Remote Telemonitoring Program Showed Good Long-Term VA After nAMD Conversion

Emily Y. Chew, MD

Patients in a remote telemonitoring program were associated with excellent visual acuity (VA) in a long-term follow-up after conversion to neovascular age-related macular degeneration (nAMD), according to new findings.

A team of investigators led by Emily Y. Chew, MD, Director of the Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, evaluated long-term VA and the performance of a monitoring strategy with a self-operated artificial-intelligence–enabled home monitoring system in conjunction with standard care for early detection of nAMD.

The retrospective review of the ALOFT study included patients with dry-age-related macular degeneration from 5 referral clinics. Investigators reviewed the clinical data of patients monitoring with the ForeSeeHome device from August 2010 to July 2020.

The main outcomes measured were VA at baseline, VA at diagnosis of nAMD for eyes that converted during the monitor period, and VA from the final study follow-up, weekly frequency of use, and duration of monitoring. Additionally, the measures collected included the modality of conversion diagnosis (system alert vs. detection by other standard care means), and duration and number of treatments since conversion to final study follow-up.

Investigators reviewed 3334 eyes of 2123 patients with a mean (SD) age of 74 years and monitored for a mean (SD) duration of 3.1 years. This added to a total of 1,706,433 tests in 10,474 eye-monitoring years. The mean weekly use per patient was 5.2 and this persisted over the usage period, according to the data.

It additionally suggested 285 eyes were converted to nAMD while monitored at an annual rate of 2.72% and were treated with a mean (SD) of 17.3 injections over a mean of 2.7 years. This equaled out to 6.4 injections per year for eyes treated for >1 year.

Data show the median VAs at baseline and at final follow-up for eyes that did not convert were 20/27 and 20/34, with a median change of 0.0 letters.

Then, the median VAs at baseline, conversion, and final follow-up for eyes that converted during the monitoring period were 20/30, 20/39, and 20/32 with a median change from baseline to conversion, baseline to recent, and conversion to recent of –4, –4, and 0 letters, respectively.

Investigators noted 52% of conversions detection hada system alert before conversion and 48% of patients were detected by symptoms or routine visit. Patients experienced a non-AMD alert on average every 4.6 years, they added.

Further, the team indicated at conversion and at final follow-up, the proportion (95% confidence interval [CI]) of eyes that maintained a ≥20/40 was 84% (78% to 88%) and 82% (76% to 86%), respectively.

The study, “Analysis of the Long-term Visual Outcomes of ForeseeHome Remote Telemonitoring: The ALOFT Study,” was published in Ophthalmology Retina.