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

Abstract

Aims This study aims to quantify the diagnostic test-accuracy of three visual function self-monitoring tests for detection of active disease in patients with neovascular age-related macular degeneration (nAMD) when compared with usual care. An integrated qualitative study will investigate the acceptability of these home-based testing strategies. Methods All consenting participants are provided with an equipment pack containing an iPod touch with two vision test applications installed and a paper journal of reading tests. Participants self-monitor their vision at home each week with all three tests for 12-18 months. Usual care continues over this period. Key eligibility criteria are: age ≥50 years; at least one eye with AMD with ≥6-≤42 months since first AMD treatment; and vision not worse than Snellen 6/60, LogMAR 1.04 or 33 letters. The primary outcome, and reference standard, is diagnosis of active disease during usual care monitoring in the Hospital Eye Service. Secondary outcomes include duration of study participation, ability of participants to do the tests, adherence to weekly testing and acceptability of the tests to participants. Conclusions Recruitment is in progress at five NHS centres. Challenges in procuring equipment, setting up the devices and transporting devices containing lithium batteries to participating sites delayed the start of recruitment. The study will describe the performance of the tests self-administered at home in detecting active disease compared to usual care monitoring. It will also describe the feasibility of the NHS implementing patient-administered electronic tests or similar applications at home for monitoring health. Study registration ISRCTN identifier: 79058224.

Glaucoma Home Monitoring Using a Tablet-Based Visual Field Test (Eyecatcher): An Assessment of Accuracy and Adherence Over 6 Months

“…Home-monitoring would further allow for more VF testing, and more frequent VF testing: both important for rapid, robust clinical decision-making 12 , 23 . For these reasons, interest in home monitoring is growing both for glaucoma 14 , 21 , 22 , as well as for the management of other chronic ophthalmic conditions 24 , 25 , 26 , 27 and in healthcare generally 28 . This interest is likely to intensify following COVID-19, as both hospitals and patients look to further minimize in-person appointments 29 , 30 .…”

The COVID-19 pandemic and ophthalmic care: a qualitative study of patients with neovascular age-related macular degeneration (nAMD)

“…The study included a subset of nAMD patients who were taking part in a larger diagnostic accuracy study of home-monitoring tests (MONARCH). 14 Participants were recruited from four sites within the UK. Maximum variation sampling was used to ensure that a range of perspectives were captured in relation to age category (young-old 50-69 years and older-old 70+years), gender, laterality of nAMD (unilateral and bilateral) and time since first treatment (6-17 months, 18-29 months and 30-41 months).…”

The Clinical Use of Vernier Acuity: Resolution of the Visual Cortex Is More Than Meets the Eye

“…Following the COVID-19 pandemic and with rising pressures on clinics for ophthalmic treatments, greater attention is being given to the use of home monitoring to facilitate provision of streamlined care ( Jones et al, 2021 ; Ward et al, 2021 ). Targeted vernier acuity tools can also be utilised, within the clinic setting or even in a patient’s home, to monitor changes in macular function, particularly important in diseases such as age-related macular degeneration (AMD).…”