Real-World Performance of a Self-Operated Home Monitoring System for Early Detection of Neovascular Age-Related Macular Degeneration

Ho, Allen C.; Heier, Jeffrey S.; Holekamp, Nancy M.; Garfinkel, Richard A.; Ladd, Byron; Awh, Carl C.; Singh, Rishi P.; Sanborn, George E.; Jacobs, Jennifer; Elman, Michael J.; Loewenstein, Anat; Eichenbaum, David

doi:10.3390/jcm10071355

Cited by 23 publications

(15 citation statements)

References 34 publications

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“…One promising aspect of OCT technology that may dramatically increase the amount of available data, and clinical utility, is its emerging portability. Options for at home self-administered OCT imaging are already under investigation (47,48). The clinical goals of at home testing include early detection of disease through screening, closer monitoring of active disease progression, and a reduction in the number of necessary in-person clinical visits.…”

Section: Discussionmentioning

confidence: 99%

OCT and OCT Angiography Offer New Insights and Opportunities in Schizophrenia Research and Treatment

Green

Choi

Ramchandran

et al. 2022

Front. Digit. Health

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The human retina and retinal imaging technologies continue to increasingly gain the attention of schizophrenia researchers. With the same embryologic origin as the brain, the retina offers a window into neurovascular changes that may underlie disease. Recently, two technologies that have already revolutionized the field of ophthalmology, optical coherence tomography (OCT), and a functional extension of this, optical coherence tomography angiography (OCTA), have gained traction. Together, these non-invasive technologies allow for microscopic imaging of both structural and vascular features of the retina. With ease of use and no side effects, these devices are likely to prove powerful digital health tools in the study and treatment of schizophrenia. They may also prove key to discovering disease relevant biomarkers that underly neurodevelopmental and neurodegenerative aspects of conditions such as schizophrenia.

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Section: Discussionmentioning

confidence: 99%

OCT and OCT Angiography Offer New Insights and Opportunities in Schizophrenia Research and Treatment

Green

Choi

Ramchandran

et al. 2022

Front. Digit. Health

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“…The importance of predicting the conversion to exudative AMD within 2 years is that it can impact the development of follow-up and monitoring schedules for a patient and for potentially selecting a higher-risk group of patients who may benefit from more expensive home-monitoring strategies. (Busquets and Sabbagh 2021) (Ho et al 2021) (Pershing and Stein 2017) A personalized monitoring approach could potentially allow earlier detection of these patients, thereby leading to earlier therapeutic intervention and better visual outcomes.…”

Section: Discussionmentioning

confidence: 99%

Automated large-scale AMD progression prediction using machine-read OCT biomarkers

Rudas

Chiang

Corradetti

et al. 2022

Preprint

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Age-related Macular Degeneration (AMD) is a major cause of irreversible vision loss in individuals over 55 years old in the United States. While anti-vascular growth factor injections can be used to treat macular neovascularization (MNV), there are currently no treatments available to halt or reverse geographic atrophy, which is the late-stage of nonneovascular AMD. There is a great interest in detecting early biomarkers associated with a higher risk for AMD progression in order to design early intervention clinical trials. The annotation of structural biomarkers on optical coherence tomography (OCT) B-scans is a laborious, complex and time-consuming process, and discrepancies between human graders can introduce variability into this assessment. To address this issue, a deep-learning model (SLIVER-net) was proposed, which could identify AMD biomarkers on structural OCT volumes with high precision and without human supervision. However, the validation was performed on a small dataset, and the true predictive power of these detected biomarkers in the context of a large cohort has not been evaluated. In this retrospective cohort study, we perform the largest-scale validation of these biomarkers to date. We also assess how these features combined with other EHR data (demographics, comorbidities, etc) affect and/or improve the prediction performance relative to known factors. Our hypothesis is that these biomarkers can be identified by a machine learning algorithm without human supervision, in a way that they preserve their predictive nature. The way we test this hypothesis is by building several machine learning models utilizing these machine-read biomarkers, and assessing their added predictive power. We found that not only can we show that the machine-read OCT B-scan biomarkers are predictive of AMD progression, we also observe that our proposed combined OCT and EHR data-based algorithm significantly outperforms the state-of-the-art solution in clinically relevant metrics and provides actionable information which has the potential to improve patient care. In addition, it provides a framework for automated large-scale processing of OCT volumes, making it possible to analyze vast archives without human supervision.

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“…Ensuring regular and reliable device usage is essential when implementing home monitoring of disease activity. Although there have been positive reports of long-term compliance [ 16 ], large non-proprietary studies of the ForeseeHome device have shown significant underutilisation in the general population compared to the initial study cohorts, with up to a quarter of patients ceasing usage within 1 year [ 17 ]. Regular imaging would be essential if home monitoring becomes the primary method of disease surveillance.…”

Section: Barriers and Future Challengesmentioning

confidence: 99%

Perspectives on the Home Monitoring of Macular Disease

2022

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Recent advancements in imaging technology have led to increasing interest in home monitoring of macular disease. The prevalence of macular disease is projected to rise considerably over time, leading to a significant burden on hospital services for age-related macular degeneration and diabetic macular edema. Home monitoring has the potential to augment conventional hospital assessment and so enable improved access to clinical care for low-and moderate-risk patients, while also allowing sensitive detection of early signs of disease that may require prompt intervention. Despite this, there are significant considerations before largescale implementation could be possible. These are related to both the current availability of home monitoring technology and the logistical barriers to its widespread introduction. Access to home monitoring is also likely to be more challenging in lower-income communities and countries, with subsequent implications for health inequality that will need to be considered and addressed appropriately.

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Real-World Performance of a Self-Operated Home Monitoring System for Early Detection of Neovascular Age-Related Macular Degeneration

Cited by 23 publications

References 34 publications

OCT and OCT Angiography Offer New Insights and Opportunities in Schizophrenia Research and Treatment

OCT and OCT Angiography Offer New Insights and Opportunities in Schizophrenia Research and Treatment

Automated large-scale AMD progression prediction using machine-read OCT biomarkers

Perspectives on the Home Monitoring of Macular Disease

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