Abstract
Purpose :
Telemedicine, despite its growing popularity, has seen limited adoption in ophthalmology. The goal of this work is to evaluate performance of a tele-ophthalmology model that uses in-home testing, analysis of testing in real time by automated intelligence, a dedicated monitoring center and the physician’s office.
Methods :
Data was collected from one clinical study and one clinical trial to understand the utility of this tele-ophthalmology model for remote monitoring of patients with age-relayed macular degeneration (AMD). The clinical study uses a home testing device (ForeseeHome) with macular visual field testing utilizing hyperacuity techniques to monitor metamorphopsia between office visits to detect conversion to neovascular AMD. The clinical trial uses a self-operated optical coherence tomography (OCT) device (home OCT) to monitor retinal fluid in patients being treated for neovascular AMD. Both devices have a dedicated monitoring center with alert and compliance management, service assistance, and technical support. The specific outcomes that were studied included compliance rates, longitudinal compliance, duration on the program, ease of device use, patient experience with daily usage, and patient experience with monitoring center support. Patient experiences were measured using survey questions with 1 being strongly agree to 5 being strongly disagree.
Results :
The patients in the ForeseeHome clinical study showed a compliance of 5.2 tests per week, and this compliance rate was largely maintained over a period of 10 years, ranging from average 4.8 to 6.9 tests per week. A Kaplan-Meier analysis predicted patients to be on the program for median (IQR) of 4.5 (4.3-4.7) and mean (SD) of 3.7 (3.4-4.0) years. The average patient responses in the OCT trial to questions regarding experience tended on the positive side (1 being highly positive and 5 being highly negative). The nAMD patients rated ease of use at a mean of 1.31, convenience of daily use at 1.38, and help with service calls at 2.00.
Conclusions :
A tele-ophthalmology model that employs a monitoring center along with an in-home testing device is a viable solution with both clinical usefulness and excellent patient acceptance over an extended period. The extension of such a model for other applications in ophthalmology can increase use of telemedicine in the field.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.