (PHP) to help detect choroidal neovascularization in its earliest stages in patients with AMD.
“It’s all about early detection. Right now, current methods like the use of the Amsler grid as a way to monitor at home for the change from dry to wet AMD are not all that great,” Regillo told Ocular Surgery News in a follow-up interview. “The PHP has been a proven way to catch the transformation from dry to wet at an earlier stage, when there’s less vision loss.”
Impact on public health
Regillo said that wet AMD is commonly detected when visual acuity has diminished to 20/60 or 20/80.
“That’s kind of the norm, and although anti-VEGF therapy on average does improve vision, it doesn’t restore good vision in most of those patients. Good vision is defined as 20/40 or better. With 20/40 or better, you can do any typical visual task like read a newspaper or drive in an unrestricted fashion,” Regillo said. “[If you] catch patients when their vision is 20/40 or better and then start the anti-VEGF therapy, the chances of keeping them 20/40 or better, which is good vision, is up over 70%. Some studies show it to be as high as 80%. That’s over several years. So, it’s really about early detection.”
In the HOME study, Regillo and colleagues found that 87% of patients who used the ForeseeHome program and 62% of patients who relied on standard monitoring had visual acuity of 20/40 or better at the time of CNV detection.
“No less than 100,000 and as much as 300,000 cases of wet AMD would be detected at better vision earlier on in their course,” he said. “Therefore, those patients are likely to have a much more favorable course with anti-VEGF therapy after [CNV] is detected.”
Maintaining 20/40 vision after detection of CNV is the real challenge, Regillo said.
Home monitoring system
Regillo said that 20% to 25% of patients cannot use the ForeseeHome monitoring system.
“In some of those patients it doesn’t work well because their vision has already decreased. It’s not as useful for those patients because their visual acuity is already knocked down from central vision loss,” Regillo said.
Additionally, the device may be cost-prohibitive for patients because many third-party payers do not cover it, he said.
The PHP device is part of a system in which AMD is closely monitored.
“It’s telemonitoring because the device sends signals to a reading center that interprets and then alerts the patient and the office that a change has occurred that could mean the transformation from dry AMD to wet AMD,” Regillo said.
The device is sent to the patient’s home. The patient pays an initiation fee and a monthly monitoring fee, he said. – by Matt Hasson and David W. Mullin
- For more information:
- Carl D. Regillo, MD, can be reached at Wills Eye Institute, 840 Walnut St., Suite 1020, Philadelphia, PA 19107; email: cregillo@aol.com.
Disclosure: Regillo reports he is an investigator for and receives grant support from Notal Vision.