At-Home Monitoring of Choroidal Neovascularization Led To Higher Detection Rate, Less Vision Loss Than Office Visits Daily use of a home monitoring device (ForeseeHome device, Notal Vision) resulted in better detection of choroidal neovascularization (CNV) and showed that routine office visits did not detect CNV at a high rate when compared with device use, according to David S. Boyer, MD.1 In the HOME study, 1520 patients were randomized to standard care or device use. Patients in the standard care arm were required to attend routine offices visits to detect CNV. Patients in the device arm performed at-home testing in addition to attending routine office visits. Both groups were self-monitored and were examined following the report of symptoms. Patients in the device arm were also examined following an alert from the device. Mean follow up was 1.4 years. Over that time period, 51 patients in the device arm and 31 patients in the standard care arm developed CNV. Patients with CNV in the device arm lost a median of 4 letters from baseline to detection of CNV (interquartile range [IQR], -11.0 to -1.0 letters); patients with CNV in the standard care arm lost a median 9 letters from baseline to detection of CNV (IQR, -14.0 to -4.0 letters; P = .021). The rate of detecting incidence of CNV in the device arm (as reported by symptoms or by device alerts) was 11.6% (95% CI, 8.1%–15.2%). The detection rate for incidence of CNV in the standard care arm (as reported by symptoms) was 26% (95% CI; 15.5%–36.8%). Eyes with new incidence of CNV in the device arm when the device was used as instructed (ie, twice per week) lost a median 3 letters upon presentation due to symptoms or device alerts, and eyes with new incidence of CNV in the standard care arm lost 11.5 letters upon presentation due to symptoms (P = .03). Speaking about the standard care arm, Dr. Boyer said that the “detection rate was very high. If patients come in with symptoms, there is a high chance that they have CNV.” Still, these patients presented late in the disease course. “So you get very few visits [in the standard of care arm], but you get very poor vision results.” Judy E. Kim, MD, reported on lesion size in eyes with incidence of CNV confirmed by fluorescein angiography or optical coherence tomography.2 Eyes with CNV detected in the standard care arm (n = 23) had a 1.46 disc area mean lesion area. Eyes with CNV detected in the device arm (n = 39) had a 0.64 disc area mean lesion size (P = .05). “Like many diseases, early detection of a disease increases the likelihood of better patient outcomes,” Dr. Kim said. Dr. Kim noted the importance of this data when considered alongside data from the CATT study, which, she said, found that “eyes that had small lesion size at the time of diagnosis were more likely to have better visual acuity at 1 year of treatment.” 1.Boyer DS. The Home Monitoring of the Eye (HOME) study: potential implication of findings on management of intermediate-AMD patients. Paper presented at: American Society of Retina Specialists 2014 Annual Meeting; August 9-13, 2014; San Diego, CA. 2.Kim JE. The HOME Study: lesion characteristics of early choroidal neovascularization. Paper presented at: American Society of Retina Specialists 2014 Annual Meeting; August 9-13, 2014; San Diego, CA.
Posted on: Sun, 14 Sep 2014 00:18:17 +0000
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