A Deeper Look at Three Emerging Areas in Neovascular AMD
A Deeper Look at Three Emerging Areas in Neovascular AMD
In many situations in medicine, early detection of disease can translate into better patient outcomes. The best predictor of visual acuity 1 or 2 years after initiation of anti-VEGF treatment for neovascular AMD is visual acuity at the time of therapy initiation. Specifically, patients with worse baseline visual acuity tend to have worse final visual acuity than patients with better baseline visual acuity. Furthermore, increasing time between symptom onset and initiation of anti-VEGF treatment correlates with decreased visual acuity at presentation and after successful treatment. Therefore, early detection of neovascularization in AMD is critical to optimizing visual outcomes.
Current monitoring of AMD patients at risk for CNVM consists of periodic office-based examination and self-monitoring with use of an Amsler grid. Use of the ForeseeHome device (Notal Vision, Inc.; St Louis, Missouri) may allow earlier detection of CNVM and therefore better long-term visual function. This device has been tested in the Home Monitoring of the Eye (HOME) study, a phase 3, unmasked, randomized trial that was part of the Age-Related Eye Disease Study 2, a trial of nutrient supplements in AMD patients at high risk of developing CNVM.
The ForeseeHome™ device combines macular visual field testing and telemonitoring. The test capitalizes on the human ability to perceive minute differences in the relative localization of two objects in space, or preferential hyperacuity perimetry. A typical test measures 500 retinal data points within the central 14° of the macular visual field and can potentially detect early functional abnormalities associated with CNVM, before the patient is aware of symptoms or changes in visual acuity. Such changes are then transmitted to the monitoring center and trigger an alert to the designated physician.
Of the 1520 patients enrolled in the HOME study, 82 developed CNVM during a mean follow-up of 1.4 years. Patients using the ForeseeHome device demonstrated a statistically significant smaller decline in visual acuity, with fewer letters lost from baseline to time of CNVM detection (-4 letters) compared with patients not using the device (-9 letters). Medicare approval for the device is currently being sought.
Other screening techniques, such as phone- and tablet-based systems, need further study.
Diagnostics
In many situations in medicine, early detection of disease can translate into better patient outcomes. The best predictor of visual acuity 1 or 2 years after initiation of anti-VEGF treatment for neovascular AMD is visual acuity at the time of therapy initiation. Specifically, patients with worse baseline visual acuity tend to have worse final visual acuity than patients with better baseline visual acuity. Furthermore, increasing time between symptom onset and initiation of anti-VEGF treatment correlates with decreased visual acuity at presentation and after successful treatment. Therefore, early detection of neovascularization in AMD is critical to optimizing visual outcomes.
Current monitoring of AMD patients at risk for CNVM consists of periodic office-based examination and self-monitoring with use of an Amsler grid. Use of the ForeseeHome device (Notal Vision, Inc.; St Louis, Missouri) may allow earlier detection of CNVM and therefore better long-term visual function. This device has been tested in the Home Monitoring of the Eye (HOME) study, a phase 3, unmasked, randomized trial that was part of the Age-Related Eye Disease Study 2, a trial of nutrient supplements in AMD patients at high risk of developing CNVM.
The ForeseeHome™ device combines macular visual field testing and telemonitoring. The test capitalizes on the human ability to perceive minute differences in the relative localization of two objects in space, or preferential hyperacuity perimetry. A typical test measures 500 retinal data points within the central 14° of the macular visual field and can potentially detect early functional abnormalities associated with CNVM, before the patient is aware of symptoms or changes in visual acuity. Such changes are then transmitted to the monitoring center and trigger an alert to the designated physician.
Of the 1520 patients enrolled in the HOME study, 82 developed CNVM during a mean follow-up of 1.4 years. Patients using the ForeseeHome device demonstrated a statistically significant smaller decline in visual acuity, with fewer letters lost from baseline to time of CNVM detection (-4 letters) compared with patients not using the device (-9 letters). Medicare approval for the device is currently being sought.
Other screening techniques, such as phone- and tablet-based systems, need further study.