Improved Adherence to Vision Self-monitoring with the Vision and Memory Stimulating (VMS) Journal for Non-neovascular Age-related Macular Degeneration during a Randomized Controlled Trial

Abstract

ObjectiveAn educational, interactive journal [Vision and Memory Stimulating (VMS) journal] was developed to boost patient confidence and promote long-term adherence with weekly vision self-monitoring in age-related macular degeneration (AMD) patients at risk for vision loss from new-onset neovascularization.MethodsIn a multicenter randomized controlled trial, 198 subjects with intermediate stage, non-neovascular AMD received the VMS journal or followed usual care (e.g. their doctor’s instructions for vision monitoring; Amsler grid). At 6 and/or 12 months post-enrollment, 157 subjects completed a questionnaire on vision self-monitoring.ResultsAt 6 and 12 months, respectively, 85% and 80% of the VMS journal subjects reported vision monitoring at least weekly, which represent statistically significant 7.1 and 4.2 times greater odds than the 50% of controls who monitored weekly at both follow-up times (p<0.001). At 6 and 12 months, respectively, 29% and 25% of controls indicated that they had not checked their vision in the past 6 months, while only 1.5% and 5% of the VMS journal subjects reported no vision self-monitoring. At 6 and 12 months, respectively, only 15% and 13% of the VMS journal subjects vs. 53% and 44% of the controls reported that they did not feel confident that they were taking care of their sight by self-monitoring (p<0.001). Usual care controls had statistically significant 6.7 and 5.0 times greater odds of reporting non-confidence at 6 and 12 months, respectively. There was no statistically significant change in weekly vs. less frequent self-monitoring between the groups (p=0.68), with 81% of all subjects reporting no change in frequency between 6 and 12 months.ConclusionsThese findings support the efficacy of the VMS journal for increasing vision self-monitoring adherence and confidence, in addition to promoting persistence in weekly monitoring over the course of a year in AMD subjects at risk for exudative retinal changes.

Home-Monitoring Vision Tests to Detect Active Neovascular Age-Related Macular Degeneration

“…The KeepSight Journal (KSJ [International Macular and Retinal Foundation]) is a paper-based booklet of near-vision tests for weekly monitoring, 1 eye at a time, using 3 monitoring strategies . It assesses near visual acuity using puzzles with diminishing font sizes (Figure 1A), self-reported distortion by encouraging patients to view objects with straight lines in the home (environmental Amsler) (Figure 1B), and distortion or scotomas using a modified Amsler chart or visual- and memory-stimulating grid (Figure 1C) . Four raw test scores were generated for each testing occasion: near visual acuity worse than baseline, Amsler grid worse than baseline, household object appearance worse than baseline, ordinal near visual acuity (on a scale of 1-6, the number of font sizes displayed in each puzzle).…”

Monitoring for neovascular age-related macular degeneration (AMD) reactivation at home: the MONARCH study

“…The following tests are being evaluated: (a) KeepSight Journal (KSJ) [ 6 ] adapted by the study team for UK use, (b) MyVisionTrack® (mVT) electronic application [ 5 , 8 , 9 , 12 , 15 ] (Genentech Inc.) and (c) MultiBit (MBT) electronic application [ 13 , 14 ], developed by Visumetrics, licensed by Novartis International AG.…”

“…Therefore, any test must detect an increase or change in visual disability, not just the presence of disability. Technologies such as visual and memory stimulating grids [ 6 ], preferential hyperacuity perimetry [ 4 , 7 ] and shape discrimination tests [ 5 , 8 – 11 ] have been reported to quantify distortion more accurately than either the Amsler grid or visual acuity in clinical settings [ 3 ].…”

“…The MONARCH study is evaluating three home-monitoring tests. All have some supporting peer-reviewed literature and usability data from AMD populations [ 5 , 6 , 8 , 9 , 12 – 15 ]. Two of these tests are electronic applications that run on an iPod touch and one is a paper journal of reading puzzles.…”

Inequalities in Uptake and Use of Digital Applications for Home-Monitoring of Neovascular Age-Related Macular Degeneration in an Elderly Visually Impaired Population: The MONARCH Study

“…The MONARCH study (Monitoring for Neovascular Age-related Macular Degeneration Reactivation at Home) was a multicenter diagnostic test accuracy study that aimed to evaluate the effectiveness of a home-based monitoring system for patients with age-related macular degeneration (AMD). 5 Tests evaluated included one paper-and-pencil test (KeepSight Journal [KSJ]) 6 and two tests implemented as software applications (apps: MyVisionTrack [mVT] 7 and MultiBit [MBT]) 8 on an iPod Touch device (Apple, Cupertino, CA, USA). The device, equipped with internet access via a MiFi device, allowed the data to be automatically transmitted to a server and then to the study database.…”