W. Lloyd Clark, MD: Management of nAMD Using Home OCT Monitoring

New first-time treatment experience results suggest the feasibility of home optical coherence tomography (OCT)-guided management of neovascular age-related macular degeneration (nAMD).

The data, presented at the 127th Annual American Academy of Ophthalmology (AAO) Meeting in San Francisco, California, showed statistically significant reductions in treatment frequency with an increase in treatment interval from 8.0 to 15.3 weeks, with no change in visual acuity at 6 months, with the use of home OCT.

“We’re really excited about the home OCT – this has the opportunity to offer a new type of personalized medicine, an important concept in modern healthcare,” presenting investigator W. Lloyd Clark, MD, told HCPLive. “Certainly, combining this technology with extended dosing can really make an impact on treatment burden for patients.”

Clark described the first-ever clinical study of home OCT-guided management of nAMD, to help define the process of home OCT-based management. The analysis evaluated the impact of home OCT-guided management on treatment burden and visual acuity. Prior observation studies of home OCT provided the opportunity for daily home OCT imaging and provided insight into fluid exposure and dynamics in between office visits.

However, Clark noted these office-based decisions were solely based on in-office exams, not home OCT imaging. The current study assessed the feasibility and impact of nAMD management using data collected from the home OCT. A patient obtains images at home, a monitoring center collects the image, an artificial intelligence (AI)-based platform evaluates the presence of the disease, and a retina specialist verifies, and treats based on that information.

The study included a total of 15 patients (27 eyes) with diagnosed nAMD in ≥1 eye. They performed daily home OCT scans over a 6-month follow-up period and were invited to a clinical office based on a physician review of home OCT data, triggered by fluid parameters. Regardless of disease activity, patients were observed at 3-month and 6-month time points for safety.

Key outcome measures for the study were the change in treatment burden and changes in visual acuity before and during the home OCT-guided management. Higher treatment burdens were observed in 4 subjects.

Overall, over the 6-month study period, the mean treatment interval increased from 8.0 to 15.3 weeks (P <.01), a statistically significant change. Regarding visual acuity, the mean change during the study period was 0 letters (P =.45)

Clark noted patients and technology performed well, with patients obtaining an average of 6 scans per week. There was a total of 40 home OCT-triggered visits – in analysis, 39 of 40 visits were confirmed based on in-office imaging, and treatment was recommended in 37 cases.

Limitations were identified, including the small cohort of 27 eyes, the non-randomized study design, with retrospective treatment history as a comparator, the non-standardized treatment protocols, and Snellen visual acuity.

For more insight into the analysis, watch the full interview with Dr. Clark.

References

_{Clark WL., Holekamp NM., de Bues A., Heier JS. Management of Treatment-Experienced nAMD Patients Using Home OCT Monitoring. Presented at the 2023 American Academy of Ophthalmology Annual Meeting, November 3 – 6, 2023.}