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Merina Thomas, Shiri Zayit-Soudry, Peggy Orr, Susan B. Bressler, Neil M. Bressler; Preferential Hyperacuity Perimetry Home Monitoring in Patients Following Treatment for Neovascular Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3825.
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To determine how often changes on a preferential hyperacuity perimeter, used as a home monitoring device (ForeseeHome (TM), Notal Vision, Tel Aviv), correspond to features of active neovascular AMD judged to require resumption of treatment in study participants who have had recent deferral of antiangiogenic treatment for neovascular AMD based on clinical examination and fundus imaging.
Following approval by the Johns Hopkins University School of Medicine’s Institutional Review Board, all participants met the following eligibility criteria: age 55 or older, receipt of anti-VEGF treatment for neovascular AMD within the past 3 months, judged not to need treatment at the baseline study visit (which is at most 3 months from the time of most recent treatment), ability to successfully pass a qualification test on the device, and visual acuity with habitual correction of 20/63 or better in the study eye(s).Participants completed an initial test in the clinic using the ForeseeHome (TM) with the study eye (or better-seeing eye if both eyes were eligible). Participants with an unreliable test (i.e., a test with a pre-determined insufficient percentage of correct responses or excess of non-responded stimuli) were exited from the study. Devices were administered to participants for home use with instructions to use the monitor at least twice per week. If the device signaled a change in hyperacuity perimetry, the participant was asked to return to the clinic for an examination aimed at detecting active neovascular AMD that would lead to resumption of anti-VEGF therapy.
30 (90%, 95% confidence interval [CI] 73% to 100%) of 36 eyes among 35 participants fulfilled the eligibility criteria and produced a reliable qualifying test. All study eyes have been monitoring with the device for 5 months, during which time 4 study eyes had a true positive alert signal from the device, 4 had a false positive, 20 had a false negative, and 24 had a true negative.
For patients who had prior anti-VEGF therapy for CNV in which treatment is suspended at a particular visit due to absence of active disease, the preferential hyperacuity perimeter used as a home monitoring device occasionally detected changes warranting resumption of anti-VEGF therapy prior to a routine return visit. However, as a large number of participants had active disease detected at a clinical exam that was not recognized by monitoring, the device would not be acceptable for routine home monitoring in this circumstance without further modification and testing.
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