Early Detection Of Exudative Age-related Macular Degeneration With A Home-based Preferential Hyperacuity Perimeter

Abstract

Purpose: : In patients with exudative age-related macular degeneration (AMD), large randomized trials have demonstrated that better initial acuity and smaller lesion size are predictors of better absolute acuity following therapy. Therefore, early detection may afford better patient outcomes. The purpose of this study was to determine whether a home-based preferential hyperacuity perimeter (PHP) could detect early conversion from dry to wet AMD and to assess the stability of patient testing over time.

Methods: : Enrolled patients with intermediate AMD were instructed on daily use of the home-based PHP device, the ForeseeHome, which examines the macula for central visual field defects and automatically transmits results to a reading center. In the event of a change in test scores, the patient’s ophthalmologist was notified. All eyes with 40 tests or more were included in the analysis. Statistical distributions of the first 20 test scores and last 20 test scores were compared.

Results: : 80 eyes of 62 patients performed an average [range] of 82 [40-281] tests in a period of 157 [52-349] days with a usage frequency of 4.2±1.7 tests per week. No statistically significant differences in the average (p= 0.87) or standard deviation (p=0.65) of test scores were found when comparing the first and last 20 tests. Among 5 patients who demonstrated test-retest instability (deterioration in test scores), 3 were diagnosed with CNV and treated - all were asymptomatic upon diagnosis. The specificity of the test was 0.97.

Conclusions: : In patients with intermediate AMD, frequent monitoring with a home-based PHP was applied successfully with stable test scores over several months. New cases of CNV were detected with a high sensitivity and specificity in asymptomatic patients. The ForeseeHome device shows promise as a telemedicine approach for early detection of conversion from dry to wet AMD.

Clinical Trial: : http://www.clinicaltrials.gov NCT01083147

Keywords: age-related macular degeneration • clinical (human) or epidemiologic studies: systems/equipment/techniques • choroid: neovascularization