Study investigates enablers, barriers of engagement with app-based home monitoring
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A study carried out at Moorfields Eye Hospital in London investigated enablers and barriers of engagement with app-based home monitoring of vision in patients with retinal diseases.
“The strongest predictor of uptake in our patient cohort was age, with older individuals relatively less likely to become active users, representing a risk factor for digital exclusion,” the authors wrote.
Better vision was positively associated with uptake and compliance.
The Home Vision Monitor app (HVM, Genentech) is an FDA-cleared, CE-marked self-test that uses shape discrimination hyperacuity to detect metamorphopsia in the central degrees of vision, according to the study. It is associated with a web-based review portal that automatically sends an alert message to the clinician if vision changes occur. Between May 2020 and February 2021, the app was offered to 417 patients treated with intravitreal injection who had a smartphone. They were asked to self-test twice a week.
The analysis of HVM data was integrated with an engagement survey to evaluate uptake, compliance and use rate and their association with patient characteristics. Uptake was defined as success in installing the app and using it at least once. Compliance was defined as regular use of the app for at least 4 weeks. Use rate was the total number of tests during the study period.
Two hundred fifty-eight patients (61.9%) were classified as active users, and 166 (64.3%) fulfilled the definition of compliance. Mean weekly app use was 1.83. Younger age, better vision and the number of injections at baseline were positively associated with uptake and compliance. Patients with age-related macular degeneration were more likely to be compliant than those with macular edema.
The survey, completed by 117 active users, showed a strong association between comfort with modern technologies and higher levels of app use rate. The expectation that closer vision monitoring could lead to improved eye health was the most common motivation to use the app.
Within the study, 26 alerts for vision worsening were triggered. In eight cases, changes were not subjectively perceived by the patients. Notification alerts demonstrated high sensitivity (84.6%) and specificity (88.5%).
Studies in controlled research environments have shown that the use of smartphone-based home monitoring apps can be beneficial for the management of patients with retinal diseases, according to the authors. However, “for real-world translation of such benefits to occur, potential barriers to adoption not manifested in controlled research environments require careful consideration,” they wrote.
Targeted interventions, such as educational initiatives aimed at increasing digital literacy, should be developed to address digital exclusion.
“As health care systems increasingly adopt digital and remote models of care, issues such as digital exclusion require careful consideration to both ensure equitable access and avert disparate outcomes,” the authors wrote.
Perspective
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This study addresses the crucial issue of whether potential users, ie, an elderly population with various degrees of visual impairment, are willing and capable of taking advantage of home monitoring technology, as well as assessing its clinical efficacy.
As the authors noted, modern ophthalmology is facing numerous challenges of an aging population and increased prevalence of chronic conditions such as AMD and diabetic retinopathy, which require constant monitoring. The current COVID-19 pandemic has put clinical services under further strain and has highlighted the need for effective home-monitoring solutions.
The study showed that home monitoring facilitated by specific smartphone technologies had high rates of sensitivity and specificity. However, it also showed that part of the population may be excluded due to visual impairment and lack of digital literacy skills. Future strategies to address this issue should include the integration of real-time feedback and active support systems, both possible with smartphone technology.
Furthermore, further studies are needed to assess the feasibility of smartphone-based home monitoring technology. They should include a wider population, consisting of participants with lower educational levels and different social backgrounds. Issues regarding privacy regulations, reliability of secured clouds, and other legal and ethical questions also need to be addressed before smartphone-based home monitoring is widely implemented.
However, it is my belief that home monitoring, along with telemedicine, will be included in future models of patient care. This will include smartphone applications incorporating imaging technology, such as the ForeseeHome and the Notal Home OCT devices (both Notal Vision).
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