Home OCT allows for early personalized treatment
SEATTLE — Home OCT provides an unprecedented view of fluid recurrence and resolution patterns in individual patients, allowing for prompt, personalized treatment.
In a study presented at the American Society of Retina Specialists annual meeting by Miguel Busquets, MD, FACS, FASRS, the information provided by Home OCT (Notal Vision) in 57 eyes of 54 patients with neovascular age-related macular degeneration was retrospectively analyzed. The reactivation and resolution periods were manually segmented by expert graders, and treatment responses were quantified for two groups of patients treated within or after 7 days from recurrence.
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“[Results] demonstrate significant heterogeneity in recurrence and response fluid volume trajectories for different eyes. Regarding the fluid dynamics of recurrence, the mean fluid increase rate was 12.6 nL per day, the mean maximum fluid volume was 115 nL, and the mean duration from reactivation to treatment was 12 days,” Busquets said.
Response to treatment was quantified in a mean decrease rate of 8.3 nL per day, with a mean level of resolution of 91.6% and a mean time of 11 days to complete resolution of fluid.
“Regarding treatment timing vs. fluid characteristics, we found that the cohort treated within 1 week had statistically significantly lower values of mean volume at treatment, mean resolution time and mean area under the curve for fluid trajectories,” Busquets said.
As an example of how Home OCT can improve the timing and logistics of AMD management, he presented the case of a 75-year-old woman with neovascular AMD in the left eye who was followed with Home OCT. On day 48, an activation was noted, and 3 days later, the patient was promptly treated with aflibercept. Resolution of fluid and maintenance of a dry retina were again demonstrated by Home OCT. Visual acuity was maintained at a 20/20 level.
“This was an example of tightly managed fluid with limited visits, whereby the patient only presents to the clinic for treatment when absolutely necessary,” Busquets said.
Another case with significant subretinal fluid was treated with faricimab 10 days after recurrence, and Home OCT demonstrated full fluid resolution after 20 days. Busquets said this was as an example of fluid tolerance in which the patient maintained good vision.
“This shows how Home OCT information, coupled with clinical data, can help inform us regarding individualized treatment protocols, given the significant heterogeneity in fluid dynamics that exists between patients with neovascular AMD,” he said.
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Busquets M. Home OCT and artificial intelligence in nAMD. Presented at: American Society of Retina Specialists annual meeting; July 28-Aug. 1, 2023; Seattle.
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